Therapeutic targets of oxidative/nitrosative stress and neuroinflammation in ischemic stroke: Applications for natural product efficacy with omics and systemic biology

Oxidative/nitrosative stress and neuroinflammation are critical pathological processes in cerebral ischemia-reperfusion injury, and their intimate interactions mediate neuronal damage, blood-brain barrier (BBB) damage and hemorrhagic transformation (HT) during ischemic stroke. We review current progress towards understanding the interactions of oxidative/nitrosative stress and inflammatory responses in ischemic brain injury. The interactions between reactive oxygen species (ROS)/reactive nitrogen species (RNS) and innate immune receptors such as TLR2/4, NOD-like receptor, RAGE, and scavenger receptors are crucial pathological mechanisms that amplify brain damage during cerebral ischemic injury. Furthermore, we review the current progress of omics and systematic biology approaches for studying complex network regulations related to oxidative/nitrosative stress and inflammation in the pathology of ischemic stroke. Targeting oxidative/nitrosative stress and neuroinflammation could be a promising therapeutic strategy for ischemic stroke treatment. We then review recent advances in discovering compounds from medicinal herbs with the bioactivities of simultaneously regulating oxidative/nitrosative stress and pro-inflammatory molecules for minimizing ischemic brain injury. These compounds include sesamin, baicalin, salvianolic acid A, 6-paradol, silymarin, apocynin, 3H-1,2-Dithiole-3-thione, (-)-epicatechin, rutin, Dl-3-N-butylphthalide, and naringin. We finally summarize recent developments of the omics and systematic biology approaches for exploring the molecular mechanisms and active compounds of Traditional Chinese Medicine (TCM) formulae with the properties of antioxidant and anti-inflammation for neuroprotection. The comprehensive omics and systematic biology approaches provide powerful tools for exploring therapeutic principles of TCM formulae and developing precision medicine for stroke treatment.

Nao-Xue-Shu Oral Liquid Protects and Improves Secondary Brain Insults of Hypertensive Cerebral Hemorrhage

Aim. To determine one traditional Chinese medicine (TCM) Nao-Xue-Shu oral liquid which protects and improves secondary brain insults (SBI) in hypertensive cerebral hemorrhage (HCH). Methods. 158 patients with HCH were divided into routine clinical medicine plus Nao-Xue-Shu oral liquid (n = 78) as treatment group, and routine clinical medicine (n = 80) only served as the control group. The incidence of SBI and the classification of a favorable prognosis and a bad prognosis using the Glasgow outcome scale (GOS) were assessed to evaluate the clinical effects. The changes of IL-6 and TNF-α levels were determined to study the mechanism of the effects for the TCM. Results. The incidence of SBI at the end of week 2 was 8.97% in the treatment group and 23.75% in the control group, and the difference was significant (P < 0.001). The incidence of a favorable prognosis was 48.72% in the treatment group and 32.72% in the control group, and the difference was significant (P < 0.01) at the end of week 2. These findings indicate clear differences for IL-6 and TNF-α at the end of week 1 and week 2 compared with before treatment for the treatment group and a marked difference at the end of week 2 between the two groups. It also shows a significant difference between the end of week 2 and before treatment for IL-6 and TNF-α for the control group, although the difference was much smaller than the treatment group. Conclusion. Nao-Xue-Shu oral liquid could protect against the occurrence of SBI and improve HCH and SBI patients. It may also decrease the damage and the mass effects of the hematoma by reducing IL-6 and TNF-α to obtain the effects, and thus it is a potentially suitable drug for HCH and SBI.

Nao-Xue-Shu Oral Liquid Improves Aphasia of Mixed Stroke

Objective. The objective is to observe whether the traditional Chinese medicine (TCM) Nao-Xue-Shu oral liquid improves aphasia of mixed stroke. Methods. A total of 102 patients with aphasia of mixed stroke were divided into two groups by a single blind random method. The patients treated by standard Western medicine plus Nao-Xue-Shu oral liquid (n = 58) were assigned to the treatment group while the remaining patients treated only by standard Western medicine (n = 58) constituted the control group. Changes in the Western Aphasia Battery (WAB), Modified Rankin Scale (mRS), National Institutes of Health Stroke Scale (NIHSS), and hemorheology parameters were assessed to evaluate the effects of the treatments. Results. Excluding the patients who dropped out, 54 patients in the treatment group and 51 patients in the control group were used to evaluate the effects. Significant and persistent improvements in the WAB score, specifically comprehension, repetition, naming, and calculating, were found in the treatment group when the effects were evaluated at the end of week 2 and week 4, respectively, compared with baseline. The naming and writing scores were also improved at the end of week 4 in this group. The comprehension and reading scores were improved at the end of week 4 in the control group compared with the baseline, but the improvements were smaller than those in the treatment group. The percentages of patients at the 0-1 range of mRS were increased at the end of week 2 and week 4 in both groups, but the improvements in the treatment group were much larger than those in the control group. Greater improvements in the NIHSS scores and the hemorheology parameters in the treatment group were also observed compared with the control group at the end of week 2 and week 4. Conclusion. Nao-Xue-Shu oral liquid formulation improved aphasia in mixed stroke patients and thus might be a potentially effective drug for treating stroke aphasia.