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Schellekens MMI, Boot EM, Verhoeven JI, Ekker MS, van Alebeek ME, Brouwers PJAM, Arntz RM, van Dijk GW, Gons RAR, van Uden IWM, den Heijer T, de Kort PLM, de Laat KF, van Norden A, Vermeer SE, van Zagten MSG, van Oostenbrugge RJ, Wermer MJH, Nederkoorn PJ, van Rooij FG, van den Wijngaard IR, de Leeuw FE, Kessels RPC, Tuladhar AM. Subacute cognitive impairment after first-ever transient ischemic attack or ischemic stroke in young adults: The ODYSSEY study. Eur Stroke J 2022; 8:283-293. [PMID: 37021157 PMCID: PMC10069191 DOI: 10.1177/23969873221132032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 09/21/2022] [Indexed: 11/07/2022] Open
Abstract
Introduction: We aimed to investigate the prevalence of cognitive impairment in the subacute phase after transient ischemic attack (TIA) and ischemic stroke (IS), factors associated with a vascular cognitive disorder, and the prevalence of subjective cognitive complaints and their relation with objective cognitive performance. Patients and methods: In this multicenter prospective cohort study, we recruited patients with first-ever TIA and IS, aged 18–49 years, between 2013 and 2021 for cognitive assessment up to 6 months after index event. We calculated composite Z-scores for seven cognitive domains. We defined cognitive impairment as a composite Z-score < −1.5. We defined major vascular cognitive disorder as a Z-score < −2.0 in one or more cognitive domains. Results: Fifty three TIA and 545 IS patients completed cognitive assessment with mean time to assessment of 89.7 (SD 40.7) days. The median NIHSS at admission was 3 (interquartile range, 1–5). Cognitive impairment was common in five domains (up to 37%), with similar proportion in TIA and IS patients. Patients with major vascular cognitive disorder had a lower education level, higher NIHSS scores and more frequent lesions in the left frontotemporal lobe than without vascular cognitive disorder ( p < 0.05 FDR-corrected). Subjective memory and executive cognitive complaints were present in about two-thirds of the patients, but were weakly associated with objective cognitive performance (β: −0.32 and −0.21, respectively). Discussion and conclusion: In the subacute phase after TIA or stroke in young adults, cognitive impairment and subjective cognitive complaints are prevalent, but they are weakly associated with each other.
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Affiliation(s)
- Mijntje MI Schellekens
- Department of Neurology, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Esther M Boot
- Department of Neurology, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Jamie I Verhoeven
- Department of Neurology, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Merel S Ekker
- Department of Neurology, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | | | - Paul JAM Brouwers
- Department of Neurology, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Renate M Arntz
- Department of Neurology, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Gert W van Dijk
- Department of Neurology, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Rob AR Gons
- Department of Neurology, Catharina Hospital, Eindhoven, The Netherlands
| | - Inge WM van Uden
- Department of Neurology, Catharina Hospital, Eindhoven, The Netherlands
| | - Tom den Heijer
- Department of Neurology, Franciscus Gasthuis & Vlietland, BA Rotterdam, The Netherlands
| | - Paul LM de Kort
- Department of Neurology, Elisabeth-TweeSteden Hospital, Tilburg, Netherlands
| | | | - Anouk van Norden
- Department of Neurology, Amphia Hospital, Breda, The Netherlands
| | - Sarah E Vermeer
- Department of Neurology, Rijnstate Hospital, Arnhem, The Netherlands
| | - Marian SG van Zagten
- Department of Neurology, Jeroen Bosch Hospital, ‘s-Hertogenbosch, The Netherlands
| | - Robert J van Oostenbrugge
- Department of Neurology, School for Mental Health and Neuroscience (MHeNs), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Marieke JH Wermer
- Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Paul J Nederkoorn
- Department of Neurology, Amsterdam University Medical Centre, location AMC, Amsterdam, The Netherlands
| | - Frank G van Rooij
- Department of Neurology, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | | | - Frank-Erik de Leeuw
- Department of Neurology, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Roy PC Kessels
- Radboud University, Donders Institute for Brain, Cognition and Behaviour, Center for Cognition, Nijmegen, The Netherlands
- Vincent van Gogh Institute for Psychiatry, Venray, The Netherlands
| | - Anil M Tuladhar
- Department of Neurology, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
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Qin ZY, Yang XF, Lian CY, Yan XJ, Lin MS, Bundhun PK, Lao YY. Aspirin Versus Clopidogrel Monotherapy for the Secondary Prevention of Recurrent Cerebrovascular Attack Following Previous Ischemic Stroke in Patients with Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis. Diabetes Ther 2020; 11:1091-1101. [PMID: 32221846 PMCID: PMC7192993 DOI: 10.1007/s13300-020-00801-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Type 2 diabetes mellitus (T2DM) and stroke are two different diseases, but have many aspects in common. Aspirin is recommended as an initial treatment for the secondary prevention of recurrent ischemic stroke in patients with T2DM. However, clopidogrel is an oral antiplatelet drug that might be another choice in case of aspirin intolerance. In this analysis, we aimed to systematically compare aspirin versus clopidogrel monotherapy for the secondary prevention of recurrent cerebrovascular attack following previous ischemic stroke in patients with T2DM. METHODS Online medical databases including Web of Science, MEDLINE, Cochrane central, EMBASE and http://www.ClinicalTrials.com were searched for published articles that satisfied the inclusion and exclusion criteria of this study. Recurrent stroke, fatal stroke, cerebral hemorrhage, myocardial infarction and mortality were considered the main end points in these patients with T2DM. RevMan 5.3 software was used to statistically analyze the data representing each subgroup. Risk ratios (RRs) with 95% confidence intervals (CIs) were used to represent the results following analysis. RESULTS A total of 9218 participants with T2DM who were previously affected by ischemic stroke were included in this analysis, whereby 4917 were assigned to aspirin and 4301 to clopidogrel. This current analysis showed that there was no significant difference in recurrent stroke rate (RR: 0.79, 95% CI: 0.61-1.02; P = 0.07) observed with aspirin versus clopidogrel in these patients with T2DM. The risk of fatal stroke (RR: 0.88, 95% CI: 0.39-1.98; P = 0.76), cerebral hemorrhage (RR: 0.65, 95% CI: 0.38-1.11; P = 0.12), myocardial infarction (RR: 0.88, 95% CI: 0.43-1.79; P = 0.71) and mortality (RR: 1.07, 95% CI: 0.90-1.27; P = 0.44) were also similarly manifested. CONCLUSION Clopidogrel monotherapy was neither inferior nor superior to aspirin monotherapy for the secondary prevention of recurrent cerebrovascular attack following previous ischemic stroke in patients with T2DM. Hence, clopidogrel or aspirin monotherapy is equally safe and effective in these patients with T2DM.
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Affiliation(s)
- Zu-Ye Qin
- Department of Neurology, The First People's Hospital of Qinzhou, No. 8, Mingyang Road, Qinzhou, 535099, Guangxi Zhuang Autonomous Region, People's Republic of China
| | - Xiu-Fang Yang
- Department of Neurology, The First People's Hospital of Qinzhou, No. 8, Mingyang Road, Qinzhou, 535099, Guangxi Zhuang Autonomous Region, People's Republic of China
| | - Chao-Ying Lian
- Department of Neurology, The First People's Hospital of Qinzhou, No. 8, Mingyang Road, Qinzhou, 535099, Guangxi Zhuang Autonomous Region, People's Republic of China
| | - Xun-Jin Yan
- Department of Neurology, The First People's Hospital of Qinzhou, No. 8, Mingyang Road, Qinzhou, 535099, Guangxi Zhuang Autonomous Region, People's Republic of China
| | - Min-Shi Lin
- Department of Neurology, The First People's Hospital of Qinzhou, No. 8, Mingyang Road, Qinzhou, 535099, Guangxi Zhuang Autonomous Region, People's Republic of China
| | | | - You-Yi Lao
- Department of Neurology, The First People's Hospital of Qinzhou, No. 8, Mingyang Road, Qinzhou, 535099, Guangxi Zhuang Autonomous Region, People's Republic of China.
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Leskelä J, Pietiäinen M, Safer A, Lehto M, Metso J, Malle E, Buggle F, Becher H, Sundvall J, Grau AJ, Pussinen PJ, Palm F. Serum lipopolysaccharide neutralizing capacity in ischemic stroke. PLoS One 2020; 15:e0228806. [PMID: 32084157 PMCID: PMC7034831 DOI: 10.1371/journal.pone.0228806] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 01/21/2020] [Indexed: 12/13/2022] Open
Abstract
Introduction Periodontitis is associated with increased serum lipopolysaccharide (LPS) activity, which may be one mechanism linking periodontitis with the risk of cardiovascular diseases. As LPS-carrying proteins including lipoproteins modify LPS-activity, we investigated the determinants of serum LPS-neutralizing capacity (LPS-NC) in ischemic stroke. The association of LPS-NC and Aggregatibacter actinomycetemcomitans, a major microbial biomarker in periodontitis, was also investigated. Materials and methods The assay to measure LPS-NC was set up by spiking serum samples with E. coli LPS. The LPS-NC, LPS-binding protein (LBP), soluble CD14 (sCD14), lipoprotein profiles, apo(lipoprotein) A-I, apoB, and phospholipid transfer protein (PLTP) activity, were determined in 98 ischemic stroke patients and 100 age- and sex-matched controls. Serum and saliva immune response to A. actinomycetemcomitans, its concentration in saliva, and serotype-distribution were examined. Results LPS-NC values ranged between 51–83% in the whole population. Although several of the LPS-NC determinants differed significantly between cases and controls (PLTP, sCD14, apoA-I, HDL-cholesterol), the levels did not (p = 0.056). The main determinants of LPS-NC were i) triglycerides (β = -0.68, p<0.001), and ii) HDL cholesterol (0.260, <0.001), LDL cholesterol (-0.265, <0.001), PLTP (-0.196, 0.011), and IgG against A. actinomycetemcomitans (0.174, 0.011). Saliva A. actinomycetemcomitans concentration was higher [log mean (95% CI), 4.39 (2.35–8.19) vs. 10.7 (5.45–21) genomes/ml, p = 0.023) and serotype D more frequent (4 vs. 0%, p = 0.043) in cases than controls. Serotypeablity or serotypes did not, however, relate to the LPS-NC. Conclusion Serum LPS-NC comprised low PLTP-activity, triglyceride and LDL cholesterol concentrations, as well as high HDL cholesterol and IgG against A. actinomycetemcomitans. The present findings let us to conclude that LPS-NC did not associate with stroke.
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Affiliation(s)
- Jaakko Leskelä
- Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland
| | - Milla Pietiäinen
- Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland
| | - Anton Safer
- Institute of Global Health, University of Heidelberg, Heidelberg, Germany
| | - Markku Lehto
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland
| | - Jari Metso
- Minerva Foundation Institute for Medical Research, Helsinki, Finland
| | - Ernst Malle
- Division of Molecular Biology and Biochemistry, Gottfried Schatz Research Center, Medical University of Graz, Graz, Austria
| | - Florian Buggle
- Department of Neurology, Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - Heiko Becher
- University Medical Center Hamburg-Eppendorf, Institute of Medical Biometry and Epidemiology, Hamburg, Germany
- University Hospital Heidelberg, Institute of Global Health, Heidelberg, Germany
| | - Jouko Sundvall
- National Institute for Health and Welfare, Helsinki, Finland
| | - Armin J. Grau
- Department of Neurology, Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - Pirkko J. Pussinen
- Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland
- * E-mail:
| | - Frederick Palm
- Department of Neurology, Helios Klinikum Schleswig, Schleswig, Germany
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Abboud H, Sissani L, Labreuche J, Arauz A, Bousser MG, Bryer A, Chamorro A, Fisher M, Ford I, Fox KM, Hennerici MG, Lavados PM, Massaro A, Mattle HP, Munoz Collazos M, Rothwell PM, Steg PG, Vicaut E, Yamouth B, Amarenco P. Specificities of Ischemic Stroke Risk Factors in Arab-Speaking Countries. Cerebrovasc Dis 2017; 43:169-177. [PMID: 28199997 DOI: 10.1159/000454776] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 11/24/2016] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Stroke is largely preventable, and therefore, a better understanding of risk factors is an essential step in reducing the population stroke rate and resulting disease burden in Arab countries. SUMMARY We performed 2 separate analyses in 2 similar populations of patients with noncardioembolic ischemic stroke. This first involved 3,635 patients in the Outcomes in Patients with TIA and Cerebrovascular disease (OPTIC) registry (followed for 2 years), with baseline collection of the usual risk factors and 5 socioeconomic variables (unemployment status, residence in rural area, living in fully serviced accommodation, no health-insurance coverage, and low educational level). The second involved patients in the PERFORM trial (n = 19,100 followed up for 2 years), with baseline collection of the usual risk factors and 1 socioeconomic variable (low educational level). The primary outcome was a composite of nonfatal stroke, nonfatal myocardial infarction, or cardiovascular death. Stroke risk factors were more prevalent in patients in Arab countries. The incidence of major cardiovascular events (MACE; age- and gender-adjusted) was higher in Arab countries (OPTIC, 18.5 vs. 13.3%; PERFORM, 18.4 vs. 9.7%; both p ≤ 0.0001). These results remained significant after adjustment on risk factors and were attenuated in OPTIC after further adjustment on socioeconomic variables (hazard ratio 1.24; 95% CI 0.98-1.55; p = 0.07). Key Messages: Patients with ischemic stroke living in Arab countries had a lower mean socioeconomic status, a much higher prevalence of diabetes mellitus, and a higher rate of MACE compared with patients from non-Arab countries. This finding is partly explained by a higher prevalence of risk factors and also by a high prevalence of poverty and low educational level.
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Affiliation(s)
- Halim Abboud
- Hotel Dieu de France, Saint Joseph University, Beirut, Lebanon
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5
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Amarenco P, Sissani L, Labreuche J, Vicaut E, Bousser MG, Chamorro A, Fisher M, Ford I, Fox KM, Hennerici MG, Mattle H, Rothwell PM, Steg PG, Diener HC, Sacco RL, Greving JP, Algra A. The Intracranial-B2LEED3S Score and the Risk of Intracranial Hemorrhage in Ischemic Stroke Patients Under Antiplatelet Treatment. Cerebrovasc Dis 2017; 43:145-151. [PMID: 28088798 DOI: 10.1159/000453459] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 10/13/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Chronic antiplatelet therapy in the post-acute phase of non-cardioembolic ischemic stroke is limited by the risk of intracranial hemorrhage (ICH) complications. METHODS We developed an ICH risk score based on the PERFORM trial cohort (n = 19,100), which included patients with a non-cardioembolic ischemic stroke or transient ischemic attack, and externally validated this score in one contemporary trial of very similar size and inclusion criteria, the PRoFESS trial (n = 20,332 patients). Outcome was ICH over 2 years. A Cox proportional-hazard regression analysis identified risk factors. Discrimination was quantified with c-statistics and calibration was assessed by comparing predicted and observed ICH risk in PERFORM and PRoFESS. RESULTS ICH occurred within 2 years in 263 (1.4%) patients in PERFORM trial and in 246 (1.2%) patients in PRoFESS trial. A 13-point score based on 9 items (Intracranial-B2LEED3S score - low body mass index, blood pressure, lacune, elderly, Asian ethnicity, coronary artery or cerebrovascular disease history, dual antithrombotic agent or oral anticoagulant, gender) was derived from the PERFORM trial. In PERFORM, the observed 2-year ICH risk varied from 0.75% in low-risk (score ≤2) to 2.44% in high-risk patients (score ≥5) with an acceptable calibration but a low discrimination both in PERFORM (c-statistic 0.64, 95% CI 0.61-0.68) and on external validation in PRoFESS (0.58, 95% CI 0.55-0.62). CONCLUSION The Intracranial-B2LEED3S score helps identify patients who are at a high risk of bleeding. However, other variables need to be identified to improve the score (e.g., microbleeds) (Clinical Trial Registration Information ISRCTN66157730). URL: http://www.isrctn.com/ISRCTN66157730?totalResults=5&pageSize=10&page=1&searchType=basic-search&offset=3&q=&filters=conditionCategory%3ACirculatory+System%2CrecruitmentCountry%3ATaiwan%2CrecruitmentCountry%3AAustria&sort=.
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6
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Mawhin MA, Tilly P, Fabre JE. The receptor EP3 to PGE2: A rational target to prevent atherothrombosis without inducing bleeding. Prostaglandins Other Lipid Mediat 2015; 121:4-16. [PMID: 26463849 DOI: 10.1016/j.prostaglandins.2015.10.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Revised: 09/23/2015] [Accepted: 10/01/2015] [Indexed: 10/22/2022]
Abstract
The prostanoid E2 (PGE2) is known to modulate the aggregative response of platelets to their conventional agonists such as ADP, TXA2, thrombin or collagen. Through the activation of its receptor EP3, PGE2 sensitizes platelets to their agonists but also inhibits them through its two other receptors, EP2 and EP4. In mice, the net result of these opposed actions is the EP3-mediated potentiation of platelet aggregation and the in vivo aggravation of murine atherothrombosis. Since the pathway PGE2/EP3 is not involved in murine hemostasis, we propose a "platelet EP3 paradigm" to describe this apparently paradoxical association between the facilitating impact on atherothrombosis and the unaltered hemostasis. Consistent with this paradigm, a drug blocking EP3 dramatically decreased atherothrombosis without inducing bleeding in mice. In humans, several studies did not agree on the effect of PGE2 on platelets. Reinterpreting these data with the notion of "potentiation window" and taking the platelet initial cAMP level into account reconciled these inconsistent results. Thereby, the in vitro potentiating effect of PGE2 on human platelets becomes clear. In addition, the EP3 blocking drug DG-041 abrogated the potentiating effect of PGE2 in whole human blood but did not prolong bleeding times in volunteers. Thus, the murine "platelet EP3 paradigm" would apply to humans if the aggravating role of PGE2 on atherothrombosis is shown in patients. Therefore, testing an EP3 blocker in a phase III trial would be of high interest to fulfill the unmet medical need which is to control atherothrombosis without impacting hemostasis and thus to improve the prevention of myocardial infarction.
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Affiliation(s)
- Marie-Anne Mawhin
- LVTS, Institut National de la santé et de la recherche Médicale U1148, Hôpital Bichat, Paris, 18ième, France
| | - Peggy Tilly
- Institut de Génétique et de Biologie Moléculaire et Cellulaire, Illkirch, France
| | - Jean-Etienne Fabre
- LVTS, Institut National de la santé et de la recherche Médicale U1148, Hôpital Bichat, Paris, 18ième, France.
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7
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Rebel AA, Urquhart SA, Puig KL, Ghatak A, Brose SA, Golovko MY, Combs CK. Brain changes associated with thromboxane receptor antagonist SQ 29,548 treatment in a mouse model. J Neurosci Res 2015; 93:1279-92. [PMID: 25703023 DOI: 10.1002/jnr.23578] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Revised: 01/22/2015] [Accepted: 01/22/2015] [Indexed: 01/08/2023]
Abstract
The purpose of this study was to characterize behavioral and physiological effects of a selective thromboxane (TP) receptor antagonist, SQ 29,548, in the C57Bl/6 mouse model. At 6 months of age, male mice were given either sham or drug i.p. injections for 3 days at a dose of 2 mg/kg each day. On the day after the final injection, mice were subjected to behavioral testing before brain collection. Left hemisphere hippocampi were collected from all mice for protein analysis via Western blot. Right brain hemispheres were fixed and embedded in gelatin and then serially sectioned. The sections were immunostained with anti-c-Fos antibodies. Prostaglandin analysis was performed from remaining homogenized brain samples, minus the hippocampi. Injection of SQ 29,548 decreased selective brain prostaglandin levels compared with sham controls. This correlated with robust increases in limbic-region c-Fos immunoreactivity in the SQ 29,548-injected mice. However, drug-treated mice demonstrated no significant changes in relevant hippocampal protein levels compared with sham treatments, as determined from Western blots. Surprisingly, injection of SQ 29,548 caused mixed changes in parameters of depression and anxiety-like behavior in the mice. In conclusion, the results indicate that administration of peripheral TP receptor antagonists alters brain levels of prostanoids and influences neuronal activity, with only minimal alterations of behavior. Whether the drug affects neurons directly or through a secondary pathway involving endothelium or other tissues remains unclear.
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Affiliation(s)
- Andrew A Rebel
- Department of Biology, University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota
| | - Siri A Urquhart
- Department of Biology, University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota
| | - Kendra L Puig
- Department of Basic Sciences, University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota
| | - Atreyi Ghatak
- Department of Basic Sciences, University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota
| | - Stephen A Brose
- Department of Basic Sciences, University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota
| | - Mikhail Y Golovko
- Department of Basic Sciences, University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota
| | - Colin K Combs
- Department of Basic Sciences, University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota
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Wang X, Liu L, Huang L, Herbst-Robinson K, Cornec AS, James MJ, Sugiyama S, Bassetto M, Brancale A, Trojanowski JQ, Lee VMY, Smith AB, Brunden KR, Ballatore C. Potent, long-acting cyclopentane-1,3-Dione thromboxane (A2)-receptor antagonists. ACS Med Chem Lett 2014; 5:1015-20. [PMID: 25221659 DOI: 10.1021/ml5002085] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 07/17/2014] [Indexed: 11/29/2022] Open
Abstract
A series of derivatives of the known thromboxane A2 prostanoid (TP) receptor antagonists, 3-(6-((4-chlorophenyl)sulfonamido)-5,6,7,8-tetrahydronaphthalen-1-yl)propanoic acid and 3-(3-(2-((4-chlorophenyl)sulfonamido)ethyl)phenyl) propanoic acid, were synthesized in which the carboxylic acid functional group was replaced with substituted cyclopentane-1,3-dione (CPD) bioisosteres. Characterization of these molecules led to the discovery of remarkably potent new analogues, some of which were considerably more active than the corresponding parent carboxylic acid compounds. Depending on the choice of the C2 substituent of the CPD unit, these new derivatives can produce either a reversible or an apparent irreversible inhibition of the human TP receptor. Given the potency and the long-lasting inhibition of TP receptor signaling, these novel antagonists may comprise promising leads for the development of antithromboxane therapies.
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Affiliation(s)
| | | | | | | | | | | | | | - Marcella Bassetto
- School
of Pharmacy and Pharmaceutical Sciences, Cardiff University, King Edward VII Avenue, Cardiff CF10 3NB, United Kingdom
| | - Andrea Brancale
- School
of Pharmacy and Pharmaceutical Sciences, Cardiff University, King Edward VII Avenue, Cardiff CF10 3NB, United Kingdom
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9
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Sirimarco G, Labreuche J, Bruckert E, Goldstein LB, Fox KM, Rothwell PM, Amarenco P, Bousser MG, Chamorro A, Ford I, Fox K, Fisher M, Hennerici MG, Mattle H, Rothwell PM, Callahan F, Goldstein LB, Sillesen H, Welch KMA, Zivin JA. Atherogenic Dyslipidemia and Residual Cardiovascular Risk in Statin-Treated Patients. Stroke 2014; 45:1429-36. [DOI: 10.1161/strokeaha.113.004229] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Treatment with statins reduces the rate of cardiovascular events in high-risk patients, but residual risk persists. At least part of that risk may be attributable to atherogenic dyslipidemia characterized by low high-density lipoprotein cholesterol (≤40 mg/dL) and high triglycerides (triglycerides ≥150 mg/dL).
Methods—
We studied subjects with stroke or transient ischemic attack in the Prevention of Cerebrovascular and Cardiovascular Events of Ischemic Origin With Terutroban in Patients With a History of Ischemic Stroke or Transient Ischemic Attack (PERFORM; n=19 100) and Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL; n=4731) trials who were treated with a statin and who had high-density lipoprotein cholesterol and triglycerides measurements 3 months after randomization (n=10 498 and 2900, respectively). The primary outcome measure for this exploratory analysis was the occurrence of major cardiovascular events (nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death). We also performed a time-varying analysis to account for all available high-density lipoprotein cholesterol and triglyceride measurements.
Results—
A total of 10% of subjects in PERFORM and 9% in SPARCL had atherogenic dyslipidemia after ≥3 months on start statin therapy. After a follow-up of 2.3 years (PERFORM) and 4.9 years (SPARCL), a major cardiovascular event occurred in 1123 and 485 patients in the 2 trials, respectively. The risk of major cardiovascular events was higher in subjects with versus those without atherogenic dyslipidemia in both PERFORM (hazard ratio, 1.36; 95% confidence interval, 1.14–1.63) and SPARCL (hazard ratio, 1.40; 95% confidence interval, 1.06–1.85). The association was attenuated after multivariable adjustment (hazard ratio, 1.23; 95% confidence interval, 1.03–1.48 in PERFORM and hazard ratio, 1.24; 95% confidence interval, 0.93–1.65 in SPARCL). Time-varying analysis confirmed these findings.
Conclusions—
The presence of atherogenic dyslipidemia was associated with higher residual cardiovascular risk in PERFORM and SPARCL subjects with stroke or transient ischemic attack receiving statin therapy. Specific therapeutic interventions should now be trialed to address this residual risk.
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Affiliation(s)
- Gaia Sirimarco
- From the INSERM U698 and Paris-Diderot University, Sorbonne Paris Cité, Paris, France (G.S., J.L., P.A.); Department of Neurology and Stroke Centre, Bichat University Hospital, Paris, France (G.S., P.A.); Department of Biostatistics, EA2694, UDSL, University of Lille Nord de France, CHU Lille, Lille, France (J.L.); Department of Endocrinology, Pitié-Salpêtrière University Hospital, Paris, France (E.B.); Department of Neurology, Duke Comprehensive Stroke Center, Durham VAMC, Durham, NC (L.B.G.); NHLI
| | - Julien Labreuche
- From the INSERM U698 and Paris-Diderot University, Sorbonne Paris Cité, Paris, France (G.S., J.L., P.A.); Department of Neurology and Stroke Centre, Bichat University Hospital, Paris, France (G.S., P.A.); Department of Biostatistics, EA2694, UDSL, University of Lille Nord de France, CHU Lille, Lille, France (J.L.); Department of Endocrinology, Pitié-Salpêtrière University Hospital, Paris, France (E.B.); Department of Neurology, Duke Comprehensive Stroke Center, Durham VAMC, Durham, NC (L.B.G.); NHLI
| | - Eric Bruckert
- From the INSERM U698 and Paris-Diderot University, Sorbonne Paris Cité, Paris, France (G.S., J.L., P.A.); Department of Neurology and Stroke Centre, Bichat University Hospital, Paris, France (G.S., P.A.); Department of Biostatistics, EA2694, UDSL, University of Lille Nord de France, CHU Lille, Lille, France (J.L.); Department of Endocrinology, Pitié-Salpêtrière University Hospital, Paris, France (E.B.); Department of Neurology, Duke Comprehensive Stroke Center, Durham VAMC, Durham, NC (L.B.G.); NHLI
| | - Larry B. Goldstein
- From the INSERM U698 and Paris-Diderot University, Sorbonne Paris Cité, Paris, France (G.S., J.L., P.A.); Department of Neurology and Stroke Centre, Bichat University Hospital, Paris, France (G.S., P.A.); Department of Biostatistics, EA2694, UDSL, University of Lille Nord de France, CHU Lille, Lille, France (J.L.); Department of Endocrinology, Pitié-Salpêtrière University Hospital, Paris, France (E.B.); Department of Neurology, Duke Comprehensive Stroke Center, Durham VAMC, Durham, NC (L.B.G.); NHLI
| | - Kim M. Fox
- From the INSERM U698 and Paris-Diderot University, Sorbonne Paris Cité, Paris, France (G.S., J.L., P.A.); Department of Neurology and Stroke Centre, Bichat University Hospital, Paris, France (G.S., P.A.); Department of Biostatistics, EA2694, UDSL, University of Lille Nord de France, CHU Lille, Lille, France (J.L.); Department of Endocrinology, Pitié-Salpêtrière University Hospital, Paris, France (E.B.); Department of Neurology, Duke Comprehensive Stroke Center, Durham VAMC, Durham, NC (L.B.G.); NHLI
| | - Peter M. Rothwell
- From the INSERM U698 and Paris-Diderot University, Sorbonne Paris Cité, Paris, France (G.S., J.L., P.A.); Department of Neurology and Stroke Centre, Bichat University Hospital, Paris, France (G.S., P.A.); Department of Biostatistics, EA2694, UDSL, University of Lille Nord de France, CHU Lille, Lille, France (J.L.); Department of Endocrinology, Pitié-Salpêtrière University Hospital, Paris, France (E.B.); Department of Neurology, Duke Comprehensive Stroke Center, Durham VAMC, Durham, NC (L.B.G.); NHLI
| | - Pierre Amarenco
- From the INSERM U698 and Paris-Diderot University, Sorbonne Paris Cité, Paris, France (G.S., J.L., P.A.); Department of Neurology and Stroke Centre, Bichat University Hospital, Paris, France (G.S., P.A.); Department of Biostatistics, EA2694, UDSL, University of Lille Nord de France, CHU Lille, Lille, France (J.L.); Department of Endocrinology, Pitié-Salpêtrière University Hospital, Paris, France (E.B.); Department of Neurology, Duke Comprehensive Stroke Center, Durham VAMC, Durham, NC (L.B.G.); NHLI
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Chabriat H, Maeder P, Gass A, Michel P, Bracoud L, Hennerici MG. Results of the PERFORM magnetic resonance imaging study. J Neurol 2013; 260:3071-6. [DOI: 10.1007/s00415-013-7111-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Revised: 09/10/2013] [Accepted: 09/12/2013] [Indexed: 10/26/2022]
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Weitz JI, Eikelboom JW, Samama MM. New antithrombotic drugs: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141:e120S-e151S. [PMID: 22315258 DOI: 10.1378/chest.11-2294] [Citation(s) in RCA: 161] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
This article focuses on new antithrombotic drugs that are in or are entering phase 3 clinical testing. Development of these new agents was prompted by the limitations of existing antiplatelet, anticoagulant, or fibrinolytic drugs. Addressing these unmet needs, this article (1) outlines the rationale for development of new antithrombotic agents; (2) describes the new antiplatelet, anticoagulant, and fibrinolytic drugs; and (3) provides clinical perspectives on the opportunities and challenges faced by these novel agents.
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Affiliation(s)
- Jeffrey I Weitz
- Thrombosis and Atherosclerosis Research Institute and Department of Medicine, McMaster University, Hamilton, ON, Canada; Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON, Canada.
| | - John W Eikelboom
- Thrombosis and Atherosclerosis Research Institute and Department of Medicine, McMaster University, Hamilton, ON, Canada
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12
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Abstract
Atherothrombosis remains a major global public health problem. Chronic atherosclerotic disease is often clinically silent and coexists across vascular beds, but when complicated by thrombosis can result in acute coronary syndrome, stroke, transient ischaemic attack and critical limb ischaemia. Platelets play a role in the development of chronic atherosclerotic disease and are a key mediator of clinical events in atherothrombosis. Numerous trials have examined the role of antiplatelet agents in primary and secondary prevention and several new antiplatelet drugs are under development. In secondary prevention, there is evidence of clear benefit of single and in some cases dual antiplatelet therapy in the prevention of recurrent cerebro-vascular complications. Dual antiplatelet therapy has emerged as the standard of care in acute coronary syndromes, with aspirin typically being used in combination with clopidogrel or one of the newer more potent antiplatelet agents. Conversely, in chronic stable coronary disease, no benefit has yet been convincingly demonstrated from dual antiplatelet therapy. In cerebro-vascular disease, aspirin monotherapy remains the cornerstone of prevention of recurrent events, with clopidogrel or the combination of aspirin and dipyridamole being only modestly more efficacious. In primary prevention, the evidence for the routine use of aspirin or any other antiplatelet agent is mixed and suggests this should only be considered on an individual basis in high-risk groups where the thrombotic risk outweighs the risk of major bleeding complications.
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Affiliation(s)
- Ph G Steg
- INSERM U-698, Université Paris-Diderot, Assistance Publique-Hôpitaux de Paris, Paris, France.
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13
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Bousser MG, Amarenco P, Chamorro A, Fisher M, Ford I, Fox KM, Hennerici MG, Mattle HP, Rothwell PM, de Cordoüe A, Fratacci MD. Terutroban versus aspirin in patients with cerebral ischaemic events (PERFORM): a randomised, double-blind, parallel-group trial. Lancet 2011; 377:2013-22. [PMID: 21616527 DOI: 10.1016/s0140-6736(11)60600-4] [Citation(s) in RCA: 161] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Patients with ischaemic stroke or transient ischaemic attack (TIA) are at high risk of recurrent stroke or other cardiovascular events. We compared the selective thromboxane-prostaglandin receptor antagonist terutroban with aspirin in the prevention of cerebral and cardiovascular ischaemic events in patients with a recent non-cardioembolic cerebral ischaemic event. METHODS This randomised, double-blind, parallel-group trial was undertaken in 802 centres in 46 countries. Patients who had an ischaemic stroke in the previous 3 months or a TIA in the previous 8 days were randomly allocated with a central interactive response system to 30 mg per day terutroban or 100 mg per day aspirin. Patients and investigators were masked to treatment allocation. The primary efficacy endpoint was a composite of fatal or non-fatal ischaemic stroke, fatal or non-fatal myocardial infarction, or other vascular death (excluding haemorrhagic death). We planned a sequential statistical analysis of non-inferiority (margin 1·05) followed by analysis of superiority. Analysis was by intention to treat. The study was stopped prematurely for futility on the basis of the recommendation of the Data Monitoring Committee. This study is registered, number ISRCTN66157730. FINDINGS 9562 patients were assigned to terutroban (9556 analysed) and 9558 to aspirin (9544 analysed); mean follow-up was 28·3 months (SD 7·7). The primary endpoint occurred in 1091 (11%) patients receiving terutroban and 1062 (11%) receiving aspirin (hazard ratio [HR] 1·02, 95% CI 0·94-1·12). There was no evidence of a difference between terutroban and aspirin for the secondary or tertiary endpoints. We recorded some increase in minor bleedings with terutroban compared with aspirin (1147 [12%] vs 1045 [11%]; HR 1·11, 95% CI 1·02-1·21), but no significant differences in other safety endpoints. INTERPRETATION The trial did not meet the predefined criteria for non-inferiority, but showed similar rates of the primary endpoint with terutroban and aspirin, without safety advantages for terutroban. In a worldwide perspective, aspirin remains the gold standard antiplatelet drug for secondary stroke prevention in view of its efficacy, tolerance, and cost. FUNDING Servier, France.
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Rothwell PM, Algra A, Amarenco P. Medical treatment in acute and long-term secondary prevention after transient ischaemic attack and ischaemic stroke. Lancet 2011; 377:1681-92. [PMID: 21571151 DOI: 10.1016/s0140-6736(11)60516-3] [Citation(s) in RCA: 128] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Stroke is a major cause of death and disability worldwide. Without improvements in prevention, the burden will increase during the next 20 years because of the ageing population, especially in developing countries. Major advances have occurred in secondary prevention during the past three decades, which demonstrate the broader potential to prevent stroke. We review the main medical treatments that should be considered for most patients with transient ischaemic attack or ischaemic stroke in the acute phase and the long term, and draw attention to recent developments.
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Affiliation(s)
- Peter M Rothwell
- Stroke Prevention Research Unit, Department of Clinical Neurology, University of Oxford, Oxford, UK.
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15
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Gelosa P, Sevin G, Pignieri A, Budelli S, Castiglioni L, Blanc-Guillemaud V, Lerond L, Tremoli E, Sironi L. Terutroban, a thromboxane/prostaglandin endoperoxide receptor antagonist, prevents hypertensive vascular hypertrophy and fibrosis. Am J Physiol Heart Circ Physiol 2011; 300:H762-8. [DOI: 10.1152/ajpheart.00880.2010] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Thromboxane A2 and other eicosanoids such as isoprostanes contribute to vascular proliferation and atherosclerosis by binding to the thromboxane/prostaglandin endoperoxide receptors. The effects of terutroban, a thromboxane/prostaglandin endoperoxide receptor antagonist, on aorta remodeling were evaluated in spontaneously hypertensive stroke-prone rats (SHRSPs), a model of severe hypertension, endothelial dysfunction, vascular inflammation, and cerebrovascular diseases. Male SHRSPs were allocated to three groups receiving a standard diet ( n = 5) or a high-sodium permissive diet plus vehicle ( n = 6) or plus terutroban (30 mg·kg−1·day−1; n = 6). After 6 wk of dietary treatment, all of the animals were injected with bromodeoxyuridine and simultaneously euthanized for aorta collection. The aortic media thickness-to-lumen ratio significantly ( P < 0.0001) increased in the salt-loaded rats compared with the rats fed a standard diet, whereas terutroban treatment completely prevented media thickening ( P < 0.001). When compared with vehicle, terutroban was also effective in preventing cell proliferation in the media, as indicated by the reduced number of bromodeoxyuridine-positive ( P < 0.0001) and proliferating cell nuclear antigen-positive cells ( P < 0.0001). Severe fibrosis characterized by a significant accumulation of collagen and fibronectin in the vascular wall was observed in the vehicle-treated rats ( P < 0.01) but was completely prevented by terutroban ( P < 0.001). The latter also inhibited heat shock protein-47 ( P < 0.01) and TGF-1β expression ( P < 0.001), which were significantly increased by the high-salt diet. In conclusion, terutroban prevents the development of aorta hyperplasia and has beneficial effects on fibrotic processes by affecting TGF-β and heat shock protein-47 expression in SHRSPs. These findings provide mechanistic data supporting the beneficial effects of terutroban in preventing or retarding atherogenesis.
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Affiliation(s)
- Paolo Gelosa
- Department of Pharmacological Sciences, University of Milan, Milan, and
| | - Gulnur Sevin
- Department of Pharmacological Sciences, University of Milan, Milan, and
| | - Alice Pignieri
- Department of Pharmacological Sciences, University of Milan, Milan, and
| | - Silvia Budelli
- Department of Pharmacological Sciences, University of Milan, Milan, and
| | - Laura Castiglioni
- Department of Pharmacological Sciences, University of Milan, Milan, and
| | | | - Laurence Lerond
- Institut de Recherches Internationales Servier, Courbevoie Cedex, France
| | - Elena Tremoli
- Department of Pharmacological Sciences, University of Milan, Milan, and
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy; and
| | - Luigi Sironi
- Department of Pharmacological Sciences, University of Milan, Milan, and
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy; and
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Maeder P, Bracoud L, Chabriat H, Gass A, Michel P, Hennerici M. Design, data management, and population baseline characteristics of the PERFORM magnetic resonance imaging project. J Neurol 2010; 258:795-803. [PMID: 21128081 PMCID: PMC3090565 DOI: 10.1007/s00415-010-5841-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2010] [Revised: 10/22/2010] [Accepted: 11/15/2010] [Indexed: 11/29/2022]
Abstract
Quantitative information from magnetic resonance imaging (MRI) may substantiate clinical findings and provide additional insight into the mechanism of clinical interventions in therapeutic stroke trials. The PERFORM study is exploring the efficacy of terutroban versus aspirin for secondary prevention in patients with a history of ischemic stroke. We report on the design of an exploratory longitudinal MRI follow-up study that was performed in a subgroup of the PERFORM trial. An international multi-centre longitudinal follow-up MRI study was designed for different MR systems employing safety and efficacy readouts: new T2 lesions, new DWI lesions, whole brain volume change, hippocampal volume change, changes in tissue microstructure as depicted by mean diffusivity and fractional anisotropy, vessel patency on MR angiography, and the presence of and development of new microbleeds. A total of 1,056 patients (men and women ≥ 55 years) were included. The data analysis included 3D reformation, image registration of different contrasts, tissue segmentation, and automated lesion detection. This large international multi-centre study demonstrates how new MRI readouts can be used to provide key information on the evolution of cerebral tissue lesions and within the macrovasculature after atherothrombotic stroke in a large sample of patients.
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Affiliation(s)
- P Maeder
- Centre Hospitalier Universitaire Vaudois, Service de Radiologie, Lausanne, Switzerland.
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18
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Agewall S, Badimon L, Drouet L, Eschenhagen T, Husted S, Simon T, Steg G. Oral antiplatelet agents in ACS: from pharmacology to clinical differences. Fundam Clin Pharmacol 2010; 25:564-71. [DOI: 10.1111/j.1472-8206.2010.00890.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kei AA, Florentin M, Mikhailidis DP, Elisaf MS, Liberopoulos EN. Review: Antiplatelet Drugs: What Comes Next? Clin Appl Thromb Hemost 2010; 17:9-26. [DOI: 10.1177/1076029610385222] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Antiplatelet drugs are important components in the management of atherothrombotic vascular disease. However, several limitations restrict the safety and efficacy of current antiplatelet therapy in clinical practice. Interpatient variability and resistance to aspirin and/or clopidogrel has spurred efforts for the development of novel agents. Indeed, several antiplatelet drugs are at various stages of evaluation; those at advanced stage of development are the focus of this review.
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Affiliation(s)
- Anastazia A. Kei
- Department of Internal Medicine, University of Ioannina Medical School, Ioannina, Greece
| | - Matilda Florentin
- Department of Internal Medicine, University of Ioannina Medical School, Ioannina, Greece, Department of Clinical Biochemistry (Vascular Disease Prevention Clinics), Royal Free Campus, University College London Medical School, University College London (UCL), London, UK
| | - Dimitri P. Mikhailidis
- Department of Clinical Biochemistry (Vascular Disease Prevention Clinics), Royal Free Campus, University College London Medical School, University College London (UCL), London, UK
| | - Moses S. Elisaf
- Department of Internal Medicine, University of Ioannina Medical School, Ioannina, Greece
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20
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Hennerici MG, Bots ML, Ford I, Laurent S, Touboul PJ. Rationale, design and population baseline characteristics of the PERFORM vascular project: an ancillary study of the Prevention of cerebrovascular and cardiovascular Events of ischemic origin with teRutroban in patients with a history oF ischemic strOke or tRansient ischeMic attack (PERFORM) trial. Cardiovasc Drugs Ther 2010; 24:175-80. [PMID: 20490906 PMCID: PMC2887499 DOI: 10.1007/s10557-010-6231-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Purpose PERFORM is exploring the efficacy of terutroban versus aspirin for secondary prevention in patients with a history of ischemic stroke or transient ischemic attacks (TIAs). The PERFORM Vascular Project will evaluate the effect of terutroban on progression of atherosclerosis, as assessed by change in carotid intima-media thickness (CIMT) in a subgroup of patients. Methods and results The Vascular Project includes structural (CIMT, carotid plaques) and functional (carotid stiffness) vascular studies in all patients showing at least one carotid plaque at entry. Expected mean follow-up is 36 months. Primary endpoint is rate of change of CIMT. Secondary endpoints include emergent plaques and assessment of carotid stiffness. 1,100 patients are required for 90% statistical power to detect treatment-related CIMT difference of 0.025 mm. The first patient was randomized in April 2006. Conclusions The PERFORM Vascular Project will investigate terutroban’s effect on vascular structure and function in patients with a history of ischemic stroke or TIAs.
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Fiessinger JN, Bounameaux H, Cairols MA, Clement DL, Coccheri S, Fletcher JP, Hoffmann U, Turpie AGG. Thromboxane Antagonism with terutroban in Peripheral Arterial Disease: the TAIPAD study. J Thromb Haemost 2010; 8:2369-76. [PMID: 20723034 DOI: 10.1111/j.1538-7836.2010.04020.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Terutroban is a selective prostaglandin endoperoxide (TP) receptor antagonist with antithrombotic, antivasoconstrictive and antiatherosclerotic properties and is currently in development for long-term cardiovascular secondary prevention. OBJECTIVES TAIPAD is an international, double-blind, randomized controlled study comparing the effects of five dosages of oral terutroban vs. aspirin and placebo on platelet aggregation in peripheral arterial disease (PAD) patients. PATIENTS/METHODS After 10 day's placebo run-in, included patients (n = 435; ankle-brachial pressure index, 0.7 ± 0.1) were randomly allocated to aspirin 75 mg day(-1), terutroban 1, 2.5, 5, 10 or 30 mg day(-1) or placebo. On day 5, the placebo group was reallocated to one of the terutroban groups for the rest of the study (day 83). Ex vivo platelet aggregation induced by the thromboxane analog U46619 (7 μm) was measured 24 h after dosing, as well as platelet aggregation induced by arachidonic acid (AA), collagen and ADP. RESULTS Terutroban dose-dependently inhibited U46619-induced platelet aggregation at days 5 and 83. At day 5, the inhibition was significant vs. placebo for all terutroban dosages (P < 0.001). Terutroban (5, 10 and 30 mg day(-1)) was at least as effective as aspirin in inhibiting platelet aggregation induced by arachidonic acid (AA), collagen and adenosine diphosphate (ADP). Terutroban was well tolerated, with a safety profile similar to aspirin. CONCLUSIONS In PAD patients, terutroban dose-dependently inhibited platelet aggregation 24 h after dosing, and was at least as effective as aspirin at 5, 10 and 30 mg day(-1). Terutroban was well tolerated.
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Affiliation(s)
- J N Fiessinger
- Centre d'Investigation Clinique, Hôpital Européen Georges Pompidou, Université Descartes, Paris, France.
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22
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Abstract
The stimulation of thromboxane/endoperoxide receptors (TP) elicits diverse physiological/pathophysiological reactions, including platelet aggregation and contraction of vascular smooth muscle. Furthermore, the activation of endothelial TP promotes the expression of adhesion molecules and favors adhesion and infiltration of monocytes/macrophages. In various cardiovascular diseases, endothelial dysfunction is predominantly the result of the release of endothelium-derived contracting factors that counteract the vasodilator effect of nitric oxide produced by the endothelial nitric oxide synthase. Endothelium-dependent contractions involve the activation of cyclooxygenases, the production of reactive oxygen species along with that of endothelium-derived contracting factors, which diffuse toward the vascular smooth muscle cells and activate their TP. TP antagonists curtail the endothelial dysfunction in diseases such as hypertension and diabetes, are potent antithrombotic agents, and reduce vascular inflammation. Therefore, TP antagonists, because of this triple activity, may have a unique potential for the treatment of cardiovascular disorders.
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Abstract
Platelet responsiveness to conventional antiplatelet therapy underlies a high interindividual variability influenced by various factors. For instance, antiplatelet therapy does not curtail the expected effects in a relevant number of patients as demonstrated by the occurrence of repeated cardiovascular events including stent thrombosis and/or by inadequate platelet inhibition measured by in vitro platelet function assays. Besides non-genetic factors such as age, gender, liver and renal function and co-medication, considerable variation of antiplatelet drug responsiveness can be attributed to genetic factors including polymorphisms and genetic variants of platelet surface proteins and drug metabolizing enzymes. Nowadays, platelet pharmacogenomics has started a new field with the goal to link genetic information of various drug targets to interindividual variability of drug response. Evolving data from large cohort studies suggest a promising role for pharmacogenomics in the context of antiplatelet therapy. Additionally, with the revolution of low cost and high-throughput genotyping techniques, genetic testing has become affordable for clinical application and individualization of therapy. However, a key issue to define the future role of pharmacogenomics will rely on the benefit and the timeliness of implementing the genetic information into therapeutic decision. Hence, it warrants further investigations to document the prognostic effects of therapeutic alterations in distinct genotypes. Concerning the safety profile of emerging antiplatelet and antithrombotic drugs in certain risk groups it would be fatal to individualize treatment barely on behalf of an atherothrombotic genotype. In contrast, individual risk assessment combining non-genetic information and pharmacogenetic analysis represents a reasonable concept. Here, we provide a review on current data describing the role of pharmacogenomics in the field of antiplatelet drug treatment in cardiovascular patients with future directions.
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Affiliation(s)
- C S Zuern
- Medizinische Klinik, Abteilung Kardiologie und Kreislauferkrankungen, University Hospital Tuebingen, Tuebingen, Germany.
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Gelosa P, Ballerio R, Banfi C, Nobili E, Gianella A, Pignieri A, Brioschi M, Guerrini U, Castiglioni L, Blanc-Guillemaud V, Lerond L, Tremoli E, Sironi L. Terutroban, a Thromboxane/Prostaglandin Endoperoxide Receptor Antagonist, Increases Survival in Stroke-Prone Rats by Preventing Systemic Inflammation and Endothelial Dysfunction: Comparison with Aspirin and Rosuvastatin. J Pharmacol Exp Ther 2010; 334:199-205. [DOI: 10.1124/jpet.110.165787] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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