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Boltze J, Perez-Pinzon MA. Focused Update on Stroke Neuroimmunology: Current Progress in Preclinical and Clinical Research and Recent Mechanistic Insight. Stroke 2022; 53:1432-1437. [PMID: 35467998 DOI: 10.1161/strokeaha.122.039005] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Local and systemic inflammation contribute significantly to stroke risk factors as well as determining stroke impact and outcome. Previously being considered as an immuno-privileged domain, the central nervous system is now recognized for multiple and complex interactions with the immune system in health and disease. The sterile inflammatory response emerging after ischemic stroke is a major pathophysiological hallmark and considered to be a promising therapeutic target. Even (mal)adaptive immune responses following stroke, potentially contributing to long-term impact and outcome, are increasingly discussed. However, the complex interaction between the central nervous and the immune system are only partially understood, placing neuroimmunological investigations at the forefront of preclinical and clinical research. This Focused Update summarizes current knowledge in stroke neuroimmunology across all relevant disciplines and discusses major advances as well as recent mechanistic insights. Specifically, neuroimmunological processes and neuroinflammation following ischemic are discussed in the context of blood-brain barrier dysfunction, microglia activation, thromboinflammation, and sex differences in poststroke neuroimmunological responses. The Focused Update further highlights advances in neuroimaging and experimental treatments to visualize and counter neuroinflammatory consequences of ischemic stroke.
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Affiliation(s)
- Johannes Boltze
- School of Life Sciences, University of Warwick, Coventry, United Kingdom (J.B.)
| | - Miguel A Perez-Pinzon
- Peritz Scheinberg Cerebral Vascular Disease Research Laboratory, Department of Neurology, University of Miami Miller School of Medicine, FL (M.A.P.-P.)
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2
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Boltze J, Modo MM, Mays RW, Taguchi A, Jolkkonen J, Savitz SI. Stem Cells as an Emerging Paradigm in Stroke 4: Advancing and Accelerating Preclinical Research. Stroke 2019; 50:3299-3306. [PMID: 31658004 DOI: 10.1161/strokeaha.119.025436] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Johannes Boltze
- From the School of Life Sciences, University of Warwick, Coventry, United Kingdom (J.B.)
| | - Michel M Modo
- Departments of Radiology (M.M.M.), McGowan Institute for Regenerative Medicine, University of Pittsburgh, PA.,Bioengineering (M.M.M.), McGowan Institute for Regenerative Medicine, University of Pittsburgh, PA
| | - Robert W Mays
- Department of Neurosciences, Athersys, Inc, Cleveland, OH (R.W.M.)
| | - Akihiko Taguchi
- Department of Regenerative Medicine, Institute for Biomedical Research and Innovation, Kobe, Japan (A.T.)
| | - Jukka Jolkkonen
- Institute of Clinical Medicine-Neurology, University of Eastern Finland, Kuopio, Finland (J.J.).,Neurocenter, Kuopio University Hospital, Finland (J.J.).,A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland (J.J.)
| | - Sean I Savitz
- Institute for Stroke and Cerebrovascular Disease, UTHealth, Houston, TX (S.I.S.)
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3
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Laso-García F, Diekhorst L, Gómez-de Frutos MC, Otero-Ortega L, Fuentes B, Ruiz-Ares G, Díez-Tejedor E, Gutiérrez-Fernández M. Cell-Based Therapies for Stroke: Promising Solution or Dead End? Mesenchymal Stem Cells and Comorbidities in Preclinical Stroke Research. Front Neurol 2019; 10:332. [PMID: 31024426 PMCID: PMC6467162 DOI: 10.3389/fneur.2019.00332] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 03/19/2019] [Indexed: 01/11/2023] Open
Abstract
Stroke is a major health problem worldwide. It has been estimated that 90% of the population attributable risk of stroke is due to risk factors such as aging, hypertension, hyperglycemia, diabetes mellitus and obesity, among others. However, most animal models of stroke use predominantly healthy and young animals. These models ignore the main comorbidities associated with cerebrovascular disease, which could be one explanation for the unsuccessful bench-to-bedside translation of protective and regenerative strategies by not taking the patient's situation into account. This lack of success makes it important to incorporate comorbidities into animal models of stroke in order to study the effects of the various therapeutic strategies tested. Regarding cell therapy, the administration of stem cells in the acute and chronic phases has been shown to be safe and effective in experimental animal models of stroke. This review aims to show the results of studies with promising new therapeutic strategies such as mesenchymal stem cells, which are being tested in preclinical models of stroke associated with comorbidities and in elderly animals.
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Affiliation(s)
- Fernando Laso-García
- Neuroscience and Cerebrovascular Research Laboratory, Department of Neurology and Stroke Center, La Paz University Hospital, Neuroscience Area of IdiPAZ Health Research Institute, Autonoma University of Madrid, Madrid, Spain
| | - Luke Diekhorst
- Neuroscience and Cerebrovascular Research Laboratory, Department of Neurology and Stroke Center, La Paz University Hospital, Neuroscience Area of IdiPAZ Health Research Institute, Autonoma University of Madrid, Madrid, Spain
| | - Mari Carmen Gómez-de Frutos
- Neuroscience and Cerebrovascular Research Laboratory, Department of Neurology and Stroke Center, La Paz University Hospital, Neuroscience Area of IdiPAZ Health Research Institute, Autonoma University of Madrid, Madrid, Spain
| | - Laura Otero-Ortega
- Neuroscience and Cerebrovascular Research Laboratory, Department of Neurology and Stroke Center, La Paz University Hospital, Neuroscience Area of IdiPAZ Health Research Institute, Autonoma University of Madrid, Madrid, Spain
| | - Blanca Fuentes
- Neuroscience and Cerebrovascular Research Laboratory, Department of Neurology and Stroke Center, La Paz University Hospital, Neuroscience Area of IdiPAZ Health Research Institute, Autonoma University of Madrid, Madrid, Spain
| | - Gerardo Ruiz-Ares
- Neuroscience and Cerebrovascular Research Laboratory, Department of Neurology and Stroke Center, La Paz University Hospital, Neuroscience Area of IdiPAZ Health Research Institute, Autonoma University of Madrid, Madrid, Spain
| | - Exuperio Díez-Tejedor
- Neuroscience and Cerebrovascular Research Laboratory, Department of Neurology and Stroke Center, La Paz University Hospital, Neuroscience Area of IdiPAZ Health Research Institute, Autonoma University of Madrid, Madrid, Spain
| | - María Gutiérrez-Fernández
- Neuroscience and Cerebrovascular Research Laboratory, Department of Neurology and Stroke Center, La Paz University Hospital, Neuroscience Area of IdiPAZ Health Research Institute, Autonoma University of Madrid, Madrid, Spain
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4
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Modo MM, Jolkkonen J, Zille M, Boltze J. Future of Animal Modeling for Poststroke Tissue Repair. Stroke 2018; 49:1099-1106. [PMID: 29669872 PMCID: PMC6013070 DOI: 10.1161/strokeaha.117.018293] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 12/13/2017] [Accepted: 12/14/2017] [Indexed: 02/06/2023]
Affiliation(s)
- Michel M Modo
- From the Departments of Radiology and Bioengineering, McGowan Institute for Regenerative Medicine, University of Pittsburgh, PA (M.M.M.)
| | - Jukka Jolkkonen
- Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio (J.J.)
- Neurocenter, Kuopio University Hospital, Finland (J.J.)
| | - Marietta Zille
- Department of Translational Medicine and Cell Technology, Fraunhofer Research Institution for Marine Biotechnology and Institute for Medical and Marine Biotechnology, University of Lübeck, Mönkhofer Weg, Germany (M.Z., J.B.)
- Institute for Experimental and Clinical Pharmacology and Toxicology, University of Lübeck, Ratzeburger Allee, Germany (M.Z.)
| | - Johannes Boltze
- Department of Translational Medicine and Cell Technology, Fraunhofer Research Institution for Marine Biotechnology and Institute for Medical and Marine Biotechnology, University of Lübeck, Mönkhofer Weg, Germany (M.Z., J.B.)
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5
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Cui LL, Golubczyk D, Jolkkonen J. Top 3 Behavioral Tests in Cell Therapy Studies After Stroke. Stroke 2017; 48:3165-3167. [DOI: 10.1161/strokeaha.117.018950] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 08/23/2017] [Accepted: 08/24/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Li-li Cui
- From the Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio (L.C., J.J.); Department of Neurology and Neurosurgery, Faculty of Medical Sciences, University of Warmia and Mazury, Olsztyn, Poland (D.G.); and Neurology, Neurocenter, Kuopio University Hospital, Finland (J.J.)
| | - Dominika Golubczyk
- From the Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio (L.C., J.J.); Department of Neurology and Neurosurgery, Faculty of Medical Sciences, University of Warmia and Mazury, Olsztyn, Poland (D.G.); and Neurology, Neurocenter, Kuopio University Hospital, Finland (J.J.)
| | - Jukka Jolkkonen
- From the Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio (L.C., J.J.); Department of Neurology and Neurosurgery, Faculty of Medical Sciences, University of Warmia and Mazury, Olsztyn, Poland (D.G.); and Neurology, Neurocenter, Kuopio University Hospital, Finland (J.J.)
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Boltze J, Nitzsche F, Jolkkonen J, Weise G, Pösel C, Nitzsche B, Wagner DC. Concise Review: Increasing the Validity of Cerebrovascular Disease Models and Experimental Methods for Translational Stem Cell Research. Stem Cells 2017; 35:1141-1153. [DOI: 10.1002/stem.2595] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 02/06/2017] [Indexed: 12/12/2022]
Affiliation(s)
- Johannes Boltze
- Department of Translational Medicine and Cell Technology; Fraunhofer Research Institution for Marine Biotechnology and Cell Technology; Lübeck Germany
- Institute for Medical and Marine Biotechnology, University of Lübeck; Lübeck Germany
| | - Franziska Nitzsche
- Department of Cell Therapy; Fraunhofer Institute for Cell Therapy and Immunology; Leipzig Germany
- Department of Radiology; McGowan Institute for Regenerative Medicine, University of Pittsburgh; Pennsylvania USA
| | - Jukka Jolkkonen
- Department of Neurology; Institute of Clinical Medicine, University of Eastern Finland; Kuopio Finland
| | - Gesa Weise
- Department of Cell Therapy; Fraunhofer Institute for Cell Therapy and Immunology; Leipzig Germany
- Department of Neurology; University of Leipzig; Germany
| | - Claudia Pösel
- Department of Cell Therapy; Fraunhofer Institute for Cell Therapy and Immunology; Leipzig Germany
| | - Björn Nitzsche
- Department of Cell Therapy; Fraunhofer Institute for Cell Therapy and Immunology; Leipzig Germany
- Department of Nuclear Medicine; University Hospital Leipzig; Germany
| | - Daniel-Christoph Wagner
- Department of Cell Therapy; Fraunhofer Institute for Cell Therapy and Immunology; Leipzig Germany
- Institute of Pathology, University Medical Center Mainz; Germany
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Weise G, Pösel C, Möller K, Kranz A, Didwischus N, Boltze J, Wagner DC. High-dosage granulocyte colony stimulating factor treatment alters monocyte trafficking to the brain after experimental stroke. Brain Behav Immun 2017; 60:15-26. [PMID: 27524669 DOI: 10.1016/j.bbi.2016.08.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 07/26/2016] [Accepted: 08/10/2016] [Indexed: 12/11/2022] Open
Abstract
Ischemic stroke elicits a prompt inflammatory response that is characterized by a well-timed recruitment of peripheral immune cells to the brain. Among these, monocytes play a particularly important, but multifaceted role and have been increasingly recognized to affect stroke outcome. Granulocyte colony stimulating factor (GCSF) is known for its immunosuppressive actions on mononuclear cells, but previous studies in the stroke field were mainly confined to its neuroprotective actions. Herein, we investigated whether GCSF affects post-stroke inflammation in a mouse model of focal brain ischemia by modulating monocyte responses. Treatment with GCSF was controlled by vehicle injection, sham surgery and naive animals. Despite a significant monocytosis, high-dosage GCSF reduced the number of brain-infiltrating monocytes/macrophages four days after stroke. Lower numbers of mononuclear phagocytes in the brain were associated with smaller cerebral edema and improved motor outcome after stroke. GCSF treatment over 72h, but not 24h diminished integrin expression on circulating Ly6C+ inflammatory monocytes. In vitro experiments further revealed that GCSF strongly promotes interleukin (IL)-10 secretion by activated mononuclear cells. Blockade of the IL-10 receptor partly reversed GCSF-induced downregulation of integrin surface expression. Overall, our results suggest that high-dosage GCSF mitigates monocyte infiltration after stroke, likely by attenuating integrin-mediated adhesion to the brain endothelium in an IL-10-dependent manner. Lower amounts of mononuclear cells in the brain translate to less severe brain edema and functional impairment and thus support a harmful role of Ly6C+ inflammatory monocytes in the acute stage of stroke.
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Affiliation(s)
- Gesa Weise
- Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany; University of Leipzig, Department of Neurology, Leipzig, Germany.
| | - Claudia Pösel
- Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany
| | - Karoline Möller
- Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany
| | - Alexander Kranz
- Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany
| | - Nadine Didwischus
- Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany; Institute for Biology, Human Biology, University of Leipzig, Leipzig, Germany
| | - Johannes Boltze
- Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany; Fraunhofer Research Institution of Marine Biotechnology and Institute for Medical and Marine Biotechnology, University of Lübeck, Lübeck, Germany; Massachusetts General Hospital and Harvard Medical School, Stroke and Neurovascular Regulation Laboratory, Charlestown, MA, USA
| | - Daniel-Christoph Wagner
- Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany; Institute of Pathology, University Medical Center Mainz, Germany
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Strecker JK, Schmidt A, Schäbitz WR, Minnerup J. Neutrophil granulocytes in cerebral ischemia - Evolution from killers to key players. Neurochem Int 2016; 107:117-126. [PMID: 27884770 DOI: 10.1016/j.neuint.2016.11.006] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 11/08/2016] [Accepted: 11/14/2016] [Indexed: 12/16/2022]
Abstract
Neutrophil granulocytes (or polymorphonuclear cells, PMNs) have long been considered as crude killing machines, particularly trained to attack bacterial or fungal pathogens in wounds or infected tissues. That perspective has fundamentally changed over the last decades, as PMNs have been shown to exert a livery exchange between other cells of the innate and adaptive immune system. PMNs do provide major immunomodulatory contribution during acute inflammation and subsequent clearance. Following sterile inflammation like cerebral ischemia, PMNs are among the first hematogenous cells attracted to the ischemic tissue. As inflammation is a crucial component within stroke pathophysiology, several studies regarding the role of PMNs following cerebral ischemia have been carried out. And indeed, recent research suggests a direct connection between PMNs' influx and brain damage severity. This review highlights the latest research regarding the close interconnection between PMNs and co-working cells following cerebral ischemia. We describe how PMNs are attracted to the site of injury and their tasks within the inflamed brain tissue and the periphery. We further report of new findings regarding the interaction of PMNs with resident microglia, immigrating macrophages and T cells after stroke. Finally, we discuss recent research results from experimental studies in the context with current clinical trials and point out potential new therapeutic applications that could emerge from this new knowledge on the action and interaction of PMNs following cerebral ischemia.
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Affiliation(s)
- Jan-Kolja Strecker
- Department of Neurology, University of Münster, Albert-Schweitzer-Campus 1, Münster, Germany.
| | - Antje Schmidt
- Department of Neurology, University of Münster, Albert-Schweitzer-Campus 1, Münster, Germany
| | | | - Jens Minnerup
- Department of Neurology, University of Münster, Albert-Schweitzer-Campus 1, Münster, Germany
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Zhang Q, Chen ZW, Zhao YH, Liu BW, Liu NW, Ke CC, Tan HM. Bone Marrow Stromal Cells Combined With Sodium Ferulate and n-Butylidenephthalide Promote the Effect of Therapeutic Angiogenesis via Advancing Astrocyte-Derived Trophic Factors After Ischemic Stroke. Cell Transplant 2016; 26:229-242. [PMID: 27772541 DOI: 10.3727/096368916x693536] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Being a potential candidate for stroke treatment, bone marrow-derived mesenchymal stem/stromal cells (BM-MSCs) have been demonstrated to be able to enhance angiogenesis and proliferation of reactive astrocytes, which subsequently leads to the amelioration of neurological injury. Increasing evidence further indicates that combining BM-MSCs with certain agents, such as simvastatin, may improve therapeutic effects. Sodium ferulate (SF) and n-butylidenephthalide (BP), two main components of Radix Angelica Sinensis, are proven to be important regulators of stem cells in cell migration, differentiation, and pluripotency maintenance. This study aimed to investigate whether combining BM-MSCs with SF and BP had better therapeutic effect in the treatment of stroke, and the underlying molecular basis for the therapeutic effects was also investigated. The results showed that combination treatment notably reduced neurological injury after stroke and increased the expression of astrocyte-derived vascular endothelial growth factor (VEGF), brain-derived neurotrophic factor (BDNF), and von Willebrand factor-positive vascular density in the ischemic boundary zone as evaluated by immunofluorescence staining. After treatment with BM-MSCs plus SF and BP, astrocytes showed increased expression of VEGF and BDNF by upregulating protein kinase B/mammalian target of rapamycin (AKT/mTOR) expression in an oxygen- and glucose-deprived (OGD) environment. Human umbilical vein endothelial cells (HUVECs) incubated with the conditioned medium (CM) derived from OGD astrocytes treated with BM-MSCs plus SF and BP showed significantly increased migration and tube formation compared with those incubated with the CM derived from OGD astrocytes treated with BM-MSCs alone. These results demonstrate that combination treatment enhances the expression of astrocyte-derived VEGF and BDNF, which contribute to angiogenesis after cerebral ischemia, and the underlying mechanism is associated with activation of the astrocytic AKT/mTOR signaling pathway. Our study provides a potential therapeutic approach for ischemic stroke.
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Satani N, Savitz SI. Is Immunomodulation a Principal Mechanism Underlying How Cell-Based Therapies Enhance Stroke Recovery? Neurotherapeutics 2016; 13:775-782. [PMID: 27485235 PMCID: PMC5081125 DOI: 10.1007/s13311-016-0468-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Inflammation within the brain and in peripheral tissues contributes to brain injury following ischemic stroke. Therapeutic modulation of the inflammatory response has been actively pursued as a novel stroke treatment approach for decades, without success. In recent years, extensive studies support the high potential for cell-based therapies to become a new treatment modality for stroke and other neurological disorders. In this review, we explore different types of cellular therapies and discuss how they modulate central and peripheral inflammatory processes after stroke. Apart from identifying potential targets for cell therapy, we also discuss paracrine and immunomodulatory mechanisms of cell therapy.
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Affiliation(s)
- Nikunj Satani
- Stroke Program, McGovern Medical School, UTHealth, Houston, TX, USA.
| | - Sean I Savitz
- Stroke Program, McGovern Medical School, UTHealth, Houston, TX, USA
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Unsworth DJ, Mathias JL, Dorstyn DS. Safety and efficacy of cell therapies administered in the acute and subacute stages after stroke: a meta-analysis. Regen Med 2016; 11:725-41. [PMID: 27580670 DOI: 10.2217/rme-2016-0063] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
AIMS To evaluate the safety and efficacy of cell therapies administered acutely/sub-acutely after stroke. METHODS Five databases were searched for studies examining the safety/efficacy of cell therapies administered ≤90 days post-stroke. Reporting quality and adherence to research guidelines were evaluated. Safety and efficacy were assessed using risk ratios/pooled incidence rates and Hedge's g, respectively. RESULTS 11 therapies (Nstudies= 28) were trialed: reporting quality was high, but adherence to guidelines low. Serious adverse events were observed following five treatments; six improved outcomes. There was a trend toward larger treatment effects in non-blinded studies, younger participants, and higher dosages. CONCLUSION Although a number of therapies appear effective, many studies did not control for normal recovery (standard-care). Long-term safety also needs to be established.
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Affiliation(s)
- David J Unsworth
- Faculty of Health Science, University of Adelaide, Adelaide, South Australia, Australia
| | - Jane L Mathias
- Faculty of Health Science, University of Adelaide, Adelaide, South Australia, Australia
| | - Diana S Dorstyn
- Faculty of Health Science, University of Adelaide, Adelaide, South Australia, Australia
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12
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Tuor UI, Zhao Z, Barber PA, Qiao M. Recurrent mild cerebral ischemia: enhanced brain injury following acute compared to subacute recurrence in the rat. BMC Neurosci 2016; 17:28. [PMID: 27230275 PMCID: PMC4881167 DOI: 10.1186/s12868-016-0263-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 05/11/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the current study, a transient cerebral ischemia producing selective cell death was designated a mild ischemic insult. A comparable insult in humans is a transient ischemic attack (TIA) that is associated with functional recovery but can have imaging evidence of minor ischemic damage including cerebral atrophy. A TIA also predicts a high risk for early recurrence of a stroke or TIA and thus multiple ischemic insults are not uncommon. Not well understood is what the effect of differing recovery times between mild ischemic insults has on their pathophysiology. We investigated whether cumulative brain damage would differ if recurrence of a mild ischemic insult occurred at 1 or 3 days after a first insult. RESULTS A transient episode of middle cerebral artery occlusion via microclip was produced to elicit mild ischemic changes-predominantly scattered necrosis. This was followed 1 or 3 days later by a repeat of the same insult. Brain damage assessed histologically 7 days later was substantially greater in the 1 day recurrent group than the 3 days recurrent group, with areas of damage consisting predominantly of regions of incomplete infarction and pannecrosis in the 1 day group but predominantly regions of selective necrosis and smaller areas of incomplete infarction in the 3 days group (P < 0.05). Enhanced injury was reflected by greater number of cells staining for macrophages/microglia with ED1 and greater alterations in GFAP staining of reactive astrocytes in the 1 day than 3 days recurrent groups. The differential susceptibility to injury did not correspond to higher levels of injurious factors present at the time of the second insult such as BBB disruption or increased cytokines (tumor necrosis factor). Microglial activation, with potential for some beneficial effects, appeared greater at 3 days than 1 day. Also blood analysis demonstrated changes that included an acute increase in granulocytes and decrease in platelets at 1 day compared to 3 days post transient ischemia. CONCLUSIONS Dynamic changes in multiple inflammatory responses likely contribute to the time dependence of the extent of damage produced by recurrent mild ischemic insults. The time of mild stroke recurrence is crucial with early recurrence producing greater damage than subacute recurrence and this supports urgency for determining and implementing optimal stroke management directly after a TIA.
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Affiliation(s)
- Ursula I Tuor
- Department of Clinical Neurosciences and Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, T2N 4N1, Canada. .,Department of Physiology and Pharmacology, University of Calgary, Calgary, AB, T2N 4N1, Canada.
| | - Zonghang Zhao
- Department of Clinical Neurosciences and Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, T2N 4N1, Canada
| | - Philip A Barber
- Department of Clinical Neurosciences and Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, T2N 4N1, Canada
| | - Min Qiao
- Department of Physiology and Pharmacology, University of Calgary, Calgary, AB, T2N 4N1, Canada
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13
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Strecker JK, Olk J, Hoppen M, Gess B, Diederich K, Schmidt A, Schäbitz WR, Schilling M, Minnerup J. Combining Growth Factor and Bone Marrow Cell Therapy Induces Bleeding and Alters Immune Response After Stroke in Mice. Stroke 2016; 47:852-62. [PMID: 26839353 DOI: 10.1161/strokeaha.115.011230] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 12/31/2015] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND PURPOSE Bone marrow cell (BMC)-based therapies, either the transplantation of exogenous cells or stimulation of endogenous cells by growth factors like the granulocyte colony-stimulating factor (G-CSF), are considered a promising means of treating stroke. In contrast to large preclinical evidence, however, a recent clinical stroke trial on G-CSF was neutral. We, therefore, aimed to investigate possible synergistic effects of co-administration of G-CSF and BMCs after experimental stroke in mice to enhance the efficacy compared with single treatments. METHODS We used an animal model for experimental stroke as paradigm to study possible synergistic effects of co-administration of G-CSF and BMCs on the functional outcome and the pathophysiological mechanism. RESULTS G-CSF treatment alone led to an improved functional outcome, a reduced infarct volume, increased blood vessel stabilization, and decreased overall inflammation. Surprisingly, the combination of G-CSF and BMCs abrogated G-CSFs' beneficial effects and resulted in increased hemorrhagic infarct transformation, altered blood-brain barrier, excessive astrogliosis, and altered immune cell polarization. These increased rates of infarct bleeding were mainly mediated by elevated matrix metalloproteinase-9-mediated blood-brain barrier breakdown in G-CSF- and BMCs-treated animals combined with an increased number of dilated and thus likely more fragile vessels in the subacute phase after cerebral ischemia. CONCLUSIONS Our results provide new insights into both BMC-based therapies and immune cell biology and help to understand potential adverse and unexpected side effects.
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Affiliation(s)
- Jan-Kolja Strecker
- From the Department of Neurology, University of Münster, Albert-Schweitzer-Campus 1, Münster, Germany (J.-K.S., J.O., M.H., B.G., K.D., A.S., M.S., J.M.); and EVK Bielefeld, Bethel, Neurologische Klinik, Bielefeld, Germany (W.-R.S.).
| | - Joanna Olk
- From the Department of Neurology, University of Münster, Albert-Schweitzer-Campus 1, Münster, Germany (J.-K.S., J.O., M.H., B.G., K.D., A.S., M.S., J.M.); and EVK Bielefeld, Bethel, Neurologische Klinik, Bielefeld, Germany (W.-R.S.)
| | - Maike Hoppen
- From the Department of Neurology, University of Münster, Albert-Schweitzer-Campus 1, Münster, Germany (J.-K.S., J.O., M.H., B.G., K.D., A.S., M.S., J.M.); and EVK Bielefeld, Bethel, Neurologische Klinik, Bielefeld, Germany (W.-R.S.)
| | - Burkhard Gess
- From the Department of Neurology, University of Münster, Albert-Schweitzer-Campus 1, Münster, Germany (J.-K.S., J.O., M.H., B.G., K.D., A.S., M.S., J.M.); and EVK Bielefeld, Bethel, Neurologische Klinik, Bielefeld, Germany (W.-R.S.)
| | - Kai Diederich
- From the Department of Neurology, University of Münster, Albert-Schweitzer-Campus 1, Münster, Germany (J.-K.S., J.O., M.H., B.G., K.D., A.S., M.S., J.M.); and EVK Bielefeld, Bethel, Neurologische Klinik, Bielefeld, Germany (W.-R.S.)
| | - Antje Schmidt
- From the Department of Neurology, University of Münster, Albert-Schweitzer-Campus 1, Münster, Germany (J.-K.S., J.O., M.H., B.G., K.D., A.S., M.S., J.M.); and EVK Bielefeld, Bethel, Neurologische Klinik, Bielefeld, Germany (W.-R.S.)
| | - Wolf-Rüdiger Schäbitz
- From the Department of Neurology, University of Münster, Albert-Schweitzer-Campus 1, Münster, Germany (J.-K.S., J.O., M.H., B.G., K.D., A.S., M.S., J.M.); and EVK Bielefeld, Bethel, Neurologische Klinik, Bielefeld, Germany (W.-R.S.)
| | - Matthias Schilling
- From the Department of Neurology, University of Münster, Albert-Schweitzer-Campus 1, Münster, Germany (J.-K.S., J.O., M.H., B.G., K.D., A.S., M.S., J.M.); and EVK Bielefeld, Bethel, Neurologische Klinik, Bielefeld, Germany (W.-R.S.)
| | - Jens Minnerup
- From the Department of Neurology, University of Münster, Albert-Schweitzer-Campus 1, Münster, Germany (J.-K.S., J.O., M.H., B.G., K.D., A.S., M.S., J.M.); and EVK Bielefeld, Bethel, Neurologische Klinik, Bielefeld, Germany (W.-R.S.)
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14
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Boltze J, Arnold A, Walczak P, Jolkkonen J, Cui L, Wagner DC. The Dark Side of the Force - Constraints and Complications of Cell Therapies for Stroke. Front Neurol 2015; 6:155. [PMID: 26257702 PMCID: PMC4507146 DOI: 10.3389/fneur.2015.00155] [Citation(s) in RCA: 113] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 06/23/2015] [Indexed: 12/16/2022] Open
Abstract
Cell therapies are increasingly recognized as a promising option to augment the limited therapeutic arsenal available to fight ischemic stroke. During the last two decades, cumulating preclinical evidence has indicated a substantial efficacy for most cell treatment paradigms and first clinical trials are currently underway to assess safety and feasibility in patients. However, the strong and still unmet demand for novel stroke treatment options and exciting findings reported from experimental studies may have drawn our attention away from potential side effects related to cell therapies and the ways by which they are commonly applied. This review summarizes common and less frequent adverse events that have been discovered in preclinical and clinical investigations assessing cell therapies for stroke. Such adverse events range from immunological and neoplastic complications over seizures to cell clotting and cell-induced embolism. It also describes potential complications of clinically applicable administration procedures, detrimental interactions between therapeutic cells, and the pathophysiological environment that they are placed into, as well as problems related to cell manufacturing. Virtually each therapeutic intervention comes at a certain risk for complications. Side effects do therefore not generally compromise the value of cell treatments for stroke, but underestimating such complications might severely limit therapeutic safety and efficacy of cell treatment protocols currently under development. On the other hand, a better understanding will provide opportunities to further improve existing therapeutic strategies and might help to define those circumstances, under which an optimal effect can be realized. Hence, the review eventually discusses strategies and recommendations allowing us to prevent or at least balance potential complications in order to ensure the maximum therapeutic benefit at minimum risk for stroke patients.
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Affiliation(s)
- Johannes Boltze
- Department of Cell Therapy, Fraunhofer-Institute for Cell Therapy and Immunology , Leipzig , Germany ; Translational Center for Regenerative Medicine, University of Leipzig , Leipzig , Germany
| | - Antje Arnold
- Division of MR Research, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine , Baltimore, MD , USA ; Institute for Cell Engineering, Johns Hopkins University , Baltimore, MD , USA
| | - Piotr Walczak
- Division of MR Research, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine , Baltimore, MD , USA ; Institute for Cell Engineering, Johns Hopkins University , Baltimore, MD , USA
| | - Jukka Jolkkonen
- Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland , Kuopio , Finland
| | - Lili Cui
- Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland , Kuopio , Finland
| | - Daniel-Christoph Wagner
- Department of Cell Therapy, Fraunhofer-Institute for Cell Therapy and Immunology , Leipzig , Germany
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15
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Diederich K, Schmidt A, Beuker C, Strecker JK, Wagner DC, Boltze J, Schäbitz WR, Minnerup J. Granulocyte colony-stimulating factor (G-CSF) treatment in combination with transplantation of bone marrow cells is not superior to G-CSF treatment alone after cortical stroke in spontaneously hypertensive rats. Front Cell Neurosci 2014; 8:411. [PMID: 25538562 PMCID: PMC4255603 DOI: 10.3389/fncel.2014.00411] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 11/12/2014] [Indexed: 12/02/2022] Open
Abstract
Granulocyte-colony stimulating factor (G-CSF) and bone marrow derived mononuclear cells (BM-MNCs) have both been shown to improve functional outcome following experimental stroke. These effects are associated with increased angiogenesis and neurogenesis. In the present study, we aimed to determine synergistic effects of G-CSF and BM-NMC treatment on long-term structural and functional recovery after photothrombotic stroke. To model the etiology of stroke more closely, we used spontaneously hypertensive (SH) rats in our experiment. Bone marrow derived mononuclear cells transplantation was initiated 1 h after the onset of photothrombotic stroke. Repeated G-CSF treatment commenced immediately after BM-MNC treatment followed by daily injections for five consecutive days. The primary endpoint was functional outcome after ischemia. Secondary endpoints included analysis of neurogenesis and angiogenesis as well as determination of infarct size. Granulocyte-colony stimulating factor treated rats, either in combination with BM-MNC or alone showed improved somatosensory but not gross motor function following ischemia. No beneficial effect of BM-MNC monotherapy was found. Infarct volumes were comparable in all groups. In contrast to previous studies, which used healthy animals, post-stroke neurogenesis and angiogenesis were not enhanced by G-CSF. In conclusion, the combination of G-CSF and BM-MNC was not more effective than G-CSF alone. The reduced efficacy of G-CSF treatment and the absence of any beneficial effect of BM-MNC transplantation might be attributed to hypertension-related morbidity.
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Affiliation(s)
- Kai Diederich
- Department of Neurology, University of Münster Münster, Germany
| | - Antje Schmidt
- Department of Neurology, University of Münster Münster, Germany
| | - Carolin Beuker
- Department of Neurology, University of Münster Münster, Germany
| | | | - Daniel-Christoph Wagner
- Fraunhofer Institute for Cell Therapy and Immunology Leipzig, Germany ; Translational Center for Regenerative Medicine, University of Leipzig Leipzig, Germany
| | - Johannes Boltze
- Fraunhofer Institute for Cell Therapy and Immunology Leipzig, Germany ; Translational Center for Regenerative Medicine, University of Leipzig Leipzig, Germany
| | | | - Jens Minnerup
- Department of Neurology, University of Münster Münster, Germany
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