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Cho YD, Byoun HS, Park KH, Won YI, Lim J. The Impact of Enteral Nimodipine on Endothelial Cell Apoptosis in an Animal Subarachnoid Hemorrhage Model. Neurocrit Care 2024; 41:608-618. [PMID: 38589694 DOI: 10.1007/s12028-024-01980-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 03/11/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND Enteral nimodipine is the most evidence-based and widely used drug for the treatment of delayed cerebral ischemia and is known to have various neuroprotective functions. However, the neuroprotective mechanism of nimodipine still remains unclear, and the effects of nimodipine remain ambiguous. Herein, we studied the effect of enteral nimodipine on endothelial apoptosis after subarachnoid hemorrhage (SAH). METHODS SAH was experimentally introduced in white rabbits (n = 42) that were grouped as follows: enteral nimodipine (SAH-nimodipine group, n = 14), a control that received normal saline (SAH-saline group, n = 13), and a control without hemorrhage (control group, n = 15). On the third day after SAH induction, the brain stem, including the vertebrobasilar vascular system, was extracted. The effects of enteral nimodipine were analyzed by group using histopathologic analysis, including immunohistochemical staining of apoptosis-related proteins (Bcl2 [anti-apoptotic] and Bax [pro-apoptotic]). RESULTS Cytoplasmic vacuolation of smooth muscle cells was observed in two SAH hemorrhagic groups and was more prominent in the SAH-saline group. Endothelial desquamation was observed only in the SAH-saline group. For the basilar artery, expression of Bcl2 and Bax in the SAH-nimodipine group was lower than that in the SAH-saline group, but significant differences were not observed (pBcl2 = 0.311 and pBax = 0.720, respectively). In penetrated arterioles, the expression of Bax in the SAH-nimodipine group was significantly lower than that of the SAH-saline group (p < 0.001). The thickness of the tunica media in the basilar artery was thinner in the SAH-nimodipine group than in the SAH-saline group (p < 0.001). CONCLUSIONS This study suggests that enteral nimodipine may have a neuroprotective function by inhibiting endothelial apoptosis in small arterioles and preventing smooth muscle cell proliferation in large arteries.
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Affiliation(s)
- Young Dae Cho
- Department of Radiology, Seoul National University Hospital and Seoul National University College of Medicine, Seoul, Korea
| | - Hyoung Soo Byoun
- Department of Neurosurgery, Chungnam National University Sejong Hospital, Sejong, South Korea
- Department of Neurosurgery, Chungnam National University School of Medicine, Daejeon, Korea
| | - Kwang Hyon Park
- Department of Neurosurgery, Chungnam National University Sejong Hospital, Sejong, South Korea
| | - Young Il Won
- Department of Neurosurgery, Chungnam National University Sejong Hospital, Sejong, South Korea
| | - Jeongwook Lim
- Department of Neurosurgery, Chungnam National University Sejong Hospital, Sejong, South Korea.
- Department of Neurosurgery, Chungnam National University School of Medicine, Daejeon, Korea.
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Zhang L, Sun H, Han Z. The impact of nimodipine combined with Ginkgo biloba extract on cognitive function and ADL scores in patients with Parkinson's disease: A retrospective study. Medicine (Baltimore) 2024; 103:e38720. [PMID: 39029001 PMCID: PMC11398803 DOI: 10.1097/md.0000000000038720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/21/2024] Open
Abstract
This study aims to explore the value of nimodipine combined with Ginkgo biloba extract in improving cognitive function and daily living abilities in patients with Parkinson's disease. Clinical data from 551 patients with Parkinson's disease admitted to the Neurology Department of the Affiliated Hospital of Beihua University from January 2022 to December 2022 were retrospectively collected. Cognitive function and daily living abilities were assessed in patients before treatment, and a reevaluation was conducted after 12 weeks of medication. Patients treated solely with nimodipine were categorized into the monotherapy group, while patients treated with nimodipine combined with Ginkgo biloba extract were included in the combination group. After 1:1 propensity score matching, a total of 83 pairs of patients were matched, and differences in relevant indicators between the 2 groups were compared. The total effective rate of treatment in the combination group was 90.36%, which was higher than the control group at 72.29% (P < .05). However, after treatment, the observation group showed higher Mini-Mental State Examination and activities of daily living scores compared to the control group (P < .05). The combined treatment of nimodipine and Ginkgo biloba extract in patients with Parkinson's disease has a significant effect and can effectively improve cognitive function and enhance daily living abilities.
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Affiliation(s)
- Lianlian Zhang
- Department of Pharmacy, Affiliated Hospital of Beihua University, Jilin, China
| | - Hua Sun
- Department of Endocrinology, Affiliated Hospital of Beihua University, Jilin, China
| | - Zaigang Han
- Department of Pharmacy, Affiliated Hospital of Beihua University, Jilin, China
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3
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Balaji PG, Bhimrao LS, Yadav AK. Revolutionizing Stroke Care: Nanotechnology-Based Brain Delivery as a Novel Paradigm for Treatment and Diagnosis. Mol Neurobiol 2024:10.1007/s12035-024-04215-3. [PMID: 38829514 DOI: 10.1007/s12035-024-04215-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 05/03/2024] [Indexed: 06/05/2024]
Abstract
Stroke, a severe medical condition arising from abnormalities in the coagulation-fibrinolysis cycle and metabolic processes, results in brain cell impairment and injury due to blood flow obstruction within the brain. Prompt and efficient therapeutic approaches are imperative to control and preserve brain functions. Conventional stroke medications, including fibrinolytic agents, play a crucial role in facilitating reperfusion to the ischemic brain. However, their clinical efficacy is hampered by short plasma half-lives, limited brain tissue distribution attributed to the blood-brain barrier (BBB), and lack of targeted drug delivery to the ischemic region. To address these challenges, diverse nanomedicine strategies, such as vesicular systems, polymeric nanoparticles, dendrimers, exosomes, inorganic nanoparticles, and biomimetic nanoparticles, have emerged. These platforms enhance drug pharmacokinetics by facilitating targeted drug accumulation at the ischemic site. By leveraging nanocarriers, engineered drug delivery systems hold the potential to overcome challenges associated with conventional stroke medications. This comprehensive review explores the pathophysiological mechanism underlying stroke and BBB disruption in stroke. Additionally, this review investigates the utilization of nanocarriers for current therapeutic and diagnostic interventions in stroke management. By addressing these aspects, the review aims to provide insight into potential strategies for improving stroke treatment and diagnosis through a nanomedicine approach.
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Affiliation(s)
- Paul Gajanan Balaji
- Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research (NIPER), Raebareli (An Institute of National Importance under Department of Pharmaceuticals, Ministry of Chemicals and Fertilizers, GOI), A Transit Campus at Bijnor-Sisendi Road, Near CRPF Base Camp, Sarojini Nagar, Lucknow, 226002, Uttar Pradesh, India
| | - Londhe Sachin Bhimrao
- Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research (NIPER), Raebareli (An Institute of National Importance under Department of Pharmaceuticals, Ministry of Chemicals and Fertilizers, GOI), A Transit Campus at Bijnor-Sisendi Road, Near CRPF Base Camp, Sarojini Nagar, Lucknow, 226002, Uttar Pradesh, India
| | - Awesh K Yadav
- Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research (NIPER), Raebareli (An Institute of National Importance under Department of Pharmaceuticals, Ministry of Chemicals and Fertilizers, GOI), A Transit Campus at Bijnor-Sisendi Road, Near CRPF Base Camp, Sarojini Nagar, Lucknow, 226002, Uttar Pradesh, India.
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Poore CP, Yang J, Wei S, Fhu CK, Bichler Z, Wang J, Soong TW, Liao P. Enhanced isradipine sensitivity in vascular smooth muscle cells due to hypoxia-induced Ca v1.2 splicing and RbFox1/Fox2 downregulation. FEBS J 2024. [PMID: 38794806 DOI: 10.1111/febs.17159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 03/15/2024] [Accepted: 05/07/2024] [Indexed: 05/26/2024]
Abstract
Calcium influx via the L-type voltage-gated Cav1.2 calcium channel in smooth muscle cells regulates vascular contraction. Calcium channel blockers (CCBs) are widely used to treat hypertension by inhibiting Cav1.2 channels. Using the vascular smooth muscle cell line, A7r5 and primary culture of cerebral vascular smooth muscle cells, we found that the expression and function of Cav1.2 channels are downregulated during hypoxia. Furthermore, hypoxia induces structural changes in Cav1.2 channels via alternative splicing. The expression of exon 9* is upregulated, whereas exon 33 is downregulated. Such structural alterations of Cav1.2 channels are caused by the decreased expression of RNA-binding proteins RNA-binding protein fox-1 homolog 1 and 2 (RbFox1 and RbFox2). Overexpression of RbFox1 and RbFox2 prevents hypoxia-induced exon 9* inclusion and exon 33 exclusion. Importantly, such structural alterations of the Cav1.2 channel partly contribute to the enhanced sensitivity of Cav1.2 to isradipine (a CCB) under hypoxia. Overexpression of RbFox1 and RbFox2 successfully reduces isradipine sensitivity in hypoxic smooth muscle cells. Our results suggest a new strategy to manage ischemic diseases such as stroke and myocardial infarction.
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Affiliation(s)
| | - Jialei Yang
- School of Public Health, Guangxi Medical University, Nanning, China
| | - Shunhui Wei
- Calcium Signaling Laboratory, National Neuroscience Institute, Singapore City, Singapore
| | - Chee Kong Fhu
- Calcium Signaling Laboratory, National Neuroscience Institute, Singapore City, Singapore
| | - Zoë Bichler
- Neurobehavioural Phenotyping Core, Center for Biometric Analysis, The Jackson Laboratory, Bar Harbor, ME, USA
| | - Juejin Wang
- Department of Physiology, Nanjing Medical University, Nanjing, China
| | - Tuck Wah Soong
- Department of Physiology, National University of Singapore, Singapore, Singapore
| | - Ping Liao
- Calcium Signaling Laboratory, National Neuroscience Institute, Singapore City, Singapore
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Andersen LW, Vammen L, Granfeldt A. Animal research in cardiac arrest. Resusc Plus 2024; 17:100511. [PMID: 38148966 PMCID: PMC10750107 DOI: 10.1016/j.resplu.2023.100511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023] Open
Abstract
The purpose of this narrative review is to provide an overview of lessons learned from experimental cardiac arrest studies, limitations, translation to clinical studies, ethical considerations and future directions. Cardiac arrest animal studies have provided valuable insights into the pathophysiology of cardiac arrest, the effects of various interventions, and the development of resuscitation techniques. However, there are limitations to animal models that should be considered when interpreting results. Systematic reviews have demonstrated that animal models rarely reflect the clinical condition seen in humans, nor the complex treatment that occurs during and after a cardiac arrest. Furthermore, animal models of cardiac arrest are at a significant risk of bias due to fundamental issues in performing and/or reporting critical methodological aspects. Conducting clinical trials targeting the management of rare cardiac arrest causes like e.g. hyperkalemia and pulmonary embolism is challenging due to the scarcity of eligible patients. For these research questions, animal models might provide the highest level of evidence and can potentially guide clinical practice. To continuously push cardiac arrest science forward, animal studies must be conducted and reported rigorously, designed to avoid bias and answer specific research questions. To ensure the continued relevance and generation of valuable new insights from animal studies, new approaches and techniques may be needed, including animal register studies, systematic reviews and multilaboratory trials.
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Affiliation(s)
- Lars W. Andersen
- Department of Anesthesiology and Intensive Care Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Denmark
- Department of Anesthesiology and Intensive Care, Viborg Regional Hospital, Viborg, Denmark
- Prehospital Emergency Medical Services, Central Region Denmark, Denmark
| | - Lauge Vammen
- Department of Anesthesiology and Intensive Care Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Asger Granfeldt
- Department of Anesthesiology and Intensive Care Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Denmark
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Choudhury M, Brunton P, Schwass D, Pletzer D, Ratnayake J, Dias G, Tompkins G. Effectiveness of gold nanoparticles in prevention and treatment of oral mucositis in animal models: a systematic review. Syst Rev 2024; 13:39. [PMID: 38273391 PMCID: PMC10809540 DOI: 10.1186/s13643-023-02425-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 12/08/2023] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Oral mucositis remains a significant complication during cancer therapy with no effective treatment. Gold nanoparticles offer anti-inflammatory, antioxidant properties with low toxicity. This study systematically reviews the literature assessing gold nanoparticles in the management of oral mucositis in animal models. METHODS A literature search was undertaken using MEDLINE, Embase, PubMed, and Web of Science databases, using the format for Systematic Review Centre for Laboratory Animal Experimentation. Prior to the review, the protocol was registered in the systematic review register, PROSPERO (registration no. CRD42021272169). Outcome measures included ulceration, histopathological scores, inflammatory mediators, microbial growth, and pain. Study quality was analysed by SYRCLE risk-of-bias tool. RESULTS Only one study met the inclusion criteria, documenting reduction in ulceration, inflammatory, and oxidative biomarkers. Exposure to AuNPs prevented inflammatory response induced by 5-fluorouracil in oral mucosa of hamsters. However, a high risk of bias necessitates further research. CONCLUSION This review identifies a potential therapeutic strategy for prevention and management of oral mucositis. It also provides future direction for gold nanoparticle research in oral mucositis; however, there is lack of sufficient evidence to derive any conclusion. Research with standardized parameters including nanoparticle size, capping agent, surface charge, and appropriate oral mucositis animal models will establish risk-benefit balance and margin of safety for therapeutic use of gold nanoparticles for oral mucositis.
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Affiliation(s)
- Minati Choudhury
- Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand.
- Restorative Dentistry, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia.
| | - Paul Brunton
- Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
- DVCA, Curtin University, Perth, Australia
| | - Donald Schwass
- Department of Oral Rehabilitation, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Daniel Pletzer
- Department of Microbiology and Immunology, University of Otago, Dunedin, New Zealand.
| | - Jithendra Ratnayake
- Department of Oral Sciences, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - George Dias
- Department of Anatomy, University of Otago, Dunedin, New Zealand
| | - Geoffrey Tompkins
- Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
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Choudhary M, Chaudhari S, Gupta T, Kalyane D, Sirsat B, Kathar U, Sengupta P, Tekade RK. Stimuli-Responsive Nanotherapeutics for Treatment and Diagnosis of Stroke. Pharmaceutics 2023; 15:1036. [PMID: 37111522 PMCID: PMC10141724 DOI: 10.3390/pharmaceutics15041036] [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: 01/26/2023] [Revised: 03/19/2023] [Accepted: 03/20/2023] [Indexed: 04/29/2023] Open
Abstract
Stroke is the second most common medical emergency and constitutes a significant cause of global morbidity. The conventional stroke treatment strategies, including thrombolysis, antiplatelet therapy, endovascular thrombectomy, neuroprotection, neurogenesis, reducing neuroinflammation, oxidative stress, excitotoxicity, hemostatic treatment, do not provide efficient relief to the patients due to lack of appropriate delivery systems, large doses, systemic toxicity. In this context, guiding the nanoparticles toward the ischemic tissues by making them stimuli-responsive can be a turning point in managing stroke. Hence, in this review, we first outline the basics of stroke, including its pathophysiology, factors affecting its development, current treatment therapies, and their limitations. Further, we have discussed stimuli-responsive nanotherapeutics used for diagnosing and treating stroke with challenges ahead for the safe use of nanotherapeutics.
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Affiliation(s)
| | | | | | | | | | | | | | - Rakesh K. Tekade
- National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Department of Pharmaceuticals, Ministry of Chemicals and Fertilizers, Opposite Air Force Station, Palaj, Gandhinagar 382355, Gujarat, India
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Qureshi AI, Akhtar IN, Ma X, Lodhi A, Bhatti I, Beall J, Broderick JP, Cassarly CN, Martin RH, Sharma R, Thakkar M, Suarez JI. Effect of Cilostazol in Animal Models of Cerebral Ischemia and Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis. Neurocrit Care 2022:10.1007/s12028-022-01637-6. [DOI: 10.1007/s12028-022-01637-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 10/27/2022] [Indexed: 12/03/2022]
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Simon-Tillaux N, Gerard AL, Rajendrabose D, Tubach F, Dechartres A. A methodological review with meta-epidemiological analysis of preclinical systematic reviews with meta-analyses. Sci Rep 2022; 12:20066. [PMID: 36414712 PMCID: PMC9681751 DOI: 10.1038/s41598-022-24447-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 11/15/2022] [Indexed: 11/24/2022] Open
Abstract
Systematic reviews and meta-analyses have been proposed as an approach to synthesize the literature and counteract the lack of power of small preclinical studies. We aimed to evaluate (1) the methodology of these reviews, (2) the methodological quality of the studies they included and (3) whether study methodological characteristics affect effect size. We searched MEDLINE to retrieve 212 systematic reviews with meta-analyses of preclinical studies published from January, 2018 to March, 2020. Less than 15% explored the grey literature. Selection, data extraction and risk of bias assessment were performed in duplicate in less than two thirds of reviews. Most of them assessed the methodological quality of included studies and reported the meta-analysis model. The risk of bias of included studies was mostly rated unclear. In meta-epidemiological analysis, none of the study methodological characteristics was associated with effect size. The methodological characteristics of systematic reviews with meta-analyses of recently published preclinical studies seem to have improved as compared with previous assessments, but the methodological quality of included studies remains poor, thus limiting the validity of their results. Our meta-epidemiological analysis did not show any evidence of a potential association between methodological characteristics of included studies and effect size.
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Affiliation(s)
- Noémie Simon-Tillaux
- grid.411439.a0000 0001 2150 9058Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), Unité de Recherche Clinique PSL-CFX, CIC-1901, AP-HP, Hôpital Pitié Salpêtrière, 75013 Paris, France
| | - Anne-Laure Gerard
- grid.411439.a0000 0001 2150 9058Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), Unité de Recherche Clinique PSL-CFX, CIC-1901, AP-HP, Hôpital Pitié Salpêtrière, 75013 Paris, France
| | - Deivanes Rajendrabose
- grid.411439.a0000 0001 2150 9058Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), Unité de Recherche Clinique PSL-CFX, CIC-1901, AP-HP, Hôpital Pitié Salpêtrière, 75013 Paris, France
| | - Florence Tubach
- grid.411439.a0000 0001 2150 9058Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), Unité de Recherche Clinique PSL-CFX, CIC-1901, AP-HP, Hôpital Pitié Salpêtrière, 75013 Paris, France
| | - Agnès Dechartres
- grid.411439.a0000 0001 2150 9058Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), Unité de Recherche Clinique PSL-CFX, CIC-1901, AP-HP, Hôpital Pitié Salpêtrière, 75013 Paris, France
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Ritskes-Hoitinga M, Pound P. The role of systematic reviews in identifying the limitations of preclinical animal research, 2000-2022: part 1. J R Soc Med 2022; 115:186-192. [PMID: 35502678 DOI: 10.1177/01410768221093551] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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Hohmann U, Ghadban C, Hohmann T, Kleine J, Schmidt M, Scheller C, Strauss C, Dehghani F. Nimodipine Exerts Time-Dependent Neuroprotective Effect after Excitotoxical Damage in Organotypic Slice Cultures. Int J Mol Sci 2022; 23:ijms23063331. [PMID: 35328753 PMCID: PMC8954806 DOI: 10.3390/ijms23063331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/14/2022] [Accepted: 03/16/2022] [Indexed: 02/01/2023] Open
Abstract
During injuries in the central nervous system, intrinsic protective processes become activated. However, cellular reactions, especially those of glia cells, are frequently unsatisfactory, and further exogenous protective mechanisms are necessary. Nimodipine, a lipophilic L-type calcium channel blocking agent is clinically used in the treatment of aneurysmal subarachnoid haemorrhage with neuroprotective effects in different models. Direct effects of nimodipine on neurons amongst others were observed in the hippocampus as well as its influence on both microglia and astrocytes. Earlier studies proposed that nimodipine protective actions occur not only via calcium channel-mediated vasodilatation but also via further time-dependent mechanisms. In this study, the effect of nimodipine application was investigated in different time frames on neuronal damage in excitotoxically lesioned organotypic hippocampal slice cultures. Nimodipine, but not nifedipine if pre-incubated for 4 h or co-applied with NMDA, was protective, indicating time dependency. Since blood vessels play no significant role in our model, intrinsic brain cell-dependent mechanisms seems to strongly be involved. We also examined the effect of nimodipine and nifedipine on microglia survival. Nimodipine seem to be a promising agent to reduce secondary damage and reduce excitotoxic damage.
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Affiliation(s)
- Urszula Hohmann
- Medical Faculty, Institute of Anatomy and Cell Biology, Martin Luther University Halle-Wittenberg, 06112 Halle (Saale), Germany; (U.H.); (C.G.); (T.H.); (J.K.); (M.S.)
| | - Chalid Ghadban
- Medical Faculty, Institute of Anatomy and Cell Biology, Martin Luther University Halle-Wittenberg, 06112 Halle (Saale), Germany; (U.H.); (C.G.); (T.H.); (J.K.); (M.S.)
| | - Tim Hohmann
- Medical Faculty, Institute of Anatomy and Cell Biology, Martin Luther University Halle-Wittenberg, 06112 Halle (Saale), Germany; (U.H.); (C.G.); (T.H.); (J.K.); (M.S.)
| | - Joshua Kleine
- Medical Faculty, Institute of Anatomy and Cell Biology, Martin Luther University Halle-Wittenberg, 06112 Halle (Saale), Germany; (U.H.); (C.G.); (T.H.); (J.K.); (M.S.)
| | - Miriam Schmidt
- Medical Faculty, Institute of Anatomy and Cell Biology, Martin Luther University Halle-Wittenberg, 06112 Halle (Saale), Germany; (U.H.); (C.G.); (T.H.); (J.K.); (M.S.)
| | - Christian Scheller
- Department of Neurosurgery, Medical Faculty, Martin Luther University Halle-Wittenberg, 06120 Halle (Saale), Germany; (C.S.); (C.S.)
| | - Christian Strauss
- Department of Neurosurgery, Medical Faculty, Martin Luther University Halle-Wittenberg, 06120 Halle (Saale), Germany; (C.S.); (C.S.)
| | - Faramarz Dehghani
- Medical Faculty, Institute of Anatomy and Cell Biology, Martin Luther University Halle-Wittenberg, 06112 Halle (Saale), Germany; (U.H.); (C.G.); (T.H.); (J.K.); (M.S.)
- Correspondence: ; Tel.: +49-3455571707
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12
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Gonzales NR, Grotta JC. Pharmacologic Modification of Acute Cerebral Ischemia. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00057-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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13
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Menon JML, Ritskes-Hoitinga M, Pound P, van Oort E. The impact of conducting preclinical systematic reviews on researchers and their research: A mixed method case study. PLoS One 2021; 16:e0260619. [PMID: 34898637 PMCID: PMC8668092 DOI: 10.1371/journal.pone.0260619] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 11/15/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Systematic reviews (SRs) are cornerstones of evidence-based medicine and have contributed significantly to breakthroughs since the 1980's. However, preclinical SRs remain relatively rare despite their many advantages. Since 2011 the Dutch health funding organisation (ZonMw) has run a grant scheme dedicated to promoting the training, coaching and conduct of preclinical SRs. Our study focuses on this funding scheme to investigate the relevance, effects and benefits of conducting preclinical SRs on researchers and their research. METHODS We recruited researchers who attended funded preclinical SR workshops and who conducted, are still conducting, or prematurely stopped a SR with funded coaching. We gathered data using online questionnaires followed by semi-structured interviews. Both aimed to explore the impact of conducting a SR on researchers' subsequent work, attitudes, and views about their research field. Data-analysis was performed using Excel and ATLAS.ti. RESULTS Conducting preclinical SRs had two distinct types of impact. First, the researchers acquired new skills and insights, leading to a change in mindset regarding the quality of animal research. This was mainly seen in the way participants planned, conducted and reported their subsequent animal studies, which were more transparent and of a higher quality than their previous work. Second, participants were eager to share their newly acquired knowledge within their laboratories and to advocate for change within their research teams and fields of interest. In particular, they emphasised the need for preclinical SRs and improved experimental design within preclinical research, promoting these through education and published opinion papers. CONCLUSION Being trained and coached in the conduct of preclinical SRs appears to be a contributing factor to many beneficial changes which will impact the quality of preclinical research in the long-term. Our findings suggest that this ZonMw funding scheme is helpful in improving the quality and transparency of preclinical research. Similar funding schemes should be encouraged, preferably by a broader group of funders or financers, in the future.
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Affiliation(s)
- Julia M. L. Menon
- Department for Health Evidence, Systematic Review Centre for Laboratory (animal) Experimentation (SYRCLE), Radboud University Medical Center, Nijmegen, The Netherlands
- Preclinicaltrials.eu, Netherlands Heart Institute, Utrecht, The Netherlands
| | - Merel Ritskes-Hoitinga
- Department for Health Evidence, Systematic Review Centre for Laboratory (animal) Experimentation (SYRCLE), Radboud University Medical Center, Nijmegen, The Netherlands
- Department for Clinical Medicine, AUGUST, Aarhus University, Aarhus, Denmark
| | | | - Erica van Oort
- ZonMw (Netherlands Organisation for Health Research and Development), The Hague, The Netherlands
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Yeowell G, Burns D, Fatoye F, Gebrye T, Wright A, Mwacalimba K, Odeyemi I. Indicators of Health-Related Quality of Life in Cats With Degenerative Joint Disease: Systematic Review and Proposal of a Conceptual Framework. Front Vet Sci 2021; 8:582148. [PMID: 34869707 PMCID: PMC8636455 DOI: 10.3389/fvets.2021.582148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 10/19/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: The assessment of health-related quality of life (HRQoL) is becoming increasingly important in companion animals. This study describes a systematic review and development of a proposed conceptual framework to assess HRQoL in cats with osteoarthritis (OA). Methods: The conceptual framework was developed according to published guidelines. A comprehensive search of the CAB Direct, Scopus, PubMed, and Web of Science databases was carried out for publications in English from inception to November 12, 2019. Search words used were "cat", "feline", "chronic pain", "pain", and "quality of life". Publications were selected if they were full-text and peer-reviewed, based on primary data, and identified or measured behavioral symptoms of chronic musculoskeletal pain in cats. A systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A data extraction form was developed from categories identified in the literature review and piloted on a small number of studies to ascertain the appropriateness for relevant data extraction. Categories were then finalized, and key domains were identified. The domains were then synthesized to develop a conceptual framework. Results: A total of 454 studies were identified, of which 14 met the eligibility criteria and were included in the meta-synthesis. All 14 were assessed to be of good quality. Seven domains related to HRQoL in cats with OA were thematically identified from the data: mobility, physical appearance, energy and vitality, mood, pain expression, sociability, and physical and mental wellbeing. The three main HRQoL domains were pain expression, mobility, and physical and mental wellbeing, which impacted all the others. Pain and mobility impacted all six other domains, with increased pain and decreased mobility negatively impacting physical appearance, energy and vitality, mood, sociability, and physical and mental wellbeing. Conclusions and Relevance: This is the first study to develop an evidence-based conceptual framework for the assessment of HRQoL in cats with OA. The proposed conceptual framework suggests that effective management of chronic pain in cats may improve their overall HRQoL.
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Affiliation(s)
- Gillian Yeowell
- Department of Health Professions, Manchester Metropolitan University, Manchester, United Kingdom
| | - Danielle Burns
- Department of Health Professions, Manchester Metropolitan University, Manchester, United Kingdom
| | - Francis Fatoye
- Department of Health Professions, Manchester Metropolitan University, Manchester, United Kingdom
| | - Tadesse Gebrye
- Department of Health Professions, Manchester Metropolitan University, Manchester, United Kingdom
| | - Andrea Wright
- Outcomes Research, International Center of Excellence, Zoetis, Dublin, Ireland
| | | | - Isaac Odeyemi
- Outcomes Research, International Center of Excellence, Zoetis, Dublin, Ireland
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Evaluating the clinical translational relevance of animal models for limbal stem cell deficiency: A systematic review. Ocul Surf 2021; 23:169-183. [PMID: 34583088 DOI: 10.1016/j.jtos.2021.09.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 09/20/2021] [Accepted: 09/23/2021] [Indexed: 12/13/2022]
Abstract
PURPOSE Animal models are pivotal for elucidating pathophysiological mechanisms and evaluating novel therapies. This systematic review identified studies that developed or adapted animal models of limbal stem cell deficiency (LSCD), assessed their reporting quality, summarized their key characteristics, and established their clinical translational relevance to human disease. METHODS The protocol was prospectively registered (PROSPERO CRD42020203937). Searches were conducted in PubMed, Ovid EMBASE and Web of Science in August 2020. Two authors screened citations, extracted data, assessed the reporting quality of eligible studies using the ARRIVE guidelines, and judged the clinical translational relevance of each model using a custom matrix. RESULTS 105 studies were included. Rabbits were the most common animal species. Overall, 97% of studies recapitulated LSCD to a clinical etiology, however 62% did not provide sufficient methodological detail to enable independent reproduction of the model. Adverse events and/or exclusion of animals were infrequently (20%) reported. Approximately one-quarter of studies did not produce the intended severity of LSCD; 34% provided insufficient information to assess the fidelity of disease induction. Adjunctive diagnostic confirmation of LSCD induction was performed in 13% of studies. CONCLUSIONS This is the first systematic review to assess the reporting quality and clinical translational relevance of animal models of LSCD. Models of LSCD have evolved over time, resulting in variable reporting of the characteristics of animals, experimental procedures and adverse events. In most studies, validation of LSCD was made using clinical tests; newer adjunctive techniques would enhance diagnostic validation. As most studies sought to evaluate novel therapies for LSCD, animal models should ideally recapitulate all features of the condition that develop in patients.
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Li C, Sun T, Jiang C. Recent advances in nanomedicines for the treatment of ischemic stroke. Acta Pharm Sin B 2021; 11:1767-1788. [PMID: 34386320 PMCID: PMC8343119 DOI: 10.1016/j.apsb.2020.11.019] [Citation(s) in RCA: 72] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 08/27/2020] [Accepted: 09/13/2020] [Indexed: 12/20/2022] Open
Abstract
Ischemic stroke is a cerebrovascular disease normally caused by interrupted blood supply to the brain. Ischemia would initiate the cascade reaction consisted of multiple biochemical events in the damaged areas of the brain, where the ischemic cascade eventually leads to cell death and brain infarction. Extensive researches focusing on different stages of the cascade reaction have been conducted with the aim of curing ischemic stroke. However, traditional treatment methods based on antithrombotic therapy and neuroprotective therapy are greatly limited for their poor safety and treatment efficacy. Nanomedicine provides new possibilities for treating stroke as they could improve the pharmacokinetic behavior of drugs in vivo, achieve effective drug accumulation at the target site, enhance the therapeutic effect and meanwhile reduce the side effect. In this review, we comprehensively describe the pathophysiology of stroke, traditional treatment strategies and emerging nanomedicines, summarize the barriers and methods for transporting nanomedicine to the lesions, and illustrate the latest progress of nanomedicine in treating ischemic stroke, with a view to providing a new feasible path for the treatment of cerebral ischemia.
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Key Words
- AEPO, asialo-erythropoietin
- APOE, apolipoprotein E
- BBB, blood‒brain barrier
- BCECs, brain capillary endothelial cells
- Blood‒brain barrier
- CAT, catalase
- COX-1, cyclooxygenase-1
- CXCR-4, C-X-C chemokine receptor type 4
- Ce-NPs, ceria nanoparticles
- CsA, cyclosporine A
- DAMPs, damage-associated molecular patterns
- GFs, growth factors
- GPIIb/IIIa, glycoprotein IIb/IIIa
- HMGB1, high mobility group protein B1
- Hb, hemoglobin
- ICAM-1, intercellular adhesion molecule-1
- IL-1β, interleukin-1β
- IL-6, interleukin-6
- Ischemic cascade
- LFA-1, lymphocyte function-associated antigen-1
- LHb, liposomal Hb
- MCAO, middle cerebral artery occlusion
- MMPs, matrix metalloproteinases
- MSC, mesenchymal stem cell
- NF-κB, nuclear factor-κB
- NGF, nerve growth factor
- NMDAR, N-methyl-d-aspartate receptor
- NOS, nitric oxide synthase
- NPs, nanoparticles
- NSCs, neural stem cells
- Nanomedicine
- Neuroprotectant
- PBCA, poly-butylcyanoacrylate
- PCMS, poly (chloromethylstyrene)
- PEG, poly-ethylene-glycol
- PEG-PLA, poly (ethylene-glycol)-b-poly (lactide)
- PLGA NPs, poly (l-lactide-co-glycolide) nanoparticles
- PSD-95, postsynaptic density protein-95
- PSGL-1, P-selectin glycoprotein ligand-1
- RBCs, red blood cells
- RES, reticuloendothelial system
- RGD, Arg-Gly-Asp
- ROS, reactive oxygen species
- Reperfusion
- SDF-1, stromal cell-derived factor-1
- SHp, stroke homing peptide
- SOD, superoxide dismutase
- SUR1-TRPM4, sulfonylurea receptor 1-transient receptor potential melastatin-4
- Stroke
- TEMPO, 2,2,6,6-tetramethylpiperidine-1-oxyl
- TIA, transient ischemic attack
- TNF-α, tumor necrosis factor-α
- Thrombolytics
- cRGD, cyclic Arg-Gly-Asp
- e-PAM-R, arginine-poly-amidoamine ester
- iNOS, inducible nitric oxide synthase
- miRNAs, microRNAs
- nNOS, neuron nitric oxide synthase
- siRNA, small interfering RNA
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Narayan SK, Grace Cherian S, Babu Phaniti P, Babu Chidambaram S, Rachel Vasanthi AH, Arumugam M. Preclinical animal studies in ischemic stroke: Challenges and some solutions. Animal Model Exp Med 2021; 4:104-115. [PMID: 34179718 PMCID: PMC8212819 DOI: 10.1002/ame2.12166] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 01/28/2021] [Indexed: 01/01/2023] Open
Abstract
Despite the impressive efficacies demonstrated in preclinical research, hundreds of potentially neuroprotective drugs have failed to provide effective neuroprotection for ischemic stroke in human clinical trials. Lack of a powerful animal model for human ischemic stroke could be a major reason for the failure to develop successful neuroprotective drugs for ischemic stroke. This review recapitulates the available cerebral ischemia animal models, provides an anatomical comparison of the circle of Willis of each species, and describes the functional assessment tests used in these ischemic stroke models. The distinct differences between human ischemic stroke and experimental stroke in available animal models is explored. Innovative animal models more closely resembling human strokes, better techniques in functional outcome assessment and better experimental designs generating clearer and stronger evidence may help realise the development of truly neuroprotective drugs that will benefit human ischemic stroke patients. This may involve use of newer molecules or revisiting earlier studies with new experimental designs. Translation of any resultant successes may then be tested in human clinical trials with greater confidence and optimism.
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Affiliation(s)
- Sunil K. Narayan
- Comprehensive Stroke Care and Neurobiology Centre, Department of NeurologyJawaharlal Institute of Postgraduate Medical Education and ResearchPuducherryIndia
| | - Simy Grace Cherian
- Comprehensive Stroke Care and Neurobiology Centre, Department of NeurologyJawaharlal Institute of Postgraduate Medical Education and ResearchPuducherryIndia
| | - Prakash Babu Phaniti
- Department of Biotechnology & School of Medical SciencesUniversity of HyderabadHyderabadIndia
| | | | | | - Murugesan Arumugam
- Comprehensive Stroke Care and Neurobiology Centre, Department of NeurologyJawaharlal Institute of Postgraduate Medical Education and ResearchPuducherryIndia
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18
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Leenaars C, Tsaioun K, Stafleu F, Rooney K, Meijboom F, Ritskes-Hoitinga M, Bleich A. Reviewing the animal literature: how to describe and choose between different types of literature reviews. Lab Anim 2021; 55:129-141. [PMID: 33135562 PMCID: PMC8044607 DOI: 10.1177/0023677220968599] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 10/01/2020] [Indexed: 12/15/2022]
Abstract
Before starting any (animal) research project, review of the existing literature is good practice. From both the scientific and the ethical perspective, high-quality literature reviews are essential. Literature reviews have many potential advantages besides synthesising the evidence for a research question. First, they can show if a proposed study has already been performed, preventing redundant research. Second, when planning new experiments, reviews can inform the experimental design, thereby increasing the reliability, relevance and efficiency of the study. Third, reviews may even answer research questions using already available data. Multiple definitions of the term literature review co-exist. In this paper, we describe the different steps in the review process, and the risks and benefits of using various methodologies in each step. We then suggest common terminology for different review types: narrative reviews, mapping reviews, scoping reviews, rapid reviews, systematic reviews and umbrella reviews. We recommend which review to select, depending on the research question and available resources. We believe that improved understanding of review methods and terminology will prevent ambiguity and increase appropriate interpretation of the conclusions of reviews.
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Affiliation(s)
- Cathalijn Leenaars
- Institute for Laboratory Animal Science, Hannover Medical School, Germany
- Department of Animals in Science and Society, Utrecht University, the Netherlands
| | - Katya Tsaioun
- Evidence-based Toxicology Collaboration, Johns Hopkins Bloomberg School of Public Health (EBTC), USA
| | - Frans Stafleu
- Department of Animals in Science and Society, Utrecht University, the Netherlands
| | - Kieron Rooney
- Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Australia
| | - Franck Meijboom
- Department of Animals in Science and Society, Utrecht University, the Netherlands
| | - Merel Ritskes-Hoitinga
- SYRCLE, Department for Health Evidence (section HTA), Radboud Institute for Health Sciences, The Netherlands
- AUGUST, Department for Clinical Medicine, Aarhus University, Denmark
| | - André Bleich
- Institute for Laboratory Animal Science, Hannover Medical School, Germany
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19
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Aliena-Valero A, Baixauli-Martín J, Castelló-Ruiz M, Torregrosa G, Hervás D, Salom JB. Effect of uric acid in animal models of ischemic stroke: A systematic review and meta-analysis. J Cereb Blood Flow Metab 2021; 41:707-722. [PMID: 33210575 PMCID: PMC7983496 DOI: 10.1177/0271678x20967459] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Addition of uric acid (UA) to thrombolytic therapy, although safe, showed limited efficacy in improving patients' stroke outcome, despite alleged neuroprotective effects of UA in preclinical research. This systematic review assessed the effects of UA on brain structural and functional outcomes in animal models of ischemic stroke. We searched Medline, Embase and Web of Science to identify 16 and 14 eligible rodent studies for qualitative and quantitative synthesis, respectively. Range of evidence met 10 of a possible 13 STAIR criteria. Median (Q1, Q3) quality score was 7.5 (6, 10) on the CAMARADES 15-item checklist. For each outcome, we used standardised mean difference (SMD) as effect size and random-effects modelling. Meta-analysis showed that UA significantly reduced infarct size (SMD: -1.18; 95% CI [-1.47, -0.88]; p < 0.001), blood-brain barrier (BBB) impairment/oedema (SMD: -0.72; 95% CI [-0.97, -0.48]; p < 0.001) and neurofunctional deficit (SMD: -0.98; 95% CI [-1.32, -0.63]; p < 0.001). Overall, there was low to moderate between-study heterogeneity and sizeable publication bias. In conclusion, published rodent data suggest that UA improves outcome following ischemic stroke by reducing infarct size, improving BBB integrity and ameliorating neurofunctional condition. Specific recommendations are given for further high-quality preclinical research required to better inform clinical research.
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Affiliation(s)
- Alicia Aliena-Valero
- Unidad Mixta de Investigación Cerebrovascular, Instituto de Investigación Sanitaria La Fe - Universidad de Valencia, Valencia, Spain
| | | | - María Castelló-Ruiz
- Unidad Mixta de Investigación Cerebrovascular, Instituto de Investigación Sanitaria La Fe - Universidad de Valencia, Valencia, Spain.,Departamento de Biología Celular, Biología Funcional y Antropología Física, Universidad de Valencia, Valencia, Spain
| | - Germán Torregrosa
- Unidad Mixta de Investigación Cerebrovascular, Instituto de Investigación Sanitaria La Fe - Universidad de Valencia, Valencia, Spain
| | - David Hervás
- Unidad de Bioestadística, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Juan B Salom
- Unidad Mixta de Investigación Cerebrovascular, Instituto de Investigación Sanitaria La Fe - Universidad de Valencia, Valencia, Spain.,Departamento de Fisiología, Universidad de Valencia, Valencia, Spain
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20
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Bath PM, Appleton JP, England T. The Hazard of Negative (Not Neutral) Trials on Treatment of Acute Stroke: A Review. JAMA Neurol 2020; 77:114-124. [PMID: 31790551 DOI: 10.1001/jamaneurol.2019.4107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Importance While there are a limited number of beneficial treatments for acute stroke (eg, stroke units, reperfusion, aspirin, hemicraniectomy), there are more negative (as opposed to neutral) interventions spanning multiple different mechanisms of action. To reduce the risk of future negative studies, it is vital to understand why previous interventions appeared to cause harm. Observations The limited number of beneficial treatments for acute ischemic stroke are far outnumbered by negative (not neutral) interventions that worsened outcomes in randomized clinical trials (RCTs), including those with putative neuroprotectant, anticoagulant, anti-inflammatory, free radical-scavenging, hemorrhagic, or vasoactive activity. Other agents reduced thrombolytic efficiency or exhibited neuropsychiatric or cardiac toxicity. In intracerebral hemorrhage, platelet transfusion was hazardous. Although reperfusion treatments should be given as soon as possible, very early intervention with other strategies may instead be hazardous, as has been seen with physical therapy and vasodepressors. Conclusions and Relevance The lessons learned from negative stroke RCTs are vital for designing future studies. Multicenter preclinical studies are necessary, and animals that die must be included in analyses. Randomized clinical trials must assess multiple neurological, vascular, cardiac, and general safety effects, whether these are on target or off target. All preclinical trials and RCTs must be published in full. Learning from the past will help to reduce the number of negative stroke RCTs in the future.
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Affiliation(s)
- Philip M Bath
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, England.,Stroke, Nottingham University Hospitals NHS Trust, Nottingham, England
| | - Jason P Appleton
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, England.,Stroke, Nottingham University Hospitals NHS Trust, Nottingham, England
| | - Timothy England
- Vascular Medicine, Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Royal Derby Hospital Centre, Derby, England
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21
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Ritskes-Hoitinga M, Leenaars C, Beumer W, Coenen-de Roo T, Stafleu F, Meijboom FLB. Improving Translation by Identifying Evidence for More Human-Relevant Preclinical Strategies. Animals (Basel) 2020; 10:E1170. [PMID: 32664195 PMCID: PMC7401546 DOI: 10.3390/ani10071170] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/02/2020] [Accepted: 07/08/2020] [Indexed: 12/13/2022] Open
Abstract
Preclinical animal studies are performed to analyse the safety and efficacy of new treatments, with the aim to protect humans. However, there are questions and concerns about the quality and usefulness of preclinical animal research. Translational success rates vary between 0 and 100%, and no clear relationship has been found with possible predictive factors such as animal species or field of research. Therefore, it is not yet possible to indicate what factors predict successful translation. Translational strategies were therefore discussed at an international conference held in the Netherlands in November 2019, aiming to develop practical guidelines for more robust animal-to-human translation. The conference was organised during the course of a research project funded by the Dutch Research Council (313-99-310), addressing possible solutions for the low translational values that had been published for a multitude of animal studies in human health care. This article provides an overview of the project and the conference discussions. Based on the conference results and the findings from the research project, we define four points of attention that are crucial in the search for improved translational success rates: (a) optimising the methods and design of studies; (b) incorporation of the complexity of the human patient in research; (c) start with the patient rather than existing animal models as the gold standard; and (d) more and better collaboration within the chain from funding to pharmacy. We conclude that this requires improved organization and use of procedures, as well as a change of attitude and culture in research, including a consideration of the translational value of animal-free innovations and human-relevant science.
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Affiliation(s)
- Merel Ritskes-Hoitinga
- SYRCLE, Department for Health Evidence (section HTA), Radboud Institute for Health Sciences, Radboud University Medical Centre, 6500 HB Nijmegen, The Netherlands
| | - Cathalijn Leenaars
- Unit Animals in Science and Society, Department of Population Health Sciences, Faculty of Veterinary Medicine, Utrecht University, 3508 TD Utrecht, The Netherlands
- Institute for Laboratory Animal Science, Hannover Medical School, 30625 Hannover, Germany
| | - Wouter Beumer
- ProQR Therapeutics NV, 2333 CK Leiden, The Netherlands
| | - Tineke Coenen-de Roo
- Central Animal Facility, Leiden University Medical Centre, 2300 RC Leiden, The Netherlands
| | - Frans Stafleu
- Ethics Institute, Faculty of Humanities, Utrecht University, 3508 TC Utrecht, The Netherlands
| | - Franck L B Meijboom
- Unit Animals in Science and Society, Department of Population Health Sciences, Faculty of Veterinary Medicine, Utrecht University, 3508 TD Utrecht, The Netherlands
- Ethics Institute, Faculty of Humanities, Utrecht University, 3508 TC Utrecht, The Netherlands
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22
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Pound P, Ritskes-Hoitinga M. Can prospective systematic reviews of animal studies improve clinical translation? J Transl Med 2020; 18:15. [PMID: 31918734 PMCID: PMC6953128 DOI: 10.1186/s12967-019-02205-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 12/31/2019] [Indexed: 01/27/2023] Open
Abstract
Systematic reviews are powerful tools with the potential to generate high quality evidence. Their application to animal studies has been instrumental in exposing the poor quality of these studies, as well as a catalyst for improvements in study design, conduct and reporting. It has been suggested that prospective systematic reviews of animal studies (i.e. systematic reviews conducted prior to clinical trials) would allow scrutiny of the preclinical evidence, providing valuable information on safety and efficacy, and helping to determine whether clinical trials should proceed. However, while prospective systematic reviews allow valuable scrutiny of the preclinical animal data, they are not necessarily able to reliably predict the safety and efficacy of an intervention when trialled in humans. Consequently, they may not reliably safeguard humans participating in clinical trials and might potentially result in lost opportunities for beneficial clinical treatments. Furthermore, animal and human studies are often conducted concurrently, which not only makes prospective systematic reviews of animal studies impossible, but suggests that animal studies do not inform human studies in the manner presumed. We suggest that this points to a confused attitude regarding animal studies, whereby tradition demands that they precede human studies but practice indicates that their findings are often ignored. We argue that it is time to assess the relative contributions of animal and human research in order to better understand how clinical knowledge is actually produced.
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Affiliation(s)
- Pandora Pound
- Safer Medicines Trust, PO Box 122, Kingsbridge, TQ7 9AX, UK.
| | - Merel Ritskes-Hoitinga
- SYRCLE, Department for Health Evidence, Radboud University Medical Center, PO Box 9101, Route 133, 6500 HB, Nijmegen, The Netherlands
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23
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Dhir N, Medhi B, Prakash A, Goyal MK, Modi M, Mohindra S. Pre-clinical to Clinical Translational Failures and Current Status of Clinical Trials in Stroke Therapy: A Brief Review. Curr Neuropharmacol 2020; 18:596-612. [PMID: 31934841 PMCID: PMC7457423 DOI: 10.2174/1570159x18666200114160844] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 10/31/2019] [Accepted: 12/28/2019] [Indexed: 12/16/2022] Open
Abstract
In stroke (cerebral ischemia), despite continuous efforts both at the experimental and clinical level, the only approved pharmacological treatment has been restricted to tissue plasminogen activator (tPA). Stroke is the leading cause of functional disability and mortality throughout worldwide. Its pathophysiology starts with energy pump failure, followed by complex signaling cascade that ultimately ends in neuronal cell death. Ischemic cascade involves excessive glutamate release followed by raised intracellular sodium and calcium influx along with free radicals' generation, activation of inflammatory cytokines, NO synthases, lipases, endonucleases and other apoptotic pathways leading to cell edema and death. At the pre-clinical stage, several agents have been tried and proven as an effective neuroprotectant in animal models of ischemia. However, these agents failed to show convincing results in terms of efficacy and safety when the trials were conducted in humans following stroke. This article highlights the various agents which have been tried in the past but failed to translate into stroke therapy along with key points that are responsible for the lagging of experimental success to translational failure in stroke treatment.
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Affiliation(s)
| | - Bikash Medhi
- Address correspondence to this author at the Department of Pharmacology, Research Block B, 4th Floor, Room no 4043, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, 160012, India; E-mail:
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24
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Ramirez FD, Jung RG, Motazedian P, Perry-Nguyen D, Di Santo P, MacDonald Z, Clancy AA, Labinaz A, Promislow S, Simard T, Provencher S, Bonnet S, Graham ID, Wells GA, Hibbert B. Journal Initiatives to Enhance Preclinical Research: Analyses of Stroke, Nature Medicine, Science Translational Medicine. Stroke 2020; 51:291-299. [PMID: 31718504 PMCID: PMC6924942 DOI: 10.1161/strokeaha.119.026564] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 08/08/2019] [Accepted: 08/28/2019] [Indexed: 01/01/2023]
Abstract
Background and Purpose- Preclinical research using animals often informs clinical trials. However, its value is dependent on its scientific validity and reproducibility, which are, in turn, dependent on rigorous study design and reporting. In 2011, Stroke introduced a Basic Science Checklist to enhance the reporting and methodology of its preclinical studies. Except for Nature and Science journals, few others have implemented similar initiatives. We sought to estimate the impact of these journal interventions on the quality of their published reports. Methods- All articles published in Stroke, Nature Medicine, and Science Translational Medicine over 9 to 18 years and in 2 control journals without analogous interventions over a corresponding 11.5 years were reviewed to identify reports of experiments in nonhuman mammals with proposed clinical relevance. The effect of journal interventions on the reporting and use of key study design elements was estimated via interrupted time-series analyses. Results- Of 33 009 articles screened, 4162 studies met inclusion criteria. In the 3.5 to 12 years preceding each journal's intervention, the proportions of studies reporting and using key study design elements were stable except for blinding in Stroke and randomization in Science Translational Medicine, which were both increasing. Post-intervention, abrupt and often marked increases were seen in the reporting of randomization status (level change: +17% to +44%, P≤0.005), blinding (level change: +20% to +40%, P≤0.008), and sample size estimation (level change: 0% to +40%, P≤0.002 in 2 journals). Significant but more modest improvements in the use of these study design elements were also observed. These improvements were not seen in control journals. Conclusions- Journal interventions such as Stroke's author submission checklist can meaningfully improve the quality of published preclinical research and should be considered to enhance study transparency and design. However, such interventions are alone insufficient to fully address widespread shortcomings in preclinical research practices.
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Affiliation(s)
- F. Daniel Ramirez
- From the Division of Cardiology (F.D.R., P.D.S., S. Promislow, T.S., B.H.), University of Ottawa Heart Institute, ON, Canada
- CAPITAL Research Group (F.D.R., R.G.J., P.M., D.P.-N., P.D.S., A.L., S. Promislow, T.S., B.H.), University of Ottawa Heart Institute, ON, Canada
- School of Epidemiology and Public Health (F.D.R., P.D.S., I.D.G., G.A.W.), University of Ottawa, ON, Canada
- Electrophysiology and Ablation Unit, Hôpital cardiologique du Haut-Lévêque, Centre hospitalier universitaire (CHU) de Bordeaux, Bordeaux-Pessac, France (F.D.R.)
- L’Institut de rythmologie et modélisation cardiaque (LIRYC), Université de Bordeaux, Bordeaux-Pessac, France (F.D.R.)
| | - Richard G. Jung
- CAPITAL Research Group (F.D.R., R.G.J., P.M., D.P.-N., P.D.S., A.L., S. Promislow, T.S., B.H.), University of Ottawa Heart Institute, ON, Canada
- Vascular Biology and Experimental Medicine Laboratory (R.G.J., P.M., D.P.-N., A.L., T.S., B.H.), University of Ottawa Heart Institute, ON, Canada
- Department of Cellular and Molecular Medicine (R.G.J., T.S., B.H.), University of Ottawa, ON, Canada
- Faculty of Medicine (R.G.J., P.M., D.P.-N., Z.M.), University of Ottawa, ON, Canada
| | - Pouya Motazedian
- CAPITAL Research Group (F.D.R., R.G.J., P.M., D.P.-N., P.D.S., A.L., S. Promislow, T.S., B.H.), University of Ottawa Heart Institute, ON, Canada
- Vascular Biology and Experimental Medicine Laboratory (R.G.J., P.M., D.P.-N., A.L., T.S., B.H.), University of Ottawa Heart Institute, ON, Canada
- Faculty of Medicine (R.G.J., P.M., D.P.-N., Z.M.), University of Ottawa, ON, Canada
- Department of Medicine, University of Calgary Cumming School of Medicine, AB, Canada (P.M.)
| | - Dylan Perry-Nguyen
- CAPITAL Research Group (F.D.R., R.G.J., P.M., D.P.-N., P.D.S., A.L., S. Promislow, T.S., B.H.), University of Ottawa Heart Institute, ON, Canada
- Vascular Biology and Experimental Medicine Laboratory (R.G.J., P.M., D.P.-N., A.L., T.S., B.H.), University of Ottawa Heart Institute, ON, Canada
- Faculty of Medicine (R.G.J., P.M., D.P.-N., Z.M.), University of Ottawa, ON, Canada
| | - Pietro Di Santo
- From the Division of Cardiology (F.D.R., P.D.S., S. Promislow, T.S., B.H.), University of Ottawa Heart Institute, ON, Canada
- CAPITAL Research Group (F.D.R., R.G.J., P.M., D.P.-N., P.D.S., A.L., S. Promislow, T.S., B.H.), University of Ottawa Heart Institute, ON, Canada
- School of Epidemiology and Public Health (F.D.R., P.D.S., I.D.G., G.A.W.), University of Ottawa, ON, Canada
| | - Zachary MacDonald
- Faculty of Medicine (R.G.J., P.M., D.P.-N., Z.M.), University of Ottawa, ON, Canada
- Department of Emergency Medicine (Z.M.), University of Ottawa, ON, Canada
| | - Aisling A. Clancy
- Department of Obstetrics and Gynecology (A.A.C.), University of Ottawa, ON, Canada
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (A.A.C.)
| | - Alisha Labinaz
- CAPITAL Research Group (F.D.R., R.G.J., P.M., D.P.-N., P.D.S., A.L., S. Promislow, T.S., B.H.), University of Ottawa Heart Institute, ON, Canada
- Vascular Biology and Experimental Medicine Laboratory (R.G.J., P.M., D.P.-N., A.L., T.S., B.H.), University of Ottawa Heart Institute, ON, Canada
- Faculty of Science (A.L.), University of Ottawa, ON, Canada
| | - Steven Promislow
- From the Division of Cardiology (F.D.R., P.D.S., S. Promislow, T.S., B.H.), University of Ottawa Heart Institute, ON, Canada
- CAPITAL Research Group (F.D.R., R.G.J., P.M., D.P.-N., P.D.S., A.L., S. Promislow, T.S., B.H.), University of Ottawa Heart Institute, ON, Canada
| | - Trevor Simard
- From the Division of Cardiology (F.D.R., P.D.S., S. Promislow, T.S., B.H.), University of Ottawa Heart Institute, ON, Canada
- CAPITAL Research Group (F.D.R., R.G.J., P.M., D.P.-N., P.D.S., A.L., S. Promislow, T.S., B.H.), University of Ottawa Heart Institute, ON, Canada
- Vascular Biology and Experimental Medicine Laboratory (R.G.J., P.M., D.P.-N., A.L., T.S., B.H.), University of Ottawa Heart Institute, ON, Canada
- Department of Cellular and Molecular Medicine (R.G.J., T.S., B.H.), University of Ottawa, ON, Canada
| | - Steeve Provencher
- Pulmonary Hypertension Research Group, Centre de recherche de l’Institut universitaire de cardiologie et de pneumologie de Québec (S. Provencher, S.B.), Université Laval, Québec City, Canada
- Department of Medicine (S. Provencher, S.B.), Université Laval, Québec City, Canada
| | - Sébastien Bonnet
- Pulmonary Hypertension Research Group, Centre de recherche de l’Institut universitaire de cardiologie et de pneumologie de Québec (S. Provencher, S.B.), Université Laval, Québec City, Canada
- Department of Medicine (S. Provencher, S.B.), Université Laval, Québec City, Canada
| | - Ian D. Graham
- School of Epidemiology and Public Health (F.D.R., P.D.S., I.D.G., G.A.W.), University of Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, ON, Canada (I.D.G.)
| | - George A. Wells
- Cardiovascular Research Methods Centre (G.A.W.), University of Ottawa Heart Institute, ON, Canada
- School of Epidemiology and Public Health (F.D.R., P.D.S., I.D.G., G.A.W.), University of Ottawa, ON, Canada
| | - Benjamin Hibbert
- From the Division of Cardiology (F.D.R., P.D.S., S. Promislow, T.S., B.H.), University of Ottawa Heart Institute, ON, Canada
- CAPITAL Research Group (F.D.R., R.G.J., P.M., D.P.-N., P.D.S., A.L., S. Promislow, T.S., B.H.), University of Ottawa Heart Institute, ON, Canada
- Vascular Biology and Experimental Medicine Laboratory (R.G.J., P.M., D.P.-N., A.L., T.S., B.H.), University of Ottawa Heart Institute, ON, Canada
- Department of Cellular and Molecular Medicine (R.G.J., T.S., B.H.), University of Ottawa, ON, Canada
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Ritskes-Hoitinga M, van Luijk J. How Can Systematic Reviews Teach Us More about the Implementation of the 3Rs and Animal Welfare? Animals (Basel) 2019; 9:ani9121163. [PMID: 31861205 PMCID: PMC6941037 DOI: 10.3390/ani9121163] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 12/12/2019] [Accepted: 12/14/2019] [Indexed: 02/06/2023] Open
Abstract
Simple Summary The three Rs stand for Replacement, Reduction, and Refinement of animal studies and were published for the first time in 1959 by Russell and Burch. Replacement refers to avoiding the use of (non-human) animals in research. Reduction implies using fewer animals, for example, by better statistical methods and better literature studies, and Refinement means reducing the discomfort and improving the welfare of animals used in experiments. The three Rs have gained more interest and popularity since the 1970s, and have now become the crucial central element in the revised legislation in Europe, the EU Directive 2010/63EU, controlling the proper use of animals in experiments in the European member states. Animals are used in order to improve the health and welfare of other non-human animals, in veterinary medicine, and of humans, for toxicological purposes and in clinical medicine. Using animals in experiments has always been subject to ethical and societal debate. At Syrcle, we have introduced the methodology of systematic reviews for preclinical animal studies since 2012. This methodology comes from the clinical field and is a key element in evidence-based medicine, as systematic reviews summarise the scientific evidence as objectively as possible. A systematic review (SR) is defined as a literature review focused on a single question that tries to identify, appraise, select, and synthesise all high-quality research evidence relevant to that question. Introducing this methodology for the preclinical animal studies seems very logical, as animal studies in clinical medicine are performed for protecting humans from ineffective or unsafe treatments. Systematic reviews thus lead to summarising evidence from preclinical studies before entering clinical trials. In addition to protecting humans, systematic reviews can also be used to implement the three Rs. Examples of how systematic reviews contribute to implementing the three Rs are provided in the following article, thus demonstrating the value for protecting animals as well. Abstract This paper describes the introduction of the systematic review methodology in animal-based research and the added value of this methodology in relation to the 3Rs and beyond. The 3Rs refer to Replacement, Reduction, and Refinement of animal studies. A systematic review (SR) is defined as a literature review focused on a single question that tries to identify, appraise, select, and synthesise all high-quality research evidence relevant to that question. Examples are given on how SRs lead to the implementation of the 3Rs and better science. Additionally, a broader context is given regarding societal, political, and scientific developments. Various examples of systematic reviews are given to illustrate the current situation regarding reporting, quality, and translatability of animal-based research. Furthermore, initiatives that have emerged to move further towards more responsible and sustainable research is of benefit for both animals and humans.
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Abstract
Novel therapeutic intervention that aims to enhance the endogenous recovery potential of the brain during the subacute phase of stroke has produced promising results. The paradigm shift in treatment approaches presents new challenges to preclinical and clinical researchers alike, especially in the functional endpoints domain. Shortcomings of the "neuroprotection" era of stroke research are yet to be fully addressed. Proportional recovery observed in clinics, and potentially in animal models, requires a thorough reevaluation of the methods used to assess recovery. To this end, this review aims to give a detailed evaluation of functional outcome measures used in clinics and preclinical studies. Impairments observed in clinics and animal models will be discussed from a functional testing perspective. Approaches needed to bridge the gap between clinical and preclinical research, along with potential means to measure the moving target recovery, will be discussed. Concepts such as true recovery of function and compensation and methods that are suitable for distinguishing the two are examined. Often-neglected outcomes of stroke, such as emotional disturbances, are discussed to draw attention to the need for further research in this area.
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Affiliation(s)
- Mustafa Balkaya
- Burke Neurological Research Institute, White Plains, NY, USA
| | - Sunghee Cho
- Burke Neurological Research Institute, White Plains, NY, USA.,Feil Family Brain and Mind Research Institute, Weill Cornell Medicine at Burke Neurological Research Institute, White Plains, NY, USA
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4-Imidazo[2,1-b]thiazole-1,4-DHPs and neuroprotection: preliminary study in hits searching. Eur J Med Chem 2019; 169:89-102. [PMID: 30861492 DOI: 10.1016/j.ejmech.2019.02.075] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 02/21/2019] [Accepted: 02/27/2019] [Indexed: 12/25/2022]
Abstract
In the present work we describe the synthesis, characterization and evaluation of neuroprotective effects of a focused library of 4-imidazo[2,1-b]thiazole-1,4-dihydropyridines. Furthermore, the new dihydropyridines were subjected to functional in vitro assays in cardiac tissues and vascular smooth muscle to determine their possible selectivity in counteracting the effects of neurodegeneration. In particular the strategy adopted for designing the compounds involves the imidazo[2,1-b]thiazole nucleus. The observed properties show that substituents at C2 and C6 of the bicyclic scaffold are able to influence the cardiovascular parameters and the neuroprotective activity. In comparison to nifedipine, a set of derivatives such as compound 6, showed a neuroprotective profile of particular interest.
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van Hoorn CE, Hoeks SE, Essink H, Tibboel D, de Graaff JC. A systematic review and narrative synthesis on the histological and neurobehavioral long-term effects of dexmedetomidine. Paediatr Anaesth 2019; 29:125-136. [PMID: 30475445 PMCID: PMC6850292 DOI: 10.1111/pan.13553] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 11/13/2018] [Accepted: 11/15/2018] [Indexed: 01/29/2023]
Abstract
BACKGROUND Recent experimental studies suggest that currently used anesthetics have neurotoxic effects on young animals. Clinical studies are increasingly publishing about the effects of anesthesia on the long-term outcome, providing contradictory results. The selective alpha-2 adrenergic receptor agonist dexmedetomidine has been suggested as an alternative nontoxic sedative agent. AIMS The aim of this systematic review was to assess the potential neuroprotective and neurobehavioral effects of dexmedetomidine in young animals and children. METHODS Systematic searches separately for preclinical and clinical studies were performed in Medline Ovid and Embase on February 14, 2018. RESULTS The initial search found preclinical (n = 661) and clinical (n = 240) studies. A total of 20 preclinical studies were included. None of the clinical studies met the predefined eligibility criteria. Histologic injury by dexmedetomidine was evaluated in 11 studies, and was confirmed in three of these studies (caspase-3 activation or apoptosis). Decrease of injury caused by another anesthetic was evaluated in 16 studies and confirmed in 13 of these. Neurobehavioral tests were performed in seven out of the 20 studies. Of these seven rodent studies, three studies tested the effects of dexmedetomidine alone on neurobehavioral outcome in animals (younger than P21). All three studies found no negative effect of dexmedetomidine on the outcome. In six studies, outcome was evaluated when dexmedetomidine was administered following another anesthetic. Dexmedetomidine was found to lessen the negative effects of the anesthetic. CONCLUSION In animals, dexmedetomidine was found not to induce histologic injury and to show a beneficial effect when administered with another anesthetic. No clinical results on the long-term effects in children have been identified yet.
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Affiliation(s)
- Camille E. van Hoorn
- Department of AnesthesiaSophia Children’s Hospital, Erasmus MCRotterdamThe Netherlands
| | - Sanne E. Hoeks
- Department of AnesthesiaSophia Children’s Hospital, Erasmus MCRotterdamThe Netherlands
| | - Heleen Essink
- Department of AnesthesiaSophia Children’s Hospital, Erasmus MCRotterdamThe Netherlands
| | - Dick Tibboel
- Department of Pediatric Surgery and Intensive CareSophia Children’s Hospital, Erasmus MCRotterdamThe Netherlands
| | - Jurgen C. de Graaff
- Department of AnesthesiaSophia Children’s Hospital, Erasmus MCRotterdamThe Netherlands
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Seow D, Yasui Y, Hutchinson ID, Hurley ET, Shimozono Y, Kennedy JG. The Subchondral Bone Is Affected by Bone Marrow Stimulation: A Systematic Review of Preclinical Animal Studies. Cartilage 2019; 10:70-81. [PMID: 28573889 PMCID: PMC6376565 DOI: 10.1177/1947603517711220] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE Despite the mechanical and biological roles of subchondral bone (SCB) in articular cartilage health, there remains no consensus on the postoperative morphological status of SCB following bone marrow stimulation (BMS). The purpose of this systematic review was to clarify the morphology of SCB following BMS in preclinical, translational animal models. DESIGN The MEDLINE and EMBASE databases were systematically reviewed using specific search terms on April 19, 2016 based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The morphology of the SCB was assessed using of microcomputed tomography (bone density) and histology (microscopic architecture). RESULTS Seventeen animal studies with 520 chondral lesions were included. The morphology of SCB did not recover following BMS. Compared with untreated chondral defects, BMS resulted in superior morphology of superficial SCB and cartilage but inferior morphology (specifically bone density, P < 0.05) of the deep SCB. Overall, the use of biological adjuvants during BMS resulted in the superior postoperative morphology of SCB. CONCLUSIONS Alterations in the SCB following BMS were confirmed. Biologics adjuvants may improve the postoperative morphology of both SCB and articular cartilage. Refinements of BMS techniques should incorporate consideration of SCB damage and restoration. Investigations to optimize BMS techniques incorporating both minimally invasive approaches and biologically augmented platforms are further warranted.
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Affiliation(s)
- Dexter Seow
- Hospital for Special Surgery, New York, NY, USA,Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Youichi Yasui
- Hospital for Special Surgery, New York, NY, USA,Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Ian D. Hutchinson
- Hospital for Special Surgery, New York, NY, USA,Department of Orthopaedic Surgery, Albany Medical Center, Albany, NY, USA
| | - Eoghan T. Hurley
- Hospital for Special Surgery, New York, NY, USA,Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Yoshiharu Shimozono
- Hospital for Special Surgery, New York, NY, USA,Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan,Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - John G. Kennedy
- Hospital for Special Surgery, New York, NY, USA,John G. Kennedy, Hospital for Special Surgery, 523 East 72nd Street, Suite 507, New York, NY 10021, USA.
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Kaffman A, White JD, Wei L, Johnson FK, Krystal JH. Enhancing the Utility of Preclinical Research in Neuropsychiatry Drug Development. Methods Mol Biol 2019; 2011:3-22. [PMID: 31273690 DOI: 10.1007/978-1-4939-9554-7_1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Most large pharmaceutical companies have downscaled or closed their clinical neuroscience research programs in response to the low clinical success rate for drugs that showed tremendous promise in animal experiments intended to model psychiatric pathophysiology. These failures have raised serious concerns about the role of preclinical research in the identification and evaluation of new pharmacotherapies for psychiatry. In the absence of a comprehensive understanding of the neurobiology of psychiatric disorders, the task of developing "animal models" seems elusive. The purpose of this review is to highlight emerging strategies to enhance the utility of preclinical research in the drug development process. We address this issue by reviewing how advances in neuroscience, coupled with new conceptual approaches, have recently revolutionized the way we can diagnose and treat common psychiatric conditions. We discuss the implications of these new tools for modeling psychiatric conditions in animals and advocate for the use of systematic reviews of preclinical work as a prerequisite for conducting psychiatric clinical trials. We believe that work in animals is essential for elucidating human psychopathology and that improving the predictive validity of animal models is necessary for developing more effective interventions for mental illness.
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Affiliation(s)
- Arie Kaffman
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
| | - Jordon D White
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Lan Wei
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Frances K Johnson
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - John H Krystal
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
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Podraza KM, Mehta Y, Husak VA, Lippmann E, O'Brien TE, Kartje GL, Tsai SY. Improved functional outcome after chronic stroke with delayed anti-Nogo-A therapy: A clinically relevant intention-to-treat analysis. J Cereb Blood Flow Metab 2018; 38:1327-1338. [PMID: 28952904 PMCID: PMC6077927 DOI: 10.1177/0271678x17730994] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 08/10/2017] [Accepted: 08/11/2017] [Indexed: 11/15/2022]
Abstract
Many preclinical treatment strategies for stroke have failed when tested in human trials. Although the reasons for these translation failures are multifactorial, one potential concern is the statistical analysis of the preclinical data. One way to rigorously evaluate new therapies is to use an intention-to-treat analysis in preclinical studies. Therefore, in this study, we set out to evaluate the treatment efficacy of a potential clinically relevant therapeutic agent for stroke, i.e., anti-Nogo-A immunotherapy, using an intention-to-treat analysis. Adult rats were trained on the skilled forelimb reaching task and subsequently underwent an ischemic stroke. Nine weeks later, the rats either received intracerebroventricular anti-Nogo-A antibody, control antibody, or no treatment. Skilled reaching performance was assessed by a non-linear model using both an intention-to-treat and per-protocol analysis. Following testing, dendritic complexity was evaluated in the contralesional and perilesional sensorimotor cortex. Both intention-to-treat and per-protocol analysis showed that anti-Nogo-A immunotherapy resulted in statistically significant improved recovery on the skilled forelimb reaching task, although treatment effect was less (though statistically significant) in the intention-to-treat group. Improved functional performance was not shown to be associated with dendritic changes. In conclusion, this study provides evidence for the importance of using intention-to-treat paradigms in testing preclinical therapeutic strategies.
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Affiliation(s)
- Katherine M Podraza
- Research Service,
Edward
Hines Jr. Veterans Affairs Hospital, Hines,
IL, USA
- Loyola University Chicago Health
Sciences Division, Maywood, IL, USA
| | - Yasmin Mehta
- Research Service,
Edward
Hines Jr. Veterans Affairs Hospital, Hines,
IL, USA
| | - Vicki A Husak
- Research Service,
Edward
Hines Jr. Veterans Affairs Hospital, Hines,
IL, USA
| | - Elise Lippmann
- Loyola University Chicago Health
Sciences Division, Maywood, IL, USA
| | - Timothy E O'Brien
- Department of Mathematics and Statistics
and Institute of Environmental Sustainability, Loyola University Chicago, Chicago,
IL, USA
| | - Gwendolyn L Kartje
- Research Service,
Edward
Hines Jr. Veterans Affairs Hospital, Hines,
IL, USA
- Loyola University Chicago Health
Sciences Division, Maywood, IL, USA
| | - Shih-Yen Tsai
- Research Service,
Edward
Hines Jr. Veterans Affairs Hospital, Hines,
IL, USA
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32
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Ingwersen J, De Santi L, Wingerath B, Graf J, Koop B, Schneider R, Hecker C, Schröter F, Bayer M, Engelke AD, Dietrich M, Albrecht P, Hartung HP, Annunziata P, Aktas O, Prozorovski T. Nimodipine confers clinical improvement in two models of experimental autoimmune encephalomyelitis. J Neurochem 2018; 146:86-98. [PMID: 29473171 DOI: 10.1111/jnc.14324] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 02/07/2018] [Accepted: 02/08/2018] [Indexed: 12/31/2022]
Abstract
Multiple sclerosis is characterised by inflammatory neurodegeneration, with axonal injury and neuronal cell death occurring in parallel to demyelination. Regarding the molecular mechanisms responsible for demyelination and axonopathy, energy failure, aberrant expression of ion channels and excitotoxicity have been suggested to lead to Ca2+ overload and subsequent activation of calcium-dependent damage pathways. Thus, the inhibition of Ca2+ influx by pharmacological modulation of Ca2+ channels may represent a novel neuroprotective strategy in the treatment of secondary axonopathy. We therefore investigated the effects of the L-type voltage-gated calcium channel blocker nimodipine in two different models of mouse experimental autoimmune encephalomyelitis (EAE), an established experimental paradigm for multiple sclerosis. We show that preventive application of nimodipine (10 mg/kg per day) starting on the day of induction had ameliorating effects on EAE in SJL/J mice immunised with encephalitic myelin peptide PLP139-151 , specifically in late-stage disease. Furthermore, supporting these data, administration of nimodipine to MOG35-55 -immunised C57BL/6 mice starting at the peak of pre-established disease, also led to a significant decrease in disease score, indicating a protective effect on secondary CNS damage. Histological analysis confirmed that nimodipine attenuated demyelination, axonal loss and pathological axonal β-amyloid precursor protein accumulation in the cerebellum and spinal cord in the chronic phase of disease. Of note, we observed no effects of nimodipine on the peripheral immune response in EAE mice with regard to distribution, antigen-specific proliferation or activation patterns of lymphocytes. Taken together, our data suggest a CNS-specific effect of L-type voltage-gated calcium channel blockade to inflammation-induced neurodegeneration.
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Affiliation(s)
- Jens Ingwersen
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Lorenzo De Santi
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Britta Wingerath
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Jonas Graf
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Barbara Koop
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Reiner Schneider
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Christina Hecker
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Friederike Schröter
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Mary Bayer
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Anna Dorothee Engelke
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Michael Dietrich
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Philipp Albrecht
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Hans-Peter Hartung
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Pasquale Annunziata
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Orhan Aktas
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Tim Prozorovski
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
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Guo R, Gao L, Xu B. Current Evidence of Adult Stem Cells to Enhance Anterior Cruciate Ligament Treatment: A Systematic Review of Animal Trials. Arthroscopy 2018; 34:331-340.e2. [PMID: 28967542 DOI: 10.1016/j.arthro.2017.07.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 07/10/2017] [Accepted: 07/13/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To systematically review the available preclinical evidence of adult stem cells as a biological augmentation in the treatment of animal anterior cruciate ligament (ACL) injury. STUDY DESIGN Systematic review. METHODS PubMed (MEDLINE) and Embase were searched for the eligible studies. The inclusion criteria were controlled animal trials of adult stem cells used in ACL treatment (repair or reconstruction). Studies of natural ACL healing without intervention, in vitro studies, ex vivo studies, and studies without controls were excluded. Evidence level, methodologic quality, and risk of bias of each included study were identified using previously established tools. RESULTS Thirteen animal studies were included. Six of 7 studies using bone marrow-derived mesenchymal stem (stromal) cells (BMSCs) reported a positive enhancement in histology, biomechanics, and biochemistry within 12 weeks postoperatively. Four studies using ACL-derived vascular stem cells showed a promoting effect in histology, biomechanics, and imaging within 8 weeks postoperatively. Two studies focusing on animal tendon-derived stem cells (TDSCs) and human umbilical cord blood-derived mesenchymal stem cells (hUCB-MSCs) reported promotable effects for the early healing in a small animal ACL model. CONCLUSIONS BMSCs, ACL-derived vascular stem cells, TDSCs, and hUCB-MSCs were shown to enhance the healing of ACL injury during the early phase in small animal models. CLINICAL RELEVANCE Results of clinical trials using adult stem cells in ACL treatment are conflicting, and a systematic review of the current best preclinical evidence is crucial to guide further application.
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Affiliation(s)
- Ruipeng Guo
- Department of Sports Medicine and Arthroscopic Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China; Laboratory for Biomechanics and Biomaterials, Hannover Medical School, Hannover, Germany
| | - Liang Gao
- Center for Experimental Orthopaedics, Saarland University Medical Center, Homburg/Saar, Germany
| | - Bin Xu
- Department of Sports Medicine and Arthroscopic Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
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A systematic review of near-infrared spectroscopy in flap monitoring: Current basic and clinical evidence and prospects. J Plast Reconstr Aesthet Surg 2017; 71:246-257. [PMID: 29175135 DOI: 10.1016/j.bjps.2017.10.020] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 09/09/2017] [Accepted: 10/13/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Near-infrared spectroscopy (NIRS) has been reported to be a reliable non-invasive modality for free flap monitoring; however, the history of its application in flap monitoring is short, and there is no definite consensus regarding its use at present. OBJECTIVES The aim of this review is to clarify the evidence related to post-operative flap monitoring using NIRS and examine its appropriateness and usability. MATERIALS AND METHODS The PubMed and Web of Science databases were searched using the strings "flap monitoring AND near-infrared spectroscopy" and "flap monitoring AND tissue oxygen saturation," with a study period from inception to December 31, 2016. Two authors independently extracted articles and assessed the quality of the studies. Articles related to NIRS for flap perfusion monitoring were classified and selected regardless of study type. RESULTS A total of 15 clinical studies and 8 animal studies were identified and reviewed. The evidence and information on various aspects of NIRS flap monitoring were summarized. The overall flap success rate was 99.5%, and the flap salvage rate was 91.1%, when measuring StO2 at intervals of every 2 h or sooner. Single StO2 monitoring was able to detect vascular compromise with 99.1% sensitivity and 99.9% specificity, and earlier than other monitoring methods, but additional Hb concentration monitoring was useful for avoiding false negatives and differentiating arterial and venous occlusion. CONCLUSIONS NIRS can be used for flap monitoring and displays high accuracy in various situations; however, further studies are needed to take full advantage of the potential of NIRS.
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Barron CC, Lalu MM, Stewart DJ, Fergusson D, Yang H, Moher D, Liu P, Mazer D, Devereaux PJ, McIntyre L. Assessment of safety and efficacy of mesenchymal stromal cell therapy in preclinical models of acute myocardial infarction: a systematic review protocol. Syst Rev 2017; 6:226. [PMID: 29116020 PMCID: PMC5688817 DOI: 10.1186/s13643-017-0601-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 10/02/2017] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Despite advances in treatment, acute myocardial infarction (MI) is still associated with significant morbidity and mortality, especially in patients with extensive damage and scar formation. Based on some promising preclinical studies, there is interest in the use of mesenchymal stromal cells (MSCs) to promote cardiac repair after acute MI. However, there is a need for a systematic review of this evidence to summarize the efficacy and safety of MSCs in preclinical models of MI. This will better inform the translation of MSC therapy for acute MI and guide the design of a future clinical trial. METHODS/DESIGN A systematic literature search of MEDLINE, Embase, and BIOSIS Previews will be conducted. We will identify comparative preclinical studies (randomized and non-randomized) of myocardial infarction that include animals given MSC therapy versus a vehicle/placebo. The primary outcome will be left ventricular ejection fraction. Secondary and tertiary outcomes will include death, infarct size, measures of cardiac function, biochemical outcomes, and MSC retention and differentiation. Risk of bias will be assessed using the Cochrane Risk of Bias Tool. Subgroup analyses will be performed to measure how various sources of preclinical study heterogeneity affect the direction and magnitude of the primary outcome. We will meta-analyze data using inverse variance random effects modeling. DISCUSSION This systematic review of preclinical evidence will provide a summary of the efficacy and safety of MSCs in animal models of MI. The results will help determine whether sufficient evidence exists to conduct a clinical trial in humans and inform its design.
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Affiliation(s)
- Carly C Barron
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, Canada.,Blueprint Translational Research Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.,Department of Medicine, McMaster University, Hamilton, Canada
| | - Manoj M Lalu
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, Canada.,Blueprint Translational Research Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.,Regenerative Medicine Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Duncan J Stewart
- Department of Medicine, McMaster University, Hamilton, Canada.,Department of Cell and Molecular Medicine, University of Ottawa, Ottawa, Canada
| | - Dean Fergusson
- Blueprint Translational Research Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.,Department of Epidemiology & Community Medicine, University of Ottawa, Ottawa, Canada
| | - Homer Yang
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, Canada
| | - David Moher
- Blueprint Translational Research Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Peter Liu
- The Ottawa Heart Institute, Ottawa, Canada
| | - David Mazer
- Department of Anesthesia, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - P J Devereaux
- Population Health Research Institute, David Braley Cardiac, Vascular, and Stroke Research Institute, McMaster University, Hamilton, Canada
| | - Lauralyn McIntyre
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Department of Medicine (Division of Critical Care), University of Ottawa, 501 Smyth Rd, Box 201, Ottawa, ON, K1H 8L6, Canada.
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Zwierzyna M, Overington JP. Classification and analysis of a large collection of in vivo bioassay descriptions. PLoS Comput Biol 2017; 13:e1005641. [PMID: 28678787 PMCID: PMC5517062 DOI: 10.1371/journal.pcbi.1005641] [Citation(s) in RCA: 12] [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: 02/27/2017] [Revised: 07/19/2017] [Accepted: 06/21/2017] [Indexed: 12/17/2022] Open
Abstract
Testing potential drug treatments in animal disease models is a decisive step of all preclinical drug discovery programs. Yet, despite the importance of such experiments for translational medicine, there have been relatively few efforts to comprehensively and consistently analyze the data produced by in vivo bioassays. This is partly due to their complexity and lack of accepted reporting standards-publicly available animal screening data are only accessible in unstructured free-text format, which hinders computational analysis. In this study, we use text mining to extract information from the descriptions of over 100,000 drug screening-related assays in rats and mice. We retrieve our dataset from ChEMBL-an open-source literature-based database focused on preclinical drug discovery. We show that in vivo assay descriptions can be effectively mined for relevant information, including experimental factors that might influence the outcome and reproducibility of animal research: genetic strains, experimental treatments, and phenotypic readouts used in the experiments. We further systematize extracted information using unsupervised language model (Word2Vec), which learns semantic similarities between terms and phrases, allowing identification of related animal models and classification of entire assay descriptions. In addition, we show that random forest models trained on features generated by Word2Vec can predict the class of drugs tested in different in vivo assays with high accuracy. Finally, we combine information mined from text with curated annotations stored in ChEMBL to investigate the patterns of usage of different animal models across a range of experiments, drug classes, and disease areas.
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Affiliation(s)
- Magdalena Zwierzyna
- BenevolentAI, London, United Kingdom
- Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - John P. Overington
- BenevolentAI, London, United Kingdom
- Institute of Cardiovascular Science, University College London, London, United Kingdom
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Wessell A, Kole MJ, Badjatia N, Parikh G, Albrecht JS, Schreibman DL, Simard JM. High Compliance with Scheduled Nimodipine Is Associated with Better Outcome in Aneurysmal Subarachnoid Hemorrhage Patients Cotreated with Heparin Infusion. Front Neurol 2017. [PMID: 28649230 PMCID: PMC5465287 DOI: 10.3389/fneur.2017.00268] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Introduction We sought to determine whether compliance with scheduled nimodipine in subarachnoid hemorrhage patients impacted patient outcomes, with the intent of guiding future nimodipine management in patients who experience nimodipine-induced hypotension. Methods We performed a retrospective analysis of 118 consecutive aneurysmal subarachnoid hemorrhage patients treated with the Maryland Low-Dose IV Heparin Infusion Protocol. Patients were categorized into three independent nimodipine compliance groups: ≥1 dose held, ≥1 dose split, and no missed or split-doses. A split-dose was defined as 30 mg of nimodipine administered every 2 h. Our primary outcome was discharge to home. Bivariate and multivariable logistic regression analyses were used to assess predictors of discharge disposition as a function of nimodipine compliance. Results Of the 118 patients, 20 (17%) received all nimodipine doses, 6 (5%) received split-doses but never had a full dose held, and 92 (78%) had ≥1 dose held. Forty-five percent of patients were discharged to home, including 75% who received all doses, 67% who received ≥1 split-doses, and 37% with ≥1 missed doses (p = 0.003). Multivariable analysis showed that, along with age and World Federation of Neurosurgical Societies grade, nimodipine compliance was an independent predictor of clinical outcome; compared to missing one or more nimodipine doses, full dosing compliance was associated with increased odds of discharge to home (odds ratio 5.20; 95% confidence intervals 1.46–18.56). Conclusion In aneurysmal subarachnoid hemorrhage patients with modified Fisher scores 2 through 4 who are cotreated with a low-dose heparin infusion, full compliance with nimodipine dosing was associated with increased odds of discharge to home.
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Affiliation(s)
- Aaron Wessell
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Matthew J Kole
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Neeraj Badjatia
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD, United States.,Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, United States.,Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Gunjan Parikh
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Jennifer S Albrecht
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, United States
| | - David L Schreibman
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD, United States.,Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - J Marc Simard
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD, United States.,Department of Pathology, University of Maryland School of Medicine, Baltimore, MD, United States.,Department of Physiology, University of Maryland School of Medicine, Baltimore, MD, United States
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Geng JL, Aa JY, Feng SQ, Wang SY, Wang P, Zhang Y, Ouyang BC, Wang JK, Zhu YJ, Huang WZ, Wang ZZ, Xiao W, Wang GJ. Exploring the neuroprotective effects of ginkgolides injection in a rodent model of cerebral ischemia-reperfusion injury by GC-MS based metabolomic profiling. J Pharm Biomed Anal 2017; 142:190-200. [PMID: 28514718 DOI: 10.1016/j.jpba.2017.04.031] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 04/07/2017] [Accepted: 04/09/2017] [Indexed: 12/18/2022]
Abstract
Cerebral ischemia-reperfusion (I/R) injury usually contributes to mortality and disability after ischemic stroke. Ginkgolides injection (GIn), a standard preparation composed of ginkgo diterpene lactones extract, is clinically used for neuroprotective treatment on reconvalescents of cerebral infarction. However, the understanding about its therapeutic mechanism is still lacking. In this study, a gas chromatography-mass spectrometry (GC-MS) based metabolomic approach coupled with multivariate data analysis (MVDA) was applied to explore the neuroprotective effects of GIn in a rodent model of focal ischemic stroke induced by transient middle cerebral artery occlusion (tMCAO). Metabolomic profiling revealed a series of metabolic perturbations that underlie the cerebral I/R pathological events. GIn can reverse the I/R induced brain metabolic deviations by modulating multiple metabolic pathways, such as glycolysis, Krebs cycle, pentose phosphate pathway (PPP), γ-aminobutyrate (GABA) shunt and lipid metabolism. Moreover, the main bioactive components of GIn were distributed to brain tissue much more easily in tMCAO rats than in normal rats after an intravenous administration, suggesting that the increased cerebral exposure to ginkgolides in I/R pathological condition potentially facilitated the neuroprotective effects of GIn by directly targeting at brain. The present study provided valuable information for our understanding about metabolic changes of cerebral I/R injury and clinical application of GIn.
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Affiliation(s)
- Jian-Liang Geng
- Key Laboratory of Drug Metabolism and Pharmacokinetics, China Pharmaceutical University, Nanjing 210009, China
| | - Ji-Ye Aa
- Key Laboratory of Drug Metabolism and Pharmacokinetics, China Pharmaceutical University, Nanjing 210009, China
| | - Si-Qi Feng
- Key Laboratory of Drug Metabolism and Pharmacokinetics, China Pharmaceutical University, Nanjing 210009, China
| | - Shu-Yao Wang
- Jiangsu Kanion Modern Chinese Medicine Institute, Nanjing 210017, China; State Key Laboratory of Pharmaceutical New-Tech for Chinese Medicine, Jiangsu Kanion Pharmaceutical Co., Ltd., Lianyungang 222001, China
| | - Pei Wang
- Key Laboratory of Drug Metabolism and Pharmacokinetics, China Pharmaceutical University, Nanjing 210009, China
| | - Yue Zhang
- Key Laboratory of Drug Metabolism and Pharmacokinetics, China Pharmaceutical University, Nanjing 210009, China
| | - Bing-Chen Ouyang
- Key Laboratory of Drug Metabolism and Pharmacokinetics, China Pharmaceutical University, Nanjing 210009, China
| | - Jian-Kun Wang
- Key Laboratory of Drug Metabolism and Pharmacokinetics, China Pharmaceutical University, Nanjing 210009, China
| | - Ye-Jin Zhu
- Key Laboratory of Drug Metabolism and Pharmacokinetics, China Pharmaceutical University, Nanjing 210009, China
| | - Wen-Zhe Huang
- Jiangsu Kanion Modern Chinese Medicine Institute, Nanjing 210017, China; State Key Laboratory of Pharmaceutical New-Tech for Chinese Medicine, Jiangsu Kanion Pharmaceutical Co., Ltd., Lianyungang 222001, China
| | - Zhen-Zhong Wang
- Jiangsu Kanion Modern Chinese Medicine Institute, Nanjing 210017, China; State Key Laboratory of Pharmaceutical New-Tech for Chinese Medicine, Jiangsu Kanion Pharmaceutical Co., Ltd., Lianyungang 222001, China
| | - Wei Xiao
- Jiangsu Kanion Modern Chinese Medicine Institute, Nanjing 210017, China; State Key Laboratory of Pharmaceutical New-Tech for Chinese Medicine, Jiangsu Kanion Pharmaceutical Co., Ltd., Lianyungang 222001, China.
| | - Guang-Ji Wang
- Key Laboratory of Drug Metabolism and Pharmacokinetics, China Pharmaceutical University, Nanjing 210009, China.
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Tsiouris CG, Kelesi M, Vasilopoulos G, Kalemikerakis I, Papageorgiou EG. The efficacy of probiotics as pharmacological treatment of cutaneous wounds: Meta-analysis of animal studies. Eur J Pharm Sci 2017; 104:230-239. [PMID: 28392493 DOI: 10.1016/j.ejps.2017.04.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 04/01/2017] [Accepted: 04/02/2017] [Indexed: 11/29/2022]
Abstract
The aim of the current meta-analysis of animal studies was to evaluate the efficacy of probiotics as pharmacological treatment of cutaneous wounds. A systematic electronic literature search was conducted and in total six animal studies which undertake twelve experiments met our inclusion criteria. We used the percentage (%) of wound area at the end of the first week after initial wounding to evaluate the efficacy of the probiotic treatment. The heterogeneity was estimated as statistically significant (p<0.0001) and therefore the meta-analysis was performed with the random-effect model. Based on the estimated Hedges' g (Hedges, 1982), the administration of probiotics was associated with acceleration of the wound contraction (g=-2.55; 95%CI=-3.59, -1.50; p<0.0001). The meta-regression analysis showed that the moderator sterile kefir extract has the greater effect on the overall estimated efficacy of probiotic treatment (g=-5.6983; p=0.0442) with bacteria probiotic therapies (70% kefir gel, L. brevis, L. fermentum, L. plantarum, L. reuteri) following (g=-2.3814; p=0.0003). For bacteria dose moderator, the results showed that increase in bacterial dose corresponds to increase of the estimated overall effect size (g=-10.2056; p=0.0053). The linear regression test of funnel plot asymmetry showed absence of publication bias. In conclusion, the results indicate that probiotics administration is an effective pharmacological treatment of cutaneous wounds. However, due to the heterogeneity among studies, further research is required.
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Affiliation(s)
- Christos G Tsiouris
- Department of Nursing, Faculty of Health and Caring Professions, Technological Educational Institution of Athens, Greece
| | - Martha Kelesi
- Department of Nursing, Faculty of Health and Caring Professions, Technological Educational Institution of Athens, Greece
| | - Georgios Vasilopoulos
- Department of Nursing, Faculty of Health and Caring Professions, Technological Educational Institution of Athens, Greece
| | - Ioannis Kalemikerakis
- Department of Nursing, Faculty of Health and Caring Professions, Technological Educational Institution of Athens, Greece
| | - Effie G Papageorgiou
- Department of Medical Laboratories, Faculty of Health and Caring Professions, Technological Educational Institution of Athens, Greece.
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40
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Ramirez FD, Motazedian P, Jung RG, Di Santo P, MacDonald ZD, Moreland R, Simard T, Clancy AA, Russo JJ, Welch VA, Wells GA, Hibbert B. Methodological Rigor in Preclinical Cardiovascular Studies: Targets to Enhance Reproducibility and Promote Research Translation. Circ Res 2017; 120:1916-1926. [PMID: 28373349 PMCID: PMC5466021 DOI: 10.1161/circresaha.117.310628] [Citation(s) in RCA: 108] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 03/11/2017] [Accepted: 03/31/2017] [Indexed: 01/13/2023]
Abstract
RATIONALE Methodological sources of bias and suboptimal reporting contribute to irreproducibility in preclinical science and may negatively affect research translation. Randomization, blinding, sample size estimation, and considering sex as a biological variable are deemed crucial study design elements to maximize the quality and predictive value of preclinical experiments. OBJECTIVE To examine the prevalence and temporal patterns of recommended study design element implementation in preclinical cardiovascular research. METHODS AND RESULTS All articles published over a 10-year period in 5 leading cardiovascular journals were reviewed. Reports of in vivo experiments in nonhuman mammals describing pathophysiology, genetics, or therapeutic interventions relevant to specific cardiovascular disorders were identified. Data on study design and animal model use were collected. Citations at 60 months were additionally examined as a surrogate measure of research impact in a prespecified subset of studies, stratified by individual and cumulative study design elements. Of 28 636 articles screened, 3396 met inclusion criteria. Randomization was reported in 21.8%, blinding in 32.7%, and sample size estimation in 2.3%. Temporal and disease-specific analyses show that the implementation of these study design elements has overall not appreciably increased over the past decade, except in preclinical stroke research, which has uniquely demonstrated significant improvements in methodological rigor. In a subset of 1681 preclinical studies, randomization, blinding, sample size estimation, and inclusion of both sexes were not associated with increased citations at 60 months. CONCLUSIONS Methodological shortcomings are prevalent in preclinical cardiovascular research, have not substantially improved over the past 10 years, and may be overlooked when basing subsequent studies. Resultant risks of bias and threats to study validity have the potential to hinder progress in cardiovascular medicine as preclinical research often precedes and informs clinical trials. Stroke research quality has uniquely improved in recent years, warranting a closer examination for interventions to model in other cardiovascular fields.
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Affiliation(s)
- F Daniel Ramirez
- From the Division of Cardiology (F.D.R., P.M., R.G.J., P.D.S., T.S., J.J.R., B.H.), CAPITAL Research Group (F.D.R., P.M., R.G.J., P.D.S., Z.D.M.D., R.M., T.S., J.J.R., B.H.), Vascular Biology and Experimental Medicine Laboratory (R.G.J., T.S., B.H.), and Cardiovascular Research Methods Centre (G.A.W.), University of Ottawa Heart Institute, Ontario, Canada; and School of Epidemiology, Public Health and Preventive Medicine (F.D.R., V.A.W., G.A.W.), Department of Cellular and Molecular Medicine (R.G.J., T.S., B.H.), Department of Radiology (R.M.), Department of Obstetrics and Gynecology (A.A.C.), Bruyère Research Institute (V.A.W.), and Centre for Global Health (V.A.W.), University of Ottawa, Ontario, Canada
| | - Pouya Motazedian
- From the Division of Cardiology (F.D.R., P.M., R.G.J., P.D.S., T.S., J.J.R., B.H.), CAPITAL Research Group (F.D.R., P.M., R.G.J., P.D.S., Z.D.M.D., R.M., T.S., J.J.R., B.H.), Vascular Biology and Experimental Medicine Laboratory (R.G.J., T.S., B.H.), and Cardiovascular Research Methods Centre (G.A.W.), University of Ottawa Heart Institute, Ontario, Canada; and School of Epidemiology, Public Health and Preventive Medicine (F.D.R., V.A.W., G.A.W.), Department of Cellular and Molecular Medicine (R.G.J., T.S., B.H.), Department of Radiology (R.M.), Department of Obstetrics and Gynecology (A.A.C.), Bruyère Research Institute (V.A.W.), and Centre for Global Health (V.A.W.), University of Ottawa, Ontario, Canada
| | - Richard G Jung
- From the Division of Cardiology (F.D.R., P.M., R.G.J., P.D.S., T.S., J.J.R., B.H.), CAPITAL Research Group (F.D.R., P.M., R.G.J., P.D.S., Z.D.M.D., R.M., T.S., J.J.R., B.H.), Vascular Biology and Experimental Medicine Laboratory (R.G.J., T.S., B.H.), and Cardiovascular Research Methods Centre (G.A.W.), University of Ottawa Heart Institute, Ontario, Canada; and School of Epidemiology, Public Health and Preventive Medicine (F.D.R., V.A.W., G.A.W.), Department of Cellular and Molecular Medicine (R.G.J., T.S., B.H.), Department of Radiology (R.M.), Department of Obstetrics and Gynecology (A.A.C.), Bruyère Research Institute (V.A.W.), and Centre for Global Health (V.A.W.), University of Ottawa, Ontario, Canada
| | - Pietro Di Santo
- From the Division of Cardiology (F.D.R., P.M., R.G.J., P.D.S., T.S., J.J.R., B.H.), CAPITAL Research Group (F.D.R., P.M., R.G.J., P.D.S., Z.D.M.D., R.M., T.S., J.J.R., B.H.), Vascular Biology and Experimental Medicine Laboratory (R.G.J., T.S., B.H.), and Cardiovascular Research Methods Centre (G.A.W.), University of Ottawa Heart Institute, Ontario, Canada; and School of Epidemiology, Public Health and Preventive Medicine (F.D.R., V.A.W., G.A.W.), Department of Cellular and Molecular Medicine (R.G.J., T.S., B.H.), Department of Radiology (R.M.), Department of Obstetrics and Gynecology (A.A.C.), Bruyère Research Institute (V.A.W.), and Centre for Global Health (V.A.W.), University of Ottawa, Ontario, Canada
| | - Zachary D MacDonald
- From the Division of Cardiology (F.D.R., P.M., R.G.J., P.D.S., T.S., J.J.R., B.H.), CAPITAL Research Group (F.D.R., P.M., R.G.J., P.D.S., Z.D.M.D., R.M., T.S., J.J.R., B.H.), Vascular Biology and Experimental Medicine Laboratory (R.G.J., T.S., B.H.), and Cardiovascular Research Methods Centre (G.A.W.), University of Ottawa Heart Institute, Ontario, Canada; and School of Epidemiology, Public Health and Preventive Medicine (F.D.R., V.A.W., G.A.W.), Department of Cellular and Molecular Medicine (R.G.J., T.S., B.H.), Department of Radiology (R.M.), Department of Obstetrics and Gynecology (A.A.C.), Bruyère Research Institute (V.A.W.), and Centre for Global Health (V.A.W.), University of Ottawa, Ontario, Canada
| | - Robert Moreland
- From the Division of Cardiology (F.D.R., P.M., R.G.J., P.D.S., T.S., J.J.R., B.H.), CAPITAL Research Group (F.D.R., P.M., R.G.J., P.D.S., Z.D.M.D., R.M., T.S., J.J.R., B.H.), Vascular Biology and Experimental Medicine Laboratory (R.G.J., T.S., B.H.), and Cardiovascular Research Methods Centre (G.A.W.), University of Ottawa Heart Institute, Ontario, Canada; and School of Epidemiology, Public Health and Preventive Medicine (F.D.R., V.A.W., G.A.W.), Department of Cellular and Molecular Medicine (R.G.J., T.S., B.H.), Department of Radiology (R.M.), Department of Obstetrics and Gynecology (A.A.C.), Bruyère Research Institute (V.A.W.), and Centre for Global Health (V.A.W.), University of Ottawa, Ontario, Canada
| | - Trevor Simard
- From the Division of Cardiology (F.D.R., P.M., R.G.J., P.D.S., T.S., J.J.R., B.H.), CAPITAL Research Group (F.D.R., P.M., R.G.J., P.D.S., Z.D.M.D., R.M., T.S., J.J.R., B.H.), Vascular Biology and Experimental Medicine Laboratory (R.G.J., T.S., B.H.), and Cardiovascular Research Methods Centre (G.A.W.), University of Ottawa Heart Institute, Ontario, Canada; and School of Epidemiology, Public Health and Preventive Medicine (F.D.R., V.A.W., G.A.W.), Department of Cellular and Molecular Medicine (R.G.J., T.S., B.H.), Department of Radiology (R.M.), Department of Obstetrics and Gynecology (A.A.C.), Bruyère Research Institute (V.A.W.), and Centre for Global Health (V.A.W.), University of Ottawa, Ontario, Canada
| | - Aisling A Clancy
- From the Division of Cardiology (F.D.R., P.M., R.G.J., P.D.S., T.S., J.J.R., B.H.), CAPITAL Research Group (F.D.R., P.M., R.G.J., P.D.S., Z.D.M.D., R.M., T.S., J.J.R., B.H.), Vascular Biology and Experimental Medicine Laboratory (R.G.J., T.S., B.H.), and Cardiovascular Research Methods Centre (G.A.W.), University of Ottawa Heart Institute, Ontario, Canada; and School of Epidemiology, Public Health and Preventive Medicine (F.D.R., V.A.W., G.A.W.), Department of Cellular and Molecular Medicine (R.G.J., T.S., B.H.), Department of Radiology (R.M.), Department of Obstetrics and Gynecology (A.A.C.), Bruyère Research Institute (V.A.W.), and Centre for Global Health (V.A.W.), University of Ottawa, Ontario, Canada
| | - Juan J Russo
- From the Division of Cardiology (F.D.R., P.M., R.G.J., P.D.S., T.S., J.J.R., B.H.), CAPITAL Research Group (F.D.R., P.M., R.G.J., P.D.S., Z.D.M.D., R.M., T.S., J.J.R., B.H.), Vascular Biology and Experimental Medicine Laboratory (R.G.J., T.S., B.H.), and Cardiovascular Research Methods Centre (G.A.W.), University of Ottawa Heart Institute, Ontario, Canada; and School of Epidemiology, Public Health and Preventive Medicine (F.D.R., V.A.W., G.A.W.), Department of Cellular and Molecular Medicine (R.G.J., T.S., B.H.), Department of Radiology (R.M.), Department of Obstetrics and Gynecology (A.A.C.), Bruyère Research Institute (V.A.W.), and Centre for Global Health (V.A.W.), University of Ottawa, Ontario, Canada
| | - Vivian A Welch
- From the Division of Cardiology (F.D.R., P.M., R.G.J., P.D.S., T.S., J.J.R., B.H.), CAPITAL Research Group (F.D.R., P.M., R.G.J., P.D.S., Z.D.M.D., R.M., T.S., J.J.R., B.H.), Vascular Biology and Experimental Medicine Laboratory (R.G.J., T.S., B.H.), and Cardiovascular Research Methods Centre (G.A.W.), University of Ottawa Heart Institute, Ontario, Canada; and School of Epidemiology, Public Health and Preventive Medicine (F.D.R., V.A.W., G.A.W.), Department of Cellular and Molecular Medicine (R.G.J., T.S., B.H.), Department of Radiology (R.M.), Department of Obstetrics and Gynecology (A.A.C.), Bruyère Research Institute (V.A.W.), and Centre for Global Health (V.A.W.), University of Ottawa, Ontario, Canada
| | - George A Wells
- From the Division of Cardiology (F.D.R., P.M., R.G.J., P.D.S., T.S., J.J.R., B.H.), CAPITAL Research Group (F.D.R., P.M., R.G.J., P.D.S., Z.D.M.D., R.M., T.S., J.J.R., B.H.), Vascular Biology and Experimental Medicine Laboratory (R.G.J., T.S., B.H.), and Cardiovascular Research Methods Centre (G.A.W.), University of Ottawa Heart Institute, Ontario, Canada; and School of Epidemiology, Public Health and Preventive Medicine (F.D.R., V.A.W., G.A.W.), Department of Cellular and Molecular Medicine (R.G.J., T.S., B.H.), Department of Radiology (R.M.), Department of Obstetrics and Gynecology (A.A.C.), Bruyère Research Institute (V.A.W.), and Centre for Global Health (V.A.W.), University of Ottawa, Ontario, Canada
| | - Benjamin Hibbert
- From the Division of Cardiology (F.D.R., P.M., R.G.J., P.D.S., T.S., J.J.R., B.H.), CAPITAL Research Group (F.D.R., P.M., R.G.J., P.D.S., Z.D.M.D., R.M., T.S., J.J.R., B.H.), Vascular Biology and Experimental Medicine Laboratory (R.G.J., T.S., B.H.), and Cardiovascular Research Methods Centre (G.A.W.), University of Ottawa Heart Institute, Ontario, Canada; and School of Epidemiology, Public Health and Preventive Medicine (F.D.R., V.A.W., G.A.W.), Department of Cellular and Molecular Medicine (R.G.J., T.S., B.H.), Department of Radiology (R.M.), Department of Obstetrics and Gynecology (A.A.C.), Bruyère Research Institute (V.A.W.), and Centre for Global Health (V.A.W.), University of Ottawa, Ontario, Canada.
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Karsy M, Brock A, Guan J, Taussky P, Kalani MYS, Park MS. Neuroprotective strategies and the underlying molecular basis of cerebrovascular stroke. Neurosurg Focus 2017; 42:E3. [DOI: 10.3171/2017.1.focus16522] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Stroke is a leading cause of disability in the US. Although there has been significant progress in the area of medical and surgical thrombolytic technologies, neuroprotective agents to prevent secondary cerebral injury and to minimize disability remain limited. Only limited success has been reported in preclinical and clinical trials evaluating a variety of compounds. In this review, the authors discuss the most up-to-date information regarding the underlying molecular biology of stroke as well as strategies that aim to mitigate this complex signaling cascade. Results of historical research trials involving N-methyl-d-aspartate and α-amino-3-hydroxy-5-methyl-4-isoxazole propionate receptor antagonists, clomethiazole, antioxidants, citicoline, nitric oxide, and immune regulators have laid the groundwork for current progress. In addition, more recent studies involving therapeutic hypothermia, magnesium, albumin, glyburide, uric acid, and a variety of other treatments have provided more options. The use of neuroprotective agents in combination or with existing thrombolytic treatments may be one of many exciting areas of further development. Although past trials of neuroprotective agents in ischemic stroke have been limited, significant insights into mechanisms of stroke, animal models, and trial design have incrementally improved approaches for future therapies.
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Cui HJ, He HY, Yang AL, Zhou HJ, Tang T, Luo JK. Hyperbaric oxygen for experimental intracerebral haemorrhage: Systematic review and stratified meta-analysis. Brain Inj 2017; 31:456-465. [PMID: 28426381 DOI: 10.1080/02699052.2017.1279752] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Han-Jin Cui
- Institute of Integrative Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Key Lab of Chinese Gan of SATCM, Changsha, Hunan, China
| | - Hao-Yu He
- Institute of Mental Health, Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - A-Li Yang
- Institute of Hyperbaric Oxygen, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Institute of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Hua-Jun Zhou
- Institute of Neurology, The First College of Clinical Medical Sciences, China Three Gorges University, Yichang, Hubei, China
| | - Tao Tang
- Institute of Integrative Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Key Lab of Chinese Gan of SATCM, Changsha, Hunan, China
| | - Jie-Kun Luo
- Institute of Integrative Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Key Lab of Chinese Gan of SATCM, Changsha, Hunan, China
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Lalu MM, Sullivan KJ, Mei SH, Moher D, Straus A, Fergusson DA, Stewart DJ, Jazi M, MacLeod M, Winston B, Marshall J, Hutton B, Walley KR, McIntyre L. Evaluating mesenchymal stem cell therapy for sepsis with preclinical meta-analyses prior to initiating a first-in-human trial. eLife 2016; 5. [PMID: 27870924 PMCID: PMC5153252 DOI: 10.7554/elife.17850] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Accepted: 11/02/2016] [Indexed: 12/22/2022] Open
Abstract
Evaluation of preclinical evidence prior to initiating early-phase clinical studies has typically been performed by selecting individual studies in a non-systematic process that may introduce bias. Thus, in preparation for a first-in-human trial of mesenchymal stromal cells (MSCs) for septic shock, we applied systematic review methodology to evaluate all published preclinical evidence. We identified 20 controlled comparison experiments (980 animals from 18 publications) of in vivo sepsis models. Meta-analysis demonstrated that MSC treatment of preclinical sepsis significantly reduced mortality over a range of experimental conditions (odds ratio 0.27, 95% confidence interval 0.18–0.40, latest timepoint reported for each study). Risk of bias was unclear as few studies described elements such as randomization and no studies included an appropriately calculated sample size. Moreover, the presence of publication bias resulted in a ~30% overestimate of effect and threats to validity limit the strength of our conclusions. This novel prospective application of systematic review methodology serves as a template to evaluate preclinical evidence prior to initiating first-in-human clinical studies. DOI:http://dx.doi.org/10.7554/eLife.17850.001 Most attempts to transform exciting findings from laboratories into clinical treatments are unsuccessful. One reason for this may be the failure to consider all of the laboratory work that has been performed before deciding to test a treatment on patients for the first time. In particular, negative findings (that suggest that a potential new treatment is ineffective) may be overlooked. Stem cells may help to treat life-threatening infections, but this has not been tested in human patients. However, the effectiveness of stem cell treatments has been tested in animals that act as models of human infection. Before deciding to begin a clinical trial of stem cell therapy for life-threatening infections, Lalu et al. performed an exhaustive search to find all the studies in which stem cells were used to treat animal models of infection. Combining the results of all of these studies using particular analysis techniques revealed that stem cell therapy increased the survival of these animals overall. These positive effects were seen over a range of different experimental conditions (for example, when treating the animals with different doses of stem cells, or giving the doses at different times). Lalu et al. also identified some limitations with most of the laboratory studies that had tested stem cell therapy for infections. Many of the studies used animal models that may not be the best representations of humans with severe infection. In addition, many of the scientists did not report that they had used methods (such as randomization) that would generate the most confidence in their results. Despite these limitations, there was a lot of consistency in the reported results. Overall, the results support the decision to proceed to a clinical trial that tests the effectiveness of stem cells for treating human infections. More generally, Lalu et al.’s analysis demonstrates a way of considering all laboratory evidence before deciding to proceed to a first clinical trial in humans. This may help researchers to identify promising therapies to further develop, and also to identify potential failures before they are tested in patients. DOI:http://dx.doi.org/10.7554/eLife.17850.002
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Affiliation(s)
- Manoj M Lalu
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, Canada.,Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Canada.,Regenerative Medicine Program, The Ottawa Hospital Research Institute, Ottawa, Canada
| | - Katrina J Sullivan
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Canada
| | - Shirley Hj Mei
- Regenerative Medicine Program, The Ottawa Hospital Research Institute, Ottawa, Canada
| | - David Moher
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Canada.,School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Canada
| | - Alexander Straus
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Canada
| | - Dean A Fergusson
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Canada
| | - Duncan J Stewart
- Regenerative Medicine Program, The Ottawa Hospital Research Institute, Ottawa, Canada.,Department of Cell and Molecular Medicine, University of Ottawa, Ottawa, Canada
| | - Mazen Jazi
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Malcolm MacLeod
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, United Kingdom
| | - Brent Winston
- Department of Critical Care Medicine, University of Calgary, Calgary, Canada
| | - John Marshall
- Departments of Surgery and Critical Care Medicine, Keenan Research Centre of the Li KaShing Knowledge Institute, St. Michaels Hospital, The University of Toronto, Toronto, Canada
| | - Brian Hutton
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Canada
| | - Keith R Walley
- Department of Medicine, Centre for Heart Lung Innovation, University of British Columbia, Vancouver, Canada
| | - Lauralyn McIntyre
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Canada.,Department of Medicine, University of Ottawa, Ottawa, Canada
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Efficacy of the superoxide dismutase mimetic tempol in animal hypertension models: a meta-analysis. J Hypertens 2016; 33:14-23. [PMID: 25380160 DOI: 10.1097/hjh.0000000000000422] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Considering the growing body of evidence that indicates the contribution of superoxide anions (O2) and other reactive oxygen species (ROS) to the development of hypertension, we assessed whether animal models of hypertension have a benefic effect with tempol, a superoxide dismutase mimetic, to help augment the design of future studies. METHODS Studies published between July 1998 and December 2012 on blood pressure (BP) in different hypertensive models were obtained after an electronic and manual search of PubMed. In-depth analyses of the methodological quality of the studies and the mean arterial pressure (MAP) changes after treatment with tempol were performed, as well as the subgroup analyses on the route of tempol delivery. RESULTS Out of the 144 identified studies, 28 were included after screening. The data showed that tempol reduced MAP by computing the standardized mean difference with the value of 4.622 (95% confidence interval 3.24-5.99). The quality of studies included in the meta-analysis was category II; however, omission of details in the trials might have biased the results. There was substantial heterogeneity in the results with an I of 94.45%, which persisted after stratifying for the route of tempol delivery. CONCLUSION In conclusion, this analysis shows that antioxidant treatment with tempol can reduce BP, suggesting that ROS plays a role in the pathogenesis of increased BP in the hypertension models used in the current research practice.
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Zhang G, Wang D, Miao S, Zou X, Liu G, Zhu Y. Extracellular vesicles derived from mesenchymal stromal cells may possess increased therapeutic potential for acute kidney injury compared with conditioned medium in rodent models: A meta-analysis. Exp Ther Med 2016; 11:1519-1525. [PMID: 27073476 DOI: 10.3892/etm.2016.3076] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 01/26/2016] [Indexed: 12/14/2022] Open
Abstract
The potential involvement of the endocrine/paracrine mechanisms in the mesenchymal stromal cells (MSCs) therapy for acute kidney injury (AKI) has been increasingly studied. The aim of the present meta-analysis was to systematically review the therapeutic role of MSC-conditioned medium (CM) or MSCs released by extracellular vesicles (Evs) for the treatment of AKI in rodent models. Studies were identified using PubMed and Scopus databases using a custom search strategy and eligibility criteria. Data regarding serum creatinine (SCr) concentration, CM or Evs, measurement time point, AKI model (toxic or non-toxic) and other parameters, including delivery route, animal type and animal numbers, were extracted. Pooled analysis and subgroup analysis as well as multivariable meta-regression were performed. Heterogeneity and publication bias were also investigated. A total of 13 studies were included and analyzed. Pooled analysis showed reduced SCr (0.93 [0.67, 1.20], mg/dl) in rodent models of AKI after CM/Evs therapy. The results of the subgroup analysis suggested that Evs induced an increased therapeutic effect, in the form of SCr reduction, as compared with CM (P=0.05). There were also other significant influential factors for SCr reduction including measurement time point (P=0.0004) and therapeutic time point (P<0.0001) after surgery. By contrast, parameters such as delivery route, injury type and cell type were not significant influential factors. Multivariable meta-regression analysis showed that measurement time point (P=0.041), therapeutic time point (P=0.03), Evs or CM (P=0.0003) and cell type (P<0.0001) were influential factors in the reduction of SCr. The present meta-analysis indicates that CM or Evs derived from MSCs are able to improve the impaired renal function in rodents modelling AKI. Compared with CM, Evs may produce a more marked therapeutic effect in recovery from renal failure. In addition, CM or Evs administration in early stages of AKI may result in more evident effects.
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Affiliation(s)
- Guangyuan Zhang
- Department of Urology, Shanghai First People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200080, P.R. China
| | - Dandan Wang
- Department of Nephrology, The Second People's Hospital of Shenzhen, Guangzhou Medical University, Shenzhen, Guangzhou, Guangdong 510182, P.R. China
| | - Shuai Miao
- Department of Urology, Shanghai First People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200080, P.R. China
| | - Xiangyu Zou
- Department of Urology, Shanghai First People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200080, P.R. China
| | - Guohua Liu
- Department of Urology, Shanghai First People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200080, P.R. China
| | - Yingjian Zhu
- Department of Urology, Shanghai First People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200080, P.R. China
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Qi N, Li WJ, Tian H. A systematic review of animal and clinical studies on the use of scaffolds for urethral repair. ACTA ACUST UNITED AC 2016; 36:111-117. [PMID: 26838750 DOI: 10.1007/s11596-016-1551-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 09/29/2015] [Indexed: 12/26/2022]
Abstract
Replacing urethral tissue with functional scaffolds has been one of the challenging problems in the field of urethra reconstruction or repair over the last several decades. Various scaffold materials have been used in animal studies, but clinical studies on use of scaffolds for urethral repair are scarce. The aim of this study was to review recent animal and clinical studies on the use of different scaffolds for urethral repair, and to evaluate these scaffolds based on the evidence from these studies. PubMed and OVID databases were searched to identify relevant studies, in conjunction with further manual search. Studies that met the inclusion criteria were systematically evaluated. Of 555 identified studies, 38 were included for analysis. It was found that in both animal and clinical studies, scaffolds seeded with cells were used for repair of large segmental defects of the urethra, such as in tubular urethroplasty. When the defect area was small, cell-free scaffolds were more likely to be applied. A lot of pre-clinical and limited clinical evidence showed that natural or artificial materials could be used as scaffolds for urethral repair. Urinary tissue engineering is still in the immature stage, and the safety, efficacy, cost-effectiveness of the scaffolds are needed for further study.
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Affiliation(s)
- Na Qi
- Department of Medical Genetics, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Wen-Jiao Li
- Department of Medical Genetics, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Hong Tian
- Department of Medical Genetics, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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Yang L, Yao M, Lan Y, Mo W, Sun YL, Wang J, Wang YJ, Cui XJ. Melatonin for Spinal Cord Injury in Animal Models: A Systematic Review and Network Meta-Analysis. J Neurotrauma 2016; 33:290-300. [PMID: 26414869 DOI: 10.1089/neu.2015.4038] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Long Yang
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Institute of Spine Disease, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Min Yao
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Institute of Spine Disease, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yun Lan
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Institute of Spine Disease, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Wei Mo
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Institute of Spine Disease, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yue-li Sun
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Institute of Spine Disease, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jing Wang
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yong-jun Wang
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Institute of Spine Disease, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xue-jun Cui
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Institute of Spine Disease, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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48
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Gonzales NR, Grotta JC. Pharmacologic Modification of Acute Cerebral Ischemia. Stroke 2016. [DOI: 10.1016/b978-0-323-29544-4.00055-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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49
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Potential variables affecting the quality of animal studies regarding pathophysiology of traumatic spinal cord injuries. Spinal Cord 2015; 54:579-83. [DOI: 10.1038/sc.2015.215] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 10/17/2015] [Accepted: 11/06/2015] [Indexed: 12/09/2022]
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50
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Hooijmans CR, IntHout J, Ritskes-Hoitinga M, Rovers MM. Meta-analyses of animal studies: an introduction of a valuable instrument to further improve healthcare. ILAR J 2015; 55:418-26. [PMID: 25541544 PMCID: PMC4276598 DOI: 10.1093/ilar/ilu042] [Citation(s) in RCA: 117] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In research aimed at improving human health care, animal studies still play a crucial role, despite political and scientific efforts to reduce preclinical experimentation in laboratory animals. In animal studies, the results and their interpretation are not always straightforward, as no single study is executed perfectly in all steps. There are several possible sources of bias, and many animal studies are replicates of studies conducted previously. Use of meta-analysis to combine the results of studies may lead to more reliable conclusions and a reduction of unnecessary duplication of animal studies. In addition, due to the more exploratory nature of animal studies as compared to clinical trials, meta-analyses of animal studies have greater potential in exploring possible sources of heterogeneity. There is an abundance of literature on how to perform meta-analyses on clinical data. Animal studies, however, differ from clinical studies in some aspects, such as the diversity of animal species studied, experimental design, and study characteristics. In this paper, we will discuss the main principles and practices for meta-analyses of experimental animal studies.
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