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Moser U. Tetrahydrocannabinol and cannabidiol as an oromucosal spray in a 1:1 ratio: a therapeutic option for patients with central post-stroke pain syndrome? BMJ Case Rep 2021; 14:14/7/e243072. [PMID: 34230048 DOI: 10.1136/bcr-2021-243072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Central pain after stroke due to brainstem infarction is very rare. Treatment is difficult and specific guidelines are lacking. This is the report of a 61-year-old female patient who, after a posterolateral left medulla oblongata insult with incomplete Wallenberg syndrome, subsequently developed a burning and tingling pain in the contralateral leg and a burning and shooting pain in the ipsilateral face in trigeminal branches 1 and 2. More than 3 years of therapy with amitriptyline, gabapentin, pregabalin and various grade II and III opioids was ineffective or showed intolerable side effects. The administration of tetrahydrocannabinol and cannabidiol as an oromucosal spray in a 1:1 ratio improved the pain situation and quality of life quickly and permanently. The encouraging results in the present case may suggest that treatment with medical cannabis should be considered in similar cases when standard therapies are insufficient.
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Zhou X, Qu Y, Gan G, Zhu S, Huang Y, Liu Y, Zhu J, Xie B, Tan Z. Cyclosporine A Plus Ischemic Postconditioning Improves Neurological Function in Rats After Cardiac Resuscitation. Neurocrit Care 2020; 32:812-821. [PMID: 31576483 DOI: 10.1007/s12028-019-00849-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND OBJECTIVE Attenuation of neuronal apoptosis helps maintain neurological function in patients after cardiac arrest. After ischemia-reperfusion, both cyclosporin A (CsA) and ischemic postconditioning independently protect mitochondria and thus reduce nerve injury. This study employed a rat model to evaluate the neuroprotective effect of combining ischemic postconditioning with CsA after cardiopulmonary resuscitation (CPR). METHODS Rats were apportioned equally to model control, postconditioned, CsA-treated, or CsA + postconditioned groups. Asphyxial cardiac arrest was imposed using modified Utstein-style guidelines. In the appropriate groups, postconditioning was implemented by ischemia and reperfusion (clamping and loosening the left femoral artery); CsA treatment was delivered with a single intravenous dose. Neurological deficits were scored at different times after CPR. Histological evaluation and electron microscopy were used to evaluate tissue damage, and TUNEL and flow cytometry were used to measure the apoptotic rate of hippocampal neurons and size of the mitochondrial permeability transition pore (mPTP) opening. RESULTS The apoptotic rate was significantly lower in the postconditioned and CsA-treated groups compared with the model control and lowest in the CsA + postconditioned group. By histological evaluation and electron microscopy, the least damage was observed in the CsA + postconditioned group. The neurological deficit score of the CsA + postconditioned group was significantly higher than that of the CsA-treated group, but the size of the mPTP openings of these two groups was comparable. CONCLUSION Ischemic postconditioning combined with CsA exerted a better neuroprotective effect after CPR than did either postconditioning or CsA alone. Inhibiting the opening of the mPTP is not the only neuroprotective mechanism.
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Affiliation(s)
- Xiang Zhou
- Department of Anesthesiology, General Hospital of Central Theater Command of People's Liberation Army of China, Wuhan, China
- Southern Medical University, Guangzhou, China
| | - YanLiang Qu
- Department of Anesthesiology, No. 971 Hospital of the PLA Navy, Qingdao, China
| | - GuoShen Gan
- Southern Medical University, Guangzhou, China
| | - ShuiBo Zhu
- Department of Thoracic Cardiovascular Surgery, General Hospital of Central Theater Command of People's Liberation Army of China, 627 Wuluo Road, Wuhan, 430070, Hubei, China.
- Southern Medical University, Guangzhou, China.
| | - Yang Huang
- Southern Medical University, Guangzhou, China
| | - Yong Liu
- Department of Thoracic Cardiovascular Surgery, General Hospital of Central Theater Command of People's Liberation Army of China, 627 Wuluo Road, Wuhan, 430070, Hubei, China
| | - Jian Zhu
- Department of Thoracic Cardiovascular Surgery, General Hospital of Central Theater Command of People's Liberation Army of China, 627 Wuluo Road, Wuhan, 430070, Hubei, China
| | - Biao Xie
- Southern Medical University, Guangzhou, China
| | - ZhiTian Tan
- Southern Medical University, Guangzhou, China
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Gao J, Bai P, Li Y, Li J, Jia C, Wang T, Zhao H, Si Y, Chen J. Metabolomic Profiling of the Synergistic Effects of Ginsenoside Rg1 in Combination with Neural Stem Cell Transplantation in Ischemic Stroke Rats. J Proteome Res 2020; 19:2676-2688. [PMID: 31968172 DOI: 10.1021/acs.jproteome.9b00639] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Jian Gao
- The Third Affiliated Hospital, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Peng Bai
- The Third Affiliated Hospital, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Yuanyuan Li
- Beijing University of Chinese Medicine, Beijing 100029, China
| | - Jingzhong Li
- Beijing University of Chinese Medicine, Beijing 100029, China
| | - Caixia Jia
- Beijing University of Chinese Medicine, Beijing 100029, China
| | - Tieshan Wang
- Beijing University of Chinese Medicine, Beijing 100029, China
| | - Haibin Zhao
- Dongfang Hospital, Beijing University of Chinese Medicine, Beijing 100078, China
| | - Yinchu Si
- Beijing University of Chinese Medicine, Beijing 100029, China
| | - Jianxin Chen
- Beijing University of Chinese Medicine, Beijing 100029, China
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Safronova MN, Kovalenko AV, Mizurkina OA. [Combined neuroprotection in the treatment of post-stroke aphasia]. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 119:20-26. [PMID: 31464285 DOI: 10.17116/jnevro201911907120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To evaluate the efficacy of combined neuroprotection in the restoration of speech function in patients with acute ischemic stroke in the carotid region. MATERIAL AND METHODS The study included 257 patients (median age 60 (55; 72) years) with ischemic stroke and motor or sensorimotor aphasia. The degree of speech recovery was characterized by an increase in the score on the scale of the speech questionnaire (SQ) on the 21st day from the beginning of the disease. Patients were divided into low recovery (ΔSQ ≤6) and high recovery (ΔSQ >6) groups. All patients received neuroprotectors of different groups. RESULTS The greatest efficacy was shown for cortexin in combination with mexidol: the ΔSQ >6 group included 24 (70.6%) and the group ΔSQ ≤6 10 (29.4%) patients out of 34 patients. The lowest efficacy was observed for gliatilin in monotherapy: an increase was ≤6 points in 24 (68.6%) patients and >6 points in 11 (31.4%), and for combinations of ceraxon and mexidol: 26 (61.9%) and 6 (38.1%) patients with low- and high level of speech recovery, respectively (p=0.041). CONCLUSION Combined neuroprotective therapy using drugs with neuromodulatory and antioxidant effects (cortexin and mexidol) in the acute period of ischemic stroke is effective in the treatment of post-stroke aphasia.
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Affiliation(s)
- M N Safronova
- Kemerovo State Medical University, Kemerovo, Russia; Regional Clinical Hospital for Veterans of Wars, Kemerovo, Russia
| | - A V Kovalenko
- Kemerovo State Medical University, Kemerovo, Russia; Barbarash Kemerovo Regional Cardiological Clinic, Kemerovo, Russia; Research Institute of Complex Problems of Cardiovascular Diseases, Kemerovo, Russia
| | - O A Mizurkina
- Barbarash Kemerovo Regional Cardiological Clinic, Kemerovo, Russia
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Wang JQ, Dong Y, Li SJ, Pan CL, Liu HY, Wang YK, Xu L, Yang JH, Cui YX, He JT, Mang J, Xu ZX. Knockdown of microRNA-17-5p Enhances the Neuroprotective Effect of Act A/Smads Signal Loop After Ischemic Injury. Neurochem Res 2019; 44:1807-1817. [PMID: 31093905 DOI: 10.1007/s11064-019-02815-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 04/19/2019] [Accepted: 05/09/2019] [Indexed: 01/22/2023]
Abstract
Cerebral ischemic injury is a leading cause of human mortality and disability, seriously threatening human health in the world. Activin A (Act A), as a well-known neuroprotective factor, could alleviate ischemic brain injury mainly through Act A/Smads signaling. In our previous study, a noncanonical Act A/Smads signal loop with self-amplifying property was found, which strengthened the neuroprotective effect of Act A. However, this neuroprotective effect was limited due to the self-limiting behavior mediated by Smad anchor for receptor activation (SARA) protein. It was reported that microRNA-17-5p (miR-17-5p) could suppress the expression of SARA in esophageal squamous cell carcinoma. Thus we proposed that knockdown of miR-17-5p could strengthen the neuroprotective effect of Act A/Smads signal loop through SARA. To testify this hypothesis, oxygen-glucose deficiency (OGD) was introduced to highly differentiated rattus pheochromocytoma (PC12) cells. After the transfection of miR-17-5p mimic or inhibitor, the activity of Act A signal loop was quantified by the expression of phosphorylated Smad3. The results showed that suppression of miR-17-5p up-regulated the expression of SARA protein, which prolonged and strengthened the activity of Act A signaling through increased phosphorylation of downstream Smad3 and accumulation of Act A ligand. Further luciferase assay confirmed that SARA was a direct target gene of miR-17-5p. These practical discoveries will bring new insight on the endogenous neuroprotective effects of Act A signal loop by interfering a novel target: miR-17-5p.
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Affiliation(s)
- Jiao-Qi Wang
- Department of Neurology, China-Japan Union Hospital, Jilin University, 126 Xiantai Street, Changchun, 130012, China
| | - Yue Dong
- Department of Neurology, China-Japan Union Hospital, Jilin University, 126 Xiantai Street, Changchun, 130012, China
| | - Si-Jia Li
- Department of Clinical Medicine, College of Clinical Medicine, Bethune Medicine Institute, Jilin University, 828 Xinmin Street, Changchun, 130012, China
| | - Cheng-Liang Pan
- Department of Clinical Medicine, College of Clinical Medicine, Bethune Medicine Institute, Jilin University, 828 Xinmin Street, Changchun, 130012, China
| | - Hong-Yu Liu
- Department of Neurology, China-Japan Union Hospital, Jilin University, 126 Xiantai Street, Changchun, 130012, China
| | - Yu-Kai Wang
- Department of Neurology, China-Japan Union Hospital, Jilin University, 126 Xiantai Street, Changchun, 130012, China
| | - Lei Xu
- Department of Neurology, China-Japan Union Hospital, Jilin University, 126 Xiantai Street, Changchun, 130012, China
| | - Jia-Hui Yang
- Department of Neurology, China-Japan Union Hospital, Jilin University, 126 Xiantai Street, Changchun, 130012, China
| | - Yun-Xia Cui
- Department of Neurology, China-Japan Union Hospital, Jilin University, 126 Xiantai Street, Changchun, 130012, China
| | - Jin-Ting He
- Department of Neurology, China-Japan Union Hospital, Jilin University, 126 Xiantai Street, Changchun, 130012, China
| | - Jing Mang
- Department of Neurology, China-Japan Union Hospital, Jilin University, 126 Xiantai Street, Changchun, 130012, China
| | - Zhong-Xin Xu
- Department of Neurology, China-Japan Union Hospital, Jilin University, 126 Xiantai Street, Changchun, 130012, China.
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Zhou X, Yong L, Huang Y, Zhu S, Song X, Li B, Zhu J, Wang H. The protective effects of distal ischemic treatment on apoptosis and mitochondrial permeability in the hippocampus after cardiopulmonary resuscitation. J Cell Physiol 2018; 233:6902-6910. [PMID: 29323705 DOI: 10.1002/jcp.26459] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Accepted: 01/05/2018] [Indexed: 02/05/2023]
Abstract
Apoptosis and mitochondrial dysfunction are the main cause of neurological injury after cardiopulmonary resuscitation (CPR). However, the effects of distal ischemic treatments on ischemia induced apoptosis are rarely studied, and the mechanism by which mitochondrial dysfunction contributes to CPR still unclear. A rat model of distal ischemia was established by clipping the right femoral artery. Rats were divided into blank, model, pre distal ischemic treatment, per-treatment, and post-treatment groups. Neurological deficit score was scored to evaluate neurologic function after cardiopulmonary resuscitation for 72 hr. We employed TUNEL and flow cytometry to measure the rate of apoptosis of hippocampal neurons, the integrity of mitochondrial membrane and the degree of mitochondrial permeability transition pore (mPTP) opening. The rate of apoptosis rate of hippocampal CA1 neurons in the pre-treatment and post-treatment groups were significantly lower than that of the model group. Moreover, the integrity of the mitochondrial membrane in the pre-treatment and post-treatment groups was higher than that in the model and per- treatment groups. Furthermore, the degree of mPTP opening was lower in the pre-treatment and post-treatment groups than the untreated and per-treatment groups. Taken together, our results show that ischemic preconditioning and post processing can maintain the integrity of mitochondria, perhaps by inhibiting the opening of mPTP, and reducing apoptosis of hippocampal neurons by regulating expression of apoptosis related proteins after CPR, to improve neurological function. This study highlights a novel target pathway for treatment of CPR.
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Affiliation(s)
- Xiang Zhou
- Department of Anesthesiology, Wuhan General Hospital of People's Liberation Army of China, Wuhan, China
- Southern Medical University, Guangzhou, China
| | - Liu Yong
- Department of Thoracic Cardiovascular Surgery, ZhongNan Hospital of WuHan University, Wuhan, China
| | - Yang Huang
- Southern Medical University, Guangzhou, China
| | - ShuiBo Zhu
- Southern Medical University, Guangzhou, China
- Department of Thoracic Cardiovascular Surgery, Wuhan General Hospital of People's Liberation Army of China, Wuhan, China
| | - XiaoYang Song
- Department of Anesthesiology, Wuhan General Hospital of People's Liberation Army of China, Wuhan, China
| | - BiXi Li
- Department of Anesthesiology, Wuhan General Hospital of People's Liberation Army of China, Wuhan, China
| | - Jian Zhu
- Department of Thoracic Cardiovascular Surgery, Wuhan General Hospital of People's Liberation Army of China, Wuhan, China
| | - HaiBo Wang
- Southern Medical University, Guangzhou, China
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Barakat W, Fahmy A, Askar M, El-Kannishy S. Effectiveness of arginase inhibitors against experimentally induced stroke. Naunyn Schmiedebergs Arch Pharmacol 2018; 391:603-612. [PMID: 29600431 DOI: 10.1007/s00210-018-1489-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Accepted: 03/22/2018] [Indexed: 01/28/2023]
Abstract
Stroke is a lethal disease, but it disables more than it kills. Stroke is the second leading cause of death and the most frequent cause of permanent disability in adults worldwide, with 90% of survivors having residual deficits. The pathophysiology of stroke is complex and involves a strong inflammatory response associated with oxidative stress and activation of several proteolytic enzymes. The current study was designed to investigate the effect of arginase inhibitors (L-citruline and L-ornithine) against ischemic stroke induced in rats by middle cerebral artery occlusion (MCAO). MCAO resulted in alteration in rat behavior, brain infarct, and edema associated with disruption of the blood-brain barrier (BBB). This was mediated through overexpression of arginase I and II, inducible NOS (iNOS), malondialdehyde (MDA), advanced glycation end products (AGEs), TNF-α, and IL-1β and downregulation of endothelial nitric oxide synthase (eNOS). Treatment with L-citruline and L-ornithine and the standard neuroprotective drug cerebrolysin ameliorated all the deleterious effects of stroke. These results indicate the possible use of arginase inhibitors in the treatment of stroke after suitable clinical trials are done.
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Affiliation(s)
- Waleed Barakat
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Tabuk University, Tabuk, Kingdom of Saudi Arabia.
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Zagazig University, Zagazig, Egypt.
| | - Ahmad Fahmy
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Zagazig University, Zagazig, Egypt
| | - Mohamed Askar
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Zagazig University, Zagazig, Egypt
| | - Sherif El-Kannishy
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Tabuk University, Tabuk, Kingdom of Saudi Arabia
- Analytical Toxicology - Emergency Hospital, Faculty of Medicine, University of Mansoura, Mansoura, Egypt
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8
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Cui X, Fu Z, Wang M, Nan X, Zhang B. Pitavastatin treatment induces neuroprotection through the BDNF-TrkB signalling pathway in cultured cerebral neurons after oxygen-glucose deprivation. Neurol Res 2018; 40:391-397. [PMID: 29544396 DOI: 10.1080/01616412.2018.1447318] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Along with their lipid-lowering effect, statins have been reported to have neuroprotective function in both in vivo and in vitro models of neurodegenerative diseases. We conducted this study in order to uncover the he neuroprotective effect of the lipophilic statin pitavastatin (PTV) and investigate the underlying molecular mechanisms using primary cultured cerebral neurons exposed to oxygen-glucose deprivation (OGD). METHODS The primary cultured cerebral neurons were randomly assigned into four groups: the control group, the pitavastatin treatment group, the OGD group and the OGD + pitavastatin treatment group. The pitavastatin's concentration were set as follows: 1μM, 15μM, 30μM. After 3 hours OGD treatment, we use MTT method to assessment cell viability, immunofluorescence to observe neuron morphology and western blot method analysis the BDNF, TrkB. RESULTS PTV at concentrations of 1 μM and 15 μM elevated the survival rate of cortical neurons exposed to OGD, whereas 30 μM PTV did not show such an effect. Moreover, PTV promoted neuronal dendrite growth at concentrations of 1 μM and 15 μM. Increased expression levels of brain-derived neurotrophic factor (BDNF) and tropomyosin-related kinase B (TrkB) were observed in both of the following two scenarios: when neurons were treated with PTV for 48 hours and when PTV was added after the OGD procedure. CONCLUSION Pitavastatin treatment induces neuroprotection in cultured cerebral neurons after oxygen-glucose deprivation this neuroprotection induced by PTV involves the BDNF-TrkB signalling pathway.
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Affiliation(s)
- Xiaoyan Cui
- a Department of Neurology , The First Affiliated Hospital of Zhengzhou University , Zhengzhou , China
| | - Zhenqiang Fu
- a Department of Neurology , The First Affiliated Hospital of Zhengzhou University , Zhengzhou , China
| | - Menghan Wang
- a Department of Neurology , The First Affiliated Hospital of Zhengzhou University , Zhengzhou , China
| | - Xiaofei Nan
- c School of Information and Engineering , Zhengzhou University , Zhengzhou , China
| | - Boai Zhang
- a Department of Neurology , The First Affiliated Hospital of Zhengzhou University , Zhengzhou , China.,b Institute of Clinical Medical Research , The First Affiliated Hospital of Zhengzhou University , Zhengzhou , China
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9
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Zhou X, Liu Y, Huang Y, Zhu S, Zhu J, Wang R. Hypertonic saline infusion suppresses apoptosis of hippocampal cells in a rat model of cardiopulmonary resuscitation. Sci Rep 2017; 7:5783. [PMID: 28724904 PMCID: PMC5517425 DOI: 10.1038/s41598-017-05919-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 06/06/2017] [Indexed: 02/07/2023] Open
Abstract
Hypertonic saline (HS) attenuates cerebral edema, improves microcirculation perfusion and alleviates inflammation. However, whether the beneficial effect of HS on neurological function after cardiopulmonary resuscitation (CPR) in rat model of asphyxial cardiac arrest (CA) is mediated via attenuating apoptosis of neurons is not known. We studied the neuroprotective effect of HS in rats after CA and CPR, and explored the likely underlying mechanisms. Animals were randomly assigned to 4 equal groups (n = 15 each) according to the different infusions administered during resuscitation: control (C), normal saline (NS), hypertonic saline (HS), and hydroxyethyl starch (HES) groups. NDS at 12, 24, 48 and 72 h post-ROSC in the HS group were significantly higher than those in the NS and HES groups. Western blot analysis demonstrated a significant increase in Bcl-2 expression in HS, as compared to that in the NS and HES groups. However, Bax and Caspase-3 expressions in HS were significantly lower than that in the NS and HES groups. The apoptosis rate in HS was significantly lower than that in the NS and HES groups, suggesting HS treatment during resuscitation could effectively suppress neuronal cell apoptosis in hippocampal CA1 post-ROSC and improve neuronal function.
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Affiliation(s)
- Xiang Zhou
- Southern Medical University, Guangzhou, China
- Department of Thoracic Cardiovascular Surgery, Wuhan General Hospital of People's Liberation Army of China, Guangzhou, China
| | - Yong Liu
- Department of Thoracic Cardiovascular Surgery, Wuhan General Hospital of People's Liberation Army of China, Guangzhou, China
| | - Yang Huang
- Southern Medical University, Guangzhou, China
| | - ShuiBo Zhu
- Southern Medical University, Guangzhou, China.
- Department of Thoracic Cardiovascular Surgery, Wuhan General Hospital of People's Liberation Army of China, Guangzhou, China.
| | - Jian Zhu
- Department of Thoracic Cardiovascular Surgery, Wuhan General Hospital of People's Liberation Army of China, Guangzhou, China
| | - RongPing Wang
- Department of Thoracic Cardiovascular Surgery, Wuhan General Hospital of People's Liberation Army of China, Guangzhou, China
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10
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Effects of Noggin-Transfected Neural Stem Cells on Neural Functional Recovery and Underlying Mechanism in Rats with Cerebral Ischemia Reperfusion Injury. J Stroke Cerebrovasc Dis 2017; 26:1547-1559. [DOI: 10.1016/j.jstrokecerebrovasdis.2017.02.034] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 01/23/2017] [Accepted: 02/02/2017] [Indexed: 01/06/2023] Open
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Povlsen GK, Longden TA, Bonev AD, Hill-Eubanks DC, Nelson MT. Uncoupling of neurovascular communication after transient global cerebral ischemia is caused by impaired parenchymal smooth muscle Kir channel function. J Cereb Blood Flow Metab 2016; 36:1195-201. [PMID: 27052838 PMCID: PMC4929704 DOI: 10.1177/0271678x16638350] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 01/18/2016] [Accepted: 01/18/2016] [Indexed: 12/28/2022]
Abstract
Transient global cerebral ischemia is often followed by delayed disturbances of cerebral blood flow, contributing to neuronal injury. The pathophysiological processes underlying such disturbances are incompletely understood. Here, using an established model of transient global cerebral ischemia, we identify dramatically impaired neurovascular coupling following ischemia. This impairment results from the loss of functional inward rectifier potassium (KIR) channels in the smooth muscle of parenchymal arterioles. Therapeutic strategies aimed at protecting or restoring cerebrovascular KIR channel function may therefore improve outcomes following ischemia.
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Affiliation(s)
- Gro Klitgaard Povlsen
- Department of Pharmacology, College of Medicine, University of Vermont, Burlington, Vermont, USA Department of Clinical Experimental Research, Glostrup Research Institute, Glostrup University Hospital, Glostrup, Denmark
| | - Thomas A Longden
- Department of Pharmacology, College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Adrian D Bonev
- Department of Pharmacology, College of Medicine, University of Vermont, Burlington, Vermont, USA
| | | | - Mark T Nelson
- Department of Pharmacology, College of Medicine, University of Vermont, Burlington, Vermont, USA Institute of Cardiovascular Sciences, University of Manchester, Manchester, UK
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12
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George PM, Steinberg GK. Novel Stroke Therapeutics: Unraveling Stroke Pathophysiology and Its Impact on Clinical Treatments. Neuron 2015; 87:297-309. [PMID: 26182415 PMCID: PMC4911814 DOI: 10.1016/j.neuron.2015.05.041] [Citation(s) in RCA: 265] [Impact Index Per Article: 29.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Stroke remains a leading cause of death and disability in the world. Over the past few decades our understanding of the pathophysiology of stroke has increased, but greater insight is required to advance the field of stroke recovery. Clinical treatments have improved in the acute time window, but long-term therapeutics remain limited. Complex neural circuits damaged by ischemia make restoration of function after stroke difficult. New therapeutic approaches, including cell transplantation or stimulation, focus on reestablishing these circuits through multiple mechanisms to improve circuit plasticity and remodeling. Other research targets intact networks to compensate for damaged regions. This review highlights several important mechanisms of stroke injury and describes emerging therapies aimed at improving clinical outcomes.
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Affiliation(s)
- Paul M George
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA 94305, USA; Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA; Stanford Stroke Center, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Gary K Steinberg
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA 94305, USA; Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA; Stanford Stroke Center, Stanford University School of Medicine, Stanford, CA 94305, USA.
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13
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Li D, Zhang M, Zhang Q, Wang Y, Song X, Zhang Q. Functional recovery after acute intravenous administration of human umbilical cord mesenchymal stem cells in rats with cerebral ischemia-reperfusion injury. Intractable Rare Dis Res 2015; 4:98-104. [PMID: 25984429 PMCID: PMC4428194 DOI: 10.5582/irdr.2015.01010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Revised: 04/16/2015] [Accepted: 04/22/2015] [Indexed: 01/14/2023] Open
Abstract
Cell therapy is a potential approach for treatment of strokes. Mesenchymal stem cells (MSCs) are a potential cell source for clinical use because they are safe and easy to obtain. A peptide solution can promote neural regeneration. Previously, such a solution was stereotactically injected into the brain of rats with cerebral infarction, resulting in improvement in the animal's neurological function and reduction in the infarction volume, but the injury was relatively severe. The current study established a rat model of cerebral ischemia-reperfusion (I/R) injury. MSCs isolated from Wharton's jelly of human umbilical cords (HUMSCs) were injected intravenously immediately after cerebral I/R injury(3 × 10(6) cells per rat). Twenty-four h and 14 d after surgery, animal behavior was evaluated using the Rogers test and infarct lesion volume was evaluated by 2,3,5-triphenyltetrazolium chloride staining. Fourteen d after surgery, brain tissues were collected at 14 d to study migration/implantation of HUMSCs, cellular proliferation, neural regeneration and astrocyte activation. Compared to cerebral I/R injury alone, HUMSC treatment improved function at 14 d after surgery, with no reduction in infarct volume or migration or implantation of cells into the damaged brain areas. Nevertheless, 14 d after surgery, HUMSC administration increased cellular proliferation and the level of neurofilament 200 level and decreased the level of glial fibrillary acidic protein. After cerebral I/R injury, acute intravenous administration of HUMSCs could promote recovery by activating endogenous neural regeneration and inhibiting astrocyte activation, without migration and implantation directly into lesions.
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Affiliation(s)
- Dongmei Li
- Department of Neurology, Qingdao Municipal Hospital, Qingdao, Shandong, China
| | - Min Zhang
- Department of Neurology, Qingdao Municipal Hospital, Qingdao, Shandong, China
- Address correspondence to: Dr. Min Zhang, Department of Neurology, Qingdao Municipal Hospital, Qingdao, No.1, Jiaozhou Road, 266011 Qingdao, Shandong, China. E-mail:
| | - Qiuhua Zhang
- Department of Rehabilitation, Shuangshan Hospital of the Zibo Mining Group, Zibo, Shangdong, China
| | - Yue Wang
- Department of Neurology, Qingdao Municipal Hospital, Qingdao, Shandong, China
| | - Xuxia Song
- Department of Neurology, Qingdao Municipal Hospital, Qingdao, Shandong, China
| | - Qiuling Zhang
- Department of Physiology, Taishan Medical College, Taian, Shandong, China
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Anosova LV, Levina EA, Chutko LS. [A role of neuroprotective therapy in the rehabilitation of children with sensorineural hearing loss, IV degrees, after cochlear implanta-tion]. Zh Nevrol Psikhiatr Im S S Korsakova 2015; 115:43-46. [PMID: 26977915 DOI: 10.17116/jnevro201511510243-46] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To study clinical/psychological characteristics in children with sensorineural hearing loss, IV degrees, before and after the cochlear implantation (CI) and to assess the dynamics of speech development during the rehabilitation using the neuroprotective drug cerebrolysin. MATERIAL AND METHODS Authors examined 93 patients, aged from 5 to 8 years. The main group (n=46) received cerebrolysin, the control group was not treated with this drug. A diagnostic study included patient's history, neurological and neuropsychological examinations, auditory perception and sound reproduction. RESULTS AND CONCLUSION According to the Meaningful Use of Speech Scale, 23% of children of the main group demonstrated the best results due to the better speech communication strategies. No significant between-group differences were found in the level of auditory perception 6 months after CI. The level of articulation was higher in the main group. Cognitive functioning was improved in children treated with cerebrolysin.
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Affiliation(s)
- L V Anosova
- FGBU 'Sankt-Peterburgskij nauchno-issledovatel'skij institut uha, gorla, nosa i rechi' Minzdrava RF, Sankt-Peterburg
| | - E A Levina
- FGBU 'Sankt-Peterburgskij nauchno-issledovatel'skij institut uha, gorla, nosa i rechi' Minzdrava RF, Sankt-Peterburg
| | - L S Chutko
- FGBUN 'Institut mozga cheloveka im. N.P. Behterevoj' Rossijskoj akademii nauk, Sankt-Peterburg
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Mangus DB, Huang L, Applegate PM, Gatling JW, Zhang J, Applegate RL. A systematic review of neuroprotective strategies after cardiac arrest: from bench to bedside (Part I - Protection via specific pathways). Med Gas Res 2014; 4:9. [PMID: 24808942 PMCID: PMC4012247 DOI: 10.1186/2045-9912-4-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 03/25/2014] [Indexed: 01/04/2023] Open
Abstract
Neurocognitive deficits are a major source of morbidity in survivors of cardiac arrest. Treatment options that could be implemented either during cardiopulmonary resuscitation or after return of spontaneous circulation to improve these neurological deficits are limited. We conducted a literature review of treatment protocols designed to evaluate neurologic outcome and survival following cardiac arrest with associated global cerebral ischemia. The search was limited to investigational therapies that were utilized to treat global cerebral ischemia associated with cardiac arrest. In this review we discuss potential mechanisms of neurologic protection following cardiac arrest including actions of several medical gases such as xenon, argon, and nitric oxide. The 3 included mechanisms are: 1. Modulation of neuronal cell death; 2. Alteration of oxygen free radicals; and 3. Improving cerebral hemodynamics. Only a few approaches have been evaluated in limited fashion in cardiac arrest patients and results show inconclusive neuroprotective effects. Future research focusing on combined neuroprotective strategies that target multiple pathways are compelling in the setting of global brain ischemia resulting from cardiac arrest.
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Affiliation(s)
- Dustin B Mangus
- Department of Anesthesiology, Loma Linda University School of Medicine, Loma Linda University Medical Center, Room 2532, 11234 Anderson Street, Loma Linda, CA 92354, USA
| | - Lei Huang
- Department of Anesthesiology, Loma Linda University School of Medicine, Loma Linda University Medical Center, Room 2532, 11234 Anderson Street, Loma Linda, CA 92354, USA ; Department of Basic Sciences, Division of Physiology, Loma Linda University School of Medicine, 11041 Campus Street, Loma Linda, CA, USA
| | - Patricia M Applegate
- Department of Cardiology, Loma Linda University School of Medicine, 11201 Benton St, Loma Linda, CA 92354, USA
| | - Jason W Gatling
- Department of Anesthesiology, Loma Linda University School of Medicine, Loma Linda University Medical Center, Room 2532, 11234 Anderson Street, Loma Linda, CA 92354, USA
| | - John Zhang
- Department of Basic Sciences, Division of Physiology, Loma Linda University School of Medicine, 11041 Campus Street, Loma Linda, CA, USA ; Department of Anesthesiology, Loma Linda University School of Medicine, Loma Linda University Medical Center, Room 2532, 11234 Anderson Street, Loma Linda, CA 92354, USA ; Department of Neurosurgery, Loma Linda University School of Medicine, 11041 Campus Street, Loma Linda, CA 92354, USA
| | - Richard L Applegate
- Department of Anesthesiology, Loma Linda University School of Medicine, Loma Linda University Medical Center, Room 2532, 11234 Anderson Street, Loma Linda, CA 92354, USA
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Flores JJ, Zhang Y, Klebe DW, Lekic T, Fu W, Zhang JH. Small molecule inhibitors in the treatment of cerebral ischemia. Expert Opin Pharmacother 2014; 15:659-80. [PMID: 24491068 DOI: 10.1517/14656566.2014.884560] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Stroke is the world's second leading cause of death. Although recombinant tissue plasminogen activator is an effective treatment for cerebral ischemia, its limitations and ischemic stroke's complex pathophysiology dictate an increased need for the development of new therapeutic interventions. Small molecule inhibitors (SMIs) have the potential to be used as novel therapeutic modalities for stroke, since many preclinical and clinical trials have established their neuroprotective capabilities. AREAS COVERED This paper provides a summary of the pathophysiology of stroke as well as clinical and preclinical evaluations of SMIs as therapeutic interventions for cerebral ischemia. Cerebral ischemia is broken down into four mechanisms in this article: thrombosis, ischemic insult, mitochondrial injury and immune response. Insight is provided into preclinical and current clinical assessments of SMIs targeting each mechanism as well as a summary of reported results. EXPERT OPINION Many studies demonstrated that pre- or post-treatment with certain SMIs significantly ameliorated adverse effects from stroke. Although some of these promising SMIs moved on to clinical trials, they generally failed, possibly due to the poor translation of preclinical to clinical experiments. Yet, there are many steps being taken to improve the quality of experimental research and translation to clinical trials.
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Affiliation(s)
- Jerry J Flores
- Loma Linda University School of Medicine, Department of Physiology and Pharmacology , Risley Hall, Room 223, Loma Linda, CA 92354 , USA
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