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Dhadwal N, Cunningham K, Pino W, Hampton S, Fischer D. Altered Mental Status at the Extreme: Behavioral Evaluation of Disorders of Consciousness. Semin Neurol 2024. [PMID: 39102862 DOI: 10.1055/s-0044-1788807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/07/2024]
Abstract
Disorders of consciousness represent altered mental status at its most severe, comprising a continuum between coma, the vegetative state/unresponsive wakefulness syndrome, the minimally conscious state, and emergence from the minimally conscious state. Patients often transition between these levels throughout their recovery, and determining a patient's current level can be challenging, particularly in the acute care setting. Although healthcare providers have classically relied on a bedside neurological exam or the Glasgow Coma Scale to aid with assessment of consciousness, studies have identified multiple limitations of doing so. Neurobehavioral assessment measures, such as the Coma Recovery Scale-Revised, have been developed to address these shortcomings. Each behavioral metric has strengths as well as weaknesses when applied in the acute care setting. In this review, we appraise common assessment approaches, outline alternative measures for fine-tuning these assessments in the acute care setting, and highlight strategies for implementing these practices in an interdisciplinary manner.
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Affiliation(s)
- Neha Dhadwal
- Department of Physical Medicine and Rehabilitation, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kyle Cunningham
- Good Shepherd Penn Partners at the Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - William Pino
- Good Shepherd Penn Partners at the Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Stephen Hampton
- Department of Physical Medicine and Rehabilitation, University of Pennsylvania, Philadelphia, Pennsylvania
| | - David Fischer
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania
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2
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Sanchez G, Byl M, Pham QG, Eapen BC. Neuropharmacology in Traumatic Brain Injury. Phys Med Rehabil Clin N Am 2024; 35:619-636. [PMID: 38945655 DOI: 10.1016/j.pmr.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
One of the primary goals in traumatic brain injury (TBI) treatment is to minimize secondary brain damage and promote neuroprotection. In TBI rehabilitation, we seek to facilitate neurologic recovery and restore what independence is possible given a patient's physical and cognitive impairments. These goals must be balanced with treatment of the various symptoms that may occur following TBI. This is challenging given the fact that many of the typical treatments for certain symptoms also come with side effects which could be problematic in the TBI population.
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Affiliation(s)
- Gabriel Sanchez
- Physical Medicine & Rehabilitation Residency Program, Greater Los Angeles VA Healthcare System, 11301 Wilshire Boulevard, Los Angeles, CA 90073, USA
| | - Merideth Byl
- Physical Medicine & Rehabilitation Residency Program, Greater Los Angeles VA Healthcare System, 11301 Wilshire Boulevard, Los Angeles, CA 90073, USA
| | - Quynh Giao Pham
- Division of Physical Medicine and Rehabilitation, Department of Medicine, David Geffen School of Medicine at UCLA; Physical Medicine & Rehabilitation Residency Program, Greater Los Angeles VA Healthcare System, David Geffen School of Medicine at UCLA
| | - Blessen C Eapen
- Division of Physical Medicine and Rehabilitation, University of California, Los Angeles (UCLA); Physical Medicine and Rehabilitation Service, VA Greater Los Angeles Healthcare System; David Geffen School of Medicine at UCLA.
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3
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Cataford G, Monton LA, Karzon S, Livernoche-Leduc C, Saavedra-Mitjans M, Potvin MJ, Bernard F, Burry L, Arbour C, Williamson DR. Cognitive and Motor Function Effects of Antipsychotics in Traumatic Brain Injury: A Systematic Review of Pre-Clinical Studies. Neurotrauma Rep 2024; 5:181-193. [PMID: 38463417 PMCID: PMC10924062 DOI: 10.1089/neur.2023.0108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024] Open
Abstract
Traumatic brain injury (TBI) survivors often suffer from agitated behaviors and will most likely receive pharmacological treatments. Choosing an optimal and safe treatment that will not interfere with neurological recovery remains controversial. By interfering with dopaminergic circuits, antipsychotics may impede processes important to cognitive recovery. Despite their frequent use, there have been no large randomized controlled studies of antipsychotics for the management of agitated behaviors during the acute TBI recovery period. We conducted a systematic review and meta-analysis of pre-clinical studies evaluating the effects of antipsychotics post-TBI on both cognitive and motor recovery. MEDLINE and Embase databases were searched up to August 2, 2023. Pre-clinical studies evaluating the effects of antipsychotics on cognitive and motor functions post-TBI were considered. Risk of bias was evaluated with the Systematic Review Centre for Laboratory Animal Experimentation (SYRCLE) tool. We identified 15 studies including a total of 1188 rodents, mostly conducted in male Sprague-Dawley rats using cortical impact injury. The analysis revealed no consistent effect of haloperidol on motor functions, but risperidone was associated with a significant impairment in motor function on day 5 post-injury (7.05 sec; 95% confidence interval [CI]: 1.47, 12.62; I2 = 92%). Other atypical antipsychotics did not result in impaired motor function. When evaluating cognitive function, haloperidol- (23.00 sec; 95% CI: 17.42-28.59; I2 = 7%) and risperidone-treated rats (24.27 sec; 95% CI: 16.18-32.36; I2 = 0%) were consistently impaired when compared to controls. In studies evaluating atypical antipsychotics, no impairments were observed. Clinicians should avoid the regular use of haloperidol and risperidone, and future human studies should be conducted with atypical antipsychotics.
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Affiliation(s)
| | | | - Stephanie Karzon
- Faculté de Médecine, Université de Montréal, Montreal, Quebec, Canada
| | - Camille Livernoche-Leduc
- Départment de psychologie, Université du Québec à Montréal, Montreal, Quebec, Canada
- Research center, CIUSSS-Nord-de-l'Île-de-Montréal, Hôpital du Sacré-Cœur de Montréal. Montreal, Quebec, Canada
| | - Mar Saavedra-Mitjans
- Faculté de pharmacie, Université de Montréal, Montreal, Quebec, Canada
- Research center, CIUSSS-Nord-de-l'Île-de-Montréal, Hôpital du Sacré-Cœur de Montréal. Montreal, Quebec, Canada
| | - Marie-Julie Potvin
- Départment de psychologie, Université du Québec à Montréal, Montreal, Quebec, Canada
- Research center, CIUSSS-Nord-de-l'Île-de-Montréal, Hôpital du Sacré-Cœur de Montréal. Montreal, Quebec, Canada
| | - Francis Bernard
- Faculté de Médecine, Université de Montréal, Montreal, Quebec, Canada
- Research center, CIUSSS-Nord-de-l'Île-de-Montréal, Hôpital du Sacré-Cœur de Montréal. Montreal, Quebec, Canada
| | - Lisa Burry
- Pharmacy Department, Mount Sinai Hospital. Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Caroline Arbour
- Research center, CIUSSS-Nord-de-l'Île-de-Montréal, Hôpital du Sacré-Cœur de Montréal. Montreal, Quebec, Canada
- Faculté de sciences infirmières, Université de Montréal, Montreal, Quebec, Canada
| | - David R Williamson
- Faculté de pharmacie, Université de Montréal, Montreal, Quebec, Canada
- Research center, CIUSSS-Nord-de-l'Île-de-Montréal, Hôpital du Sacré-Cœur de Montréal. Montreal, Quebec, Canada
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4
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Vozzella VJ, Bittner RA, Ranellone TS, Grimm KM, Palmer KN, Carpio AN, Abel QC, Moschonas EH, Bondi CO, Kline AE. A bridge to recovery: Acute amantadine prior to environmental enrichment after brain trauma augments cognitive benefit. Exp Neurol 2024; 373:114648. [PMID: 38081352 DOI: 10.1016/j.expneurol.2023.114648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/20/2023] [Accepted: 12/04/2023] [Indexed: 12/22/2023]
Abstract
Environmental enrichment (EE) facilitates motor and cognitive recovery after traumatic brain injury (TBI). Historically, EE has been provided immediately and continuously after TBI, but this paradigm does not model the clinic where rehabilitation is typically not initiated until after critical care. Yet, treating TBI early may facilitate recovery. Hence, we sought to provide amantadine (AMT) as a bridge therapy before commencing EE. It was hypothesized that bridging EE with AMT would augment motor and cognitive benefits. Anesthetized adult male rats received a cortical impact (2.8 mm deformation at 4 m/s) or sham surgery and then were housed in standard (STD) conditions where they received intraperitoneal AMT (10 mg/kg or 20 mg/kg) or saline vehicle (VEH; 1 mL/kg) beginning 24 h after surgery and once daily during the 6-day bridge phase or once daily for 19 days for the non-bridge groups (i.e., continuously STD-housed) to compare the effects of acute AMT plus EE vs. chronic AMT alone. Abbreviated EE, which was presented to closer emulate clinical rehabilitation (e.g., 6 h/day), began on day 7 for the AMT bridge and chronic EE groups. Motor (beam-walking) and cognition (acquisition of spatial learning and memory) were assessed on days 7-11 and 14-19, respectively. Cortical lesion volume and hippocampal cell survival were quantified on day 21. EE, whether provided in combination with VEH or AMT, and AMT (20 mg/kg) + STD, benefitted motor and cognition vs. the STD-housed VEH and AMT (10 mg/kg) groups (p < 0.05). The AMT (20 mg/kg) + EE group performed better than the VEH + EE, AMT (10 mg/kg) + EE, and AMT (20 mg/kg) + STD groups in the acquisition of spatial learning (p < 0.05) but did not differ in motor function (p > 0.05). All groups receiving EE exhibited decreased cortical lesion volumes and increased CA3 neuron survival relative to the STD-housed groups (p < 0.05) but did not differ from one another (p > 0.05). The added cognitive benefit achieved by bridging EE with AMT (20 mg/kg) supports the hypothesis that the temporal separation of combinational therapies is more effective after TBI.
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Affiliation(s)
- Vincent J Vozzella
- Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA 15213, United States of America; Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA 15213, United States of America
| | - Rachel A Bittner
- Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA 15213, United States of America; Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA 15213, United States of America
| | - Tyler S Ranellone
- Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA 15213, United States of America; Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA 15213, United States of America
| | - Kelsey M Grimm
- Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA 15213, United States of America; Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA 15213, United States of America
| | - Kelsey N Palmer
- Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA 15213, United States of America; Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA 15213, United States of America
| | - Anna N Carpio
- Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA 15213, United States of America; Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA 15213, United States of America
| | - Quinn C Abel
- Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA 15213, United States of America; Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA 15213, United States of America
| | - Eleni H Moschonas
- Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA 15213, United States of America; Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA 15213, United States of America; Center for Neuroscience, University of Pittsburgh, Pittsburgh, PA 15213, United States of America
| | - Corina O Bondi
- Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA 15213, United States of America; Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA 15213, United States of America; Center for Neuroscience, University of Pittsburgh, Pittsburgh, PA 15213, United States of America; Neurobiology, University of Pittsburgh, Pittsburgh, PA 15213, United States of America
| | - Anthony E Kline
- Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA 15213, United States of America; Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA 15213, United States of America; Center for Neuroscience, University of Pittsburgh, Pittsburgh, PA 15213, United States of America; Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA 15213, United States of America; Center for the Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, PA 15213, United States of America; Psychology, University of Pittsburgh, Pittsburgh, PA 15213, United States of America.
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5
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Cui J, Zhao D, Xu M, Li Z, Qian J, Song N, Wang J, Xie J. Characterization of graded 6-Hydroxydopamine unilateral lesion in medial forebrain bundle of mice. Sci Rep 2024; 14:3721. [PMID: 38355892 PMCID: PMC10866897 DOI: 10.1038/s41598-024-54066-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 02/08/2024] [Indexed: 02/16/2024] Open
Abstract
Parkinson's disease (PD) is the second most common age-related neurodegenerative disease, with a progressive loss of dopaminergic cells and fibers. The purpose of this study was to use different doses of 6-hydroxydopamine (6-OHDA) injection into the medial forebrain bundle (MFB) of mice to mimic the different stages of the disease and to characterize in detail their motor and non-motor behavior, as well as neuropathological features in the nigrostriatal pathway. MFB were injected with 0.5 μg, 1 μg, 2 μg of 6-OHDA using a brain stereotaxic technique. 6-OHDA induced mitochondrial damage dose-dependently, as well as substantia nigra pars compacta (SNpc) tyrosine hydroxylase-positive (TH+) cell loss and striatal TH fiber loss. Activation of astrocytes and microglia in the SNpc and striatum were consistently observed at 7 weeks, suggesting a long-term glial response in the nigrostriatal system. Even with a partial or complete denervation of the nigrostriatal pathway, 6-OHDA did not cause anxiety, although depression-like behavior appeared. Certain gait disturbances were observed in 0.5 μg 6-OHDA lesioned mice, and more extensive in 1 μg group. Despite the loss of more neurons from 2 μg 6-OHDA, there was no further impairment in behaviors compared to 1 μg 6-OHDA. Our data have implications that 1 μg 6-OHDA was necessary and sufficient to induce motor and non-motor symptoms in mice, thus a valuable mouse tool to explore disease progression and new treatment in PD.
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Affiliation(s)
- Juntao Cui
- Institute of Brain Science and Disease, Qingdao University, Qingdao, 266071, China
- Shandong Provincial Key Laboratory of Pathogenesis and Prevention of Neurological Disorders, Qingdao University, Qingdao, 266071, China
- School of Basic Medicine, Qingdao University, Qingdao, 266071, China
| | - Di Zhao
- Institute of Brain Science and Disease, Qingdao University, Qingdao, 266071, China
- Shandong Provincial Key Laboratory of Pathogenesis and Prevention of Neurological Disorders, Qingdao University, Qingdao, 266071, China
| | - Manman Xu
- Institute of Brain Science and Disease, Qingdao University, Qingdao, 266071, China
- Shandong Provincial Key Laboratory of Pathogenesis and Prevention of Neurological Disorders, Qingdao University, Qingdao, 266071, China
- School of Basic Medicine, Qingdao University, Qingdao, 266071, China
| | - Zheheng Li
- School of Basic Medicine, Qingdao University, Qingdao, 266071, China
| | - Junliang Qian
- Institute of Brain Science and Disease, Qingdao University, Qingdao, 266071, China
- Shandong Provincial Key Laboratory of Pathogenesis and Prevention of Neurological Disorders, Qingdao University, Qingdao, 266071, China
- School of Basic Medicine, Qingdao University, Qingdao, 266071, China
| | - Ning Song
- Institute of Brain Science and Disease, Qingdao University, Qingdao, 266071, China.
- Shandong Provincial Key Laboratory of Pathogenesis and Prevention of Neurological Disorders, Qingdao University, Qingdao, 266071, China.
- School of Basic Medicine, Qingdao University, Qingdao, 266071, China.
| | - Jun Wang
- Institute of Brain Science and Disease, Qingdao University, Qingdao, 266071, China.
- Shandong Provincial Key Laboratory of Pathogenesis and Prevention of Neurological Disorders, Qingdao University, Qingdao, 266071, China.
- School of Basic Medicine, Qingdao University, Qingdao, 266071, China.
| | - Junxia Xie
- Institute of Brain Science and Disease, Qingdao University, Qingdao, 266071, China.
- Shandong Provincial Key Laboratory of Pathogenesis and Prevention of Neurological Disorders, Qingdao University, Qingdao, 266071, China.
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6
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Moschonas EH, Ranellone TS, Vozzella VJ, Rennerfeldt PL, Bondi CO, Annas EM, Bittner RA, Tamura DM, Reddy RI, Eleti RR, Cheng JP, Jarvis JM, Fink EL, Kline AE. Efficacy of a music-based intervention in a preclinical model of traumatic brain injury: An initial foray into a novel and non-pharmacological rehabilitative therapy. Exp Neurol 2023; 369:114544. [PMID: 37726048 PMCID: PMC10591861 DOI: 10.1016/j.expneurol.2023.114544] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 08/29/2023] [Accepted: 09/16/2023] [Indexed: 09/21/2023]
Abstract
Traumatic brain injury (TBI) causes neurobehavioral and cognitive impairments that negatively impact life quality for millions of individuals. Because of its pernicious effects, numerous pharmacological interventions have been evaluated to attenuate the TBI-induced deficits or to reinstate function. While many such pharmacotherapies have conferred benefits in the laboratory, successful translation to the clinic has yet to be achieved. Given the individual, medical, and societal burden of TBI, there is an urgent need for alternative approaches to attenuate TBI sequelae and promote recovery. Music based interventions (MBIs) may hold untapped potential for improving neurobehavioral and cognitive recovery after TBI as data in normal, non-TBI, rats show plasticity and augmented cognition. Hence, the aim of this study was to test the hypothesis that providing a MBI to adult rats after TBI would improve cognition, neurobehavior, and histological endpoints. Adult male rats received a moderate-to-severe controlled cortical impact injury (2.8 mm impact at 4 m/s) or sham surgery (n = 10-12 per group) and 24 h later were randomized to classical Music or No Music (i.e., ambient room noise) for 3 h/day from 19:00 to 22:00 h for 30 days (last day of behavior). Motor (beam-walk), cognitive (acquisition of spatial learning and memory), anxiety-like behavior (open field), coping (shock probe defensive burying), as well as histopathology (lesion volume), neuroplasticity (BDNF), and neuroinflammation (Iba1, and CD163) were assessed. The data showed that the MBI improved motor, cognitive, and anxiety-like behavior vs. No Music (p's < 0.05). Music also reduced cortical lesion volume and activated microglia but increased resting microglia and hippocampal BDNF expression. These findings support the hypothesis and provide a compelling impetus for additional preclinical studies utilizing MBIs as a potential efficacious rehabilitative therapy for TBI.
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Affiliation(s)
- Eleni H Moschonas
- Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA 15213, United States of America; Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA 15213, United States of America; Center for Neuroscience, University of Pittsburgh, Pittsburgh, PA 15213, United States of America
| | - Tyler S Ranellone
- Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA 15213, United States of America; Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA 15213, United States of America
| | - Vincent J Vozzella
- Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA 15213, United States of America; Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA 15213, United States of America
| | - Piper L Rennerfeldt
- Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA 15213, United States of America; Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA 15213, United States of America
| | - Corina O Bondi
- Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA 15213, United States of America; Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA 15213, United States of America; Center for Neuroscience, University of Pittsburgh, Pittsburgh, PA 15213, United States of America; Neurobiology, University of Pittsburgh, Pittsburgh, PA 15213, United States of America
| | - Ellen M Annas
- Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA 15213, United States of America; Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA 15213, United States of America
| | - Rachel A Bittner
- Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA 15213, United States of America; Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA 15213, United States of America
| | - Dana M Tamura
- Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA 15213, United States of America; Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA 15213, United States of America
| | - Rithika I Reddy
- Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA 15213, United States of America; Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA 15213, United States of America
| | - Rithik R Eleti
- Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA 15213, United States of America; Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA 15213, United States of America
| | - Jeffrey P Cheng
- Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA 15213, United States of America; Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA 15213, United States of America
| | - Jessica M Jarvis
- Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA 15213, United States of America; Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA 15213, United States of America
| | - Ericka L Fink
- Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA 15213, United States of America; Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA 15213, United States of America
| | - Anthony E Kline
- Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA 15213, United States of America; Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA 15213, United States of America; Center for Neuroscience, University of Pittsburgh, Pittsburgh, PA 15213, United States of America; Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA 15213, United States of America; Center for the Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, PA 15213, United States of America; Psychology, University of Pittsburgh, Pittsburgh, PA 15213, United States of America.
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7
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Li LM, Carson A, Dams-O'Connor K. Psychiatric sequelae of traumatic brain injury - future directions in research. Nat Rev Neurol 2023; 19:556-571. [PMID: 37591931 DOI: 10.1038/s41582-023-00853-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2023] [Indexed: 08/19/2023]
Abstract
Despite growing appreciation that traumatic brain injury (TBI) is an important public health burden, our understanding of the psychiatric and behavioural consequences of TBI remains limited. These changes are particularly detrimental to a person's sense of self, their relationships and their participation in the wider community, and they continue to have devastating individual and cumulative effects long after TBI. This Review relates specifically to TBIs that confer objective clinical or biomarker evidence of structural brain injury; symptomatic head injuries without such evidence are outside the scope of this article. Common psychiatric, affective and behavioural sequelae of TBI and their proposed underlying mechanisms are outlined, along with a brief overview of current treatments. Suggestions for how scientists and clinicians can work together in the future to address the chasms in clinical care and knowledge are discussed in depth.
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Affiliation(s)
- Lucia M Li
- Department of Brain Sciences, Imperial College London, London, UK.
| | - Alan Carson
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Kristen Dams-O'Connor
- Brain Injury Research Center, Department of Rehabilitation and Human Performance, Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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8
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Min YJ, Yao HH, Wang L, Cheng LH, Hong ES. Comparison and effect of moxibustion and acupuncture on Nogo/NgR signaling pathway in rats with cerebral ischemia/reperfusion injury. J Tradit Complement Med 2023; 13:430-440. [PMID: 37693099 PMCID: PMC10491986 DOI: 10.1016/j.jtcme.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 03/04/2023] [Accepted: 03/10/2023] [Indexed: 04/03/2023] Open
Abstract
Background and aim In China, acupuncture and moxibustion have been used effectively to treat various diseases for thousands of years. However, the evidence for a difference in the efficacies of moxibustion and acupuncture in cerebral infarction treatment is scarce. We aimed to compare the effects of acupuncture and moxibustion treatment on the Nogo/NgR signaling pathway in rats with cerebral ischemia/reperfusion (I/R) injury. Experimental procedure Eighty male SD rats were randomly divided into five groups, based on treatment received: sham surgery (sham group), middle cerebral artery occlusion (MCAO, MCAO group), MCAO and NEP(1-40) inhibitor injection (MCAO + block group), MCAO and moxibustion (MCAO + moxi group), and MCAO and minimal acupuncture (MCAO + MA group). Neurological status was evaluated before treatment, and cerebral infarction volume (IV) and neurological function; Nogo-A, NgR, p75NTR, and LINGO-1 expressions; and NgR and LINGO-1 co-expression were assessed after treatment. Results and conclusion After treatment, barring Nogo-A mRNA and protein expression in the MCAO + block group, the Longa score and IV significantly decreased; Nogo-A, NgR, p75NTR, and LINGO-1 mRNA and protein expressions as well as NgR and LINGO-1 co-expression significantly decreased in cerebral tissues; whereas the BWT score increased (P < 0.01) in the MCAO + moxi group, compared with the MCAO group. Except for NgR and LINGO-1 protein expressions, there were no significant differences in the abovementioned parameters between rats that underwent acupuncture and moxibustion. Acupuncture and moxibustion have similar effects on Nogo/NgR signaling pathway inhibition after cerebral infarction.
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Affiliation(s)
- You-jiang Min
- School of Traditional Chinese Medicine, Nanchang Medical College, Nanchang, 330052, Jiangxi, China
- Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, 330006, Jiangxi, China
| | - Hai-hua Yao
- Shanghai Eighth People's Hospital, Shanghai, 200235, Shanghai, China
| | - Li Wang
- School of Traditional Chinese Medicine, Nanchang Medical College, Nanchang, 330052, Jiangxi, China
| | - Li-hong Cheng
- Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, 330006, Jiangxi, China
| | - En-si Hong
- Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, 330006, Jiangxi, China
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9
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Manno FAM, Cheung P, Basnet V, Khan MS, Mao Y, Pan L, Ma V, Cho WC, Tian S, An Z, Feng Y, Cai YL, Pienkowski M, Lau C. Subtle alterations of vestibulomotor functioning in conductive hearing loss. Front Neurosci 2023; 17:1057551. [PMID: 37706156 PMCID: PMC10495589 DOI: 10.3389/fnins.2023.1057551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 06/08/2023] [Indexed: 09/15/2023] Open
Abstract
Introduction Conductive hearing loss (CHL) attenuates the ability to transmit air conducted sounds to the ear. In humans, severe hearing loss is often accompanied by alterations to other neural systems, such as the vestibular system; however, the inter-relations are not well understood. The overall goal of this study was to assess vestibular-related functioning proxies in a rat CHL model. Methods Male Sprague-Dawley rats (N=134, 250g, 2months old) were used in a CHL model which produced a >20dB threshold shift induced by tympanic membrane puncture. Auditory brainstem response (ABRs) recordings were used to determine threshold depth at different times before and after CHL. ABR threshold depths were assessed both manually and by an automated ABR machine learning algorithm. Vestibular-related functioning proxy assessment was performed using the rotarod, balance beam, elevator vertical motion (EVM) and Ferris-wheel rotation (FWR) assays. Results The Pre-CHL (control) threshold depth was 27.92dB±11.58dB compared to the Post-CHL threshold depth of 50.69dB±13.98dB (mean±SD) across the frequencies tested. The automated ABR machine learning algorithm determined the following threshold depths: Pre-CHL=24.3dB, Post-CHL same day=56dB, Post-CHL 7 days=41.16dB, and Post-CHL 1 month=32.5dB across the frequencies assessed (1, 2, 4, 8, 16, and 32kHz). Rotarod assessment of motor function was not significantly different between pre and post-CHL (~1week) rats for time duration (sec) or speed (RPM), albeit the former had a small effect size difference. Balance beam time to transverse was significantly longer for post-CHL rats, likely indicating a change in motor coordination. Further, failure to cross was only noted for CHL rats. The defection count was significantly reduced for CHL rats compared to control rats following FWR, but not EVM. The total distance traveled during open-field examination after EVM was significantly different between control and CHL rats, but not for FWR. The EVM is associated with linear acceleration (acting in the vertical plane: up-down) stimulating the saccule, while the FWR is associated with angular acceleration (centrifugal rotation about a circular axis) stimulating both otolith organs and semicircular canals; therefore, the difference in results could reflect the specific vestibular-organ functional role. Discussion Less movement (EVM) and increase time to transverse (balance beam) may be associated with anxiety and alterations to defecation patterns (FWR) may result from autonomic disturbances due to the impact of hearing loss. In this regard, vestibulomotor deficits resulting in changes in balance and motion could be attributed to comodulation of auditory and vestibular functioning. Future studies should manipulate vestibular functioning directly in rats with CHL.
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Affiliation(s)
- Francis A. M. Manno
- Department of Physics, East Carolina University, Greenville, NC, United States
- Department of Biomedical Engineering, Center for Imaging Science, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD, United States
- Center for Advanced Nuclear Safety and Sustainable Development, City University of Hong Kong, Kowloon, Hong Kong SAR, China
- Department of Physics, City University of Hong Kong, Kowloon, Hong Kong SAR, China
| | - Pikting Cheung
- Department of Physics, City University of Hong Kong, Kowloon, Hong Kong SAR, China
| | - Vardhan Basnet
- Department of Physics, City University of Hong Kong, Kowloon, Hong Kong SAR, China
| | | | - Yuqi Mao
- Department of Nautical Injury Prevention, Faculty of Navy Medicine, Second Military Medical University, Shanghai, China
| | - Leilei Pan
- Department of Nautical Injury Prevention, Faculty of Navy Medicine, Second Military Medical University, Shanghai, China
| | - Victor Ma
- Department of Clinical Oncology, Queen Elizabeth Hospital, Kowloon, Hong Kong SAR, China
| | - William C. Cho
- Department of Clinical Oncology, Queen Elizabeth Hospital, Kowloon, Hong Kong SAR, China
| | - Shile Tian
- School of Biomedical Engineering, Southern Medical University, Guangzhou, China
| | - Ziqi An
- School of Biomedical Engineering, Southern Medical University, Guangzhou, China
| | - Yanqiu Feng
- School of Biomedical Engineering, Southern Medical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Medical Image Processing and Guangdong Province Engineering Laboratory for Medical Imaging and Diagnostic Technology, Southern Medical University, Guangzhou, China
- Key Laboratory of Mental Health of the Ministry of Education, Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, Guangdong Province Key Laboratory of Psychiatric Disorders, Department of Neurobiology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
| | - Yi-Ling Cai
- Department of Physics, City University of Hong Kong, Kowloon, Hong Kong SAR, China
| | - Martin Pienkowski
- Osborne College of Audiology, Salus University, Elkins Park, PA, United States
| | - Condon Lau
- Center for Advanced Nuclear Safety and Sustainable Development, City University of Hong Kong, Kowloon, Hong Kong SAR, China
- Department of Physics, City University of Hong Kong, Kowloon, Hong Kong SAR, China
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10
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Chen F, Qian J, Cao Z, Li A, Cui J, Shi L, Xie J. Chemogenetic and optogenetic stimulation of zona incerta GABAergic neurons ameliorates motor impairment in Parkinson's disease. iScience 2023; 26:107149. [PMID: 37416450 PMCID: PMC10319825 DOI: 10.1016/j.isci.2023.107149] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 04/26/2023] [Accepted: 06/12/2023] [Indexed: 07/08/2023] Open
Abstract
Parkinson's disease (PD) is characterized by the degeneration of dopaminergic neurons in the substantia nigra and leads to progressive motor dysfunction. While studies have focused on the basal ganglia network, recent evidence suggests neuronal systems outside the basal ganglia are also related to PD pathogenesis. The zona incerta (ZI) is a predominantly inhibitory subthalamic region for global behavioral modulation. This study investigates the role of GABAergic neurons in the ZI in a mouse model of 6-hydroxydopamine (6-OHDA)-induced PD. First, we found a decrease in GABA-positive neurons in the ZI, and then the mice used chemogenetic/optogenetic stimulation to activate or inhibit GABAergic neurons. The motor performance of PD mice was significantly improved by chemogenetic/optogenetic activation of GABAergic neurons, and repeated chemogenetic activation of ZI GABAergic neurons increased the dopamine content in the striatum. Our work identifies the role of ZI GABAergic neurons in regulating motor behaviors in 6-OHDA-lesioned PD model mice.
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Affiliation(s)
- Fenghua Chen
- Department of Physiology, Shandong Provincial Key Laboratory of Pathogenesis and Prevention of Neurological Disorders, School of Basic Medicine, Qingdao University, Qingdao, China
- Institute of Brain Science and Disease, Qingdao University, Qingdao, China
| | - Junliang Qian
- Institute of Brain Science and Disease, Qingdao University, Qingdao, China
| | - Zhongkai Cao
- Department of Physiology, Shandong Provincial Key Laboratory of Pathogenesis and Prevention of Neurological Disorders, School of Basic Medicine, Qingdao University, Qingdao, China
- Institute of Brain Science and Disease, Qingdao University, Qingdao, China
| | - Ang Li
- Department of Physiology, Shandong Provincial Key Laboratory of Pathogenesis and Prevention of Neurological Disorders, School of Basic Medicine, Qingdao University, Qingdao, China
- Institute of Brain Science and Disease, Qingdao University, Qingdao, China
| | - Juntao Cui
- Department of Physiology, Shandong Provincial Key Laboratory of Pathogenesis and Prevention of Neurological Disorders, School of Basic Medicine, Qingdao University, Qingdao, China
- Institute of Brain Science and Disease, Qingdao University, Qingdao, China
| | - Limin Shi
- Department of Physiology, Shandong Provincial Key Laboratory of Pathogenesis and Prevention of Neurological Disorders, School of Basic Medicine, Qingdao University, Qingdao, China
- Institute of Brain Science and Disease, Qingdao University, Qingdao, China
| | - Junxia Xie
- Department of Physiology, Shandong Provincial Key Laboratory of Pathogenesis and Prevention of Neurological Disorders, School of Basic Medicine, Qingdao University, Qingdao, China
- Institute of Brain Science and Disease, Qingdao University, Qingdao, China
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11
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Mazhar M, Yang G, Xu H, Liu Y, Liang P, Yang L, Spáčil R, Shen H, Zhang D, Ren W, Yang S. Zhilong Huoxue Tongyu capsule attenuates intracerebral hemorrhage induced redox imbalance by modulation of Nrf2 signaling pathway. Front Pharmacol 2023; 14:1197433. [PMID: 37351503 PMCID: PMC10282143 DOI: 10.3389/fphar.2023.1197433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 05/24/2023] [Indexed: 06/24/2023] Open
Abstract
Background: One of the severely debilitating and fatal subtypes of hemorrhagic stroke is intracerebral hemorrhage (ICH), which lacks an adequate cure at present. The Zhilong Huoxue Tongyu (ZLHXTY) capsule has been utilized effectively since last decade to treat ICH, in some provinces of China but the scientific basis for its mechanism is lacking. Purpose: To investigate the neuroprotective role of ZLHXTY capsules for ICH-induced oxidative injury through the regulation of redox imbalance with the Nrf2 signaling pathway. Methods: Autologous blood injection model of ICH in C57BL/6J mice was employed. Three treatment groups received ZLHXTY once daily through oral gavage at doses 0.35 g/kg, 0.7 g/kg, and 1.4 g/kg, started after 2 h and continued for 72 h of ICH induction. The neurological outcome was measured using a balance beam test. Serum was tested for inflammatory markers IL-1β, IL-6, and TNF-α through ELISA, oxidative stress through hydrogen peroxide content assay, and antioxidant status by total antioxidant capacity (T-AOC) assay. Nuclear extract from brain tissue was assayed for Nrf2 transcriptional factor activity. RT-qPCR was performed for Nfe2l2, Sod1, Hmox1, Nqo1, and Mgst1; and Western blotting for determination of protein expression of Nrf2, p62, Pp62, Keap, HO1, and NQO1. Fluoro-jade C staining was also used to examine neuronal damage. Results: ZLHXTY capsule treatment following ICH demonstrated a protective effect against oxidative brain injury. Neurological scoring showed improvement in behavioral outcomes. ELISA-based identification demonstrated a significant decline in the expression of serum inflammatory markers. Hydrogen peroxide content in serum was found to be reduced. The total antioxidant capacity was also reduced in serum, but the ZLHXTY extract showed a concentration-dependent increase in T-AOC speculating at its intrinsic antioxidant potential. Nrf2 transcriptional factor activity, mRNA and protein expression analyses revealed normalization of Nrf2 and its downstream targets, which were previously elevated as a result of oxidative stress induced by ICH. Neuronal damage was also reduced markedly after ZLHXTY treatment as revealed by Fluoro-jade C staining. Conclusion: ZLHXTY capsules possess an intrinsic antioxidant potential that can modulate the ICH-induced redox imbalance in the brain as revealed by the normalization of Nrf2 and its downstream antioxidant targets.
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Affiliation(s)
- Maryam Mazhar
- National Traditional Chinese Medicine Clinical Research Base and Drug Research Center, the Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
- Institute of Integrated Chinese and Western Medicine of Southwest Medical University, Luzhou, China
| | - Guoqiang Yang
- Research Center for Integrated Chinese and Western Medicine, the Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China
- Molecular Imaging and Therapy Research Unit, Center of Radiation Research and Medical Imaging, Department of Radiologic Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Houping Xu
- Preventive Treatment Center, the Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
| | - Yulin Liu
- Institute of Integrated Chinese and Western Medicine of Southwest Medical University, Luzhou, China
- Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Pan Liang
- National Traditional Chinese Medicine Clinical Research Base and Drug Research Center, the Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
- Institute of Integrated Chinese and Western Medicine of Southwest Medical University, Luzhou, China
| | - Luyin Yang
- National Traditional Chinese Medicine Clinical Research Base and Drug Research Center, the Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
- Institute of Integrated Chinese and Western Medicine of Southwest Medical University, Luzhou, China
| | - Roman Spáčil
- The Czech Center for Traditional Chinese Medicine, Olomouc, Czechia
| | - Hongping Shen
- National Traditional Chinese Medicine Clinical Research Base and Drug Research Center, the Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
- Institute of Integrated Chinese and Western Medicine of Southwest Medical University, Luzhou, China
| | - Dechou Zhang
- National Traditional Chinese Medicine Clinical Research Base and Drug Research Center, the Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
- Institute of Integrated Chinese and Western Medicine of Southwest Medical University, Luzhou, China
| | - Wei Ren
- National Traditional Chinese Medicine Clinical Research Base and Drug Research Center, the Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
- Institute of Integrated Chinese and Western Medicine of Southwest Medical University, Luzhou, China
| | - Sijin Yang
- National Traditional Chinese Medicine Clinical Research Base and Drug Research Center, the Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
- Institute of Integrated Chinese and Western Medicine of Southwest Medical University, Luzhou, China
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12
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Stockbridge MD, Keser Z. Supporting Post-Stroke Language and Cognition with Pharmacotherapy: Tools for Each Phase of Care. Curr Neurol Neurosci Rep 2023; 23:335-343. [PMID: 37271792 PMCID: PMC10257638 DOI: 10.1007/s11910-023-01273-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2023] [Indexed: 06/06/2023]
Abstract
PURPOSE OF REVIEW There is enormous enthusiasm for the possibility of pharmacotherapies to treat language deficits that can arise after stroke. Speech language therapy remains the most frequently utilized and most strongly evidenced treatment, but the numerous barriers to patients receiving the therapy necessary to recover have motivated the creation of a relatively modest, yet highly cited, body of evidence to support the use of pharmacotherapy to treat post-stroke aphasia directly or to augment traditional post-stroke aphasia treatment. In this review, we survey the use of pharmacotherapy to preserve and support language and cognition in the context of stroke across phases of care, discuss key ongoing clinical trials, and identify targets that may become emerging interventions in the future. RECENT FINDINGS Recent trials have shifted focus from short periods of drug therapy supporting therapy in the chronic phase to longer terms approaching pharmacological maintenance beginning more acutely. Recent innovations in hyperacute stroke care, such as tenecteplase, and acute initiation of neuroprotective agents and serotonin reuptake inhibitors are important areas of ongoing research that complement the ongoing search for effective adjuvants to later therapy. Currently there are no drugs approved in the United States for the treatment of aphasia. Nevertheless, pharmacological intervention may provide a benefit to all phases of stroke care.
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Affiliation(s)
- Melissa D Stockbridge
- Department of Neurology, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Phipps 4, Suite 446, Baltimore, MD, 21287, USA.
| | - Zafer Keser
- Department of Neurology, Mayo Clinic, Rochester, MN, 55905, USA
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13
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Moschonas EH, Niesman PJ, Vozzella VJ, Bittner RA, Brennan CJ, Cheng JP, Bondi CO, Kline AE. Enriching adult male rats prior to traumatic brain injury does not attenuate neurobehavioral or histological deficits. Brain Res 2023; 1807:148314. [PMID: 36878341 PMCID: PMC10081453 DOI: 10.1016/j.brainres.2023.148314] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 02/26/2023] [Accepted: 03/02/2023] [Indexed: 03/07/2023]
Abstract
Environmental enrichment (EE) confers significant increases in neurobehavioral and cognitive recovery and decreases histological damage in various models of traumatic brain injury (TBI). However, despite EE's pervasiveness, little is known regarding its prophylactic potential. Thus, the goal of the current study was to determine whether enriching rats prior to a controlled cortical impact exerts protection as evidenced by attenuated injury-induced neurobehavioral and histological deficits relative to rats without prior EE. The hypothesis was that enrichment prior to TBI would be protective. After two weeks of EE or standard (STD) housing, anesthetized adult male rats received either a controlled cortical impact (2.8 mm deformation at 4 m/s) or sham injury and then were placed in EE or STD conditions. Motor (beam-walk) and cognitive (spatial learning) performance were assessed on post-operative days 1-5 and 14-18, respectively. Cortical lesion volume was quantified on day 21. The group that was housed in STD conditions before TBI and received post-injury EE performed significantly better in motor, cognitive, and histological outcomes vs. both groups in STD conditions regardless of whether having received pre-injury EE or not (p < 0.05). That no differences in any endpoint were revealed between the two STD-housed groups after TBI suggests that enriching rats prior to TBI does not attenuate neurobehavioral or histological deficits and therefore does not support the hypothesis.
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Affiliation(s)
- Eleni H Moschonas
- Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA 15213, United States; Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA 15213, United States; Center for Neuroscience, University of Pittsburgh, Pittsburgh, PA 15213, United States
| | - Peter J Niesman
- Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA 15213, United States; Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA 15213, United States
| | - Vincent J Vozzella
- Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA 15213, United States; Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA 15213, United States
| | - Rachel A Bittner
- Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA 15213, United States; Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA 15213, United States
| | - Connor J Brennan
- Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA 15213, United States; Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA 15213, United States
| | - Jeffrey P Cheng
- Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA 15213, United States; Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA 15213, United States
| | - Corina O Bondi
- Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA 15213, United States; Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA 15213, United States; Center for Neuroscience, University of Pittsburgh, Pittsburgh, PA 15213, United States; Neurobiology, University of Pittsburgh, Pittsburgh, PA 15213, United States
| | - Anthony E Kline
- Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA 15213, United States; Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA 15213, United States; Center for Neuroscience, University of Pittsburgh, Pittsburgh, PA 15213, United States; Center for the Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, PA 15213, United States; Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA 15213, United States; Psychology, University of Pittsburgh, Pittsburgh, PA 15213, United States.
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O'Dell MW. Stroke Rehabilitation and Motor Recovery. Continuum (Minneap Minn) 2023; 29:605-627. [PMID: 37039412 DOI: 10.1212/con.0000000000001218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
OBJECTIVE Up to 50% of the nearly 800,000 patients who experience a new or recurrent stroke each year in the United States fail to achieve full independence afterward. More effective approaches to enhance motor recovery following stroke are needed. This article reviews the rehabilitative principles and strategies that can be used to maximize post-stroke recovery. LATEST DEVELOPMENTS Evidence dictates that mobilization should not begin prior to 24 hours following stroke, but detailed guidelines beyond this are lacking. Specific classes of potentially detrimental medications should be avoided in the early days poststroke. Patients with stroke who are unable to return home should be referred for evaluation to an inpatient rehabilitation facility. Research suggests that a substantial increase in both the dose and intensity of upper and lower extremity exercise is beneficial. A clinical trial supports vagus nerve stimulation as an adjunct to occupational therapy for motor recovery in the upper extremity. The data remain somewhat mixed as to whether robotics, transcranial magnetic stimulation, functional electrical stimulation, and transcranial direct current stimulation are better than dose-matched traditional exercise. No current drug therapy has been proven to augment exercise poststroke to enhance motor recovery. ESSENTIAL POINTS Neurologists will collaborate with rehabilitation professionals for several months following a patient's stroke. Many questions still remain about the ideal exercise regimen to maximize motor recovery in patients poststroke. The next several years will likely bring a host of new research studies exploring the latest strategies to enhance motor recovery using poststroke exercise.
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15
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Differential Impact of Social Isolation and Space Radiation on Behavior and Motor Learning in Rats. Life (Basel) 2023; 13:life13030826. [PMID: 36983981 PMCID: PMC10057568 DOI: 10.3390/life13030826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/10/2023] [Accepted: 03/17/2023] [Indexed: 03/22/2023] Open
Abstract
Future missions to Mars will expose astronauts to several physical and psychological challenges, including exposure to space radiation (SR) and periods of social isolation (SI). Each of these stressors, in addition to mission demands, can affect physical and mental health and potentially negatively impact sleep. The effects of inflight stressors may vary with duration and time course, may be additive or compounding, and may vary with individual differences in stress resilience and vulnerability. Determining how individual differences in resilient and vulnerable phenotypes respond to these mission-related stressors and their interactions with sleep will be crucial for understanding and mitigating factors that can impair performance and damage health. Here, we examined the single and compound effects of ground-based analogs of SI and SR on sensorimotor performance on the balance beam (BB) in rats. We also assessed emotional responses during testing on the BB and assessed whether sensorimotor performance and emotion varied with individual differences in stress resiliency using our established animal model in which stress produces different effects on sleep. Results showed differential motor performance and emotion in the BB task between SI and SR, and these varied based on resilient and vulnerable phenotypes. These findings demonstrate that identifying individual responses to stressors that can impact sensorimotor ability and behavior necessary to perform mission-related tasks will be of particular importance for astronauts and future missions. Should similar effects occur in humans, there may be considerable inter-individual variability in the impact that flight stressors have on the mental health of astronauts and their ability to perform mission-related tasks.
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Li W, Abdul Y, Chandran R, Jamil S, Ward RA, Abdelsaid M, Dong G, Fagan SC, Ergul A. Deferoxamine prevents poststroke memory impairment in female diabetic rats: potential links to hemorrhagic transformation and ferroptosis. Am J Physiol Heart Circ Physiol 2023; 324:H212-H225. [PMID: 36563009 PMCID: PMC9870589 DOI: 10.1152/ajpheart.00490.2022] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 11/23/2022] [Accepted: 11/29/2022] [Indexed: 12/24/2022]
Abstract
Diabetes increases the risk of poststroke cognitive impairment (PSCI). Greater hemorrhagic transformation (HT) after stroke is associated with vasoregression and cognitive decline in male diabetic rats. Iron chelator deferoxamine (DFX) prevents vasoregression and improves outcomes. Although diabetic female rats develop greater HT, its impact on poststroke cerebrovascularization and cognitive outcomes remained unknown. We hypothesized that diabetes mediates pathological neovascularization, and DFX attenuates poststroke cerebrovascular remodeling and improves neurological outcomes in female diabetic rats. Female control and diabetic animals were treated with DFX or vehicle for 7 days after stroke. Vascular indices, microglial activation, and blood-brain barrier (BBB) integrity were evaluated on day 14. Results from diabetic female rats were partially compared with our previously published findings in male counterparts. Hemin-induced programmed cell death was studied in male and female brain microvascular endothelial cell lines (BMVEC). There was no vasoregression after stroke in either control or diabetic female animals. DFX prevented diabetes-mediated gliovascular remodeling and compromised BBB integrity while improving memory function in diabetes. Comparisons of female and male rats indicated sex differences in cognitive and vascular outcomes. Hemin mediated ferroptosis in both male and female BMVECs. DFX improved survival but had differential effects on ferroptosis signaling in female and male cells. These results suggest that stroke and associated HT do not affect cerebrovascularization in diabetic female rats, but iron chelation may provide a novel therapeutic strategy in the prevention of poststroke memory impairment in females with diabetes via the preservation of gliovascular integrity and improvement of endothelial cell survival.NEW & NOTEWORTHY The current study shows for the first time that diabetes does not promote aberrant cerebrovascularization in female rats. This contrasts with what we reported in male animals in various diabetes models. Deferoxamine preserved recognition memory function in diabetic female animals after stroke. The effect(s) of stroke and deferoxamine on cerebrovascular density and microglial activation also appear(s) to be different in female diabetic rats. Lastly, deferoxamine exerts detrimental effects on animals and BMVECs under control conditions.
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Affiliation(s)
- Weiguo Li
- Ralph H. Johnson Veterans Affairs Health Care System, Charleston, South Carolina
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Yasir Abdul
- Ralph H. Johnson Veterans Affairs Health Care System, Charleston, South Carolina
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Raghavendar Chandran
- Ralph H. Johnson Veterans Affairs Health Care System, Charleston, South Carolina
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Sarah Jamil
- Ralph H. Johnson Veterans Affairs Health Care System, Charleston, South Carolina
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Rebecca A Ward
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Guangkuo Dong
- Department of Neuroscience and Regenerative Medicine, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Susan C Fagan
- Program in Clinical and Experimental Therapeutics, University of Georgia College of Pharmacy, Augusta, Georgia
- Charlie Norwood Veterans Affairs Medical Center, Augusta, Georgia
| | - Adviye Ergul
- Ralph H. Johnson Veterans Affairs Health Care System, Charleston, South Carolina
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, South Carolina
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Waterhouse BD, Predale HK, Plummer NW, Jensen P, Chandler DJ. Probing the structure and function of locus coeruleus projections to CNS motor centers. Front Neural Circuits 2022; 16:895481. [PMID: 36247730 PMCID: PMC9556855 DOI: 10.3389/fncir.2022.895481] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 08/30/2022] [Indexed: 11/13/2022] Open
Abstract
The brainstem nucleus locus coeruleus (LC) sends projections to the forebrain, brainstem, cerebellum and spinal cord and is a source of the neurotransmitter norepinephrine (NE) in these areas. For more than 50 years, LC was considered to be homogeneous in structure and function such that NE would be released uniformly and act simultaneously on the cells and circuits that receive LC projections. However, recent studies have provided evidence that LC is modular in design, with segregated output channels and the potential for differential release and action of NE in its projection fields. These new findings have prompted a radical shift in our thinking about LC operations and demand revision of theoretical constructs regarding impact of the LC-NE system on behavioral outcomes in health and disease. Within this context, a major gap in our knowledge is the relationship between the LC-NE system and CNS motor control centers. While we know much about the organization of the LC-NE system with respect to sensory and cognitive circuitries and the impact of LC output on sensory guided behaviors and executive function, much less is known about the role of the LC-NE pathway in motor network operations and movement control. As a starting point for closing this gap in understanding, we propose using an intersectional recombinase-based viral-genetic strategy TrAC (Tracing Axon Collaterals) as well as established ex vivo electrophysiological assays to characterize efferent connectivity and physiological attributes of mouse LC-motor network projection neurons. The novel hypothesis to be tested is that LC cells with projections to CNS motor centers are scattered throughout the rostral-caudal extent of the nucleus but collectively display a common set of electrophysiological properties. Additionally, we expect to find these LC projection neurons maintain an organized network of axon collaterals capable of supporting selective, synchronous release of NE in motor circuitries for the purpose of coordinately regulating operations across networks that are responsible for balance and movement dynamics. Investigation of this hypothesis will advance our knowledge of the role of the LC-NE system in motor control and provide a basis for treating movement disorders resulting from disease, injury, or normal aging.
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Affiliation(s)
- Barry D. Waterhouse
- Department of Cell Biology and Neuroscience, Rowan University, Stratford, NJ, United States,*Correspondence: Barry D. Waterhouse,
| | - Haven K. Predale
- Department of Cell Biology and Neuroscience, Rowan University, Stratford, NJ, United States
| | - Nicholas W. Plummer
- Neurobiology Laboratory, Department of Health and Human Services, National Institute of Environmental Health Sciences, National Institutes of Health, Raleigh, NC, United States
| | - Patricia Jensen
- Neurobiology Laboratory, Department of Health and Human Services, National Institute of Environmental Health Sciences, National Institutes of Health, Raleigh, NC, United States
| | - Daniel J. Chandler
- Department of Cell Biology and Neuroscience, Rowan University, Stratford, NJ, United States
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Zheng Y, Hu Y, Han Z, Yan F, Zhang S, Yang Z, Zhao F, Li L, Fan J, Wang R, Luo Y. Lomitapide ameliorates middle cerebral artery occlusion-induced cerebral ischemia/reperfusion injury by promoting neuronal autophagy and inhibiting microglial migration. CNS Neurosci Ther 2022; 28:2183-2194. [PMID: 36052650 PMCID: PMC9627359 DOI: 10.1111/cns.13961] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 08/17/2022] [Accepted: 08/18/2022] [Indexed: 02/06/2023] Open
Abstract
AIMS Stroke has a high incidence and is a disabling condition that can lead to severe cognitive, motor, and sensory dysfunction. In this study, we employed a drug repurposing strategy to investigate the neuroprotective effect of lomitapide on focal ischemic brain injury and explore its potential mechanism of action. METHODS Experimental cerebral ischemia was induced by middle cerebral artery occlusion (MCAO) in adult male C57BL/6 mice and simulated by oxygen-glucose deprivation in N2a-BV2 cells in co-cultivation. RESULTS Lomitapide significantly increased the survival rate, reduced the neuronal tissue loss, and improved the neurological function after MCAO. Furthermore, lomitapide could increase the expression of LC3-II, reduce the expression of P62 and LAMP2, promote autophagic flux, and inhibit apoptosis by increasing and inhibiting the expression of the apoptosis-associated proteins Bcl-2 and Bax, respectively. In addition, lomitapide inhibited the migration of pro-inflammatory microglia. CONCLUSION Lomitapide is a lipid-lowering drug, and this is the first study to explore its protective effect on ischemic nerve injury in vitro and in vivo. Our results suggest that lomitapide can be repositioned as a potential therapeutic drug for the treatment of stroke.
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Affiliation(s)
- Yangmin Zheng
- Institute of Cerebrovascular Disease Research and Department of NeurologyXuanwu Hospital of Capital Medical UniversityBeijingChina,Beijing Geriatric Medical Research Center and Beijing Key Laboratory of Translational Medicine for Cerebrovascular DiseasesBeijingChina
| | - Yue Hu
- Institute of Cerebrovascular Disease Research and Department of NeurologyXuanwu Hospital of Capital Medical UniversityBeijingChina
| | - Ziping Han
- Institute of Cerebrovascular Disease Research and Department of NeurologyXuanwu Hospital of Capital Medical UniversityBeijingChina,Beijing Geriatric Medical Research Center and Beijing Key Laboratory of Translational Medicine for Cerebrovascular DiseasesBeijingChina
| | - Feng Yan
- Institute of Cerebrovascular Disease Research and Department of NeurologyXuanwu Hospital of Capital Medical UniversityBeijingChina,Beijing Geriatric Medical Research Center and Beijing Key Laboratory of Translational Medicine for Cerebrovascular DiseasesBeijingChina
| | - Sijia Zhang
- Institute of Cerebrovascular Disease Research and Department of NeurologyXuanwu Hospital of Capital Medical UniversityBeijingChina
| | - Zhenhong Yang
- Institute of Cerebrovascular Disease Research and Department of NeurologyXuanwu Hospital of Capital Medical UniversityBeijingChina
| | - Fangfang Zhao
- Institute of Cerebrovascular Disease Research and Department of NeurologyXuanwu Hospital of Capital Medical UniversityBeijingChina
| | - Lingzhi Li
- Institute of Cerebrovascular Disease Research and Department of NeurologyXuanwu Hospital of Capital Medical UniversityBeijingChina
| | - Junfen Fan
- Institute of Cerebrovascular Disease Research and Department of NeurologyXuanwu Hospital of Capital Medical UniversityBeijingChina,Beijing Geriatric Medical Research Center and Beijing Key Laboratory of Translational Medicine for Cerebrovascular DiseasesBeijingChina
| | - Rongliang Wang
- Institute of Cerebrovascular Disease Research and Department of NeurologyXuanwu Hospital of Capital Medical UniversityBeijingChina,Beijing Geriatric Medical Research Center and Beijing Key Laboratory of Translational Medicine for Cerebrovascular DiseasesBeijingChina
| | - Yumin Luo
- Institute of Cerebrovascular Disease Research and Department of NeurologyXuanwu Hospital of Capital Medical UniversityBeijingChina,Beijing Geriatric Medical Research Center and Beijing Key Laboratory of Translational Medicine for Cerebrovascular DiseasesBeijingChina
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Stockbridge MD, Keser Z, Bunker LD, Hillis AE. No evidence of impediment by three common classes of prescription drugs to post-stroke aphasia recovery in a retrospective longitudinal sample. PLoS One 2022; 17:e0270135. [PMID: 35749406 PMCID: PMC9231759 DOI: 10.1371/journal.pone.0270135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 06/04/2022] [Indexed: 11/18/2022] Open
Abstract
A number of pharmaceuticals have been identified as potential adjuvants to speech language therapy following stroke, but it is also important to consider which pharmaceuticals may result in a less robust recovery. Here we examine whether post-stroke language recovery was meaningfully impeded by cholinergic, GABAergic, or dopaminergic medications patients received. Eighty participants with left hemisphere stroke were examined retrospectively to see whether the use of one of these three classes of medication prior to admission for acute stroke, during their inpatient stay, or at discharge was associated with differences in recovery on three common measures of language. While prescription of any of the candidate drugs was relatively uncommon, groups were very well matched for many common factors that impact performance. When age, education, and acute lesion volume were controlled, there were no significant differences in performance among those taking cholinergic, GABAergic, or dopaminergic medications and those who were not. Those who experienced a "good recovery" of language (≥10% improvement on any one language measure over time) had similar exposure to these drugs to those with a poor recovery. This work represents a first look at these drug classes with regard to their effects on the recovery of language after stroke and should not be interpreted as resolving all potential for concern, but these results do offer modest reassurance that these common classes of pharmacotherapy, when given for short periods in this population, do not appear to have marked deleterious effects on post-stroke recovery of language.
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Affiliation(s)
- Melissa D. Stockbridge
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- * E-mail:
| | - Zafer Keser
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Lisa D. Bunker
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Argye E. Hillis
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- Department of Cognitive Science, Krieger School of Arts and Sciences, Johns Hopkins University, Baltimore, Maryland, United States of America
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Mazhar M, Yang G, Mao L, Liang P, Tan R, Wang L, Xu H, Yang L, Ren W, Yang S. Zhilong Huoxue Tongyu Capsules Ameliorate Early Brain Inflammatory Injury Induced by Intracerebral Hemorrhage via Inhibition of Canonical NFкβ Signalling Pathway. Front Pharmacol 2022; 13:850060. [PMID: 35431931 PMCID: PMC9008889 DOI: 10.3389/fphar.2022.850060] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 03/09/2022] [Indexed: 11/18/2022] Open
Abstract
Background: Intracerebral hemorrhage (ICH) is a debilitating and fatal condition with continuously rising incidence globally, without effective treatment available. Zhilong Huoxue Tongyu (ZLHXTY) capsule is a traditional Chinese medicine that is used for ICH treatment in China. However, the evidence based mechanism is not clear. Purpose: To study the protective effects of ZLHXTY capsules against ICH pathogenesis via targetting nuclear factor kappa β (NFкβ) canonical signalling pathway. Methods: C57BL/6 J mice ICH models using autologous blood injection were used to study the effect of ZLHXTY (1.4 g/kg P.O.) after 24 and 72 hrs of ICH induction. The neurological scoring, corner turn test and balance beam with scoring was performed to assess neurological damage. Hematoxylin/eosin and nissl staining was used for histopathological evaluation. Levels of TNFα, NFкB, iNOS, COX2, IL1, IL6 were measured using real time qPCR and western blotting. Protein levels of IKKβ and IкBα were analyzed through western blotting. Immunofluorescence for co-expression of NeuN/TNFα, NeuN/NFкB, Iba1/TNFα, and Iba1/NFкB was also performed. Results: Treatment with ZLHXTY capsules after ICH ameliorated inflammatory brain injury after 24 and 72 h; revealed by neurological scoring, hematoxylin/eosin and nissl staining. The qPCR and western blot analyses demonstrated significant downregulation of TNFα, NFкB, iNOS, COX2, IL1β and IL6. Further, the IKKβ and IкBα revealed significant downregulation and upregulation respectively in western blot. Immunofluorescence also revealed attenuated expression of TNFα and NFкB in neurons and also low expression of Iba1. Conclusion: ZLHXTY capsules elicit its neuroprotective effect by targetting the NFкβ canonical signalling pathway, thereby ameliorating the ICH induced brain injury.
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Affiliation(s)
- Maryam Mazhar
- National Traditional Chinese Medicine Clinical Research Base and Drug Research Center, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
- Institute of Integrated Chinese and Western Medicine, Southwest Medical University, Luzhou, China
- *Correspondence: Sijin Yang, ; Wei Ren, ; Maryam Mazhar,
| | - Guoqiang Yang
- Research Center for Integrated Chinese and Western Medicine, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
- Research Unit of Molecular Imaging Probes, Department of Radiologic Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Linshen Mao
- National Traditional Chinese Medicine Clinical Research Base and Drug Research Center, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
- Institute of Integrated Chinese and Western Medicine, Southwest Medical University, Luzhou, China
| | - Pan Liang
- National Traditional Chinese Medicine Clinical Research Base and Drug Research Center, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
| | - Ruizhi Tan
- Research Center for Integrated Chinese and Western Medicine, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
| | - Li Wang
- Research Center for Integrated Chinese and Western Medicine, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
| | - Houping Xu
- Preventive Treatment Center, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
| | - Luyin Yang
- National Traditional Chinese Medicine Clinical Research Base and Drug Research Center, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
| | - Wei Ren
- National Traditional Chinese Medicine Clinical Research Base and Drug Research Center, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
- *Correspondence: Sijin Yang, ; Wei Ren, ; Maryam Mazhar,
| | - Sijin Yang
- National Traditional Chinese Medicine Clinical Research Base and Drug Research Center, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
- Institute of Integrated Chinese and Western Medicine, Southwest Medical University, Luzhou, China
- *Correspondence: Sijin Yang, ; Wei Ren, ; Maryam Mazhar,
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Bajamundi-Plyler C, Hatfield R, Rosier JT, Roy D. A Case Study on the Management of the Behavioral Sequelae of Traumatic Brain Injury. J Acad Consult Liaison Psychiatry 2022; 63:316-323. [PMID: 35123125 DOI: 10.1016/j.jaclp.2022.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 01/02/2022] [Accepted: 01/15/2022] [Indexed: 11/19/2022]
Affiliation(s)
- Clare Bajamundi-Plyler
- Department of Psychiatry, Marshall University Joan C. Edwards School of Medicine, Huntington, WV.
| | - Rachael Hatfield
- Department of Behavioral Health, Hershel "Woody" Williams VA Medical Center, Huntington, WV
| | - James Tyler Rosier
- Department of Neurology, Marshall University Joan C. Edwards School of Medicine, Huntington, WV
| | - Durga Roy
- Department of Psychiatry and Behavioral Science, Johns Hopkins School of Medicine, Baltimore, MD
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22
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Kumagawa T, Moro N, Maeda T, Kobayashi M, Furukawa Y, Shijo K, Yoshino A. Anti-inflammatory effect of P2Y1 receptor blocker MRS2179 in a rat model of traumatic brain injury. Brain Res Bull 2022; 181:46-54. [DOI: 10.1016/j.brainresbull.2022.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 01/16/2022] [Accepted: 01/19/2022] [Indexed: 02/07/2023]
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23
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Liew SL, Lin DJ, Cramer SC. Interventions to Improve Recovery After Stroke. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00061-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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24
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Sharma VK, Wong LK. Middle Cerebral Artery Disease. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00024-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Stockbridge MD. Better language through chemistry: Augmenting speech-language therapy with pharmacotherapy in the treatment of aphasia. HANDBOOK OF CLINICAL NEUROLOGY 2022; 185:261-272. [PMID: 35078604 PMCID: PMC11289691 DOI: 10.1016/b978-0-12-823384-9.00013-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Speech and language therapy is the standard treatment of aphasia. However, many individuals have barriers in seeking this measure of extensive rehabilitation treatment. Investigating ways to augment therapy is key to improving poststroke language outcomes for all patients with aphasia, and pharmacotherapies provide one such potential solution. Although no medications are currently approved for the treatment of aphasia by the United States Food and Drug Administration, numerous candidate mechanisms for pharmaceutical manipulation continue to be identified based on our evolving understanding of the neurometabolic experience of stroke recovery across molecular, cellular, and functional levels of inquiry. This chapter will review evidence for catecholaminergic, glutamatergic, cholinergic, and serotonergic drug therapies and discuss future directions for both candidate drug selection and pharmacotherapy practice in people with aphasia.
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Affiliation(s)
- Melissa D Stockbridge
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
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26
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Jitsuki S. [CRMP2 binding compound accelerates functional recovery from central nervous system damage]. Nihon Yakurigaku Zasshi 2022; 157:244-247. [PMID: 35781453 DOI: 10.1254/fpj.22011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Brain injury causes temporary or permanent impairment of brain function due to an accident or circulation disorders. Even after rehabilitation training, there are often persistent functional impairments. Recent advances in our understanding of the repair mechanisms of neural circuits after brain injury have led to the possibility that these mechanisms may offer potential therapeutic targets for drugs that promote functional recovery after brain injury. Neuroplasticity is believed to be important for the recovery process after brain injury in the brain regions associated with injured region for compensation. The effectiveness of drugs for restoring brain function after stroke investigated in a variety of animal models and clinical trials has been focused on drugs that act on the monoamine system to modulate neuroplasticity, as well as other targets such as NMDA receptors and CCR5. Recently, we focused on novel small compound, edonerpic maleate, as a drug which facilitates experience-dependent synaptic delivery of AMPA receptor. We found that edonerpic maleate binds to Collapsin-response mediator protein 2, a downstream molecule of Semaphorin and enhance synaptic plasticity by facilitating synaptic delivery of AMPA receptors, thereby promoting functional recovery in a rehabilitation-dependent manner after brain injury in rodents and non-human primates. Further investigations is needed to seek more appropriate drug targets from both preclinical animal studies and clinical trials, and to translate preclinical results into successful clinical trials.
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Affiliation(s)
- Susumu Jitsuki
- Department of Biochemistry, Mie University Graduate school of Medicine
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27
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Scalp Acupuncture and Treadmill Training Inhibits Neuronal Apoptosis through Activating cIAP1 in Cerebral Ischemia Rats. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:1418616. [PMID: 34804173 PMCID: PMC8604578 DOI: 10.1155/2021/1418616] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 10/02/2021] [Accepted: 10/26/2021] [Indexed: 12/20/2022]
Abstract
Stroke is the leading cause of long-term disability in developed countries. Multitudinous evidence suggests that treadmill training treatment is beneficial for balance and stroke rehabilitation; however, the need for stroke therapy remains unmet. In the present study, a cerebral ischemia rat model was established by permanent middle cerebral artery occlusion (pMCAO) to explore the therapeutic effect and mechanism of scalp acupuncture combined with treadmill training on ischemic stroke. Terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling and neuronal nuclear protein (NeuN) double staining and cellular inhibitor of apoptosis protein-1 (cIAP1) and NeuN immunofluorescence double staining were used to detect the short-term and long-term neuroprotective effects of scalp acupuncture combined with treadmill training on pMCAO rats. In addition, the antiapoptotic effect of the combined treatment was evaluated in pMCAO rats transfected with cIAP1 shRNA. Western blotting was used to detect the relative protein expression in the caspase-8/-9/-3 activation pathway downstream of cIAP1 to further clarify its regulatory mechanism. Our results showed that scalp acupuncture combined with treadmill training successfully achieved short-term and long-term functional improvement within 14 days after stroke, significantly inhibited neuronal apoptosis, and upregulated the expression of cIAP1 protein in the ischemic penumbra area of the ischemic brain. However, no significant functional improvement and antiapoptotic effect were found in pMCAO rats transfected with cIAP1 shRNA. Western blotting results showed that the combined therapy markedly inhibited the activation of the caspase-8/-9/-3 pathway. These findings indicate that scalp acupuncture combined with treadmill training therapy may serve as a more effective alternative modality in the treatment of ischemic stroke, playing an antiapoptotic role by upregulating the expression of cIAP1 and inhibiting the activation of the caspase-8/-9/-3 pathway.
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Borozdenko DA, Ezdoglian AA, Shmigol TA, Gonchar DI, Lyakhmun DN, Tarasenko DV, Golubev YV, Cherkashova EA, Namestnikova DD, Gubskiy IL, Lagunin AA, Gubsky LV, Chekhonin VP, Borisevich SS, Gureev MA, Shagina AD, Kiseleva NM, Negrebetsky VV, Baukov YI. A Novel Phenylpyrrolidine Derivative: Synthesis and Effect on Cognitive Functions in Rats with Experimental Ishemic Stroke. Molecules 2021; 26:molecules26206124. [PMID: 34684709 PMCID: PMC8541353 DOI: 10.3390/molecules26206124] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 10/05/2021] [Accepted: 10/07/2021] [Indexed: 12/15/2022] Open
Abstract
We performed an in silico, in vitro, and in vivo assessment of a potassium 2-[2-(2-oxo-4-phenylpyrrolidin-1-yl) acetamido]ethanesulfonate (compound 1) as a potential prodrug for cognitive function improvement in ischemic brain injury. Using in silico methods, we predicted the pharmacological efficacy and possible safety in rat models. In addition, in silico data showed neuroprotective features of compound 1, which were further supported by in vitro experiments in a glutamate excitotoxicity-induced model in newborn rat cortical neuron cultures. Next, we checked whether compound 1 is capable of crossing the blood-brain barrier in intact and ischemic animals. Compound 1 improved animal behavior both in intact and ischemic rats and, even though the concentration in intact brains was low, we still observed a significant anxiety reduction and activity escalation. We used molecular docking and molecular dynamics to support our hypothesis that compound 1 could affect the AMPA receptor function. In a rat model of acute focal cerebral ischemia, we studied the effects of compound 1 on the behavior and neurological deficit. An in vivo experiment demonstrated that compound 1 significantly reduced the neurological deficit and improved neurological symptom regression, exploratory behavior, and anxiety. Thus, here, for the first time, we show that compound 1 can be considered as an agent for restoring cognitive functions.
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Affiliation(s)
- Denis A. Borozdenko
- Department of Medicinal Chemistry and Toxicology, Pirogov Russian National Research Medical University, 117997 Moscow, Russia; (D.A.B.); (A.A.E.); (T.A.S.); (D.I.G.); (D.N.L.); (D.V.T.); (Y.V.G.); (A.A.L.); (L.V.G.); (A.D.S.); (N.M.K.); (V.V.N.)
| | - Aiarpi A. Ezdoglian
- Department of Medicinal Chemistry and Toxicology, Pirogov Russian National Research Medical University, 117997 Moscow, Russia; (D.A.B.); (A.A.E.); (T.A.S.); (D.I.G.); (D.N.L.); (D.V.T.); (Y.V.G.); (A.A.L.); (L.V.G.); (A.D.S.); (N.M.K.); (V.V.N.)
| | - Tatiana A. Shmigol
- Department of Medicinal Chemistry and Toxicology, Pirogov Russian National Research Medical University, 117997 Moscow, Russia; (D.A.B.); (A.A.E.); (T.A.S.); (D.I.G.); (D.N.L.); (D.V.T.); (Y.V.G.); (A.A.L.); (L.V.G.); (A.D.S.); (N.M.K.); (V.V.N.)
| | - Darya I. Gonchar
- Department of Medicinal Chemistry and Toxicology, Pirogov Russian National Research Medical University, 117997 Moscow, Russia; (D.A.B.); (A.A.E.); (T.A.S.); (D.I.G.); (D.N.L.); (D.V.T.); (Y.V.G.); (A.A.L.); (L.V.G.); (A.D.S.); (N.M.K.); (V.V.N.)
| | - Dmitri N. Lyakhmun
- Department of Medicinal Chemistry and Toxicology, Pirogov Russian National Research Medical University, 117997 Moscow, Russia; (D.A.B.); (A.A.E.); (T.A.S.); (D.I.G.); (D.N.L.); (D.V.T.); (Y.V.G.); (A.A.L.); (L.V.G.); (A.D.S.); (N.M.K.); (V.V.N.)
| | - Dmitri V. Tarasenko
- Department of Medicinal Chemistry and Toxicology, Pirogov Russian National Research Medical University, 117997 Moscow, Russia; (D.A.B.); (A.A.E.); (T.A.S.); (D.I.G.); (D.N.L.); (D.V.T.); (Y.V.G.); (A.A.L.); (L.V.G.); (A.D.S.); (N.M.K.); (V.V.N.)
| | - Yaroslav V. Golubev
- Department of Medicinal Chemistry and Toxicology, Pirogov Russian National Research Medical University, 117997 Moscow, Russia; (D.A.B.); (A.A.E.); (T.A.S.); (D.I.G.); (D.N.L.); (D.V.T.); (Y.V.G.); (A.A.L.); (L.V.G.); (A.D.S.); (N.M.K.); (V.V.N.)
| | - Elvira A. Cherkashova
- Department of Neurology, Neurosurgery and Medical Genetics, Faculty of Medicine Federal State Budgetary Institution, Federal Center of Brain Research and Neurotechnologies, Federal Medical Bio-logical Agency, 117997 Moscow, Russia; (E.A.C.); (D.D.N.); (I.L.G.)
| | - Daria D. Namestnikova
- Department of Neurology, Neurosurgery and Medical Genetics, Faculty of Medicine Federal State Budgetary Institution, Federal Center of Brain Research and Neurotechnologies, Federal Medical Bio-logical Agency, 117997 Moscow, Russia; (E.A.C.); (D.D.N.); (I.L.G.)
| | - Ilya L. Gubskiy
- Department of Neurology, Neurosurgery and Medical Genetics, Faculty of Medicine Federal State Budgetary Institution, Federal Center of Brain Research and Neurotechnologies, Federal Medical Bio-logical Agency, 117997 Moscow, Russia; (E.A.C.); (D.D.N.); (I.L.G.)
| | - Alexey A. Lagunin
- Department of Medicinal Chemistry and Toxicology, Pirogov Russian National Research Medical University, 117997 Moscow, Russia; (D.A.B.); (A.A.E.); (T.A.S.); (D.I.G.); (D.N.L.); (D.V.T.); (Y.V.G.); (A.A.L.); (L.V.G.); (A.D.S.); (N.M.K.); (V.V.N.)
- Institute of Biomedical Chemistry, 119121 Moscow, Russia
| | - Leonid V. Gubsky
- Department of Medicinal Chemistry and Toxicology, Pirogov Russian National Research Medical University, 117997 Moscow, Russia; (D.A.B.); (A.A.E.); (T.A.S.); (D.I.G.); (D.N.L.); (D.V.T.); (Y.V.G.); (A.A.L.); (L.V.G.); (A.D.S.); (N.M.K.); (V.V.N.)
- Department of Neurology, Neurosurgery and Medical Genetics, Faculty of Medicine Federal State Budgetary Institution, Federal Center of Brain Research and Neurotechnologies, Federal Medical Bio-logical Agency, 117997 Moscow, Russia; (E.A.C.); (D.D.N.); (I.L.G.)
| | - Vladimir P. Chekhonin
- Department of Medical Nanobiotechnologies, Pirogov Russian National Research Medical University, 117997 Moscow, Russia;
| | - Sophia S. Borisevich
- Laboratory of Physical Chemistry, Ufa Institute of Chemistry UFRS RAS, pr. Oktyabrya 71, 450054 Ufa, Russia;
| | - Maxim A. Gureev
- Laboratory of Bioinformatics, Research Center “Digital Biodesign and Personalized Healthcare”, I.M. Sechenov University, 119991 Moscow, Russia;
- Laboratory of Bioinformatics and Computational Modelling of Biological Systems, Department of Computational Biology, Sirius University of Science and Technology, 354340 Sochi, Russia
| | - Anastasia D. Shagina
- Department of Medicinal Chemistry and Toxicology, Pirogov Russian National Research Medical University, 117997 Moscow, Russia; (D.A.B.); (A.A.E.); (T.A.S.); (D.I.G.); (D.N.L.); (D.V.T.); (Y.V.G.); (A.A.L.); (L.V.G.); (A.D.S.); (N.M.K.); (V.V.N.)
| | - Nina M. Kiseleva
- Department of Medicinal Chemistry and Toxicology, Pirogov Russian National Research Medical University, 117997 Moscow, Russia; (D.A.B.); (A.A.E.); (T.A.S.); (D.I.G.); (D.N.L.); (D.V.T.); (Y.V.G.); (A.A.L.); (L.V.G.); (A.D.S.); (N.M.K.); (V.V.N.)
| | - Vadim V. Negrebetsky
- Department of Medicinal Chemistry and Toxicology, Pirogov Russian National Research Medical University, 117997 Moscow, Russia; (D.A.B.); (A.A.E.); (T.A.S.); (D.I.G.); (D.N.L.); (D.V.T.); (Y.V.G.); (A.A.L.); (L.V.G.); (A.D.S.); (N.M.K.); (V.V.N.)
| | - Yuri I. Baukov
- Department of Medicinal Chemistry and Toxicology, Pirogov Russian National Research Medical University, 117997 Moscow, Russia; (D.A.B.); (A.A.E.); (T.A.S.); (D.I.G.); (D.N.L.); (D.V.T.); (Y.V.G.); (A.A.L.); (L.V.G.); (A.D.S.); (N.M.K.); (V.V.N.)
- Correspondence:
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Fujiwara Y, Kitano H, Yamamoto T, Kokubun S, Hidai C. Activation peptide of coagulation factor IX improves the prognosis after traumatic brain injury. Biochem Biophys Res Commun 2021; 569:35-40. [PMID: 34225078 DOI: 10.1016/j.bbrc.2021.06.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 06/27/2021] [Indexed: 11/26/2022]
Abstract
Recently, coagulation factor IX and its activation peptide have been reported to suppress the permeability of vascular endothelial cells. In this study, the therapeutic effects of a synthesized activation peptide is investigated in traumatic brain injury model rats. In cerebral contusion, dysfunction of the blood brain barrier with increasing vascular permeability promotes the progression of neuropathy after injury. The model rats were generated by controlled cortical impact. Then, rats were intravenously injected with 350 μg/kg of the synthesized activation peptide or PBS as a control, every day for a month. Behavioral studies were conducted during a month of observation. For morphological analysis, macro- and microscopic observation were performed. Water content of brain tissue was used to assess edema. To assess the function of blood brain barrier, Evans Blue method was employed. In the neurological examinations and beam-walking, the treated rats performed significantly better than control rats. Measurements of cerebral defect volume showed that the treatment significantly reduced it by 82%. Nissl stain showed that neural cells adjacent to impacts were lost in control rats, but saved in treated rats. The treatment significantly reduced brain edema and extravascular leakage of Evans blue. Intravenous injection with a synthesized activation peptide significantly reduced damage to neural tissue and improved neural functioning in the model rats.
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Affiliation(s)
- Yuusuke Fujiwara
- Division of Dental Surgery, Nihon University School of Medicine, Tokyo, 173-8610, Japan.
| | - Hisataka Kitano
- Division of Dental Surgery, Nihon University School of Medicine, Tokyo, 173-8610, Japan.
| | - Takamitsu Yamamoto
- Department of Neurological Surgery, Nihon University School of Medicine, Tokyo, 173-8610, Japan.
| | - Shinichiro Kokubun
- Division of Physiology, Department of Biomedical Science, Nihon University School of Medicine, Tokyo, 173-8610, Japan.
| | - Chiaki Hidai
- Medical Education Center, Nihon University School of Medicine, Tokyo, 173-8610, Japan.
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30
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Osier ND, Bramlett HM, Shear DA, Mondello S, Carlson SW, Dietrich WD, Deng-Bryant Y, Wang KKW, Hayes RL, Yang Z, Empey PE, Poloyac SM, Lafrenaye AD, Povlishock JT, Gilsdorf JS, Kochanek PM, Dixon CE. Kollidon VA64 Treatment in Traumatic Brain Injury: Operation Brain Trauma Therapy. J Neurotrauma 2021; 38:2454-2472. [PMID: 33843262 DOI: 10.1089/neu.2021.0089] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Loss of plasmalemmal integrity may mediate cell death after traumatic brain injury (TBI). Prior studies in controlled cortical impact (CCI) indicated that the membrane resealing agent Kollidon VA64 improved histopathological and functional outcomes. Kollidon VA64 was therefore selected as the seventh therapy tested by the Operation Brain Trauma Therapy consortium, across three pre-clinical TBI rat models: parasagittal fluid percussion injury (FPI), CCI, and penetrating ballistic-like brain injury (PBBI). In each model, rats were randomized to one of four exposures (7-15/group): (1) sham; (2) TBI+vehicle; (3) TBI+Kollidon VA64 low-dose (0.4 g/kg); and (4) TBI+Kollidon VA64 high-dose (0.8 g/kg). A single intravenous VA64 bolus was given 15 min post-injury. Behavioral, histopathological, and serum biomarker outcomes were assessed over 21 days generating a 22-point scoring matrix per model. In FPI, low-dose VA64 produced zero points across behavior and histopathology. High-dose VA64 worsened motor performance compared with TBI-vehicle, producing -2.5 points. In CCI, low-dose VA64 produced intermediate benefit on beam balance and the Morris water maze (MWM), generating +3.5 points, whereas high-dose VA64 showed no effects on behavior or histopathology. In PBBI, neither dose altered behavior or histopathology. Regarding biomarkers, significant increases in glial fibrillary acidic protein (GFAP) levels were seen in TBI versus sham at 4 h and 24 h across models. Benefit of low-dose VA64 on GFAP was seen at 24 h only in FPI. Ubiquitin C-terminal hydrolase-L1 (UCH-L1) was increased in TBI compared with vehicle across models at 4 h but not at 24 h, without treatment effects. Overall, low dose VA64 generated +4.5 points (+3.5 in CCI) whereas high dose generated -2.0 points. The modest/inconsistent benefit observed reduced enthusiasm to pursue further testing.
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Affiliation(s)
- Nicole D Osier
- Holistic Adult Health Division, University of Texas at Austin, School of Nursing, Austin, Texas, USA
- Department of Neurology, University of Texas at Austin, Dell Medical School, Austin Texas, USA
| | - Helen M Bramlett
- Department of Neurological Surgery, The Miami Project to Cure Paralysis, Miller School of Medicine, University of Miami, Miami, Florida, USA
- Bruce W. Carter Department of Veterans Affairs Medical Center, Miami, Florida, USA
| | - Deborah A Shear
- Brain Trauma Neuroprotection Program, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | | | - Shaun W Carlson
- Department of Neurological Surgery, Brain Trauma Research Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - W Dalton Dietrich
- Department of Neurological Surgery, The Miami Project to Cure Paralysis, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Ying Deng-Bryant
- Brain Trauma Neuroprotection Program, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | - Kevin K W Wang
- Program for Neurotrauma, Neuroproteomics and Biomarkers Research, Department of Emergency Medicine, McKnight Brain Institute of the University of Florida, Gainesville, Florida, USA
| | - Ronald L Hayes
- Center for Innovative Research, Center for Proteomics and Biomarkers Research, Banyan Biomarkers, Inc., Alachua, Florida, USA
| | - Zhihui Yang
- Program for Neurotrauma, Neuroproteomics and Biomarkers Research, Department of Emergency Medicine, McKnight Brain Institute of the University of Florida, Gainesville, Florida, USA
| | - Philip E Empey
- Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania, USA
| | - Samuel M Poloyac
- University of Texas Austin School of Pharmacy, Austin, Texas, USA
| | - Audrey D Lafrenaye
- Department of Anatomy and Neurobiology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - John T Povlishock
- Department of Anatomy and Neurobiology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Janice S Gilsdorf
- Brain Trauma Neuroprotection Program, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | - Patrick M Kochanek
- Safar Center for Resuscitation Research, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Departments of Pediatrics, Anesthesiology, and Clinical and Translational Science, University of Pittsburgh School of Medicine, and UPMC Children's Hospital of Pittsburgh, Pittsburgh Pennsylvania, USA
| | - C Edward Dixon
- Department of Neurological Surgery, Brain Trauma Research Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
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31
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Lukoyanov N, Watanabe H, Carvalho LS, Kononenko O, Sarkisyan D, Zhang M, Andersen MS, Lukoyanova EA, Galatenko V, Tonevitsky A, Bazov I, Iakovleva T, Schouenborg J, Bakalkin G. Left-right side-specific endocrine signaling complements neural pathways to mediate acute asymmetric effects of brain injury. eLife 2021; 10:e65247. [PMID: 34372969 PMCID: PMC8354641 DOI: 10.7554/elife.65247] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 07/07/2021] [Indexed: 12/14/2022] Open
Abstract
Brain injuries can interrupt descending neural pathways that convey motor commands from the cortex to spinal motoneurons. Here, we demonstrate that a unilateral injury of the hindlimb sensorimotor cortex of rats with completely transected thoracic spinal cord produces hindlimb postural asymmetry with contralateral flexion and asymmetric hindlimb withdrawal reflexes within 3 hr, as well as asymmetry in gene expression patterns in the lumbar spinal cord. The injury-induced postural effects were abolished by hypophysectomy and were mimicked by transfusion of serum from animals with brain injury. Administration of the pituitary neurohormones β-endorphin or Arg-vasopressin-induced side-specific hindlimb responses in naive animals, while antagonists of the opioid and vasopressin receptors blocked hindlimb postural asymmetry in rats with brain injury. Thus, in addition to the well-established involvement of motor pathways descending from the brain to spinal circuits, the side-specific humoral signaling may also add to postural and reflex asymmetries seen after brain injury.
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Affiliation(s)
- Nikolay Lukoyanov
- Departamento de Biomedicina da Faculdade de Medicina da Universidade do Porto, Instituto de Investigação e Inovação em Saúde, Instituto de Biologia Molecular e CelularPortoPortugal
| | - Hiroyuki Watanabe
- Department of Pharmaceutical Biosciences, Uppsala UniversityUppsalaSweden
| | - Liliana S Carvalho
- Departamento de Biomedicina da Faculdade de Medicina da Universidade do Porto, Instituto de Investigação e Inovação em Saúde, Instituto de Biologia Molecular e CelularPortoPortugal
| | - Olga Kononenko
- Department of Pharmaceutical Biosciences, Uppsala UniversityUppsalaSweden
| | - Daniil Sarkisyan
- Department of Pharmaceutical Biosciences, Uppsala UniversityUppsalaSweden
| | - Mengliang Zhang
- Neuronano Research Center, Department of Experimental Medical Science, Lund UniversityLundSweden
- Department of Molecular Medicine, University of Southern DenmarkOdenseDenmark
| | | | - Elena A Lukoyanova
- Departamento de Biomedicina da Faculdade de Medicina da Universidade do Porto, Instituto de Investigação e Inovação em Saúde, Instituto de Biologia Molecular e CelularPortoPortugal
| | - Vladimir Galatenko
- Faculty of Mechanics and Mathematics, Lomonosov Moscow State UniversityMoscowRussian Federation
| | - Alex Tonevitsky
- Faculty of Biology and Biotechnology, National Research University Higher School of EconomicsMoscowRussian Federation
- Shemyakin–Ovchinnikov Institute of Bioorganic Chemistry RASMoscowRussian Federation
| | - Igor Bazov
- Department of Pharmaceutical Biosciences, Uppsala UniversityUppsalaSweden
| | - Tatiana Iakovleva
- Department of Pharmaceutical Biosciences, Uppsala UniversityUppsalaSweden
| | - Jens Schouenborg
- Neuronano Research Center, Department of Experimental Medical Science, Lund UniversityLundSweden
| | - Georgy Bakalkin
- Department of Pharmaceutical Biosciences, Uppsala UniversityUppsalaSweden
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32
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Omer S, Jin SC, Koumangoye R, Robert SM, Duran D, Nelson-Williams C, Huttner A, DiLuna M, Kahle KT, Delpire E. Protein kinase D1 variant associated with human epilepsy and peripheral nerve hypermyelination. Clin Genet 2021; 100:176-186. [PMID: 33904160 DOI: 10.1111/cge.13973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 04/19/2021] [Accepted: 04/21/2021] [Indexed: 11/26/2022]
Abstract
We report the case of a patient with severe progressive epilepsy and peripheral neuropathy and a novel de novo inactivating variant (p.E79X) in Protein Kinase D1 (PKD1). Using CRISPR/Cas9, we engineered the homologous variant in mice and showed that in the homozygote mouse, it recapitulated the patient peripheral nerve hypermyelination pathology. The lethality of the homozygote mouse prevented us from performing an assessment of locomotor behavior. The mutant heterozygote mouse; however, exhibited a significant increase in kainate-induced seizure activity over wild-type mice, supporting the hypothesis that the PKD1 variant is a candidate for the cause of the patient epilepsy. Because PKD1 was previously identified in a kinomic screen as an interacting partner of the K-Cl cotransporter 3 (KCC3), and since KCC3 is involved in peripheral nerve disease and brain hyperexcitability, one possible mechanism of action of PKD1 in disease is through KCC3. We show that catalytically inactive PKD1 stimulates KCC3 activity, consistent with tonic relief of inhibitory phosphorylation. Our findings implicate a novel role for PKD1 in the human nervous system, and uncover a mechanism that could serve as a potential target to promote nervous system myelination.
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Affiliation(s)
- Salma Omer
- Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
- Neuroscience Graduate Program, Vanderbilt University Nashville, Nashville, Tennessee, USA
| | - Sheng Chih Jin
- Department of Genetics, Yale University School of Medicine, New Haven, Connecticut, USA
- Department of Genetics and the McDonnell Genome Institute, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Rainelli Koumangoye
- Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Stephanie M Robert
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Daniel Duran
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Carol Nelson-Williams
- Department of Genetics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Anita Huttner
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Michael DiLuna
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Kristopher T Kahle
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Eric Delpire
- Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
- Neuroscience Graduate Program, Vanderbilt University Nashville, Nashville, Tennessee, USA
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33
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Zhang Z, Wang S, Du L, Xu L, Lin Y, Liu K, Zou Y, Bin Li, Ye Q, Mao Y, Chen W, Zhou G, Sun H, Huang H, Li R, Li G, Li L, Wang Q, Long Q, Huang H, Geng X, Liu Y, Liu C, Li B, Zhou Z, Li J, Wang J. A pilot behavioural and neuroimaging investigation on photothrombotic stroke models in rhesus monkeys. J Neurosci Methods 2021; 362:109291. [PMID: 34293407 DOI: 10.1016/j.jneumeth.2021.109291] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 07/15/2021] [Accepted: 07/16/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND Ischemic stroke leads to a long-term disability in humans and no efficient clinical therapy exists to date. The middle cerebral artery occlusion (MCAO) model in non-human primates has shown to be of value for translational stroke research. New method In the current study, a photothrombotic (PT) stroke model was established in rhesus monkeys with either a proximal or distal segment of middle cerebral artery (MCA) thrombosis. This study is the first that compares the two approaches of PT stroke in monkeys using behavioral and physiological measurements and MRI scans. RESULTS The experiment found that infarct occurred in the MCA target regions, with all monkeys having impaired behavior reflected by deficits in neurologic function, and motor and cognition in object retrieval detour (ORD) task. The monkeys with distal MCA thrombosis developed with sequential photo-irritations of the Sylvian fissure zone, adjacent central anterior gyrus and central posterior gyrus, had similar impairments with respect to behavior and showed a tendency of a small edema volume with proximal MCA thrombosis at days 4 and 7 post PT stroke. COMPARISON WITH EXISTING METHODS The distal MCA thrombosis developed with sequential photo-irritations might provide a consistent and well-tolerated focal ischemia in rhesus monkeys, compared with other PT stroke models which usually were singly conducted on the animal's motor cortex and had a temporal effect. CONCLUSIONS The sequentially photo-irritated PT stroke model is a promising ischemic stroke model in rhesus monkey for studying human stroke pathology and physiology and for new therapies development.
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Affiliation(s)
- Zhiting Zhang
- National Resource Center for Non-Human Primates, Kunming Primate Research Center, and National Research Facility for Phenotypic & Genetic Analysis of Model Animals (Primate Facility), Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan, China; Institutes of Physical Science and Information Technology,Anhui University, Hefei, China
| | - Shuguo Wang
- First Affiliation Hospital of Kunming Medical University, Kunming, China
| | - Lingli Du
- National Resource Center for Non-Human Primates, Kunming Primate Research Center, and National Research Facility for Phenotypic & Genetic Analysis of Model Animals (Primate Facility), Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan, China
| | - Ling Xu
- National Resource Center for Non-Human Primates, Kunming Primate Research Center, and National Research Facility for Phenotypic & Genetic Analysis of Model Animals (Primate Facility), Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan, China
| | - Yu Lin
- National Resource Center for Non-Human Primates, Kunming Primate Research Center, and National Research Facility for Phenotypic & Genetic Analysis of Model Animals (Primate Facility), Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan, China
| | - Kezhong Liu
- National Resource Center for Non-Human Primates, Kunming Primate Research Center, and National Research Facility for Phenotypic & Genetic Analysis of Model Animals (Primate Facility), Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan, China; Institutes of Physical Science and Information Technology,Anhui University, Hefei, China
| | - Yanghong Zou
- First Affiliation Hospital of Kunming Medical University, Kunming, China
| | - Bin Li
- Department of Pharmacology, School of Medicine, Southeast University, Nanjing, Jiangsu, China
| | - Qingqing Ye
- Department of Pharmacology, School of Medicine, Southeast University, Nanjing, Jiangsu, China
| | - Yu Mao
- National Resource Center for Non-Human Primates, Kunming Primate Research Center, and National Research Facility for Phenotypic & Genetic Analysis of Model Animals (Primate Facility), Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan, China; School of Chinese Materia Medica, Yunnan University of Chinese Medicine. Kunming, Yunnan, China
| | - Wenxiong Chen
- National Resource Center for Non-Human Primates, Kunming Primate Research Center, and National Research Facility for Phenotypic & Genetic Analysis of Model Animals (Primate Facility), Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan, China
| | - Guangping Zhou
- First Affiliation Hospital of Kunming Medical University, Kunming, China
| | - Huaying Sun
- School of Chinese Materia Medica, Yunnan University of Chinese Medicine. Kunming, Yunnan, China
| | - Hui Huang
- Department of Neurosurgery, Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Rui Li
- National Resource Center for Non-Human Primates, Kunming Primate Research Center, and National Research Facility for Phenotypic & Genetic Analysis of Model Animals (Primate Facility), Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan, China
| | - Gui Li
- National Resource Center for Non-Human Primates, Kunming Primate Research Center, and National Research Facility for Phenotypic & Genetic Analysis of Model Animals (Primate Facility), Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan, China
| | - Lihong Li
- National Resource Center for Non-Human Primates, Kunming Primate Research Center, and National Research Facility for Phenotypic & Genetic Analysis of Model Animals (Primate Facility), Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan, China
| | - Qiong Wang
- National Resource Center for Non-Human Primates, Kunming Primate Research Center, and National Research Facility for Phenotypic & Genetic Analysis of Model Animals (Primate Facility), Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan, China
| | - Qingwei Long
- National Resource Center for Non-Human Primates, Kunming Primate Research Center, and National Research Facility for Phenotypic & Genetic Analysis of Model Animals (Primate Facility), Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan, China
| | - Hongdi Huang
- National Resource Center for Non-Human Primates, Kunming Primate Research Center, and National Research Facility for Phenotypic & Genetic Analysis of Model Animals (Primate Facility), Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan, China
| | - Xin Geng
- First Affiliation Hospital of Kunming Medical University, Kunming, China
| | - Yi Liu
- First Affiliation Hospital of Kunming Medical University, Kunming, China
| | - Cirong Liu
- Institute of Neuroscience, CAS Center for Excellence in Brain Science and Intelligence Technology, State Key Laboratory of Neuroscience, Shanghai, China
| | - Bing Li
- National Resource Center for Non-Human Primates, Kunming Primate Research Center, and National Research Facility for Phenotypic & Genetic Analysis of Model Animals (Primate Facility), Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan, China.
| | - Zhu Zhou
- First Affiliation Hospital of Kunming Medical University, Kunming, China.
| | - Jinghui Li
- First Affiliation Hospital of Kunming Medical University, Kunming, China.
| | - Jianhong Wang
- National Resource Center for Non-Human Primates, Kunming Primate Research Center, and National Research Facility for Phenotypic & Genetic Analysis of Model Animals (Primate Facility), Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan, China.
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Verduzco-Mendoza A, Carrillo-Mora P, Avila-Luna A, Gálvez-Rosas A, Olmos-Hernández A, Mota-Rojas D, Bueno-Nava A. Role of the Dopaminergic System in the Striatum and Its Association With Functional Recovery or Rehabilitation After Brain Injury. Front Neurosci 2021; 15:693404. [PMID: 34248494 PMCID: PMC8264205 DOI: 10.3389/fnins.2021.693404] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 06/03/2021] [Indexed: 01/06/2023] Open
Abstract
Disabilities are estimated to occur in approximately 2% of survivors of traumatic brain injury (TBI) worldwide, and disability may persist even decades after brain injury. Facilitation or modulation of functional recovery is an important goal of rehabilitation in all patients who survive severe TBI. However, this recovery tends to vary among patients because it is affected by the biological and physical characteristics of the patients; the types, doses, and application regimens of the drugs used; and clinical indications. In clinical practice, diverse dopaminergic drugs with various dosing and application procedures are used for TBI. Previous studies have shown that dopamine (DA) neurotransmission is disrupted following moderate to severe TBI and have reported beneficial effects of drugs that affect the dopaminergic system. However, the mechanisms of action of dopaminergic drugs have not been completely clarified, partly because dopaminergic receptor activation can lead to restoration of the pathway of the corticobasal ganglia after injury in brain structures with high densities of these receptors. This review aims to provide an overview of the functionality of the dopaminergic system in the striatum and its roles in functional recovery or rehabilitation after TBI.
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Affiliation(s)
- Antonio Verduzco-Mendoza
- Ph.D. Program in Biological and Health Sciences, Universidad Autónoma Metropolitana, Mexico City, Mexico
- Division of Biotechnology-Bioterio and Experimental Surgery, Instituto Nacional de Rehabilitación-Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Paul Carrillo-Mora
- Division of Neurosciences, Instituto Nacional de Rehabilitación-Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Alberto Avila-Luna
- Division of Neurosciences, Instituto Nacional de Rehabilitación-Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Arturo Gálvez-Rosas
- Division of Neurosciences, Instituto Nacional de Rehabilitación-Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Adriana Olmos-Hernández
- Division of Biotechnology-Bioterio and Experimental Surgery, Instituto Nacional de Rehabilitación-Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Daniel Mota-Rojas
- Neurophysiology, Behavior and Animal Welfare Assessment, DPAA, Universidad Autónoma Metropolitana, Mexico City, Mexico
| | - Antonio Bueno-Nava
- Division of Neurosciences, Instituto Nacional de Rehabilitación-Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
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35
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Flores B, Delpire E. Temporal manipulation of KCC3 expression in juvenile or adult mice suggests irreversible developmental deficit in hereditary motor sensory neuropathy with agenesis of the corpus callosum. Am J Physiol Cell Physiol 2021; 320:C722-C730. [PMID: 33596149 PMCID: PMC8163575 DOI: 10.1152/ajpcell.00594.2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 02/16/2021] [Accepted: 02/16/2021] [Indexed: 11/22/2022]
Abstract
Hereditary motor sensory neuropathy (HMSN/ACC) with agenesis of the corpus callosum (ACC) has been documented in the French-derived populations of Charlevoix and Saguenay/Lac St. Jean in Quebec, Canada, as well as a few sporadic families throughout the world. HMSN/ACC occurs because of loss-of-function mutations in the potassium-chloride cotransporter 3 (KCC3). In HMSN/ACC, motor deficits occur early in infancy with rapid and continual deterioration of motor and sensory fibers into juvenile and adulthood. Genetic work in mice has demonstrated that the disease is caused by loss of KCC3 function in neurons and particularly parvalbumin (PV)-expressing neurons. Currently, there are no treatments or cures for HMSN/ACC other than pain management. As genetic counseling in Quebec has increased as a preventative strategy, most individuals with HSMN/ACC are now adults. The onset of the disease is unknown. In particular, it is unknown if the disease starts early during development and whether it can be reversed by restoring KCC3 function. In this study, we used two separate mouse models that when combined to the PV-CreERT2 tamoxifen-inducible system allowed us to 1) disrupt KCC3 expression in adulthood or juvenile periods; and 2) reintroduce KCC3 expression in mice that first develop with a nonfunctional cotransporter. We show that disrupting or reintroducing KCC3 in the adult mouse has no effect on locomotor behavior, indicating that expression of KCC3 is critical during embryonic development and/or the perinatal period and that once the disease has started, reexpressing a functional cotransporter fails to change the course of HMSN/ACC.
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Affiliation(s)
- Bianca Flores
- Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Eric Delpire
- Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, Tennessee
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36
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Lin DJ, Cramer SC. Principles of Neural Repair and Their Application to Stroke Recovery Trials. Semin Neurol 2021; 41:157-166. [PMID: 33663003 DOI: 10.1055/s-0041-1725140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Neural repair is the underlying therapeutic strategy for many treatments currently under investigation to improve recovery after stroke. Repair-based therapies are distinct from acute stroke strategies: instead of salvaging threatened brain tissue, the goal is to improve behavioral outcomes on the basis of experience-dependent brain plasticity. Furthermore, timing, concomitant behavioral experiences, modality specific outcome measures, and careful patient selection are fundamental concepts for stroke recovery trials that can be deduced from principles of neural repair. Here we discuss core principles of neural repair and their implications for stroke recovery trials, highlighting related issues from key studies in humans. Research suggests a future in which neural repair therapies are personalized based on measures of brain structure and function, genetics, and lifestyle factors.
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Affiliation(s)
- David J Lin
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts.,VA RR&D Center for Neurorestoration and Neurotechnology, Rehabilitation R&D Service, Department of VA Medical Center, Providence, Rhode Island
| | - Steven C Cramer
- Department of Neurology, University of California, Los Angeles, California.,California Rehabilitation Institute, Los Angeles, California
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37
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Katz DI, Dwyer B. Clinical Neurorehabilitation: Using Principles of Neurological Diagnosis, Prognosis, and Neuroplasticity in Assessment and Treatment Planning. Semin Neurol 2021; 41:111-123. [PMID: 33663002 DOI: 10.1055/s-0041-1725132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Neurorehabilitation aspires to restore a person to his or her fullest potential after incurring neurological dysfunction. In medical rehabilitation, diagnosis involves assessment of medical conditions and their effects on functioning. It is usually a team effort that involves an amalgam of diagnostic assessments by multiple disciplines, leading to a collection of rehabilitative treatment plans and goals. This article discusses a clinical neurological paradigm, using rigorous clinical assessment of neuropathological and clinical diagnosis, along with prognostication of natural history and recovery. In the context of the role of neuroplasticity in recovery, this paradigm can add significant value to rehabilitation team management and planning. It contributes to enhanced understanding of neurological impairments and syndromes as they relate to functional disability, aiding in targeting deficits and setting treatment goals. Rehabilitation strategies and goals should be informed by natural history and prognosis, and viewed in the framework of the stage of recovery. Prognostic formulations should suggest an emphasis on restorative versus compensatory strategies for functional problems. Treatment planning should be informed by evidence on how interventions modulate brain reorganization in promoting recovery. Strategies that promote adaptive neuroplasticity should be favored, especially with restorative efforts, and evidence supporting optimal techniques, timing, and dosing of rehabilitation should be considered in treatment planning.
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Affiliation(s)
- Douglas I Katz
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts.,Encompass Health Braintree Rehabilitation Hospital, Braintree, Massachusetts
| | - Brigid Dwyer
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts.,Encompass Health Braintree Rehabilitation Hospital, Braintree, Massachusetts
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Cramer SC, Dodakian L, Le V, McKenzie A, See J, Augsburger R, Zhou RJ, Raefsky SM, Nguyen T, Vanderschelden B, Wong G, Bandak D, Nazarzai L, Dhand A, Scacchi W, Heckhausen J. A Feasibility Study of Expanded Home-Based Telerehabilitation After Stroke. Front Neurol 2021; 11:611453. [PMID: 33613417 PMCID: PMC7888185 DOI: 10.3389/fneur.2020.611453] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 12/04/2020] [Indexed: 01/17/2023] Open
Abstract
Introduction: High doses of activity-based rehabilitation therapy improve outcomes after stroke, but many patients do not receive this for various reasons such as poor access, transportation difficulties, and low compliance. Home-based telerehabilitation (TR) can address these issues. The current study evaluated the feasibility of an expanded TR program. Methods: Under the supervision of a licensed therapist, adults with stroke and limb weakness received home-based TR (1 h/day, 6 days/week) delivered using games and exercises. New features examined include extending therapy to 12 weeks duration, treating both arm and leg motor deficits, patient assessments performed with no therapist supervision, adding sensors to real objects, ingesting a daily experimental (placebo) pill, and generating automated actionable reports. Results: Enrollees (n = 13) were median age 61 (IQR 52-65.5), and 129 (52-486) days post-stroke. Patients initiated therapy on 79.9% of assigned days and completed therapy on 65.7% of days; median therapy dose was 50.4 (33.3-56.7) h. Non-compliance doubled during weeks 7-12. Modified Rankin scores improved in 6/13 patients, 3 of whom were >3 months post-stroke. Fugl-Meyer motor scores increased by 6 (2.5-12.5) points in the arm and 1 (-0.5 to 5) point in the leg. Assessments spanning numerous dimensions of stroke outcomes were successfully implemented; some, including a weekly measure that documented a decline in fatigue (p = 0.004), were successfully scored without therapist supervision. Using data from an attached sensor, real objects could be used to drive game play. The experimental pill was taken on 90.9% of therapy days. Automatic actionable reports reliably notified study personnel when critical values were reached. Conclusions: Several new features performed well, and useful insights were obtained for those that did not. A home-based telehealth system supports a holistic approach to rehabilitation care, including intensive rehabilitation therapy, secondary stroke prevention, screening for complications of stroke, and daily ingestion of a pill. This feasibility study informs future efforts to expand stroke TR. Clinical Trial Registration: Clinicaltrials.gov, # NCT03460587.
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Affiliation(s)
- Steven C. Cramer
- Department of Neurology, University of California, Los Angeles, Los Angeles, CA, United States
- California Rehabilitation Institute, Los Angeles, CA, United States
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | - Lucy Dodakian
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | - Vu Le
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | - Alison McKenzie
- Department of Physical Therapy, Chapman University, Orange, CA, United States
| | - Jill See
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | - Renee Augsburger
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | - Robert J. Zhou
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | - Sophia M. Raefsky
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | - Thalia Nguyen
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | | | - Gene Wong
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | - Daniel Bandak
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | - Laila Nazarzai
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | - Amar Dhand
- Department of Neurology, Brigham and Women's Hospital, Boston, MA, United States
| | - Walt Scacchi
- Institute for Software Research, University of California, Irvine, Irvine, CA, United States
| | - Jutta Heckhausen
- Department of Psychological Science, University of California, Irvine, Irvine, CA, United States
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Ferguson L, Giza CC, Serpa RO, Greco T, Folkerts M, Prins ML. Recovery From Repeat Mild Traumatic Brain Injury in Adolescent Rats Is Dependent on Pre-injury Activity State. Front Neurol 2021; 11:616661. [PMID: 33488505 PMCID: PMC7820072 DOI: 10.3389/fneur.2020.616661] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 12/01/2020] [Indexed: 12/12/2022] Open
Abstract
Adolescents and young adults have the highest incidence of mild traumatic brain injury (mTBI); sport-related activities are a major contributor. Roughly a third of these patients diagnosed with mTBI are estimated to have received a subsequent repeat mTBI (rTBI). Previously, animal studies have only modeled mTBI in sedentary animals. This study utilizes physical activity as a dependent variable prior to rTBI in adolescent rats by allowing voluntary exercise in males, establishing the rat athlete (rathlete). Rats were given access to locked or functional running wheels for 10 d prior to sham or rTBI injury. Following rTBI, rathletes were allowed voluntary access to running wheels beginning on different days post-injury: no run (rTBI+no run), immediate run (rTBI+Immed), or 3 day delay (rTBI+3dd). Rats were tested for motor and cognitive-behavioral (anxiety, social, memory) and mechanosensory (allodynia) dysfunction using a novel rat standardized concussion assessment tool on post-injury days 1,3,5,7, and 10. Protein expression of brain derived neurotrophic factor (BDNF) and proliferator-activated gamma coactivator 1-alpha (PGC1α) was measured in the parietal cortex, hippocampus, and gastrocnemius muscle. Sedentary shams displayed lower anxiety-like behaviors compared to rathlete shams on all testing days. BDNF and PGC1α levels increased in the parietal cortex and hippocampus with voluntary exercise. In rTBI rathletes, the rTBI+Immed group showed impaired social behavior, memory impairment in novel object recognition, and increased immobility compared to rathlete shams. All rats showed greater neuropathic mechanosensory sensitivity than previously published uninjured adults, with rTBI+3dd showing greatest sensitivity. These results demonstrate that voluntary exercise changes baseline functioning of the brain, and that among rTBI rathletes, delayed return to activity improved cognitive recovery.
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Affiliation(s)
- Lindsay Ferguson
- University of California Los Angeles, David Geffen School of Medicine, Department of Neurosurgery, Brain Injury Research Center, Los Angeles, CA, United States.,University of California Los Angeles, Steve Tisch BrainSPORT Program, Los Angeles, CA, United States
| | - Christopher C Giza
- University of California Los Angeles, David Geffen School of Medicine, Department of Neurosurgery, Brain Injury Research Center, Los Angeles, CA, United States.,University of California Los Angeles, Steve Tisch BrainSPORT Program, Los Angeles, CA, United States
| | - Rebecka O Serpa
- University of California Los Angeles, David Geffen School of Medicine, Department of Neurosurgery, Brain Injury Research Center, Los Angeles, CA, United States.,University of California Los Angeles, Steve Tisch BrainSPORT Program, Los Angeles, CA, United States
| | - Tiffany Greco
- University of California Los Angeles, David Geffen School of Medicine, Department of Neurosurgery, Brain Injury Research Center, Los Angeles, CA, United States.,University of California Los Angeles, Steve Tisch BrainSPORT Program, Los Angeles, CA, United States
| | - Michael Folkerts
- Department of Psychology, Seaver College, Pepperdine University, Malibu, CA, United States
| | - Mayumi L Prins
- University of California Los Angeles, David Geffen School of Medicine, Department of Neurosurgery, Brain Injury Research Center, Los Angeles, CA, United States.,University of California Los Angeles, Steve Tisch BrainSPORT Program, Los Angeles, CA, United States
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40
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MIYAZAKI T, ABE H, UCHIDA H, TAKAHASHI T. Translational medicine of the glutamate AMPA receptor. PROCEEDINGS OF THE JAPAN ACADEMY. SERIES B, PHYSICAL AND BIOLOGICAL SCIENCES 2021; 97:1-21. [PMID: 33431723 PMCID: PMC7859086 DOI: 10.2183/pjab.97.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 10/30/2020] [Indexed: 05/05/2023]
Abstract
Psychiatric and neurological disorders severely hamper patient's quality of life. Despite their high unmet needs, the development of diagnostics and therapeutics has only made slow progress. This is due to limited evidence on the biological basis of these disorders in humans. Synapses are essential structural units of neurotransmission, and neuropsychiatric disorders are considered as "synapse diseases". Thus, a translational approach with synaptic physiology is crucial to tackle these disorders. Among a variety of synapses, excitatory glutamatergic synapses play central roles in neuronal functions. The glutamate α-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid receptor (AMPAR) is a principal component of glutamatergic neurotransmission; therefore, it is considered to be a promising translational target. Here, we review the limitations of current diagnostics and therapeutics of neuropsychiatric disorders and advocate the urgent need for the promotion of translational medicine based on the synaptic physiology of AMPAR. Furthermore, we introduce our recent translational approach to these disorders by targeting at AMPARs.
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Affiliation(s)
- Tomoyuki MIYAZAKI
- Yokohama City University Graduate School of Medicine, Department of Physiology, Yokohama, Kanagawa, Japan
| | - Hiroki ABE
- Yokohama City University Graduate School of Medicine, Department of Physiology, Yokohama, Kanagawa, Japan
| | - Hiroyuki UCHIDA
- Keio University School of Medicine, Department of Neuropsychiatry, Tokyo, Japan
| | - Takuya TAKAHASHI
- Yokohama City University Graduate School of Medicine, Department of Physiology, Yokohama, Kanagawa, Japan
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41
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Abstract
PURPOSE OF REVIEW This article describes restorative therapies to improve patient outcomes after stroke. These therapies contrast with acute stroke treatments such as recombinant tissue plasminogen activator (rtPA) and thrombectomy that target clots, aim to salvage threatened brain tissue to limit injury, and have a time window measured in hours. Restorative therapies target the brain, aim to promote plasticity within surviving brain tissue, and have a time window measured in days to weeks or longer. RECENT FINDINGS A number of drugs are under study. Preclinical studies are providing attractive therapeutic candidates for translation, such as the C-C chemokine receptor 5 inhibitor maraviroc. Some drug studies have used a pragmatic approach, which is premature for the nascent field of neural repair. Substantial data support the utility of activity-dependent therapies, including constraint-induced movement therapy, with recent studies supporting the need for very high doses to generate the best functional gains. While stem cell therapies are at an early stage, mounting preclinical evidence supports the efficacy of mesenchymal stem cells; some initial human studies are supportive. Several types of brain stimulation have been examined, and in some cases initial studies are promising. SUMMARY Improved insights into stroke recovery and its treatment have the potential to reduce disability in a large segment of stroke survivors.
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42
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Jha RM, Mondello S, Bramlett HM, Dixon CE, Shear DA, Dietrich WD, Wang KKW, Yang Z, Hayes RL, Poloyac SM, Empey PE, Lafrenaye AD, Yan HQ, Carlson SW, Povlishock JT, Gilsdorf JS, Kochanek PM. Glibenclamide Treatment in Traumatic Brain Injury: Operation Brain Trauma Therapy. J Neurotrauma 2020; 38:628-645. [PMID: 33203303 DOI: 10.1089/neu.2020.7421] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Glibenclamide (GLY) is the sixth drug tested by the Operation Brain Trauma Therapy (OBTT) consortium based on substantial pre-clinical evidence of benefit in traumatic brain injury (TBI). Adult Sprague-Dawley rats underwent fluid percussion injury (FPI; n = 45), controlled cortical impact (CCI; n = 30), or penetrating ballistic-like brain injury (PBBI; n = 36). Efficacy of GLY treatment (10-μg/kg intraperitoneal loading dose at 10 min post-injury, followed by a continuous 7-day subcutaneous infusion [0.2 μg/h]) on motor, cognitive, neuropathological, and biomarker outcomes was assessed across models. GLY improved motor outcome versus vehicle in FPI (cylinder task, p < 0.05) and CCI (beam balance, p < 0.05; beam walk, p < 0.05). In FPI, GLY did not benefit any other outcome, whereas in CCI, it reduced 21-day lesion volume versus vehicle (p < 0.05). On Morris water maze testing in CCI, GLY worsened performance on hidden platform latency testing versus sham (p < 0.05), but not versus TBI vehicle. In PBBI, GLY did not improve any outcome. Blood levels of glial fibrillary acidic protein and ubiquitin carboxyl terminal hydrolase-1 at 24 h did not show significant treatment-induced changes. In summary, GLY showed the greatest benefit in CCI, with positive effects on motor and neuropathological outcomes. GLY is the second-highest-scoring agent overall tested by OBTT and the only drug to reduce lesion volume after CCI. Our findings suggest that leveraging the use of a TBI model-based phenotype to guide treatment (i.e., GLY in contusion) might represent a strategic choice to accelerate drug development in clinical trials and, ultimately, achieve precision medicine in TBI.
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Affiliation(s)
- Ruchira M Jha
- Safar Center for Resuscitation Research, Department of Critical Care Medicine, Anesthesiology, and Clinical and Translational Science, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,Departments of Neurology, Neurobiology, and Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | | | - Helen M Bramlett
- Department of Neurological Surgery, The Miami Project to Cure Paralysis, Miller School of Medicine, University of Miami, and Bruce W. Carter Department of Veterans Affairs Medical Center, Miami, Florida, USA
| | - C Edward Dixon
- Department of Neurological Surgery, Brain Trauma Research Center, Anesthesiology, and Clinical and Translational Science, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Deborah A Shear
- Brain Trauma Neuroprotection Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | - W Dalton Dietrich
- Department of Neurological Surgery, Brain Trauma Research Center, Anesthesiology, and Clinical and Translational Science, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Kevin K W Wang
- Program for Neurotrauma, Neuroproteomics & Biomarkers Research, Department of Emergency Medicine, McKnight Brin Institute of the University of Florida, Gainesville, Florida, USA
| | - Zhihui Yang
- Program for Neurotrauma, Neuroproteomics & Biomarkers Research, Department of Emergency Medicine, McKnight Brin Institute of the University of Florida, Gainesville, Florida, USA
| | - Ronald L Hayes
- Center for Innovative Research, Center for Proteomics and Biomarkers Research, Banyan Biomarkers, Inc., Alachua, Florida, USA
| | - Samuel M Poloyac
- Department of Pharmaceutical Sciences, University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania, USA
| | - Philip E Empey
- Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania, USA
| | - Audrey D Lafrenaye
- Department of Anatomy and Neurobiology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Hong Q Yan
- Department of Neurological Surgery, Brain Trauma Research Center, Anesthesiology, and Clinical and Translational Science, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Shaun W Carlson
- Department of Neurological Surgery, Brain Trauma Research Center, Anesthesiology, and Clinical and Translational Science, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - John T Povlishock
- Department of Anatomy and Neurobiology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Janice S Gilsdorf
- Brain Trauma Neuroprotection Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | - Patrick M Kochanek
- Safar Center for Resuscitation Research, Department of Critical Care Medicine, Anesthesiology, and Clinical and Translational Science, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,Departments of Pediatrics, Anesthesiology, and Clinical and Translational Science, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Ponsford J, Carrier S, Hicks A, McKay A. Assessment and Management of Patients in the Acute Stages of Recovery after Traumatic Brain Injury in Adults: A Worldwide Survey. J Neurotrauma 2020; 38:1060-1067. [PMID: 33121375 DOI: 10.1089/neu.2020.7299] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Most individuals with traumatic brain injury (TBI) experience a period of confusion after emergence from coma, termed post-traumatic amnesia, post-traumatic confusional state, or delirium. Recent guidelines suggest the importance of assessment and consistent management during this phase, but current practice worldwide remains unknown. This survey aimed to elucidate current international practice in assessment and treatment of patients in the acute stages of recovery after TBI. The web-based survey was distributed to clinicians working with patients with acute TBI. There were 400 participants (68.8% females), from 41 countries, mostly neuropsychologists, rehabilitation physicians, and occupational therapists (OTs), with an average 12.8 years of experience. Of those working with adults (n = 376, 94%), most described this acute period as post-traumatic amnesia and used its duration to indicate injury severity. More than 85% used a tool to assess patients; in order of frequency, the Glasgow Coma Scale (GCS), Westmead PTA Scale (WPTAS), Galveston Orientation and Amnesia Test, Rancho Los Amigos Scale, and O-Log. Meeting criteria on the assessment tool or clinical judgment determined emergence from this phase, indicated by recovery of orientation, day-to-day memories, and ability to follow commands or participate in rehabilitation. Most patients had physiotherapy, OT, speech therapy, and environmental changes, with a third of participants indicating sedating medication was prescribed during this phase. Findings suggest that, consistent with guidelines, PTA is a widely recognized and measured TBI recovery phase, used to determine injury severity and readiness for therapy.
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Affiliation(s)
- Jennie Ponsford
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia.,Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, Victoria, Australia.,Epworth Healthcare, Melbourne, Victoria, Australia
| | - Sarah Carrier
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia.,Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, Victoria, Australia
| | - Amelia Hicks
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia.,Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, Victoria, Australia
| | - Adam McKay
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia.,Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, Victoria, Australia.,Epworth Healthcare, Melbourne, Victoria, Australia
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Spontaneous Neuronal Plasticity in the Contralateral Motor Cortex and Corticospinal Tract after Focal Cortical Infarction in Hypertensive Rats. J Stroke Cerebrovasc Dis 2020; 29:105235. [PMID: 32992200 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105235] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 07/02/2020] [Accepted: 08/02/2020] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVES In this study, we investigated the spontaneous neural plasticity on the contralateral side in hypertensive rats, including the expression of nerve growth factors (synaptophysin [SYN] and growth-associated protein 43 [GAP-43]), and the association between nerve fiber sprouting and redistribution, and the recovery of motor functions following sensorimotor cortical infarction. METHODS Initially, Sprague-Dawley rats were induced with renal hypertension by the bilateral renal arteries clips method. Further, they were induced with cerebral ischemia by the middle cerebral artery electrocoagulation method; 70 male rats completed the study. We compared the changes in the corticospinal tract (CST) and the expressions of SYN and GAP-43 on the contralateral side in rats with cerebral infarction using immunohistochemical staining, western blot, and biotinylated dextran amine (BDA) tracing analyses. The recovery of motor function in rats after cortical infarction was evaluated by the foot-fault and beam-walk tests. RESULTS The motor behavior tests revealed that the motor function of rats could recover to various degrees after focal cortical infarction. Compared with the sham-operated group, the SYN and GAP-43 levels increased in the motor cortex of the opposite hemisphere within 28 days after middle cerebral artery occlusion (MCAO). The increase in SYN and GAP-43 expressions presented differently in layers Ⅱ, Ⅲ, and Ⅴ. The amount of BDA-positive fibers also increased significantly in the denervated cervical spinal gray matter on day 56 post-MCAO. CONCLUSIONS The increases in SYN and GAP-43 on the contralateral side of the motor cortex could promote CST sprouting and rewiring in the spinal cord gray matter and also spontaneous motor function recovery after cortical infarction.
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Ward NS, Carmichael ST. Blowing up Neural Repair for Stroke Recovery: Preclinical and Clinical Trial Considerations. Stroke 2020; 51:3169-3173. [PMID: 32951539 DOI: 10.1161/strokeaha.120.030486] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The repair and recovery of the brain after stroke is a field that is emerging in its preclinical science and clinical trials. However, recent large, multicenter clinical trials have been negative, and conflicting results emerge on biological targets in preclinical studies. The coalescence of negative clinical translation and confusion in preclinical studies raises the suggestion that perhaps the field of stroke recovery faces a fate similar to stroke neuroprotection, with interesting science ultimately proving difficult to translate to the clinic. This review highlights improvements in 4 areas of the stroke neural repair field that should reorient the field toward successful clinical translation: improvements in rodent genetic models of stroke recovery, consideration of the biological target in stroke recovery, stratification in clinical trials, and the use of appropriate clinical trial end points.
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Affiliation(s)
- Nick S Ward
- Department of Clinical and Motor Neuroscience, UCL Queen Square Institute of Neurology, London (N.S.W.)
| | - S Thomas Carmichael
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA (S.T.C.)
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46
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Phyland RK, McKay A, Olver J, Walterfang M, Hopwood M, Hicks AJ, Mortimer D, Ponsford JL. Use of olanzapine to treat agitation in traumatic brain injury: study protocol for a randomised controlled trial. Trials 2020; 21:662. [PMID: 32690072 PMCID: PMC7370410 DOI: 10.1186/s13063-020-04553-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 06/23/2020] [Indexed: 11/24/2022] Open
Abstract
Background Agitation is common in the early stages of recovery from traumatic brain injury (TBI), when patients are in post-traumatic amnesia (PTA). Agitation is associated with risk of harm to patients and caregivers. Recent guidelines recommend that agitation during PTA is managed using environmental modifications. Agitation is also frequently treated pharmacologically, with the use of atypical antipsychotics such as olanzapine among the most common. This is despite a lack of well-designed studies to support the use of antipsychotics within this context. This study will be a double-blind, placebo-controlled randomised controlled trial. We will examine the efficacy, safety, cost-effectiveness and outcomes associated with the use of olanzapine for reducing agitation in patients in PTA following TBI over and above recommended environmental management. Methods Fifty-eight TBI rehabilitation inpatients who are in PTA and are agitated will receive olanzapine or placebo for the duration of PTA. All participants will additionally receive optimal environmental management for agitation. Measures of agitation, PTA and health will be undertaken at baseline. Treatment administration will begin at a dose of 5 mg daily and may be escalated to a maximum dose of 20 mg per day. Throughout the treatment period, agitation and PTA will be measured daily, and adverse events monitored weekly. Efficacy will be assessed by treatment group comparison of average Agitated Behaviour Scale scores during PTA. Participants will cease treatment upon emergence from PTA. Agitation levels will continue to be monitored for a further 2 weeks, post-treatment measures of health will be undertaken and cognitive and functional status will be assessed. Level of agitation and functional health will be assessed at hospital discharge. At 3 months post-discharge, functional outcomes and health service utilisation will be measured. Discussion This trial will provide crucial evidence to inform the management of agitation in patients in PTA following TBI. It will provide guidance as to whether olanzapine reduces agitation over and above recommended environmental management or conversely whether it increases or prolongs agitation and PTA, increases length of inpatient hospitalisation and impacts longer term cognitive and functional outcomes. It will also speak to the safety and cost-effectiveness of olanzapine use in this population. Trial registration ANZCTR ACTRN12619000284167. Registered on 25 February 2019
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Affiliation(s)
- Ruby K Phyland
- Monash Epworth Rehabilitation Research Centre, 185-187 Hoddle Street, Richmond, Victoria, 3121, Australia. .,School of Psychological Sciences, Monash University, 18 Innovation Walk, Clayton Campus, Wellington Road, Clayton, Victoria, 3800, Australia. .,Turner Institute for Brain and Mental Health, Monash University, Level 5, 18 Innovation Walk, Clayton Campus, Clayton, Victoria, 3800, Australia.
| | - Adam McKay
- Monash Epworth Rehabilitation Research Centre, 185-187 Hoddle Street, Richmond, Victoria, 3121, Australia.,School of Psychological Sciences, Monash University, 18 Innovation Walk, Clayton Campus, Wellington Road, Clayton, Victoria, 3800, Australia.,Turner Institute for Brain and Mental Health, Monash University, Level 5, 18 Innovation Walk, Clayton Campus, Clayton, Victoria, 3800, Australia.,Department of Psychology, Epworth HealthCare, 29 Erin Street, Richmond, Victoria, 3121, Australia
| | - John Olver
- Rehabilitation Medicine, Epworth HealthCare, 89 Bridge Rd, Richmond, Victoria, 3121, Australia
| | - Mark Walterfang
- Department of Psychiatry, University of Melbourne, Royal Melbourne Hospital, Level 1 North Block, Grattan Street, Parkville, Victoria, 3052, Australia.,Royal Melbourne Hospital, 300 Grattan St, Parkville, Victoria, 3050, Australia.,Florey Institute of Neuroscience and Mental Health, University of Melbourne, 30 Royal Parade, Parkville, Victoria, 3052, Australia
| | - Malcolm Hopwood
- Department of Psychiatry, University of Melbourne, Royal Melbourne Hospital, Level 1 North Block, Grattan Street, Parkville, Victoria, 3052, Australia.,Albert Road Clinic Professorial Psychiatry Unit, University of Melbourne, 31 Albert Rd, Melbourne, Victoria, 3004, Australia
| | - Amelia J Hicks
- Monash Epworth Rehabilitation Research Centre, 185-187 Hoddle Street, Richmond, Victoria, 3121, Australia.,School of Psychological Sciences, Monash University, 18 Innovation Walk, Clayton Campus, Wellington Road, Clayton, Victoria, 3800, Australia.,Turner Institute for Brain and Mental Health, Monash University, Level 5, 18 Innovation Walk, Clayton Campus, Clayton, Victoria, 3800, Australia
| | - Duncan Mortimer
- Centre for Health Economics, Monash Business School, Monash University, Building H, Level 5, Caulfield Campus, Clayton, Victoria, 3145, Australia
| | - Jennie L Ponsford
- Monash Epworth Rehabilitation Research Centre, 185-187 Hoddle Street, Richmond, Victoria, 3121, Australia.,School of Psychological Sciences, Monash University, 18 Innovation Walk, Clayton Campus, Wellington Road, Clayton, Victoria, 3800, Australia.,Turner Institute for Brain and Mental Health, Monash University, Level 5, 18 Innovation Walk, Clayton Campus, Clayton, Victoria, 3800, Australia
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Abstract
Purpose of review Stroke is a devastating illness which severely attenuates quality of life because of paralysis. Despite recent advances in therapies during acute phase such as thrombolytic therapy, clinical option to intervene the process of rehabilitation is limited. No pharmacological intervention that could enhance the effect of rehabilitation has not been established. Recent articles, which are summarized in the review article, reported novel small compound which accelerates training-dependent motor function recovery after brain damage. Recent findings A novel small compound, edonerpic maleate, binds to collapsin response mediator protein 2 (CRMP2) and enhance synaptic plasticity leading to the acceleration of rehabilitative training-dependent functional recovery after brain damage in rodent and nonhuman primate. The clinical trial to test this effect in human is now ongoing. Future preclinical and clinical studies will delineate the potentials of this compound. Summary A novel CRMP2-binding small compound, edonerpic maleate, accelerates motor function recovery after brain damage in rodent and nonhuman primate.
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48
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Li W, Ward R, Dong G, Ergul A, O'Connor P. Neurovascular protection in voltage-gated proton channel Hv1 knock-out rats after ischemic stroke: interaction with Na + /H + exchanger-1 antagonism. Physiol Rep 2020; 7:e14142. [PMID: 31250553 PMCID: PMC6597793 DOI: 10.14814/phy2.14142] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 05/21/2019] [Indexed: 12/14/2022] Open
Abstract
Experimental studies have demonstrated protective effects of NHE‐1 inhibition on cardiac function; however, clinical trials utilizing NHE‐1 antagonists found an increase in overall mortality attributed to thromboembolic strokes. NADPH oxidase‐derived reactive oxygen species (ROS) from microglial cells have been shown to contribute to injury following stroke. We have recently demonstrated that NHE‐1 inhibition enhances ROS in macrophages in a Hv1‐dependent manner. As Hv1 protein is highly expressed in microglia, we hypothesized that “NHE‐1 inhibition may augment neurovascular injury by activating Hv1,” providing a potential mechanism for the deleterious effects of NHE‐1. The goal of this study was to determine whether neurovascular injury and functional outcomes after experimental stroke differed in wild‐type and Hv1 mutant Dahl salt‐sensitive rats treated with an NHE‐1 inhibitor. Stroke was induced using both transient and permanent of middle cerebral artery occlusion (MCAO). Animals received vehicle or NHE‐1 inhibitor KR32568 (2 mg/kg, iv) either 30 min after the start of MCAO or were pretreated (2 mg/kg, iv, day) for 3 days and then subjected to MCAO. Our data indicate that Hv1 deletion confers both neuronal and vascular protection after ischemia. In contrast to our hypothesis, inhibition of NHE‐1 provided further protection from ischemic stroke, and the beneficial effects of both pre‐ and post‐treatment with KR32568 were similar in wild‐type and Hv1−/− rats. These data indicate that Hv1 activation is unlikely to be responsible for the increased incidence of cerebrovascular events observed in the heart disease patients after NHE‐1 inhibition treatment.
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Affiliation(s)
- Weiguo Li
- Department of Pathology & Laboratory Medicine, Medical University of South Carolina, Charleston, South Carolina.,Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina
| | - Rebecca Ward
- Departments of Neuroscience & Regenerative Medicine, Augusta University, Augusta, Georgia
| | - Guangkuo Dong
- Department of Physiology, Augusta University, Augusta, Georgia
| | - Adviye Ergul
- Department of Pathology & Laboratory Medicine, Medical University of South Carolina, Charleston, South Carolina.,Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina
| | - Paul O'Connor
- Department of Physiology, Augusta University, Augusta, Georgia
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Caudal D, François V, Lafoux A, Ledevin M, Anegon I, Le Guiner C, Larcher T, Huchet C. Characterization of brain dystrophins absence and impact in dystrophin-deficient Dmdmdx rat model. PLoS One 2020; 15:e0230083. [PMID: 32160266 PMCID: PMC7065776 DOI: 10.1371/journal.pone.0230083] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 02/20/2020] [Indexed: 12/27/2022] Open
Abstract
Duchenne Muscular Dystrophy (DMD) is a severe muscle-wasting disease caused by mutations in the DMD gene encoding dystrophin, expressed mainly in muscles but also in other tissues like retina and brain. Non-progressing cognitive dysfunction occurs in 20 to 50% of DMD patients. Furthermore, loss of expression of the Dp427 dystrophin isoform in the brain of mdx mice, the most used animal model of DMD, leads to behavioral deficits thought to be linked to insufficiencies in synaptogenesis and channel clustering at synapses. Mdx mice where the locomotor phenotype is mild also display a high and maladaptive response to stress. Recently, we generated Dmdmdx rats carrying an out-of frame mutation in exon 23 of the DMD gene and exhibiting a skeletal and cardiac muscle phenotype similar to DMD patients. In order to evaluate the impact of dystrophin loss on behavior, we explored locomotion parameters as well as anhedonia, anxiety and response to stress, in Dmdmdx rats aged from 1.5 to 7 months, in comparison to wild-type (WT) littermates. Pattern of dystrophin expression in the brain of WT and Dmdmdx rats was characterized by western-blot analyses and immunohistochemistry. We showed that dystrophin-deficient Dmdmdx rats displayed motor deficits in the beam test, without association with depressive or anxiety-like phenotype. However, Dmdmdx rats exhibited a strong response to restraint-induced stress, with a large increase in freezings frequency and duration, suggesting an alteration in a functional circuit including the amygdala. In brain, large dystrophin isoform Dp427 was not expressed in mutant animals. Dmdmdx rat is therefore a good animal model for preclinical evaluations of new treatments for DMD but care must be taken with their responses to mild stress.
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Affiliation(s)
- Dorian Caudal
- Therassay Platform, CAPACITES, Université de Nantes, Nantes, France
- * E-mail:
| | - Virginie François
- Nantes Gene Therapy Laboratory, Université de Nantes, INSERM UMR 1089, Nantes, France
| | - Aude Lafoux
- Therassay Platform, CAPACITES, Université de Nantes, Nantes, France
| | | | | | - Caroline Le Guiner
- Nantes Gene Therapy Laboratory, Université de Nantes, INSERM UMR 1089, Nantes, France
| | | | - Corinne Huchet
- Therassay Platform, CAPACITES, Université de Nantes, Nantes, France
- Nantes Gene Therapy Laboratory, Université de Nantes, INSERM UMR 1089, Nantes, France
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Li X, Xiang B, Shen T, Xiao C, Dai R, He F, Lin Q. Anti-neuroinflammatory effect of 3,4-dihydroxybenzaldehyde in ischemic stroke. Int Immunopharmacol 2020; 82:106353. [PMID: 32143007 DOI: 10.1016/j.intimp.2020.106353] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 02/03/2020] [Accepted: 02/24/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Increasing evidence from human and animal studies suggests that cerebral ischemic diseases are associated with nerve dysfunction and neuroinflammation. Therefore, alleviating neuroinflammation is a potential way to treat ischemic stroke. Gastrodia elata Blume (GEB) is a traditional Chinese medicine used to treat central nervous system diseases and related conditions, such as vertigo, headache, epilepsy. We have previously shown that GEB has a protective effect in ischemic stroke, and that the underlying mechanism is related to anti-neuroinflammation. 3,4-Dihydroxybenzaldehyde (DBD) is a phenolic component of GEB and may be responsible for the neuroprotective effect of GEB; however, the detailed molecular mechanisms underlying the effects of DBD are unknown. METHODS The anti-neuroinflammatory effect of DBD and the potential mechanisms underlying it were assessed. We using a rat model of middle cerebral artery occlusion/reperfusion and lipopolysaccharide-treated BV2 microglial cells. RESULTS DBD (10 mg/kg) significantly decreased infarct volume. Additionally, it alleviated neurological deficits in the rats by inhibiting microglia activation. DBD (0.01, 0.1, and 1 μM) also significantly decreased the levels of inflammatory mediators and cytokines such as tumor necrosis factor-α, interleukin (IL)-1β, IL-6, prostaglandin E2. Furthermore, phenotypic analysis of the BV2 cells showed that DBD significantly down-regulated the expression of M1 marker but significantly up-regulated the expression of M2 marker. Moreover, it suppressed nuclear factor (NF)-κB activation and inhibited the phosphorylation of p38 mitogen-activated protein kinase (MAPK), c-Jun N-terminal kinase, and extracellular signal-regulated protein kinases 1/2. CONCLUSIONS The neuroprotective and anti-inflammatory effects of DBD are associated with selective modulation of microglia polarization and reduction in the production of inflammatory mediators and cytokines through inhibition of MAPK and NF-κB activation. These findings suggest that DBD may be a potential treatment for ischemic stroke and other neuroinflammatory diseases.
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Affiliation(s)
- Xiufang Li
- Department of Pharmacology, Yunnan University of Traditional Chinese Medicine, 1076 Yuhua Road, District of Chenggong, Kunming 650500, China
| | - Bin Xiang
- Department of Pharmacology, Yunnan University of Traditional Chinese Medicine, 1076 Yuhua Road, District of Chenggong, Kunming 650500, China
| | - Ting Shen
- Department of Pharmacology, Yunnan University of Traditional Chinese Medicine, 1076 Yuhua Road, District of Chenggong, Kunming 650500, China
| | - Chun Xiao
- Department of Pharmacology, Yunnan University of Traditional Chinese Medicine, 1076 Yuhua Road, District of Chenggong, Kunming 650500, China
| | - Rong Dai
- Department of Pharmacology, Yunnan University of Traditional Chinese Medicine, 1076 Yuhua Road, District of Chenggong, Kunming 650500, China
| | - Fangyan He
- Department of Pharmacology, Yunnan University of Traditional Chinese Medicine, 1076 Yuhua Road, District of Chenggong, Kunming 650500, China
| | - Qing Lin
- Department of Pharmacology, Yunnan University of Traditional Chinese Medicine, 1076 Yuhua Road, District of Chenggong, Kunming 650500, China.
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