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Gelen V, Özkanlar S, Kara A, Yeşildağ A. Citrate-coated silver nanoparticles loaded with agomelatine provide neuronal therapy in acute cerebral ischemia/reperfusion of rats by inhibiting the oxidative stress, endoplasmic reticulum stress, and P2X7 receptor-mediated inflammasome. ENVIRONMENTAL TOXICOLOGY 2024; 39:1531-1543. [PMID: 38009636 DOI: 10.1002/tox.24021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 10/31/2023] [Indexed: 11/29/2023]
Abstract
Cerebral ischemia and reperfusion are related to various situations like injuries after various traumas, oxidative stress, increased calcium ion, capillary hypoperfusion, microvascular hyperpermeability, leukocyte infiltration, and blood-brain barrier disruption. An antidepressant Agomelatine which is a melatonin receptor (MT1/MT2) agonist and serotonin receptor (5-HT2C) antagonist has been reported by studies to have antioxidant and anti-inflammatory effects. In our study, we aimed to detect the effects of citrate-coated silver nanoparticle-loaded agomelatine application on neurodegeneration, endoplasmic reticulum stress, autophagic and apoptotic cell death, inflammation, and P2X7R expression in the cerebral ischemia-reperfusion model to facilitate the passage of blood-brain barrier. Forty two Sprague-Dawley rats in total were divided into six equal groups (n:7) and applications were performed. Acute cerebral injury in the ischemia-reperfusion model was created 2 h after internal carotid artery ligation in rats and then at the 2nd hour of reperfusion citrate-coated silver nanoparticles loaded with Agomelatine were applied. Twenty four hours later, neurologic analysis on animals in experimental groups was performed, animals were decapitated and GSH, GPx, SOD, CAT, MDA, IL-1β, and TNF-α parameters were examined after taking blood and the cerebral tissue samples. As a result, it was determined that ischemia-reperfusion caused endoplasmic reticulum stress in the cerebral tissues and thus caused cellular injury.
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Affiliation(s)
- Volkan Gelen
- Department of Physiology, Faculty of Veterinary Medicine, Kafkas University, Kars, Turkey
| | - Seçkin Özkanlar
- Department of Biochemistry, Faculty of Veterinary Medicine, Atatürk University, Erzurum, Turkey
| | - Adem Kara
- Department of Genetics, Faculty of Science, Erzurum Technical University, Erzurum, Turkey
| | - Ali Yeşildağ
- Department of Bioengineering, Faculty of Engineering and Architecture, Kafkas University, Kars, Turkey
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Yegin B, Donmez DB, Oz S, Aydin S. Dose-related effects of ciproxifan on brain tissue in rats with cerebral ischemia-reperfusion. Int J Neurosci 2023:1-13. [PMID: 37874217 DOI: 10.1080/00207454.2023.2273767] [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: 07/03/2023] [Accepted: 10/17/2023] [Indexed: 10/25/2023]
Abstract
PURPOSE Cerebral ischemia is the result of decreased or interrupted blood flow to the brain. It is the third leading cause of death after cardiovascular disease and cancer. Cerebral ischemia is reversible or irreversible in neurons in the affected area, and subsequent free radical damage can be exacerbated if reperfusion occurs. Ciproxifan is used to study the involvement of histaminergic neurons in different phases such as wakefulness and cognition. We wanted to find out whether ciproxifan has a protective effect on the brain of rats with cerebral ischemia-reperfusion injury. MATERIALS AND METHODS A total of 64 adult rats (32 male and 32 female) were used for the experiment. Eight cages were formed with randomly selected rats. No substance was administered to the rats in Group 1 and no surgical procedure was performed. The cerebral ischemia-reperfusion model (clamping of the left common carotid artery for 15 min followed by reperfusion for 24 h) was applied to rats in Group 2, Group 3, and Group 4 after 7 days/single dose of saline and ciproxifan (10 mg/kg, 30 mg/kg). After that, the activitymeter, forced swim test (FST), and Morris water maze (MWM) were performed on all animals. RESULTS Rats treated with ciproxifan exhibit neurons and glial cells with histologic structures similar to those of the control group, and interestingly, these differences became more pronounced with increasing dose. Rats administered ciproxifan improved motor coordination, decreased total distance behavior, and improved learning ability. However, when the groups were compared by sex, no significant difference was found in the parameters. CONCLUSION Thus, we could conclude that ciproxifan has a protective effect on the brain to a certain extent, regardless of the dose.
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Affiliation(s)
- Bengi Yegin
- Departmant of Anatomy, Faculty of Medicine, Yuksek Ihtisas University, Cankaya, Turkey
| | - Dilek Burukoglu Donmez
- Department of Histology and Embryology, Faculty of Medicine, Eskisehir Osmangazi University, Odunpazarı, Turkey
| | - Semih Oz
- Departmant of Vocational School of Health Services, Eskisehir Osmangazi University, Odunpazarı, Turkey
| | - Sule Aydin
- Department of Pharmacology, Faculty of Medicine, Eskisehir Osmangazi University, Odunpazarı, Turkey
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Sharma VK, Singh TG, Mehta V, Mannan A. Biomarkers: Role and Scope in Neurological Disorders. Neurochem Res 2023; 48:2029-2058. [PMID: 36795184 DOI: 10.1007/s11064-023-03873-4] [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: 06/02/2022] [Revised: 01/19/2023] [Accepted: 01/21/2023] [Indexed: 02/17/2023]
Abstract
Neurological disorders pose a great threat to social health and are a major cause for mortality and morbidity. Effective drug development complemented with the improved drug therapy has made considerable progress towards easing symptoms associated with neurological illnesses, yet poor diagnosis and imprecise understanding of these disorders has led to imperfect treatment options. The scenario is complicated by the inability to extrapolate results of cell culture studies and transgenic models to clinical applications which has stagnated the process of improving drug therapy. In this context, the development of biomarkers has been viewed as beneficial to easing various pathological complications. A biomarker is measured and evaluated in order to gauge the physiological process or a pathological progression of a disease and such a marker can also indicate the clinical or pharmacological response to a therapeutic intervention. The development and identification of biomarkers for neurological disorders involves several issues including the complexity of the brain, unresolved discrepant data from experimental and clinical studies, poor clinical diagnostics, lack of functional endpoints, and high cost and complexity of techniques yet research in the area of biomarkers is highly desired. The present work describes existing biomarkers for various neurological disorders, provides support for the idea that biomarker development may ease our understanding underlying pathophysiology of these disorders and help to design and explore therapeutic targets for effective intervention.
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Affiliation(s)
- Vivek Kumar Sharma
- Chitkara College of Pharmacy, Chitkara University, Chandigarh, Punjab, 140401, India.,Government College of Pharmacy, Rohru, Shimla, Himachal Pradesh, 171207, India
| | - Thakur Gurjeet Singh
- Chitkara College of Pharmacy, Chitkara University, Chandigarh, Punjab, 140401, India.
| | - Vineet Mehta
- Government College of Pharmacy, Rohru, Shimla, Himachal Pradesh, 171207, India
| | - Ashi Mannan
- Chitkara College of Pharmacy, Chitkara University, Chandigarh, Punjab, 140401, India
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Ke C, Shi M, Guo D, Zhu Z, Zhong C, Xu T, Lu Y, Ding Y, Zhang Y. Metabolomics on vascular events and death after acute ischemic stroke: Aprospective matched nested case-control study. Atherosclerosis 2022; 351:1-8. [DOI: 10.1016/j.atherosclerosis.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 04/21/2022] [Accepted: 05/04/2022] [Indexed: 11/02/2022]
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Bsat S, Halaoui A, Kobeissy F, Moussalem C, El Houshiemy MN, Kawtharani S, Omeis I. Acute ischemic stroke biomarkers: a new era with diagnostic promise? Acute Med Surg 2021; 8:e696. [PMID: 34745637 PMCID: PMC8552525 DOI: 10.1002/ams2.696] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 07/15/2021] [Accepted: 09/01/2021] [Indexed: 01/14/2023] Open
Abstract
Stroke is considered as the first cause of neurological dysfunction and second cause of death worldwide. Recombinant tissue plasminogen activator is the only chemical treatment for ischemic stroke approved by the US Food and Drug Administration. It was the only standard of care for a long time with a very narrow therapeutic window, which usually ranges from 3 to 4.5 h of stroke onset; until 2015, when multiple trials demonstrated the benefit of mechanical thrombectomy during the first 6 h. In addition, recent trials showed that mechanical thrombectomy can be beneficial up to 24 h if the patients meet certain criteria including the presence of magnetic resonance imaging/computed tomography perfusion mismatch, which allows better selectivity and higher recruitment of eligible stroke patients. However, magnetic resonance imaging/computed tomography perfusion is not available in all stroke centers. Hence, physicians need other easy and available diagnostic tools to select stroke patients eligible for mechanical thrombectomy. Moreover, stroke management is still challenging for physicians, particularly those dealing with patients with "wake-up" stroke. The resulting brain tissue damage of ischemic stroke and the subsequent pathological processes are mediated by multiple molecular pathways that are modulated by inflammatory markers and post-transcriptional activity. A considerable number of published works suggest the role of inflammatory and cardiac brain-derived biomarkers (serum matrix metalloproteinase, thioredoxin, neuronal and glial markers, and troponin proteins) as well as different biomarkers including the emerging roles of microRNAs. In this review, we assess the accumulating evidence regarding the current status of acute ischemic stroke diagnostic biomarkers that could guide physicians for better management of stroke patients. Our review could give an insight into the roles of the different emerging markers and microRNAs that can be of high diagnostic value in patients with stroke. In fact, the field of stroke research, similar to the field of traumatic brain injury, is in immense need for novel biomarkers that can stratify diagnosis, prognosis, and therapy.
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Affiliation(s)
- Shadi Bsat
- Division of NeurosurgeryDepartment of SurgeryAmerican University of Beirut Medical CenterBeirutLebanon
| | - Adham Halaoui
- Division of NeurosurgeryDepartment of SurgeryAmerican University of Beirut Medical CenterBeirutLebanon
| | - Firas Kobeissy
- Department of Biochemistry and Molecular GeneticsFaculty of MedicineAmerican University of BeirutBeirutLebanon
| | - Charbel Moussalem
- Division of NeurosurgeryDepartment of SurgeryAmerican University of Beirut Medical CenterBeirutLebanon
| | | | - Sarah Kawtharani
- Division of NeurosurgeryDepartment of SurgeryAmerican University of Beirut Medical CenterBeirutLebanon
| | - Ibrahim Omeis
- Division of NeurosurgeryDepartment of SurgeryAmerican University of Beirut Medical CenterBeirutLebanon
- Department of NeurosurgeryBaylor College of MedicineHoustonTexasUSA
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Sun F, Liu H, Fu HX, Li CB, Geng XJ, Zhang XX, Zhu J, Ma Z, Gao YJ, Dou ZJ. Predictive Factors of Hemorrhage After Thrombolysis in Patients With Acute Ischemic Stroke. Front Neurol 2020; 11:551157. [PMID: 33224083 PMCID: PMC7671058 DOI: 10.3389/fneur.2020.551157] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 09/24/2020] [Indexed: 11/16/2022] Open
Abstract
Background: Ischemic stroke has a poor prognosis and brings a ponderous burden on families and society. Hemorrhagic transformation (HT) after intravenous thrombolysis can increase the mortality of patients with ischemic stroke. Thus, finding new HT biomarkers to be applicable in clinical practice is of great importance. Methods: The related risk factors were recruited for analysis, including smoking, drinking, hyperlipidemia, diabetes, anamnesis, and pathological indicators. Moreover, the relationship between serum levels of caveolin-1, caveolin-2, and HT after rt-PA treatment were also studied. Results: We studied 306 patients with acute ischemic stroke treated with recombinant tissue type plasminogen activator (rt-PA) within 4.5 h of symptom onset. The results showed that Age ≥68 years, smoking, Atrial fibrillation, NIHSS score before thrombolysis ≥17, and systolic pressure 2 h after thrombolysis (mmHg) ≥149 increased the risks of HT after rt-PA administration. Remarkably, the concentration of caveolin-1 (ng/mL) ≤ 0.12 and caveolin-2 (ng/mL) ≤ 0.43 in serum increased the risks of HT after rt-PA administration. Conclusion: Knowledge on the risk factors associated with HT after rt-PA treatment may help develop treatment strategies and reduce the risk of HT. Caveolin-1 and caveolin-2 can be predictors of HT after rt-PA administration. These findings provide evidence for future further investigations aimed to validate these biomarkers.
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Affiliation(s)
- Fan Sun
- Neurology Department, Affiliated Hospital of Chengde Medical University, Chengde, China
| | - Heng Liu
- Neurology Department, Affiliated Hospital of Chengde Medical University, Chengde, China
| | - Hui-Xiao Fu
- Neurology Department, Affiliated Hospital of Chengde Medical University, Chengde, China
| | - Cheng-Bo Li
- Neurology Department, Affiliated Hospital of Chengde Medical University, Chengde, China
| | - Xiao-Jing Geng
- Neurology Department, Affiliated Hospital of Chengde Medical University, Chengde, China
| | - Xiao-Xuan Zhang
- Neurology Department, Affiliated Hospital of Chengde Medical University, Chengde, China
| | - Jiang Zhu
- Neurology Department, Affiliated Hospital of Chengde Medical University, Chengde, China
| | - Zheng Ma
- Neurology Department, Affiliated Hospital of Chengde Medical University, Chengde, China
| | - Yan-Jun Gao
- Neurology Department, Affiliated Hospital of Chengde Medical University, Chengde, China
| | - Zhi-Jie Dou
- Neurology Department, Affiliated Hospital of Chengde Medical University, Chengde, China
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Khan A, Shin MS, Jee SH, Park YH. Global metabolomics analysis of serum from humans at risk of thrombotic stroke. Analyst 2020; 145:1695-1705. [DOI: 10.1039/c9an02032b] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
We aimed to determine the serum concentrations of altered compounds to understand the changes in metabolism and pathophysiology that occur prior to thrombotic stroke.
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Affiliation(s)
- Adnan Khan
- Metabolomics Laboratory
- Korea University College of Pharmacy
- Sejong 30019
- Republic of Korea
| | - Mal-Soon Shin
- School of Global Sport Studies
- Korea University
- Sejong 30019
- Republic of Korea
| | - Sun Ha Jee
- Department of Epidemiology and Health Promotion and Institute for Health Promotion
- Graduate School of Public Health
- Yonsei University
- Seoul 03722
- Republic of Korea
| | - Youngja H. Park
- Metabolomics Laboratory
- Korea University College of Pharmacy
- Sejong 30019
- Republic of Korea
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8
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Topuzova MP, Alekseeva TM, Panina EB, Vavilova TV, Kovzelev PD, Portik OA, Skoromets AA. [The possibility of using neuron-specific enolase as a biomarker in the acute period of stroke]. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 119:53-62. [PMID: 31825363 DOI: 10.17116/jnevro201911908253] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The article presents a review of the literature on neuron-specific enolase (NSE) as a biomarker of stroke. It is shown that NSE does not allow differentiation of the ischemic and hemorrhagic process in stroke, but is suitable for determining the extent of brain tissue destruction both in the first hours of stroke and in the dynamics. The HSE analysis can be useful for monitoring the course of the disease, control of the dynamics of the pathological process, including when the size of the lesion increases, for evaluating the effectiveness of therapy and as a prognostic biomarker.
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Affiliation(s)
- M P Topuzova
- Almazov National Medical Research Centre, St. Petersburg, Russia
| | - T M Alekseeva
- Almazov National Medical Research Centre, St. Petersburg, Russia
| | - E B Panina
- Almazov National Medical Research Centre, St. Petersburg, Russia
| | - T V Vavilova
- Almazov National Medical Research Centre, St. Petersburg, Russia
| | - P D Kovzelev
- Almazov National Medical Research Centre, St. Petersburg, Russia
| | - O A Portik
- Almazov National Medical Research Centre, St. Petersburg, Russia
| | - A A Skoromets
- Pavlov First Saint Petersburg State Medical University, St. Petersburg, Russia
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9
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Ke C, Pan CW, Zhang Y, Zhu X, Zhang Y. Metabolomics facilitates the discovery of metabolic biomarkers and pathways for ischemic stroke: a systematic review. Metabolomics 2019; 15:152. [PMID: 31754808 DOI: 10.1007/s11306-019-1615-1] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 11/11/2019] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Ischemic stroke (IS) is a major contributor to the global disease burden, and effective biomarkers for IS management in clinical practice are urgently needed. Metabolomics can detect metabolites that are small enough to cross the blood-brain barrier in a high-throughput manner, and thus represents a powerful tool for discovering biomarkers of IS. OBJECTIVES In this study, we conducted a systematic review to identify potential metabolic biomarkers and pathways that might facilitate risk predictions, clinical diagnoses, the recognition of complications, predictions of recurrence and an understanding of the pathogenesis of IS. METHODS The PubMed and Web of Science databases were searched for relevant studies published between January 2000 and July 2019. The study objectives, study designs and reported metabolic biomarkers were systematically examined and compared. Pathway analysis was performed using the MetaboAnalyst online software. RESULTS Twenty-eight studies were included in this systematic review. Many consistent metabolites, including isoleucine, leucine, valine, glycine, lysine, glutamate, LysoPC(16:0), LysoPC(18:2), serine, uric acid, citrate and palmitic acid, possess potential as biomarkers of IS. Metabolic pathways and dysregulations that are implicated in excitotoxicity, inflammation, apoptosis, oxidative stress, neuroprotection, energy failure, and elevation of intracellular Ca2+ levels, were indicated as playing important roles in the development and progression of IS. CONCLUSIONS This systematic review summarizes potential metabolic biomarkers and pathways related to IS, which may provide opportunities for the construction of diagnostic or predictive models for IS and the discovery of novel therapeutic targets.
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Affiliation(s)
- Chaofu Ke
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou, 215123, People's Republic of China
| | - Chen-Wei Pan
- School of Public Health, Medical College of Soochow University, Suzhou, 215123, China
| | - Yuxia Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou, 215123, People's Republic of China
| | - Xiaohong Zhu
- Suzhou Industrial Park Centers for Disease Control and Prevention (Institute of Health Inspection and Supervision), Suzhou, 215021, Jiangsu, People's Republic of China
| | - Yonghong Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou, 215123, People's Republic of China.
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10
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Zou Y, Gong P, Zhao W, Zhang J, Wu X, Xin C, Xiong Z, Li Z, Wu X, Wan Q, Li X, Chen J. Quantitative iTRAQ-based proteomic analysis of piperine protected cerebral ischemia/reperfusion injury in rat brain. Neurochem Int 2018; 124:51-61. [PMID: 30579855 DOI: 10.1016/j.neuint.2018.12.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 11/26/2018] [Accepted: 12/20/2018] [Indexed: 01/15/2023]
Abstract
Piperine is the key bioactive factor in black pepper, and has been reported to alleviate cerebral ischemic injury. However, the mechanisms underlying its neuroprotective effects following cerebral ischemia remain unclear. In this study, rats were administered vehicle (dimethyl sulfoxide) or piperine, 20 mg/kg, daily for 14 days before focal cerebral artery occlusion. After occlusion for 2 h followed by reperfusion for 24 h. Histological examinations were used to assess whether piperine has a neuroprotective effect in the rat model of cerebral ischemia/reperfusion injury. The levels of proteins in the ischemic penumbra were evaluated by isobaric tags for relative and absolute quantitation-based proteomics. A total of 3687 proteins were identified, including 23 proteins that were highly significantly differentially expressed between the control and piperine groups. The proteomic findings were verified by immunofluorescence and western blot analysis. Interestingly, piperine administration downregulated a number of critical factors in the complement and coagulation cascades, including complement component 3, fibrinogen gamma chain, alpha-2-macroglobulin, and serpin family A member 1. Collectively, our findings suggest that the neuroprotective effects of piperine following cerebral ischemia/reperfusion injury are related to the regulation of the complement and coagulation cascades.
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Affiliation(s)
- Yichun Zou
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, 430071, China
| | - Pian Gong
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, Hubei, 430060, China
| | - Wenyuan Zhao
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, 430071, China
| | - Jianjian Zhang
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, 430071, China
| | - Xiaolin Wu
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, 430071, China
| | - Can Xin
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, 430071, China
| | - Zhongwei Xiong
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, 430071, China
| | - Zhengwei Li
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, 430071, China
| | - Xiaohui Wu
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, 430071, China
| | - Qi Wan
- Institute of Neuroregeneration and Neurorehabilitation of Qingdao University, Qingdao, Shandong, 266071, China
| | - Xiang Li
- Queensland Brain Institute of the University of Queensland, St Lucia, Queensland, Australia
| | - Jincao Chen
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, 430071, China; Department of Neurosurgery, Tongji Hospital of Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China.
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Castellanos M, van Eendenburg C, Gubern C, Kádár E, Huguet G, Puig J, Sobrino T, Blasco G, Serena J, Sánchez JM. Low Levels of Caveolin-1 Predict Symptomatic Bleeding After Thrombolytic Therapy in Patients With Acute Ischemic Stroke. Stroke 2018; 49:1525-1527. [DOI: 10.1161/strokeaha.118.020683] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 02/19/2018] [Accepted: 03/23/2018] [Indexed: 11/16/2022]
Affiliation(s)
- Mar Castellanos
- From the Department of Neurology, A Coruña University Hospital/Biomedical Research Institute (INIBIC), Spain (M.C.)
| | | | | | - Elisabet Kádár
- Department of Biology, University of Girona, Spain (E.K., G.H.)
| | - Gemma Huguet
- Department of Biology, University of Girona, Spain (E.K., G.H.)
| | - Josep Puig
- Diagnostic Imaging Institute Research Unit (J.P., G.B.), University Hospital Dr. Josep Trueta/Girona Biomedical Research Institute, Spain
| | - Tomás Sobrino
- Clinical Neurosciences Research Laboratory, University Hospital and Research Institute of Santiago de Compostela, Spain (T.S.)
| | - Gerard Blasco
- Diagnostic Imaging Institute Research Unit (J.P., G.B.), University Hospital Dr. Josep Trueta/Girona Biomedical Research Institute, Spain
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Lee Y, Khan A, Hong S, Jee SH, Park YH. A metabolomic study on high-risk stroke patients determines low levels of serum lysine metabolites: a retrospective cohort study. MOLECULAR BIOSYSTEMS 2017; 13:1109-1120. [DOI: 10.1039/c6mb00732e] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Metabolic alteration at early neurological deterioration during cerebral ischemia.
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Affiliation(s)
- Yeseung Lee
- Metabolomics Laboratory
- College of Pharmacy
- Korea University
- Sejong City
- Korea
| | - Adnan Khan
- Metabolomics Laboratory
- College of Pharmacy
- Korea University
- Sejong City
- Korea
| | - Seri Hong
- Department of Epidemiology and Health Promotion and Institute of Health Promotion
- Graduate School of Public Health
- Yonsei University
- Seoul
- Korea
| | - Sun Ha Jee
- Department of Epidemiology and Health Promotion and Institute of Health Promotion
- Graduate School of Public Health
- Yonsei University
- Seoul
- Korea
| | - Youngja H. Park
- Metabolomics Laboratory
- College of Pharmacy
- Korea University
- Sejong City
- Korea
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Glushakova OY, Glushakov AV, Miller ER, Valadka AB, Hayes RL. Biomarkers for acute diagnosis and management of stroke in neurointensive care units. Brain Circ 2016; 2:28-47. [PMID: 30276272 PMCID: PMC6126247 DOI: 10.4103/2394-8108.178546] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 02/10/2016] [Accepted: 02/23/2016] [Indexed: 12/11/2022] Open
Abstract
The effectiveness of current management of critically ill stroke patients depends on rapid assessment of the type of stroke, ischemic or hemorrhagic, and on a patient's general clinical status. Thrombolytic therapy with recombinant tissue plasminogen activator (r-tPA) is the only effective treatment for ischemic stroke approved by the Food and Drug Administration (FDA), whereas no treatment has been shown to be effective for hemorrhagic stroke. Furthermore, a narrow therapeutic window and fear of precipitating intracranial hemorrhage by administering r-tPA cause many clinicians to avoid using this treatment. Thus, rapid and objective assessments of stroke type at admission would increase the number of patients with ischemic stroke receiving r-tPA treatment and thereby, improve outcome for many additional stroke patients. Considerable literature suggests that brain-specific protein biomarkers of glial [i.e. S100 calcium-binding protein B (S100B), glial fibrillary acidic protein (GFAP)] and neuronal cells [e.g., ubiquitin C-terminal hydrolase-L1 (UCH-L1), neuron-specific enolase (NSE), αII-spectrin breakdown products SBDP120, SBDP145, and SBDP150, myelin basic protein (MBP), neurofilament light chain (NF-L), tau protein, visinin-like protein-1 (VLP 1), NR2 peptide] injury that could be detected in the cerebrospinal fluid (CSF) and peripheral blood might provide valuable and timely diagnostic information for stroke necessary to make prompt management and decisions, especially when the time of stroke onset cannot be determined. This information could include injury severity, prognosis of short-term and long-term outcomes, and discrimination of ischemic or hemorrhagic stroke. This chapter reviews the current status of the development of biomarker-based diagnosis of stroke and its potential application to improve stroke care.
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Affiliation(s)
- Olena Y Glushakova
- Department of Neurosurgery, Virginia Commonwealth University, School of Medicine, Richmond, Virginia, USA
| | - Alexander V Glushakov
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA
- Center for Translational Research in Neurodegenerative Disease, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Emmy R Miller
- Department of Neurosurgery, Virginia Commonwealth University, School of Medicine, Richmond, Virginia, USA
| | - Alex B Valadka
- Department of Neurosurgery, Virginia Commonwealth University, School of Medicine, Richmond, Virginia, USA
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Wiseman SJ, Doubal FN, Chappell FM, Valdés-Hernández MC, Wang X, Rumley A, Lowe GD, Dennis MS, Wardlaw JM. Plasma Biomarkers of Inflammation, Endothelial Function and Hemostasis in Cerebral Small Vessel Disease. Cerebrovasc Dis 2015; 40:157-64. [PMID: 26279056 PMCID: PMC4611856 DOI: 10.1159/000438494] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 07/06/2015] [Indexed: 12/30/2022] Open
Abstract
Background The cause of lacunar ischemic stroke, a clinical feature of cerebral small vessel disease (SVD), is largely unknown. Inflammation and endothelial dysfunction have been implicated. Plasma biomarkers could provide mechanistic insights but current data are conflicting. White matter hyperintensities (WMHs) are an important imaging biomarker of SVD. It is unknown if plasma biomarkers add predictive capacity beyond age and vascular risk factors in explaining WMH. Methods We prospectively recruited patients presenting with non-disabling ischemic stroke, classifying them clinically and with the help of MRI as lacunar or cortical. We measured biomarkers of inflammation, endothelial dysfunction and hemostasis for >1 month after stroke and compared biomarker levels between stroke subtypes. We quantitatively calculated WMH. We used multiple linear regression analysis to model WMH as a function of age, sex, hypertension and smoking (the baseline model). We fitted exploratory models using plasma biomarkers as predictor variables to assess model improvement over baseline. Results We recruited 125 patients. The lacunar group (n = 65) had lower tissue plasminogen activator (t-PA) levels in unadjusted (7.39 vs. 8.59 ng/ml, p = 0.029) and adjusted (p = 0.035) analyses compared with the cortical group (n = 60). There were no significant differences in the other plasma biomarkers. The results for t-PA were consistent with an updated meta-analysis, although the effect remains non-significant (standardized mean difference −0.08 (95% CI −0.25 to 0.09)). The baseline regression model explained 29% of the variance in quantitative WMH (R2 0.289). Inflammatory biomarkers showed minor improvement over baseline (R2 0.291), but the other plasma biomarkers did not improve the baseline model. Conclusion Plasma t-PA levels appear to differ between lacunar and cortical stroke subtypes, late after stroke, independent of age, sex and vascular risk factors and may reflect endothelial dysfunction. Except for a minor additional predictive effect of inflammatory markers, plasma biomarkers do not relate to WMH severity in this small stroke population.
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Affiliation(s)
- Stewart J Wiseman
- Centre for Clinical Brain Sciences, University of Edinburgh, Glasgow, UK
| | - Fergus N Doubal
- Centre for Clinical Brain Sciences, University of Edinburgh, Glasgow, UK
| | | | | | - Xi Wang
- Centre for Clinical Brain Sciences, University of Edinburgh, Glasgow, UK
| | - An Rumley
- Institute of Cardiovascular and Medical Sciences, Royal Infirmary, University of Glasgow, Glasgow, UK
| | - Gordon D.O Lowe
- Institute of Cardiovascular and Medical Sciences, Royal Infirmary, University of Glasgow, Glasgow, UK
| | - Martin S Dennis
- Centre for Clinical Brain Sciences, University of Edinburgh, Glasgow, UK
| | - Joanna M Wardlaw
- Centre for Clinical Brain Sciences, University of Edinburgh, Glasgow, UK
- *Joanna M. Wardlaw, CCBS, Chancellor's Building, Royal Infirmary of Edinburgh, 49 Little France Crescent, Edinburgh, EH16 4SB (UK), E-Mail
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Berger RP, Fromkin J, Rubin P, Snyder J, Richichi R, Kochanek P. Serum D-dimer concentrations are increased after pediatric traumatic brain injury. J Pediatr 2015; 166:383-8. [PMID: 25454315 PMCID: PMC4469943 DOI: 10.1016/j.jpeds.2014.10.036] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 08/13/2014] [Accepted: 10/15/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To determine whether D-dimer would be increased in children with traumatic brain injury (TBI), specifically mild abusive head trauma. STUDY DESIGN D-dimer was measured using multiplex bead technology in 195 children <4 years old (n = 93 controls without TBI, n = 102 cases with TBI) using previously collected serum. D-dimer was then measured prospectively in a clinical setting in 44 children (n = 24 controls, n = 20 cases). Receiver operator curves were generated for prospective data. RESULTS In both the retrospective and prospective cohorts, median (25th-75th percentile) D-dimer was significantly higher in cases vs controls. A receiver operator curve demonstrated an area under the curve of 0.91 (95% CI 0.83-0.99) in the prospective cohort. At a cut-off of 0.59 μg/L, the sensitivity and specificity for identification of a case was 90% and 75%, respectively. CONCLUSIONS Our data suggest that serum D-dimer may be able to be used to identify which young children at risk for abusive head trauma might benefit from a head computed tomography or other additional evaluation. Additional data are needed to better identify the clinical scenarios that may result in false positive or false negative D-dimer concentrations.
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Affiliation(s)
- Rachel P. Berger
- Associate Professor of Pediatrics, Safar Center for Resuscitation Research, Children’s Hospital of Pittsburgh of UPMC, 4401 Penn Avenue, Pittsburgh, PA 15224, University of Pittsburgh, Phone: 412-692-8664, Fax: 412-692-8399
| | - Janet Fromkin
- Children’s Hospital of Pittsburgh of UPMC, 4401 Penn Avenue, Pittsburgh, PA 15224, University of Pittsburgh, Phone: 412-692-8664, Fax: 412-692-8399
| | - Pam Rubin
- Children’s Hospital of Pittsburgh of UPMC, 4401 Penn Avenue, Pittsburgh, PA 15224, University of Pittsburgh, Phone: 412-692-8664, Fax: 412-692-8399
| | - John Snyder
- UPMC Hillman Cancer Center, 5115 Centre Avenue, Pittsburgh, PA 15232, Phone: 412-623-7748, Fax: 412-623-1415
| | - Rudolph Richichi
- Statistical Analysis and Measurement Consultants, Inc., P.O. Box 224, Lanexa, VA 23089
| | - Patrick Kochanek
- Safar Center for Resuscitation Research, 3434 Fifth Avenue, Pittsburgh PA 15260, Phone: 412-383-1900
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16
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Wang L, Jiang J, Du L, Zhang X, Wang C. The prognostic value of serum pregnancy-associated plasma protein A, S100 and high sensitivity C-reactive protein in acute ischemic stroke patients without heparin administration. Clin Biochem 2014; 47:187-91. [PMID: 25117449 DOI: 10.1016/j.clinbiochem.2014.08.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 07/30/2014] [Accepted: 08/01/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES The concerns regarding the pre-analytical bias caused by medicine treatments have been raised in the diagnosis and prognosis of ischemic stroke recently. The aim of this study was to examine the prognostic value of serum pregnancy-associated plasma protein A (PAPP-A), S100 and high sensitivity C-reactive protein (hs-CRP) in heparin-naïve patients of acute ischemic stroke. DESIGN AND METHODS Serum levels of PAPP-A, S100 and hs-CRP were determined in 205 heparin-naïve patients of acute ischemic stroke and 50 healthy controls. Clinical information and radiological information were collected. Unfavorable outcomes (stroke recurrence, myocardial infarction or death) were also recorded after six months. The associations between serum biomarker levels and stroke severity/outcome were assessed. RESULTS Serum PAPP-A, S100 and hs-CRP levels increased in patients compared with controls (P<0.05). S100 and hs-CRP levels were significantly higher in patients with larger cerebral infarction sizes (P<0.05) and more severe neurological impairment (P<0.05). Serum PAPP-A level showed a progressive increase with the increase of stroke severity (P<0.05). Serum hs-CRP and National Institutes of Health Stroke Scale (NIHSS) scores were identified as independent predictors for unfavorable outcomes with odds ratios of 2.884 (1.154 to 7.210, P=0.023) and 2.887 (1.146 to 7.273, P=0.024), respectively. CONCLUSION Serum PAPP-A, S100 and hs-CRP were associated with stroke severity or outcome after ischemic stroke and may offer complementary information, essential for clinical decision making. Serum PAPP-A showed a potential value for the evaluation of stroke clinically.
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Affiliation(s)
- Lili Wang
- Department of Clinical Laboratory, Qilu Hospital, Shandong University, Jinan, Shandong 250012, China
| | - Jun Jiang
- Department of Neurosurgery, The Second Hospital, Shandong University, Jinan, Shandong 250012, China
| | - Lutao Du
- Department of Clinical Laboratory, Qilu Hospital, Shandong University, Jinan, Shandong 250012, China
| | - Xin Zhang
- Department of Clinical Laboratory, Qilu Hospital, Shandong University, Jinan, Shandong 250012, China
| | - Chuanxin Wang
- Department of Clinical Laboratory, Qilu Hospital, Shandong University, Jinan, Shandong 250012, China.
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17
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Ansar S, Chatzikonstantinou E, Wistuba-Schier A, Mirau-Weber S, Fatar M, Hennerici MG, Meairs S. Characterization of a new model of thromboembolic stroke in C57 black/6J mice. Transl Stroke Res 2014; 5:526-33. [PMID: 24347404 PMCID: PMC4092233 DOI: 10.1007/s12975-013-0315-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 11/18/2013] [Accepted: 11/29/2013] [Indexed: 11/29/2022]
Abstract
This study characterizes a new model of thromboembolic stroke of the middle cerebral artery in C57 black/6J mice, thus offering an opportunity to use the model for studying ischemic stroke in transgenic mice. Thromboembolic stroke was induced by local injection of either 1.5 or 3.0 UI of thrombin directly into the right MCA of C57 black/6J mice. Cerebral blood flow (CBF) velocity was measured continuously by laser Doppler flowmetry, which allowed documentation of both MCA occlusion and of spontaneous recanalization. After 24 h, all animals were euthanized. Cryosections were cut at 400-μm intervals and silver stained with the high-contrast method for volumetric assessment of infarct size. Interleukin (IL)-6, tumor necrosis factor-alpha (TNF-α), caspase-3 and hsp 70 protein levels were investigated by immunofluorescence. Thrombin injection resulted in clot formation in all animals. Cortical infarction occurred in 63% of the mice while 37% had a spontaneous MCA recanalization during the first 20 min following thrombin injection. In cases of successful MCA occlusion with consequent infarction, the clot was stable up to 2 h after formation. Subsequently, 20% recanalized spontaneously. Infarctions were restricted to the cortex with a mean lesion volume of 36 ± 5 for 1.5 UI and 56 ± 8 for 3.0 UI thrombin. Protein levels of IL-6, TNF-α, caspase-3, and hsp 70 were significantly increased after MCAO. The results demonstrate that the mouse thromboembolic stroke model produces cortical infarctions of consistent size in C57 black/6J mice, which is dependent upon the amount of thrombin used for clot formation. Spontaneous MCA recanalization occurs after 2 h of ischemia in 20% of mice. Thus, the thromboembolic model is an applicable stroke model for C57 black/6J mice, which mimics many of the features of human stroke, including spontaneous recanalization. However, strain differences between Swiss and C57 black/6J mice must be taken into account when using the model.
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Affiliation(s)
- Saema Ansar
- Department of Neurology, Universitätsmedizin Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Eva Chatzikonstantinou
- Department of Neurology, Universitätsmedizin Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Anja Wistuba-Schier
- Department of Neurology, Universitätsmedizin Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Silvia Mirau-Weber
- Department of Neurology, Universitätsmedizin Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Marc Fatar
- Department of Neurology, Universitätsmedizin Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Michael G. Hennerici
- Department of Neurology, Universitätsmedizin Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Stephen Meairs
- Department of Neurology, Universitätsmedizin Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
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18
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Platt SR, Coates JR, Eifler DM, Edwards GL, Kent M, Bulsara KR. Effect of treatment with simvastatin and cyclosporine on neurotransmitter concentrations in cerebrospinal fluid after subarachnoid hemorrhage in dogs. Am J Vet Res 2013; 74:1111-7. [PMID: 23879849 DOI: 10.2460/ajvr.74.8.1111] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To measure concentrations of glutamate, aspartate, γ-aminobutyric acid (GABA), and glycine in CSF of dogs with experimentally induced subarachnoid hemorrhage (SAH) and to assess effects of cyclosporine and simvastatin on these concentrations. SAMPLE CSF samples from 13 dogs. PROCEDURES In a previous study, SAH was induced in dogs via 2 injections of autologous blood into the cerebellomedullary cistern 24 hours apart. Dogs were untreated (control; n = 5) or received simvastatin alone (4) or simvastatin in combination with cyclosporine (4). Samples of CSF were collected before the first blood injection (baseline; time 0), before the second blood injection, and on days 3, 7, and 10. For the study reported here, neurotransmitter concentrations in CSF were analyzed via high-performance liquid chromatography. Data were analyzed with a repeated-measures model with adjustments for multiple comparisons by use of the Tukey method. RESULTS In control dogs, the glutamate concentration peaked on day 3 and there was a significant increase in GABA and glutamate concentrations. Glutamate concentrations were significantly lower and glycine concentrations significantly higher on day 3 after administration of simvastatin alone or simvastatin in combination with cyclosporine, compared with concentrations for the control group. No significant differences in GABA and aspartate concentrations were detected among treatment groups at any time point. CONCLUSIONS AND CLINICAL RELEVANCE Glutamate concentrations were increased in the CSF of dogs with SAH. Simvastatin administration attenuated high glutamate concentrations. A combination of immunosuppression and upregulation of nitric oxide synthase may be useful in lowering high glutamate concentrations in ischemic CNS conditions.
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Affiliation(s)
- Simon R Platt
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA 30602, USA.
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19
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Lei B, Dawson HN, Roulhac-Wilson B, Wang H, Laskowitz DT, James ML. Tumor necrosis factor α antagonism improves neurological recovery in murine intracerebral hemorrhage. J Neuroinflammation 2013; 10:103. [PMID: 23962089 PMCID: PMC3765285 DOI: 10.1186/1742-2094-10-103] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Accepted: 08/02/2013] [Indexed: 01/04/2023] Open
Abstract
Background Intracerebral hemorrhage (ICH) is a devastating stroke subtype characterized by a prominent neuroinflammatory response. Antagonism of pro-inflammatory cytokines by specific antibodies represents a compelling therapeutic strategy to improve neurological outcome in patients after ICH. To test this hypothesis, the tumor necrosis factor alpha (TNF-α) antibody CNTO5048 was administered to mice after ICH induction, and histological and functional endpoints were assessed. Methods Using 10 to 12-week-old C57BL/6J male mice, ICH was induced by collagenase injection into the left basal ganglia. Brain TNF-α concentration, microglia activation/macrophage recruitment, hematoma volume, cerebral edema, and rotorod latency were assessed in mice treated with the TNF-α antibody, CNTO5048, or vehicle. Results After ICH induction, mice treated with CNTO5048 demonstrated reduction in microglial activation/macrophage recruitment compared to vehicle-treated animals, as assessed by unbiased stereology (P = 0.049). This reduction in F4/80-positive cells was associated with a reduction in cleaved caspase-3 (P = 0.046) and cerebral edema (P = 0.026) despite similar hematoma volumes, when compared to mice treated with vehicle control. Treatment with CNTO5048 after ICH induction was associated with a reduction in functional deficit when compared to mice treated with vehicle control, as assessed by rotorod latencies (P = 0.024). Conclusions Post-injury treatment with the TNF-α antibody CNTO5048 results in less neuroinflammation and improved functional outcomes in a murine model of ICH.
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Affiliation(s)
- Beilei Lei
- Multidisciplinary Neuroprotection Laboratories, Durham, NC 27710, USA
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20
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Reuter B, Rodemer C, Grudzenski S, Couraud PO, Weksler B, Romero IA, Meairs S, Bugert P, Hennerici MG, Fatar M. Temporal profile of matrix metalloproteinases and their inhibitors in a human endothelial cell culture model of cerebral ischemia. Cerebrovasc Dis 2013; 35:514-20. [PMID: 23817219 DOI: 10.1159/000350731] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Accepted: 03/07/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Matrix metalloproteinases (MMPs) are key players in proteolytic blood-brain barrier (BBB) disruption during ischemic stroke, leading to vascular edema, hemorrhagic transformation and infiltration by leukocytes. Their effect is dampened by the endogenous tissue inhibitors of metalloproteinases (TIMPs). The respective cellular source of specific MMPs and TIMPs during BBB breakdown is still under investigation. METHODS We analyzed the MMP and TIMP release of human brain microvascular endothelial cells (BMECs) under oxygen glucose deprivation (OGD). Cultured human BMECs (the hCMEC/D3 cell line) were subjected to OGD (6, 12, 18 and 24 h). Gene expression of MMP-2, MMP-9, TIMP-1 and TIMP-2 were serially measured by quantitative real time-PCR and compared to ELISA-detected cell culture medium levels. RESULTS OGD induced a significant and long-lasting increase in MMP-2 gene expression, reaching a plateau after 12 h. Medium protein levels of MMP-2 were correspondingly elevated at 12 h of OGD. The MMP-9 synthesis rate was detectable at very low levels and remained unaffected by OGD. TIMP-1 gene expression and secretion declined under OGD, whereas both expression and secretion of TIMP-2 remained stable. Contrary to the respective gene expression rate, medium levels of MMP-2, TIMP-1 and TIMP-2 started a simultaneous decline after 12 h of OGD. This is most likely due to an impaired synthesis and enhanced consumption rate under OGD. CONCLUSIONS The objective of our study was to determine the contribution of human BMECs to the MMP metabolism under in vitro OGD conditions simulating ischemic stroke. Our results suggest that human BMECs switch to a proinflammatory state by means of an enhanced production of MMP-2, attenuated release of TIMP-1, and unaffected production of TIMP-2. Thus, human BMECs might participate in the MMP-mediated BBB breakdown during ischemic stroke. However, our data does not support human BMECs to be a source of MMP-9.
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Affiliation(s)
- Björn Reuter
- Department of Neurology, UniversitätsMedizin Mannheim, University of Heidelberg, Mannheim, Germany.
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21
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Yoo SW, Chang DY, Lee HS, Kim GH, Park JS, Ryu BY, Joe EH, Lee YD, Kim SS, Suh-Kim H. Immune following suppression mesenchymal stem cell transplantation in the ischemic brain is mediated by TGF-β. Neurobiol Dis 2013; 58:249-57. [PMID: 23759293 DOI: 10.1016/j.nbd.2013.06.001] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Revised: 05/22/2013] [Accepted: 06/01/2013] [Indexed: 12/16/2022] Open
Abstract
Transplantation of mesenchymal stem cells (MSCs) has been shown to enhance the recovery of brain functions following ischemic injury. Although immune modulation has been suggested to be one of the mechanisms, the molecular mechanisms underlying improved recovery has not been clearly identified. Here, we report that MSCs secrete transforming growth factor-beta (TGF-β) to suppress immune propagation in the ischemic rat brain. Ischemic stroke caused global death of resident cells in the infarcted area, elevated the monocyte chemoattractant protein-1 (MCP-1) level, and evoked massive infiltration of circulating CD68+ immune cells through the impaired blood-brain barrier. Transplantation of MSCs at day 3 post-ischemia blocked the subsequent upregulation of MCP-1 in the ischemic area and the infiltration of additional CD68+ immune cells. MSC-conditioned media decreased the migration and MCP-1 production of freshly isolated immune cells in vitro, and this effect was blocked by an inhibitor of TGF-β signaling or an anti-TGF-β neutralizing antibody. Finally, transplantation of TGF-β1-silenced MSCs failed to attenuate the infiltration of CD68+ cells into the ischemic brain, and was associated with only minor improvements in motor function. These results indicate that TGF-β is key to the ability of MSCs to beneficially attenuate immune reactions in the ischemic brain. Our findings offer insight into the interactions between allogeneic MSCs and the host immune system, reinforcing the prospective clinical value of using MSCs in the treatment of neurological disorders involving inflammation-mediated secondary damage.
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Affiliation(s)
- Seung-Wan Yoo
- Department of Anatomy, Ajou University School of Medicine, Suwon, South Korea
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22
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Bibl M, Welge V, Schmidt H, Esselmann H, Mollenhauer B, Lewczuk P, Otto M, Kornhuber J, Wiltfang J. Plasma amyloid-beta peptides in acute cerebral ischemia: a pilot study. J Clin Lab Anal 2013; 26:238-45. [PMID: 22811355 DOI: 10.1002/jcla.21511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Blood-based tests for a rapid and valid diagnosis as well as outcome prognosis of acute stroke are desirable. Recently, plasma Aβ40 was suggested as an independent cerebrovascular risk factor candidate. METHODS We investigated eight plasma samples of patients with clinical signs of acute cerebral ischemia for derangements of plasma amyloid-beta (Aβ) peptide patterns as compared to 13 patients with other neuropsychiatric diseases. For the analysis of plasma, we used immunoprecipitation followed by the quantitative Aβ-SDS-PAGE/immunoblot. RESULTS The major outcome was a striking decrease of Aβ1-40 in plasma paralleled by an increase in the ratio of Aβ1-38/Aβ1-40 in two patients with acute stroke. Interestingly, these patients had an onset of symptoms within only 2-4 hr before venous puncture and there was a strong correlation of Aβ1-38/Aβ1-40 levels with the time span between onset of symptoms and venous puncture. CONCLUSION From these results, we suggest the ratio of plasma Aβ1-38/Aβ1-40 as a possible biomarker for the early diagnosis of acute stroke.
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Affiliation(s)
- Mirko Bibl
- Department of Psychiatry, Psychotherapy and Addiction Medicine, Kliniken Essen-Mitte, University of Duisburg-Essen, Henricistrasse 92, Essen, Germany.
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23
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Zeng L, Liu J, Wang Y, Wang L, Weng S, Chen S, Yang GY. Cocktail blood biomarkers: prediction of clinical outcomes in patients with acute ischemic stroke. Eur Neurol 2012; 69:68-75. [PMID: 23154383 DOI: 10.1159/000342896] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Accepted: 08/16/2012] [Indexed: 12/22/2022]
Abstract
BACKGROUND Timely prediction of stroke outcomes is important for proper personalized treatment. In the present study, we aimed to develop cocktail blood biomarkers to increase prediction efficiency using a combination of hemostasis, inflammatory and repair-related biomarkers. METHODS 105 patients suffering from acute ischemic stroke were divided into good outcome group and poor outcome group by modified Rankin Scale (mRS). Cytokines including CD40L, IFN-γ, IL-1α, IL-1β, IL-6, IL-8, IL-17 and TNF-α, as well as hemostasis markers fibrinogen, fibrin degradation products (FDP), D-dimer, tissue plasminogen activator, and plasminogen activation inhibitor-1 in plasma were examined by ELISA. Repair-related biomarker microRNA-210 (miR-210) was measured by real-time PCR. The prediction efficiency was explored by receiver operator characteristic analysis. RESULTS We demonstrated that FDP, IL-6 and miR-210 levels were closely associated with mRS in stroke patients. The prediction sensitivity of FDP, IL-6 and miR-210 for stroke outcome was 72.0, 86.7 and 82.5%, respectively. Using a combination of biomarkers including FDP, IL-6 and miR-210, the prognostic sensitivity of ischemic stroke increased to 95.2%. CONCLUSION The combination of FDP, IL-6 and miR-210 has a high sensitivity for predicting stroke recovery, it serves as a potential cocktail blood biomarker. It provides a novel approach for stroke prognosis.
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Affiliation(s)
- Lili Zeng
- Department of Neurology, Ruijin Hospital, Shanghai, China
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Hoffmann A, Bredno J, Wendland MF, Derugin N, Hom J, Schuster T, Zimmer C, Su H, Ohara PT, Young WL, Wintermark M. MRI blood-brain barrier permeability measurements to predict hemorrhagic transformation in a rat model of ischemic stroke. Transl Stroke Res 2012; 3:508-16. [PMID: 24323835 DOI: 10.1007/s12975-012-0212-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Accepted: 09/03/2012] [Indexed: 10/27/2022]
Abstract
Permeability imaging might add valuable information in the risk assessment of hemorrhagic transformation. This study evaluates the predictive value of blood-brain barrier permeability (BBBP) measurements extracted from dynamic contrast-enhanced MRI for hemorrhagic transformation in ischemic stroke. Spontaneously hypertensive and Wistar rats with 2 h filament occlusion of the right MCA underwent MRI during occlusion, at 4 and 24 h post reperfusion. BBBP was imaged by DCE imaging and quantified by Patlak analysis. Cresyl-violet staining was used to characterize hemorrhage in sacrificed rats at 24 h, immediately following the last imaging study. BBBP changes were evaluated at baseline, 4 and 24 h after reperfusion. Receiver-operating characteristic (ROC) analysis was performed to determine the most accurate BBBP threshold to predict hemorrhagic transformation. In animals showing macroscopic hemorrhage at 24 h, 95th BBBP percentile values ipsilateral were 0.323 [0.260, 0.387], 0.685 [0.385, 0.985], and 0.412 [0.210, 0.613] ml/min·100 g (marginal mean [95%CI]) during occlusion, at 4 and 24 h post reperfusion, respectively. The BBBP values on the infarcted and contralateral side were significantly different at 4 (p = 0.034) and 24 h post reperfusion (p = 0.031). The predictive value of BBBP in terms of macroscopic hemorrhage was highest 4 h after reperfusion (ROC area under the curve = 84 %) with a high negative predictive value (98.3 %) and limited positive predictive value (14.9 %) for a threshold of 0.35 ml/min·100g. Altered BBBP is a necessary but not sufficient condition to cause hemorrhagic transformation in rats with an infarct. Further research is needed to identify those additional risk factors that are required for hemorrhagic transformation to develop in the setting of ischemic stroke.
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Affiliation(s)
- Angelika Hoffmann
- Department of Radiology, Neuroradiology Division, University of Virginia, Box 800170, Charlottesville, VA, 22908, USA
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Campos F, Pérez-Mato M, Agulla J, Blanco M, Barral D, Almeida Á, Brea D, Waeber C, Castillo J, Ramos-Cabrer P. Glutamate excitoxicity is the key molecular mechanism which is influenced by body temperature during the acute phase of brain stroke. PLoS One 2012; 7:e44191. [PMID: 22952923 PMCID: PMC3429451 DOI: 10.1371/journal.pone.0044191] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Accepted: 07/30/2012] [Indexed: 11/19/2022] Open
Abstract
Glutamate excitotoxicity, metabolic rate and inflammatory response have been associated to the deleterious effects of temperature during the acute phase of stroke. So far, the association of temperature with these mechanisms has been studied individually. However, the simultaneous study of the influence of temperature on these mechanisms is necessary to clarify their contributions to temperature-mediated ischemic damage. We used non-invasive Magnetic Resonance Spectroscopy to simultaneously measure temperature, glutamate excitotoxicity and metabolic rate in the brain in animal models of ischemia. The immune response to ischemia was measured through molecular serum markers in peripheral blood. We submitted groups of animals to different experimental conditions (hypothermia at 33°C, normothermia at 37°C and hyperthermia at 39°C), and combined these conditions with pharmacological modulation of glutamate levels in the brain through systemic injections of glutamate and oxaloacetate. We show that pharmacological modulation of glutamate levels can neutralize the deleterious effects of hyperthermia and the beneficial effects of hypothermia, however the analysis of the inflammatory response and metabolic rate, demonstrated that their effects on ischemic damage are less critical than glutamate excitotoxity. We conclude that glutamate excitotoxicity is the key molecular mechanism which is influenced by body temperature during the acute phase of brain stroke.
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Affiliation(s)
- Francisco Campos
- Clinical Neurosciences Research Laboratory, Department of Neurology, Hospital Universitario de Santiago, University of Santiago de Compostela, IDIS, Santiago de Compostela, Spain
- * E-mail: (PRC); (FC)
| | - María Pérez-Mato
- Clinical Neurosciences Research Laboratory, Department of Neurology, Hospital Universitario de Santiago, University of Santiago de Compostela, IDIS, Santiago de Compostela, Spain
| | - Jesús Agulla
- Clinical Neurosciences Research Laboratory, Department of Neurology, Hospital Universitario de Santiago, University of Santiago de Compostela, IDIS, Santiago de Compostela, Spain
| | - Miguel Blanco
- Clinical Neurosciences Research Laboratory, Department of Neurology, Hospital Universitario de Santiago, University of Santiago de Compostela, IDIS, Santiago de Compostela, Spain
| | - David Barral
- Clinical Neurosciences Research Laboratory, Department of Neurology, Hospital Universitario de Santiago, University of Santiago de Compostela, IDIS, Santiago de Compostela, Spain
| | - Ángeles Almeida
- Research Unit, Hospital Universitario de Salamanca and Institute of Health Sciences of Castilla and León, Salamanca, Spain
- Department of Biochemistry and Molecular Biology, University of Salamanca, Salamanca, Spain
| | - David Brea
- Clinical Neurosciences Research Laboratory, Department of Neurology, Hospital Universitario de Santiago, University of Santiago de Compostela, IDIS, Santiago de Compostela, Spain
| | - Christian Waeber
- Department of Radiology, Massachusetts General Hospital, Charlestown, Massachusetts, United States of America
| | - José Castillo
- Clinical Neurosciences Research Laboratory, Department of Neurology, Hospital Universitario de Santiago, University of Santiago de Compostela, IDIS, Santiago de Compostela, Spain
| | - Pedro Ramos-Cabrer
- Clinical Neurosciences Research Laboratory, Department of Neurology, Hospital Universitario de Santiago, University of Santiago de Compostela, IDIS, Santiago de Compostela, Spain
- * E-mail: (PRC); (FC)
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Biomarker level improves the diagnosis of embolic source in ischemic stroke of unknown origin. J Neurol 2012; 259:2538-45. [PMID: 22592287 DOI: 10.1007/s00415-012-6532-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Revised: 04/08/2012] [Accepted: 04/20/2012] [Indexed: 02/03/2023]
Abstract
The risk of recurrent stroke is likely related to etiology. Therefore it is important to identify which patients are at highest early risk. We evaluated whether selected blood biomarkers may aid in the diagnosis of stroke etiology. We studied consecutive non-lacunar stroke patients between November 2006 and January 2007, and selected undetermined origin strokes. Blood samples were drawn at arrival to test brain natriuretic peptide (BNP), D-dimer, CK-MB, myoglobin, and troponin. Second harmonic transthoracic echocardiography (SHTTE) and ECG-24 h monitoring were also performed within the first 24 h. We evaluated 294 patients with ischemic stroke; 89 had an initial undetermined origin. After a cardiological work-up, 49 were diagnosed as embolic including atrial fibrillation (4), severe aortic arch atheromatosis (24), severe wall abnormalities (12), valve disease (3), dilated cardiomyopathy (1), and patent foramen (5). Higher levels of CK-MB, BNP, and myoglobin were found in patients with embolic source in SHTTE, but only CK-MB >1.5 ng/ml and BNP >64 pg/ml remained as independent predictors: BNP (OR 8.86; CI 95 % 2.79-28.09), CK-MB (OR 6.28; CI 95 % 1.66-23.69). BNP showed specificity of 75 %, sensitivity of 63.4 %, and positive predictive value (PPV) of 75.6 %. CK-MB had specificity of 85 %, sensitivity of 47.9 %, and PPV of 79.3 %. Measuring both biomarkers improves the finding of embolic source, increasing specificity to 95 % and PPV to 88.2 %. High-level CK-MB and BNP during the acute phase of ischemic stroke are associated with an embolic source. Measurement of both biomarkers may improve the diagnosis, guiding the need to perform a heart exploration.
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Chen R, Vendrell I, Chen CPC, Cash D, O'Toole KG, Williams SA, Jones C, Preston JE, Wheeler JX. Proteomic analysis of rat plasma following transient focal cerebral ischemia. Biomark Med 2012; 5:837-46. [PMID: 22103620 DOI: 10.2217/bmm.11.89] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM This study aimed to identify plasma protein changes in a rat model of ischemic stroke using a proteomic approach. MATERIALS & METHODS Four male Sprague-Dawley rats (3-6 months old) were subjected to 90 min of left middle cerebral artery occlusion under anesthesia with 1.5% isoflurane in O(2)/air followed by 24-h reperfusion. Blood samples (~100 µl) were collected at baseline, at the end of 90-min middle cerebral artery occlusion and at 24-h postreperfusion. Brain injuries were assessed by MRI at 24-h postreperfusion. Quantitative comparison of global plasma protein expression was performed using 2D differential in-gel electrophoresis. Differentially expressed protein spots were identified using peptide sequencing tandem mass spectrometry. RESULTS These rats had clear brain infarction in the left hemisphere detected by MRI. Thirty-three protein spots of plasma samples were differentially expressed following focal cerebral ischemia/reperfusion. These protein spots belonged to eight proteins. Six of them (α2-macroglobulin, complement C3, inter-α- trypsin inhibitor heavy chain H3, serum albumin, haptoglobin and transthyretin), which are a class of acute-phase proteins, changed significantly. CONCLUSION This study describes the responses of young rats to focal cerebral ischemia and suggests that future studies should use aged animals to better mimic the clinical ischemic stroke setting.
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Affiliation(s)
- Ruoli Chen
- National Institute for Biological Standards & Control, Health Protection Agency, Blanche Lane, South Mimms, Potters Bar, Hertfordshire, UK.
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Blanco M, Campos F, Rodríguez-Yáñez M, Arias S, Fernández-Ferro J, Gómez-Sánchez JC, Castillo J. Neuroprotection or increased brain damage mediated by temperature in stroke is time dependent. PLoS One 2012; 7:e30700. [PMID: 22363473 PMCID: PMC3281866 DOI: 10.1371/journal.pone.0030700] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Accepted: 12/21/2011] [Indexed: 01/05/2023] Open
Abstract
The control of temperature during the acute phase of stroke may be a new therapeutic target that can be applied in all stroke patients, however therapeutic window or timecourse of the temperature effect is not well established. Our aim is to study the association between changes in body temperature in the first 72 hours and outcome in patients with ischemic (IS) and hemorrhagic (ICH) stroke. We prospectively studied 2931 consecutive patients (2468 with IS and 463 with ICH). Temperature was obtained at admission, and at 24, 48 and 72 hours after admission. Temperature was categorized as low (<36°C), normal (36–37°C) and high (>37°C). As the main variable, we studied functional outcome at 3 months determined by modified Rankin Scale. Temperature in stroke patients is higher than in controls, and increases gradually in the first 72 hours after stroke. A positive correlation between temperature and stroke severity determined by NIHSS was found at 24 and 48 hours, but not at admission or 72 hours. In a logistic regression model, high temperature was associated with poor outcome at 24 hours (OR 2.05, 95% CI 1.59–2.64, p<0.0001) and 48 hours (OR 1.93, 95% CI 1.08–2.34, p = 0.007), but not at admission or 72 hours. Temperature increases in patients with stroke in the first 72 hours, with the harmful effect of high temperature occurring in the first 48 hours. The neuroprotective effect of low temperature occurs within the first 24 hours from stroke onset.
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Affiliation(s)
- Miguel Blanco
- Department of Neurology, Clinical Neurosciences Research Laboratory, Hospital Clínico Universitario, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Francisco Campos
- Department of Neurology, Clinical Neurosciences Research Laboratory, Hospital Clínico Universitario, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Manuel Rodríguez-Yáñez
- Department of Neurology, Clinical Neurosciences Research Laboratory, Hospital Clínico Universitario, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Susana Arias
- Department of Neurology, Clinical Neurosciences Research Laboratory, Hospital Clínico Universitario, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - José Fernández-Ferro
- Department of Neurology, Clinical Neurosciences Research Laboratory, Hospital Clínico Universitario, University of Santiago de Compostela, Santiago de Compostela, Spain
| | | | - José Castillo
- Department of Neurology, Clinical Neurosciences Research Laboratory, Hospital Clínico Universitario, University of Santiago de Compostela, Santiago de Compostela, Spain
- * E-mail:
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Moussouttas M, Huynh TT, Khoury J, Lai EW, Dombrowski K, Pello S, Pacak K. Cerebrospinal fluid catecholamine levels as predictors of outcome in subarachnoid hemorrhage. Cerebrovasc Dis 2012; 33:173-81. [PMID: 22222551 DOI: 10.1159/000334660] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Accepted: 10/18/2011] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE Subarachnoid hemorrhage (SAH) is associated with marked sympathetic activation at the time of ictus. The purpose of this study is to determine whether early central catecholamine levels measured from cerebrospinal fluid (CSF) relate to outcome in patients with SAH. METHODS Observational study of consecutive SAH grade 3-5 patients who underwent ventriculostomy placement, but did not undergo open craniotomy for aneurysm obliteration. CSF samples were obtained during the first 48 h following symptom onset and assayed for catecholamine levels. Statistical analyses were performed to determine whether the levels predicted mortality by day 15 or mortality/disability by day 30. RESULTS For the 102 patients included, mean age was 58, and 73% were female - 21% experienced day-15 mortality, and 32% experienced mortality/disability by day 30. Early mortality was related to Hunt-Hess (H/H) grade (p < 0.001), neurogenic cardiomyopathy (NC) (p = 0.003), cerebral infarction (p = 0.001), elevated intracranial pressure (ICP) (p = 0.029), epinephrine (EPI) level (p = 0.002) and norepinephrine/3,4-dihydroxyphenylglycol (NE/DHPG) ratio (p = 0.003). Mortality/disability was related to H/H grade (p < 0.001), NC (p = 0.018), infarction (p < 0.001), elevated ICP (p = 0.002), EPI (p = 0.004) and NE/DHPG (p = 0.014). Logistic regression identified age [OR 1.09 (95% CI 1.01-1.17)], H/H grade [9.52 (1.19-77)], infarction [10.87 (1.22-100)], ICP elevation [32.26 (2-500)], EPI [1.06 (1.01-1.10)], and (inversely) DHPG [0.99 (0.99-1.00)] as independent predictors of early mortality. For mortality/disability, H/H grade [OR 21.74 (95% CI 5.62-83)], ICP elevation [18.52 (1.93-166)], and EPI [1.05 (1.02-1.09)] emerged as independent predictors. Proportional-hazards analysis revealed age [HR 1.041 (95% CI 1.003-1.08)], H/H grade [6.9 (1.54-31.25)], NC [4.31 (1.5-12.35)], and EPI [1.032 (1.009-1.054)] independently predicted early mortality. CONCLUSIONS CSF catecholamine levels are elevated in SAH patients who experience early mortality or disability. EPI may potentially serve as useful index of outcome in this population of patients with SAH.
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Affiliation(s)
- Michael Moussouttas
- Cerebrovascular and Neurocritical Care Division, Thomas Jefferson Medical Center, Philadelphia, Pa., USA.
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Rodríguez-González R, Sobrino T, Rodríguez-Yáñez M, Millán M, Brea D, Miranda E, Moldes O, Pérez J, Lomas DA, Leira R, Dávalos A, Castillo J. Association between neuroserpin and molecular markers of brain damage in patients with acute ischemic stroke. J Transl Med 2011; 9:58. [PMID: 21569344 PMCID: PMC3113955 DOI: 10.1186/1479-5876-9-58] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Accepted: 05/11/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Neuroserpin has shown neuroprotective effects in animal models of cerebral ischemia and has been associated with functional outcome after ischemic stroke. Our aim was to study whether neuroserpin serum levels could be associated to biomarkers of excitotoxicity, inflammation and blood brain barrier disruption. METHODS We prospectively included 129 patients with ischemic stroke (58.1% male; mean age, 72.4 ± 9.6 years) not treated with tPA within 12 hours (h) of symptoms onset (mean time, 4.7 ± 2.1 h). Poor functional outcome at 3 months was considered as a modified Rankin scale score >2. Serum levels of neuroserpin, Interleukin 6 (IL-6), Intercellular adhesion molecule-1 (ICAM-1), active Matrix metalloproteinase 9 (MMP-9), and cellular fibronectin (cFn) (determined by ELISA) and glutamate (determined by HPLC) were measured on admission, 24 and 72 h. The main variable was considered the decrease of neuroserpin levels within the first 24 h. ROC analysis was used to select the best predictive value for neuroserpin to predict poor functional outcome due to a lack of linearity. RESULTS The decrease of neuroserpin levels within the first 24 h was negatively correlated with serum levels at 24 hours of glutamate (r = -0.642), IL-6 (r = -0.678), ICAM-1 (r = -0.345), MMP-9 (r = -0.554) and cFn (r = -0.703) (all P < 0.0001). In the multivariate analysis, serum levels of glutamate (OR, 1.04; CI95%, 1.01-1.06, p = 0.001); IL-6 (OR, 1.4; CI95%, 1.1-1.7, p = 0.001); and cFn (OR, 1.3; CI95%, 1.1-1.6, p = 0.002) were independently associated with a decrease of neuroserpin levels <70 ng/mL at 24 h after adjusting for confounding factors. CONCLUSIONS These findings suggest that neuroprotective properties of neuroserpin may be related to the inhibition of excitotoxicity, inflammation, as well as blood brain barrier disruption that occur after acute ischemic stroke.
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Affiliation(s)
- Raquel Rodríguez-González
- Clinical Neuroscience Research Laboratory, Department of Neurology, Hospital Clínico Universitario, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Tomás Sobrino
- Clinical Neuroscience Research Laboratory, Department of Neurology, Hospital Clínico Universitario, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Manuel Rodríguez-Yáñez
- Clinical Neuroscience Research Laboratory, Department of Neurology, Hospital Clínico Universitario, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Mónica Millán
- Department of Neurosciences, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Spain
| | - David Brea
- Clinical Neuroscience Research Laboratory, Department of Neurology, Hospital Clínico Universitario, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Elena Miranda
- University of Cambridge, Cambridge Institute for Medical Research, Cambridge, UK
| | - Octavio Moldes
- Clinical Neuroscience Research Laboratory, Department of Neurology, Hospital Clínico Universitario, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Juan Pérez
- Departamento de Biología Celular, Genética y Fisiología, Universidad de Málaga, Facultad de Ciencias, Campus de Teatinos, Málaga, Spain
| | - David A Lomas
- University of Cambridge, Cambridge Institute for Medical Research, Cambridge, UK
| | - Rogelio Leira
- Clinical Neuroscience Research Laboratory, Department of Neurology, Hospital Clínico Universitario, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Antoni Dávalos
- Department of Neurosciences, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Spain
| | - José Castillo
- Clinical Neuroscience Research Laboratory, Department of Neurology, Hospital Clínico Universitario, University of Santiago de Compostela, Santiago de Compostela, Spain
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Greenhalgh AD, Ogungbenro K, Rothwell NJ, Galea JP. Translational pharmacokinetics: challenges of an emerging approach to drug development in stroke. Expert Opin Drug Metab Toxicol 2011; 7:681-95. [PMID: 21521135 DOI: 10.1517/17425255.2011.570259] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
INTRODUCTION There is increasing recognition of the importance of translational pharmacokinetics in stroke research, lack of which has been cited as one of the main contributing factors to failure of Phase III trials. AREAS COVERED The article reviews the translational issues in administration, distribution and sampling in the pharmacokinetics of putative therapeutic drugs in stroke. In addition, the role of translational pharmacometrics in drug development is discussed. The review uses the anti-inflammatory agent, IL-1 receptor antagonist, as an example. The reader will gain an insight into the pitfalls that are commonplace in translating pharmacokinetics from the preclinical to the clinical scenario. The reader will also gain an understanding of the complexities of blood-central nervous system (CNS) barriers in relation to brain pharmacokinetics and the increasing use of translational pharmacometrics in stroke research. EXPERT OPINION The translation of preclinical to clinical pharmacokinetics is a discipline that is traditionally overlooked and is likely to be a key factor responsible for failure of clinical trials. With a clear comprehensive insight into the benefits and limitations of translational pharmacokinetics in stroke, translational pharmacokinetics can be safely used to enhance the efficacy of clinical trials in stroke and their likelihood of success.
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Affiliation(s)
- Andrew D Greenhalgh
- Manchester Academic Health Sciences Centre (MAHSC), Faculty of Life Sciences, AV Hill Building, Oxford Road, Manchester M13 9PT, UK
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Pedraza S, Puig J, Blasco G, Daunis-i-Estadella J, Boada I, Bardera A, Castellanos M, Serena J. Reliability of the ABC/2 Method in Determining Acute Infarct Volume. J Neuroimaging 2011; 22:155-9. [DOI: 10.1111/j.1552-6569.2011.00588.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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NR2 antibodies: Risk assessment of transient ischemic attack (TIA)/stroke in patients with history of isolated and multiple cerebrovascular events. J Neurol Sci 2011; 300:97-102. [DOI: 10.1016/j.jns.2010.09.023] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2009] [Revised: 09/11/2010] [Accepted: 09/16/2010] [Indexed: 12/19/2022]
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Hom J, Dankbaar JW, Soares BP, Schneider T, Cheng SC, Bredno J, Lau BC, Smith W, Dillon WP, Wintermark M. Blood-brain barrier permeability assessed by perfusion CT predicts symptomatic hemorrhagic transformation and malignant edema in acute ischemic stroke. AJNR Am J Neuroradiol 2011; 32:41-8. [PMID: 20947643 DOI: 10.3174/ajnr.a2244] [Citation(s) in RCA: 121] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND PURPOSE SHT and ME are feared complications in patients with acute ischemic stroke. They occur >10 times more frequently in tPA-treated versus placebo-treated patients. Our goal was to evaluate the sensitivity and specificity of admission BBBP measurements derived from PCT in predicting the development of SHT and ME in patients with acute ischemic stroke. MATERIALS AND METHODS We retrospectively analyzed a dataset consisting of 32 consecutive patients with acute ischemic stroke with appropriate admission and follow-up imaging. We calculated admission BBBP by using delayed-acquisition PCT data and the Patlak model. Collateral flow was assessed on the admission CTA, while recanalization and reperfusion were assessed on the follow-up CTA and PCT, respectively. SHT and ME were defined according to ECASS III criteria. Clinical data were obtained from chart review. In our univariate and forward selection-based multivariate analysis for predictors of SHT and ME, we incorporated both clinical and imaging variables, including age, admission NIHSS score, admission blood glucose level, admission blood pressure, time from symptom onset to scanning, treatment type, admission PCT-defined infarct volume, admission BBBP, collateral flow, recanalization, and reperfusion. Optimal sensitivity and specificity for SHT and ME prediction were calculated by using ROC analysis. RESULTS In our sample of 32 patients, 3 developed SHT and 3 developed ME. Of the 3 patients with SHT, 2 received IV tPA, while 1 received IA tPA and treatment with the Merci device; of the 3 patients with ME, 2 received IV tPA, while 1 received IA tPA and treatment with the Merci device. Admission BBBP measurements above the threshold were 100% sensitive and 79% specific in predicting SHT and ME. Furthermore, all patients with SHT and ME--and only those with SHT and ME--had admission BBBP measurements above the threshold, were older than 65 years of age, and received tPA. Admission BBBP, age, and tPA were the independent predictors of SHT and ME in our forward selection-based multivariate analysis. Of these 3 variables, only BBBP measurements and age were known before making the decision of administering tPA and thus are clinically meaningful. CONCLUSIONS Admission BBBP, a pretreatment measurement, was 100% sensitive and 79% specific in predicting SHT and ME.
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Affiliation(s)
- J Hom
- Department of Radiology, Neuroradiology Section, Neurovascular Service, University of California, San Francisco, California, USA
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Does serum Tau protein predict the outcome of patients with ischemic stroke? J Mol Neurosci 2010; 43:241-5. [PMID: 20549384 DOI: 10.1007/s12031-010-9403-4] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2010] [Accepted: 06/02/2010] [Indexed: 10/19/2022]
Abstract
The prediction of outcome after ischemic stroke (IS) is currently based on indirect data from clinical and radiological evaluation. We evaluated the usefulness of serum Tau protein as possible prognostic markers for IS. Fifty-six patients with computed tomography-confirmed IS were enrolled. Blood samples were obtained on days 1, 3, 5, and 10 after stroke onset. Tau and S100BB serum levels were measured by commercially available enzyme-linked immunosorbent assay. Neurological deficits were quantified by the National Institute of Health Stroke Scale on days 1, 3, 5, and 10 of stroke. Functional disability was rated with the Barthel Index and Rankin Scale on days 1, 3, 5, and 10 and additionally 3 months after the stroke. Computed tomography scan was performed to calculate infarct volume on admission to hospital and on day 10 from the diagnosis of IS onset. Tau protein was detected in the serum of 47.8% patients with IS. Patients in whom Tau protein was detected in serum, when compared with patients without Tau protein, developed more severe neurological deficits, had worse functional status measured in the early and late phase of IS, and were found to have larger volume of infarction. However, Tau protein concentrations measured within the early phase of IS did not correlate with degrees of neurological deficit and disability in the early phase and also after 3 months of IS. Detection of Tau protein in the serum of patients with IS but not its concentration can be considered as a bad prognostic factor for the clinical outcome in early and late phase of IS.
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Foerch C, Montaner J, Furie KL, Ning MM, Lo EH. Invited article: searching for oracles? Blood biomarkers in acute stroke. Neurology 2009; 73:393-9. [PMID: 19652144 DOI: 10.1212/wnl.0b013e3181b05ef9] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Emerging data suggest that a wide array of measurable biomarkers in blood may provide a novel window into the pathophysiology of stroke. In this review, we survey the state of progress in the field. Three specific questions are assessed. Can biomarkers augment the clinical examination and powerful brain imaging tools to enhance the accuracy of the diagnostic process? Can biomarkers be used to help triage patients for thrombolytic therapy? Can biomarkers help predict patients who are most susceptible to malignant infarction? Many encouraging molecular candidates have been found that appear to match the known cascades of neurovascular injury after stroke. However, whether these putative biomarkers may indeed have direct clinical utility remains to be quantitatively validated. Larger clinical trials are warranted to establish the sensitivity and specificity of biomarkers for routine use in clinical stroke.
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Affiliation(s)
- C Foerch
- Neuroprotection Research Laboratory, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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Abstract
Serum biomarkers related to the cascade of inflammatory, hemostatic, glial and neuronal perturbations have been identifed to diagnose and characterize intracerebral hemorrhage and cerebral ischemia. Interpretation of most markers is confounded by their latent rise, blood-brain barrier effects, the heterogeneity of etiologies and the wide range of normal values, limiting their application for early diagnosis, lesion size estimation and long-term outcome prediction. Certain hemostatic and inflammatory constituents have been found to predict response to thrombolysis and worsening due to infarct progression and secondary hemorrhage, offering a potential role for improved treatment selection and individualization of therapy. Biomarkers will become increasingly relevant for developing targets for neuroprotective therapies, monitoring response to treatment and as surrogate end points for treatment trials.
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Affiliation(s)
- Matthew B Maas
- 175 Cambridge Street, Suite 300, Boston, MA 02114, USA, Tel.: +1 617 643 2713; ;
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Serum free hemoglobin as a novel potential biomarker for acute ischemic stroke. J Neurol 2009; 256:625-31. [DOI: 10.1007/s00415-009-0133-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2008] [Revised: 09/21/2008] [Accepted: 10/23/2008] [Indexed: 11/26/2022]
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Beaudeux JL. Accidents vasculaires cérébraux : de nouveaux marqueurs biologiques en perspective. ACTA ACUST UNITED AC 2009. [DOI: 10.1016/s1773-035x(09)70203-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Elkind MSV, Tai W, Coates K, Paik MC, Sacco RL. Lipoprotein-associated phospholipase A2 activity and risk of recurrent stroke. Cerebrovasc Dis 2008; 27:42-50. [PMID: 19018137 PMCID: PMC2846303 DOI: 10.1159/000172633] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2007] [Accepted: 07/21/2008] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Mass levels of lipoprotein-associated phospholipase A(2) (Lp-PLA(2)), a leukocyte-derived enzyme involved in the metabolism of low-density lipoprotein to pro-inflammatory mediators, are associated with prognosis after stroke. Lp-PLA(2) mass correlates only moderately with levels of Lp-PLA(2) activity. The relationship of Lp-PLA(2) activity to risk of stroke recurrence is unknown. We hypothesized that Lp-PLA(2) activity levels would predict risk of recurrence. METHODS In the population-based Northern Manhattan Stroke Study, first ischemic stroke patients >or=40 years were followed for recurrent stroke. Levels of Lp-PLA(2) activity were assessed in 467 patients, and categorized by quartile. Cox proportional hazard models were used to calculate hazard ratios (HR) and 95% confidence intervals (95% CI) for risk of recurrent stroke associated with marker quartiles after adjusting for demographics, vascular risk factors, and high-sensitivity C-reactive protein (hsCRP). RESULTS Mean age was 68.9 +/- 12.7 years; 54.6% were women; 53.3% Hispanic, 27.2% black, and 17.8% white. Median follow-up was 4.0 years, and there were 80 recurrent strokes. Compared to the lowest quartile of Lp-PLA(2) activity, those in the highest had an increased risk of recurrent stroke (adjusted HR 2.54, 95% CI 1.01-6.39). CONCLUSION Stroke patients with Lp-PLA(2) activity levels in the highest quartile, compared to those in the lowest quartile, had an increased risk of recurrence after first ischemic stroke. Further studies are warranted to determine whether this biomarker has clinical utility in determining high-risk populations of stroke survivors, and whether anti-inflammatory strategies that reduce levels of activity of Lp-PLA(2) reduce the risk of stroke recurrence.
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Affiliation(s)
- Mitchell S V Elkind
- Department of Neurology, College of Physicians and Surgeons, Columbia University, and Columbia-Presbyterian Medical Center, New York Presbyterian Hospital, New York, NY, USA.
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De Silva DA, Woon FP, Chen C, Chang HM, Wong MC. Serum erythrocyte sedimentation rate is higher among ethnic South Asian compared to ethnic Chinese ischemic stroke patients. Is this attributable to metabolic syndrome or central obesity? J Neurol Sci 2008; 276:126-9. [PMID: 18930475 DOI: 10.1016/j.jns.2008.09.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2008] [Revised: 09/10/2008] [Accepted: 09/16/2008] [Indexed: 10/21/2022]
Abstract
Inflammation, a vascular risk factor, is more pronounced among ethnic South Asians compared to ethnic Chinese in the general population. We compared serum erythrocyte sedimentation rate (ESR) levels between ethnic South Asian and Chinese acute ischemic stroke patients, and further investigated if metabolic syndrome or central obesity could account for any difference detected. We prospectively recruited consecutive ischemic stroke patients within seven days of onset. Measurement of serum ESR was performed within two days of admission. Median serum ESR was higher among the 55 ethnic South Asian (16 mm/h IQR 3-35) compared to the 165 ethnic Chinese patients (9 mm/h IQR 4-19), p=0.004). Serum ESR was correlated with age. Higher serum ESR was associated with female gender, non-smokers, patients with central obesity and low high-density lipoprotein (HDL) cholesterol. Using regression analysis, South Asian ethnicity remained significantly associated with serum ESR, independent of age, gender, smoking status, metabolic syndrome, central obesity and low HDL. Ethnic South Asian ischemic stroke patients have a higher inflammatory state compared to ethnic Chinese patients. As the higher inflammatory state is independent of demographic and risk factors, we propose an underlying genetic or cultural basis for the ethnic difference.
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