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Schnoor B, Morris K, Kottana RK, Muldoon R, Barron J, Papa AL. Fibrinolytic Platelet Decoys Reduce Cancer Metastasis by Dissociating Circulating Tumor Cell Clusters. Adv Healthc Mater 2024:e2304374. [PMID: 39075814 DOI: 10.1002/adhm.202304374] [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: 12/09/2023] [Revised: 07/07/2024] [Indexed: 07/31/2024]
Abstract
During metastasis, circulating tumor cells (CTCs) can travel in the bloodstream as individual cells or clusters, associated with fibrin and platelets. Clusters have a higher metastatic potential due to their increased ability to withstand shear stress and arrest in small vessels. Moreover, CTC-platelet interaction protects CTCs from shear stress and immune detection. The objective of this project is to develop a fibrinolytic platelet system to leverage platelet-CTC interactions and dissociate CTC clusters. For this approach, tissue plasminogen activator (tPA) is loaded onto two modified platelet systems: platelet Decoys and lyophilized platelets. The activities of the systems are characterized using a Förster Resonance Energy Transfer-based assay and an angiogenic assay. Furthermore, the ability of the system to dissociate cancer cell clusters in vitro is assessed using light transmission aggregometry. The data demonstrates that the fibrinolytic platelets can maintain tPA activity, interact with CTCs, and dissociate cancer cell clusters. Finally, fibrinolytic platelets are assessed in vivo, demonstrating a decreased tumor load and increased survival with tPA-Decoy treatment, which is selected as the optimal treatment based on favorable in vitro results and in vivo trials. Therefore, this fibrinolytic platelet approach is a promising method for leveraging platelet-CTC interactions to disperse CTC clusters and reduce metastasis.
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Affiliation(s)
- Brian Schnoor
- Department of Biomedical Engineering, School of Engineering and Applied Science, The George Washington University, Washington, DC, 20052, USA
| | - Kenise Morris
- Department of Biomedical Engineering, School of Engineering and Applied Science, The George Washington University, Washington, DC, 20052, USA
| | - Regina K Kottana
- Department of Biomedical Engineering, School of Engineering and Applied Science, The George Washington University, Washington, DC, 20052, USA
| | - Rebekah Muldoon
- Department of Biomedical Engineering, School of Engineering and Applied Science, The George Washington University, Washington, DC, 20052, USA
| | - Jaeden Barron
- Department of Biomedical Engineering, School of Engineering and Applied Science, The George Washington University, Washington, DC, 20052, USA
| | - Anne-Laure Papa
- Department of Biomedical Engineering, School of Engineering and Applied Science, The George Washington University, Washington, DC, 20052, USA
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Wu X, Jiang Z, Xu D, Zhang R, Li H. Pre-thrombolysis serum sodium concentration is associated with post-thrombolysis symptomatic intracranial hemorrhage in ischemic stroke patients. Front Neurol 2024; 15:1341522. [PMID: 38882691 PMCID: PMC11178046 DOI: 10.3389/fneur.2024.1341522] [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: 11/27/2023] [Accepted: 05/20/2024] [Indexed: 06/18/2024] Open
Abstract
Background and aim Symptomatic intracranial hemorrhage (sICH) was the most serious complication associated with alteplase intravenous thrombolysis (IVT) in acute ischemic stroke (AIS) patients. However, the relationship between serum sodium levels and post-thrombolysis symptomatic intracranial hemorrhage has not been investigated. Therefore, the aim of this study was to investigate the relationship between pre-thrombolysis serum sodium levels and sICH after IVT, as well as to explore the optimal pre-thrombolysis serum sodium levels for lowering the risk of sICH following IVT. Methods From July 1, 2017 to April 30, 2023, out-of-hospital AIS patients who received IVT in the emergency department were enrolled in this study. Serum sodium levels were measured at admission prior to IVT, and National Institutes of Health Stroke Scale scores were continuously assessed during and after thrombolysis. Routine follow-up neuroimaging was performed between 22 to 36 h after IVT. Initially, three logistic regression models and restricted cubic splines (RCS) were established to investigate the relationship between serum sodium levels and post-thrombolysis sICH. Furthermore, to evaluate the predictive value of serum sodium for post-thrombolysis sICH, we compared area under the receiver operating characteristic curve (AUROC) and net reclassification improvement (NRI) before and after incorporating serum sodium into traditional models. Finally, subgroup analysis was conducted to explore interactions between serum sodium levels and other variables. Results A total of 784 AIS patients who underwent IVT were enrolled, among whom 47 (6.0%) experienced sICH. The median serum sodium concentration for all patients was 139.10 [interquartile ranges (IQR): 137.40-141.00] mmol/L. Patients who developed sICH had lower serum sodium levels than those without sICH [138.20(IQR:136.00-140.20) vs. 139.20(IQR:137.40-141.00), p = 0.031]. Logistic regression analysis (model 3) revealed a 14% reduction in the risk of post-thrombolysis sICH for every 1 mmol/L increase in serum sodium levels after adjusting for confounding variables (p < 0.001). The risk of post-thrombolysis sICH was minimized within the serum sodium range of 139.1-140.9 mmol/L compared to serum sodium concentration below 137.0 mmol/L [odds ratio (OR) = 0.33, 95% confidence interval (CI): 0.13-0.81] in model3. Furthermore, there was a significant trend of decreasing risk for sICH as serum sodium concentrations increased across the four quartiles (P for trend = 0.036). The RCS analysis indicated a statistically significant reduction in the risk of sICH as serum sodium levels increased when the concentration was below 139.1 mmol/L. Incorporating serum sodium into traditional models improved their predictive performance, resulting in higher AUROC and NRI values. Subgroup analysis suggested that early infarct signs (EIS) appeared to moderate the relationship between serum sodium and sICH (p < 0.05). Conclusion Lower serum sodium levels were identified as independent risk factors for post-thrombolysis sICH. Maintaining pre-thrombolysis serum sodium concentrations above 139.1 mmol/L may help reduce the risk of post-thrombolysis sICH.
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Affiliation(s)
- Xiaolan Wu
- Department of Neurology, Dongyang People's Hospital, Affiliated to Wenzhou Medical University, Dongyang, China
| | - Zhuangzhuang Jiang
- Department of Neurology, Dongyang People's Hospital, Affiliated to Wenzhou Medical University, Dongyang, China
| | - Dongjuan Xu
- Department of Neurology, Dongyang People's Hospital, Affiliated to Wenzhou Medical University, Dongyang, China
| | - Rufang Zhang
- Department of Neurology, Dongyang People's Hospital, Affiliated to Wenzhou Medical University, Dongyang, China
| | - Hongfei Li
- Department of Neurology, Dongyang People's Hospital, Affiliated to Wenzhou Medical University, Dongyang, China
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Brewer PC, Ojo DT, Broughton PX, Imeh-Nathaniel A, Imeh-Nathaniel S, Nathaniel TI. Risk Factors Associated With Exclusion of Obese Patients Ischemic Stroke With a History of Smoking From Thrombolysis Therapy. Clin Appl Thromb Hemost 2024; 30:10760296241246264. [PMID: 38600881 PMCID: PMC11010763 DOI: 10.1177/10760296241246264] [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: 11/20/2023] [Revised: 03/22/2024] [Accepted: 03/23/2024] [Indexed: 04/12/2024] Open
Abstract
The objective of this study is to determine risk factors that may contribute to exclusion decision from recombinant tissue plasminogen activator (rtPA) in patients with acute ischemic stroke (AIS) with a combined current or history of smoking and obesity. This study was conducted on data from 5469 patients with AIS collected from a regional stroke registry. Risk factors associated with inclusion or exclusion from rtPA were determined using multivariate logistic regression analysis. The adjusted odds ratios and 95% confidence interval for each risk factor were used to predict the increasing odds of an association of a specific risk factor with exclusion from rtPA. In the adjusted analysis, obese patients with AIS with a history of smoking (current and previous) excluded from rtPA were more likely to present with carotid artery stenosis (OR = 0.069, 95% CI 0.011-0.442), diabetes (OR = 0.604, 95% CI 0.366-0.997), higher total cholesterol (OR = 0.975, 95% CI 0.956-0.995), and history of alcohol use (OR = 0.438, 95% CI 0.232-0.828). Higher NIHSS score (OR = 1.051, 95% CI 1.017-1.086), higher triglycerides (OR = 1.004, 95% CI 1.001-1.006), and higher high-density lipoprotein (OR = 1.028, 95% CI 1.000-1.057) were associated with the inclusion for rtPA. Our findings reveal specific risk factors that contribute to the exclusion of patients with AIS with a combined effect of smoking and obesity from rtPA. These findings suggest the need to develop management strategies to improve the use of rtPA for obese patients with AIS with a history of smoking.
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Affiliation(s)
- Philip C. Brewer
- Department of Biomedical Sciences, University of South Carolina, School of Medicine-Greenville, Greenville, SC, USA
| | - Dami T. Ojo
- Department of Biomedical Sciences, University of South Carolina, School of Medicine-Greenville, Greenville, SC, USA
| | - Philip X. Broughton
- Department of Biomedical Sciences, University of South Carolina, School of Medicine-Greenville, Greenville, SC, USA
| | | | | | - Thomas I. Nathaniel
- Department of Biomedical Sciences, University of South Carolina, School of Medicine-Greenville, Greenville, SC, USA
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Árokszállási T, Balogh E, Orbán-Kálmándi R, Pásztor M, Árokszállási A, Nagy EB, Belán I, May Z, Csépány T, Csiba L, Bagoly Z, Oláh L. Elevated Blood Alcohol Concentration Is Associated with Improved Clinical Outcomes of Intravenous Thrombolysis Treatment in Acute Ischemic Stroke Patients—A Retrospective Study. J Clin Med 2023; 12:jcm12062238. [PMID: 36983239 PMCID: PMC10051873 DOI: 10.3390/jcm12062238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/04/2023] [Accepted: 03/11/2023] [Indexed: 03/17/2023] Open
Abstract
Background: Intravenous thrombolysis (IVT) improves acute ischemic stroke (AIS) outcomes, but with limited success. In addition, ethanol potentiates the effect of r-tPA in ischemia models. Methods: The effect of acute alcohol consumption on IVT outcomes was investigated in a retrospective cohort study. AIS patients with detectable blood alcohol concentration (BAC) during IVT were included (alcohol group; n = 60). For each case, 3 control subjects who underwent IVT but denied alcohol consumption were matched in terms of age, sex, affected brain area, and stroke severity. Outcomes were determined using the NIHSS at 7 days and the modified Rankin scale (mRS) at 90 days. Results: Patients were younger and had a less severe stroke than in a standard stroke study. Favorable long-term outcomes (mRS 0–2) occurred significantly more frequently in the alcohol group compared to controls (90% vs. 63%, p < 0.001). However, the rates of hemorrhagic transformation were similar. Multiple logistic regression models identified elevated BAC as a significant protective factor against unfavorable short-term (OR: 0.091, 95% CI: 0.036–0.227, p < 0.001) and long-term outcomes (OR: 0.187, 95% CI: 0.066–0.535, p = 0.002). In patients with BAC > 0.2%, significantly lower NIHSS was observed at 3 and 7 days after IVT vs. in those with 0.01–0.2% ethanol levels. Conclusion: Elevated BAC is associated with improved outcomes in IVT-treated AIS without affecting safety.
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Affiliation(s)
- Tamás Árokszállási
- Department of Neurology, Faculty of Medicine, Doctoral School of Neuroscience, University of Debrecen, 22 Móricz Zsigmond krt, H-4032 Debrecen, Hungary
| | - Eszter Balogh
- Department of Neurology, Faculty of Medicine, Doctoral School of Neuroscience, University of Debrecen, 22 Móricz Zsigmond krt, H-4032 Debrecen, Hungary
| | - Rita Orbán-Kálmándi
- Division of Clinical Laboratory Sciences, Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, 98 Nagyerdei krt, H-4032 Debrecen, Hungary
| | - Máté Pásztor
- Department of Neurology, Medical Centre, Hungarian Defence Forces, 44 Károly Róbert krt, H-1134 Budapest, Hungary
| | - Anita Árokszállási
- Department of Oncology, Faculty of Medicine, University of Debrecen, 98 Nagyerdei krt, H-4032 Debrecen, Hungary
| | - Edit Boglárka Nagy
- Division of Radiology and Imaging Science, Department of Medical Imaging, Faculty of Medicine, University of Debrecen, 98 Nagyerdei krt, H-4032 Debrecen, Hungary
| | - Ivett Belán
- Division of Radiology and Imaging Science, Department of Medical Imaging, Faculty of Medicine, University of Debrecen, 98 Nagyerdei krt, H-4032 Debrecen, Hungary
| | - Zsolt May
- Department of Neurology, Medical Centre, Hungarian Defence Forces, 44 Károly Róbert krt, H-1134 Budapest, Hungary
| | - Tünde Csépány
- Department of Neurology, Faculty of Medicine, Doctoral School of Neuroscience, University of Debrecen, 22 Móricz Zsigmond krt, H-4032 Debrecen, Hungary
| | - László Csiba
- Department of Neurology, Faculty of Medicine, Doctoral School of Neuroscience, University of Debrecen, 22 Móricz Zsigmond krt, H-4032 Debrecen, Hungary
- ELKH-DE Cerebrovascular Research Group, 22 Móricz Zsigmond krt, H-4032 Debrecen, Hungary
| | - Zsuzsa Bagoly
- Division of Clinical Laboratory Sciences, Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, 98 Nagyerdei krt, H-4032 Debrecen, Hungary
- ELKH-DE Cerebrovascular Research Group, 22 Móricz Zsigmond krt, H-4032 Debrecen, Hungary
| | - László Oláh
- Department of Neurology, Faculty of Medicine, Doctoral School of Neuroscience, University of Debrecen, 22 Móricz Zsigmond krt, H-4032 Debrecen, Hungary
- Correspondence: ; Tel.: +36-52-255-341; Fax: +36-52-255-590
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Dabhi N, Mastorakos P, Sokolowski JD, Kellogg RT, Park MS. Effect of drug use in the treatment of acute ischemic stroke: A scoping review. Surg Neurol Int 2022; 13:367. [PMID: 36128166 PMCID: PMC9479649 DOI: 10.25259/sni_561_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 07/27/2022] [Indexed: 11/04/2022] Open
Abstract
Background:
Drugs of abuse have been associated with ischemic stroke; however, the clinical presentation, outcomes, and treatment data in this population are limited. The overall safety and efficacy of thrombolytic therapy and thrombectomy in these patients remain unclear. This scoping review summarizes published complications and clinical outcomes in patients with recent abuse of cocaine, methamphetamine (MA), cannabis, decongestant, opioids, alcohol, and 3,4-methylenedioxymethamphetamine (MDMA) presenting with acute ischemic stroke.
Methods:
We conducted a scoping review of the primary literature that assessed outcomes data of thrombolytic therapy or thrombectomy in drug users with acute ischemic stroke. We searched PubMed, Ovid Medline, and Web of Science. Demographic and stroke characteristics, treatment, complications, and clinical outcomes at last follow-up were collected and summarized.
Results:
We identified 51 studies in this review. Drugs of abuse of interest were cocaine (14 studies), MDMA (one study), MA (eight studies), cannabis (23 studies), alcohol (two studies), decongestants (one study), and opioids (two studies). Clinical presentation and stroke presentation were most commonly described features. Thrombectomy outcomes were reported for four patients total (two studies), all with history of cocaine use. Thrombolysis treatment and outcomes were reported for 8851 patients (five studies) with history of cocaine, alcohol, or cannabis. Both treatments were pursued in three patients (three studies). Treatment complications included intracerebral hemorrhage, vasospasm, and cerebral edema.
Conclusion:
Evidence for thrombolytic and thrombectomy treatment in drug users remains limited. Controlled studies are needed to examine complication profile and outcomes following thrombolytic and thrombectomy treatment in this population.
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He L, Guo ZN, Qu Y, Jin H. Hyponatremia Is Associated With Post-thrombolysis Hemorrhagic Transformation and Poor Clinical Outcome in Ischemic Stroke Patients. Front Mol Neurosci 2022; 15:879863. [PMID: 35923753 PMCID: PMC9341483 DOI: 10.3389/fnmol.2022.879863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 03/21/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveHyponatremia is the most common electrolyte disorder encountered in patients with neurological conditions, such as stroke. Studies have shown that it is associated with worse clinical outcomes and increased mortality in acute ischemic stroke (AIS). However, the role of hyponatremia has not been elucidated in patients with AIS who received intravenous thrombolysis (IVT) therapy. Therefore, this study aimed to investigate the effect of serum sodium levels on the clinical outcome and hemorrhagic transformation (HT) in patients with AIS who received thrombolytic therapy.MethodsPatients diagnosed with AIS who received IVT therapy between May 2015 and December 2020 were included in this study. All patients were screened for serum sodium levels immediately after hospital admission, before IVT therapy. The occurrence of HT was evaluated using computed tomography (CT) 24 ± 2 h after thrombolysis. Then, 3-month clinical outcomes were obtained by telephone calls or outpatient visits, and poor 3-month clinical outcomes were defined as modified Rankin Scale scores ≥3. The effects of serum sodium levels on the clinical outcome and HT were assessed using the multivariate logistic regression analysis.ResultsOf the 963 included patients, 82 (8.5%) had hyponatremia, 157 (16.3%) developed HT, and 333 (34.6%) had poor 3-month outcomes. Of the 82 patients with hyponatremia, 21 (25.6%) developed HT, and 39 (47.6%) had poor 3-month outcomes. Patients with hyponatremia had a higher incidence of post-thrombolysis HT (25.6 vs. 15.4%, p = 0.017) and worse clinical outcome (47.6 vs. 33.4%, p = 0.01) than those with normal serum sodium levels. Patients had significantly lower serum sodium levels in those with HT [138.4 (136.4–140.3, IQR) vs. 139.0 (137.2–140.7, IQR) mmol/L, p = 0.019] and poor 3 month outcome [139.0 (137.2–140.7) vs. 138.4 (136.7–140.3) mmol/L, p = 0.005] than those without. After adjusting for major covariates, the multivariate logistic regression analysis revealed that lower serum sodium levels were independently associated with an increased risk of HT [odds ratio (OR) = 1.804; 95% CI: 1.048–3.105] and poor 3-month outcome (OR = 1.647; 95% CI: 1.012–2.679).ConclusionLower serum sodium level was an independent risk factor for post-thrombolysis HT and poor clinical outcome in patients with AIS who received thrombolytic therapy.
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Affiliation(s)
- Ling He
- Stroke Center, The First Hospital of Jilin University, Changchun, China
| | - Zhen-Ni Guo
- Stroke Center, The First Hospital of Jilin University, Changchun, China
- Department of Neurology, Stroke Center, Clinical Trial and Research Center for Stroke, The First Hospital of Jilin University, Changchun, China
| | - Yang Qu
- Stroke Center, The First Hospital of Jilin University, Changchun, China
| | - Hang Jin
- Stroke Center, The First Hospital of Jilin University, Changchun, China
- *Correspondence: Hang Jin,
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Zambrano Espinoza MD, Lail NS, Vaughn CB, Shirani P, Sawyer RN, Mowla A. Does Body Mass Index Impact the Outcome of Stroke Patients Who Received Intravenous Thrombolysis? Cerebrovasc Dis 2021; 50:141-146. [PMID: 33423033 DOI: 10.1159/000511489] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 09/10/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND We sought to investigate the effect of obesity and BMI on functional outcome and rate of symptomatic intracranial hemorrhage (sICH) in a large sample of patients with acute ischemic stroke (AIS) treated with intravenous thrombolysis (IVT). METHODS In a single-center retrospective, but prospectively collected data, study of patients with AIS treated with IVT in a 10-year period, patients were placed into groups based on their BMI defined as underweight (<18.5 kg/m2), normal weight (18.5-24.9 kg/m2), overweight (25-29.9 kg/m2), or obese (<30 kg/m2). The rate of sICH and discharge modified Rankin Scale (mRS) were compared between the groups using logistic regression analysis. RESULTS In a total of 834 patients who received IVT for AIS during a 10-year period, 224 (27.0%) were obese. Obese patients did not have a higher rate of sICH after IVT for AIS on the unadjusted or adjusted analysis (adjusted OR 0.95, 95% CI 0.48-1.88). We did not find an association between obesity and poor functional outcome at discharge (adjusted OR 0.76, 95% CI 0.53-1.09). CONCLUSIONS After adjusting for confounding factors such as age, baseline National Institute of Health Stroke Scale (NIHSS), and comorbidities, obesity was not associated with an unfavorable functional outcome at discharge nor with a higher risk of sICH in patients with AIS treated with IVT.
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Affiliation(s)
| | - Navdeep Singh Lail
- Department of Neurology, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Caila B Vaughn
- Department of Neurology, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Peyman Shirani
- Departments of Neurology and Neurosurgery, University of Cincinnati Medical Center, Cincinnati, Ohio, USA
| | - Robert N Sawyer
- Department of Neurology, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Ashkan Mowla
- Division of Endovascular Neurosurgery, Department of Neurological Surgery, Keck School of Medicine, University of Southern California (USC), Los Angeles, California, USA,
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Drieu A, Lanquetin A, Levard D, Glavan M, Campos F, Quenault A, Lemarchand E, Naveau M, Pitel AL, Castillo J, Vivien D, Rubio M. Alcohol exposure-induced neurovascular inflammatory priming impacts ischemic stroke and is linked with brain perivascular macrophages. JCI Insight 2020; 5:129226. [PMID: 31990687 DOI: 10.1172/jci.insight.129226] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 01/15/2020] [Indexed: 02/06/2023] Open
Abstract
Alcohol abuse is a major public health problem worldwide, causing a wide range of preventable morbidity and mortality. In this translational study, we show that heavy drinking (HD) (≥6 standard drinks/day) is independently associated with a worse outcome for ischemic stroke patients. To study the underlying mechanisms of this deleterious effect of HD, we performed an extensive analysis of the brain inflammatory responses of mice chronically exposed or not to 10% alcohol before and after ischemic stroke. Inflammatory responses were analyzed at the parenchymal, perivascular, and vascular levels by using transcriptomic, immunohistochemical, in vivo 2-photon microscopy and molecular MRI analyses. Alcohol-exposed mice show, in the absence of any other insult, a neurovascular inflammatory priming (i.e., an abnormal inflammatory status including an increase in brain perivascular macrophages [PVM]) associated with exacerbated inflammatory responses after a secondary insult (ischemic stroke or LPS challenge). Similar to our clinical data, alcohol-exposed mice showed larger ischemic lesions. We show here that PVM are key players on this aggravating effect of alcohol, since their specific depletion blocks the alcohol-induced aggravation of ischemic lesions. This study opens potentially new therapeutic avenues aiming at blocking alcohol-induced exacerbation of the neurovascular inflammatory responses triggered after ischemic stroke.
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Affiliation(s)
- Antoine Drieu
- INSERM, Physiopathology and Imaging of Neurological Disorders, UMR-S 1237, Normandie Université, Caen, France
| | - Anastasia Lanquetin
- INSERM, Physiopathology and Imaging of Neurological Disorders, UMR-S 1237, Normandie Université, Caen, France
| | - Damien Levard
- INSERM, Physiopathology and Imaging of Neurological Disorders, UMR-S 1237, Normandie Université, Caen, France
| | - Martina Glavan
- INSERM, Physiopathology and Imaging of Neurological Disorders, UMR-S 1237, Normandie Université, Caen, France
| | - Francisco Campos
- Clinical Neurosciences Research Laboratory, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Aurélien Quenault
- INSERM, Physiopathology and Imaging of Neurological Disorders, UMR-S 1237, Normandie Université, Caen, France
| | - Eloïse Lemarchand
- INSERM, Physiopathology and Imaging of Neurological Disorders, UMR-S 1237, Normandie Université, Caen, France
| | - Mikaël Naveau
- CNRS, UMR-S 3408, GIP Cyceron, Normandie Université, Caen, France
| | - Anne Lise Pitel
- INSERM, Neuropsychologie et Imagerie de la Mémoire Humaine, UMR-S 1077, Université Paris Sciences et Lettres, Caen, France
| | - José Castillo
- Clinical Neurosciences Research Laboratory, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Denis Vivien
- INSERM, Physiopathology and Imaging of Neurological Disorders, UMR-S 1237, Normandie Université, Caen, France
| | - Marina Rubio
- INSERM, Physiopathology and Imaging of Neurological Disorders, UMR-S 1237, Normandie Université, Caen, France
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Akano EO, Otite FO, Chaturvedi S. Alcohol withdrawal is associated with poorer outcome in acute ischemic stroke. Neurology 2019; 93:e1944-e1954. [PMID: 31653706 DOI: 10.1212/wnl.0000000000008518] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 06/06/2019] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE To determine the association between alcohol abuse (AA) and alcohol withdrawal (AW) with acute ischemic stroke (AIS) outcomes. METHODS All adult AIS admissions in the United States from 2004 to 2014 were identified from the National Inpatient Sample (weighted n = 4,438,968). Multivariable-adjusted models were used to evaluate the association of AW with in-hospital medical complications, mortality, cost, and length of stay in patients with AIS. RESULTS Of the AA admissions, 10.6% of patients, representing 0.4% of all AIS, developed AW. The prevalence of AA and AW in AIS increased by 45.2% and 40.0%, respectively, over time (p for trend <0.001). Patients with AA were predominantly men (80.2%), white (65.9%), and in the 40- to 59-year (44.6%) and 60- to 79-year (45.6%) age groups. After multivariable adjustment, AIS admissions with AW had >50% increased odds of urinary tract infection, pneumonia, sepsis, gastrointestinal bleeding, deep venous thrombosis, and acute renal failure compared to those without AW. Patients with AW were also 32% more likely to die during their AIS hospitalization compared to those without AW (odds ratio 1.32, 95% confidence interval 1.11-1.58). AW was associated with ≈15-day increase in length of stay and ≈$5,000 increase in hospitalization cost (p < 0.001). CONCLUSION AW is associated with increased cost, longer hospitalizations, and higher odds of medical complications and in-hospital mortality after AIS. Proactive surveillance and management of AW may be important in improving outcomes in these patients.
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Affiliation(s)
- Emmanuel O Akano
- From the Molecular Neuropharmacology Unit (E.O.A.), National Institutes of Neurologic Disorders and Stroke, NIH, Bethesda, MD; Division of Neurocritical Care (F.O.O.), Department of Neurology, Massachusetts General Hospital/Harvard Medical School, Boston; and Department of Neurology (S.C.), University of Maryland School of Medicine, Baltimore.
| | - Fadar Oliver Otite
- From the Molecular Neuropharmacology Unit (E.O.A.), National Institutes of Neurologic Disorders and Stroke, NIH, Bethesda, MD; Division of Neurocritical Care (F.O.O.), Department of Neurology, Massachusetts General Hospital/Harvard Medical School, Boston; and Department of Neurology (S.C.), University of Maryland School of Medicine, Baltimore.
| | - Seemant Chaturvedi
- From the Molecular Neuropharmacology Unit (E.O.A.), National Institutes of Neurologic Disorders and Stroke, NIH, Bethesda, MD; Division of Neurocritical Care (F.O.O.), Department of Neurology, Massachusetts General Hospital/Harvard Medical School, Boston; and Department of Neurology (S.C.), University of Maryland School of Medicine, Baltimore
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Hassing LT, Verschoof MA, Koppen H. Alcohol Intoxication as a Stroke Mimic and the Incidence of Acute Alcohol Intoxication in Stroke. J Stroke Cerebrovasc Dis 2019; 28:104424. [PMID: 31624037 DOI: 10.1016/j.jstrokecerebrovasdis.2019.104424] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 09/17/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND AIM Alcohol intoxication can be a posterior circulation stroke mimic as they share symptoms such as dysarthria, gait disturbances and nystagmus. We describe alcohol intoxication as a stroke mimic and the frequency of acute alcohol intoxication among stroke patients. METHODS Prospective observational single-center study (2014-2017, Haga Ziekenhuis, the Hague). In all patients older than 16 years presenting as possible acute stroke less than 6 hours of onset, blood ethanol was measured; greater than 0.1 blood alcohol concentration (BAC) was considered elevated. RESULTS In total 974 patients were included: 60 (6%) had elevated blood ethanol (mean: 1.3 BAC). In 180 of 974 patients (18%) a stroke mimic was diagnosed: 12 were due to alcohol intoxication (1% of total cohort, 7% of stroke mimic, mean ethanol level: 2.2 BAC). Half of these patients denied or downplayed their alcohol consumption. Stroke and concurrent alcohol intoxication occurred in 38 of 794 strokes (5%, mean ethanol level: 1.1 BAC). Compared to other stroke patients, these 38 patients presented more often after working hours (mean 6.38pm versus 2.23pm) and received alteplase and endovascular therapy less often (24% versus 43%, P = .018 and 3% versus 10%, P = .241, respectively). CONCLUSIONS Of all patients presenting as possible acute stroke, 6% also drank alcohol. 18% of the whole cohort was diagnosed with a stroke mimic. Acute alcohol intoxication as sole diagnosis was diagnosed in 1% of the total cohort and 7% of stroke mimics, 50% denied or downplayed their alcohol consumption. 5% of all stroke patients also drank alcohol, they were significantly less likely to receive alteplase or endovascular treatment.
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Affiliation(s)
- Laurien T Hassing
- Department of Neurology, Haga Ziekenhuis, The Hague, The Netherlands.
| | | | - Hille Koppen
- Department of Neurology, Haga Ziekenhuis, The Hague, The Netherlands
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11
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Kulesh AA, Syromyatnikova LI, Golosova YA, Shestakov VV. The experience of using thrombolysis in patients with acute disturbances of cerebral circulation: efficacy, safety, predictors of outcome and hemorrhagic transformation. Zh Nevrol Psikhiatr Im S S Korsakova 2018; 118:18-24. [DOI: 10.17116/jnevro20181187118] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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12
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Martinez de Lizarrondo S, Gauberti M, Vivien D. Valproic acid: a relevant thromboprophylactic strategy? J Thromb Haemost 2016; 14:2493-2495. [PMID: 27709777 DOI: 10.1111/jth.13528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 09/26/2016] [Indexed: 01/20/2023]
Affiliation(s)
| | - M Gauberti
- Université Caen-Normandie, Unicaen, INSERM, Inserm UMR-S U919, Caen, France
- Department of Diagnostic Imaging and Interventional Radiology, Medical Center, Caen University Hospital, Caen, France
| | - D Vivien
- Université Caen-Normandie, Unicaen, INSERM, Inserm UMR-S U919, Caen, France
- Clinical Research Department, Medical Center, Caen University Hospital, Caen, France
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13
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Orset C, Haelewyn B, Allan SM, Ansar S, Campos F, Cho TH, Durand A, El Amki M, Fatar M, Garcia-Yébenes I, Gauberti M, Grudzenski S, Lizasoain I, Lo E, Macrez R, Margaill I, Maysami S, Meairs S, Nighoghossian N, Orbe J, Paramo JA, Parienti JJ, Rothwell NJ, Rubio M, Waeber C, Young AR, Touzé E, Vivien D. Efficacy of Alteplase in a Mouse Model of Acute Ischemic Stroke: A Retrospective Pooled Analysis. Stroke 2016; 47:1312-1318. [PMID: 27032444 DOI: 10.1161/strokeaha.116.012238] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 03/01/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND PURPOSE The debate over the fact that experimental drugs proposed for the treatment of stroke fail in the translation to the clinical situation has attracted considerable attention in the literature. In this context, we present a retrospective pooled analysis of a large data set from preclinical studies, to examine the effects of early versus late administration of intravenous recombinant tissue-type plasminogen activator. METHODS We collected data from 26 individual studies from 9 international centers (13 researchers; 716 animals) that compared recombinant tissue-type plasminogen activator with controls, in a unique mouse model of thromboembolic stroke induced by an in situ injection of thrombin into the middle cerebral artery. Studies were classified into early (<3 hours) versus late (≥3 hours) drug administration. Final infarct volumes, assessed by histology or magnetic resonance imaging, were compared in each study, and the absolute differences were pooled in a random-effect meta-analysis. The influence of time of administration was tested. RESULTS When compared with saline controls, early recombinant tissue-type plasminogen activator administration was associated with a significant benefit (absolute difference, -6.63 mm(3); 95% confidence interval, -9.08 to -4.17; I(2)=76%), whereas late recombinant tissue-type plasminogen activator treatment showed a deleterious effect (+5.06 mm(3); 95% confidence interval, +2.78 to +7.34; I(2)=42%; Pint<0.00001). Results remained unchanged after subgroup analyses. CONCLUSIONS Our results provide the basis needed for the design of future preclinical studies on recanalization therapies using this model of thromboembolic stroke in mice. The power analysis reveals that a multicenter trial would require 123 animals per group instead of 40 for a single-center trial.
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Affiliation(s)
- Cyrille Orset
- Inserm UMR-S U919, University Caen Normandie, GIP Cyceron, Caen, France.,Experimental Stroke Research Platform, CURB, University Caen Normandie, Caen, France
| | - Benoit Haelewyn
- Experimental Stroke Research Platform, CURB, University Caen Normandie, Caen, France
| | - Stuart M Allan
- University of Manchester, Faculty of Medical and Health Sciences, Manchester, United Kingdom
| | - Saema Ansar
- Neurologische Universitätsklinik, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.,Division of Experimental Vascular Research, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Francesco Campos
- Dept of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA.,Department of Neurology, Neurovascular Area, Clinical Neurosciences Research Laboratory, Hospital Clínico Universitario, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Tae Hee Cho
- Inserm UMR-S U919, University Caen Normandie, GIP Cyceron, Caen, France.,Dept of Stroke Medicine and Department of Neuroradiology; Université Lyon 1; CREATIS, CNRS UMR 5220-INSERM U1044 ; Hospices Civils de Lyon ; Lyon, France
| | - Anne Durand
- Dept of Stroke Medicine and Department of Neuroradiology; Université Lyon 1; CREATIS, CNRS UMR 5220-INSERM U1044 ; Hospices Civils de Lyon ; Lyon, France
| | - Mohamad El Amki
- EA4475 Pharmacologie de la Circulation Cérébrale, Faculté des Sciences Pharmaceutiques et Biologiques, Paris, France
| | - Marc Fatar
- Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Germany
| | - Isaac Garcia-Yébenes
- Unidad de Investigación Neurovascular, Departamento Farmacología, Facultad de Medicina, Universidad Complutense and Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain
| | - Maxime Gauberti
- Inserm UMR-S U919, University Caen Normandie, GIP Cyceron, Caen, France
| | - Saskia Grudzenski
- Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Germany
| | - Ignacio Lizasoain
- Unidad de Investigación Neurovascular, Departamento Farmacología, Facultad de Medicina, Universidad Complutense and Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain
| | - Eng Lo
- Departments of Radiology, and Neurology, Massachusetts General Hospital, Harvard Medical School, Charlestown, USA
| | - Richard Macrez
- Inserm UMR-S U919, University Caen Normandie, GIP Cyceron, Caen, France
| | - Isabelle Margaill
- EA4475 Pharmacologie de la Circulation Cérébrale, Faculté des Sciences Pharmaceutiques et Biologiques, Paris, France
| | - Samaneh Maysami
- University of Manchester, Faculty of Medical and Health Sciences, Manchester, United Kingdom
| | - Stephen Meairs
- Neurologische Universitätsklinik, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Norbert Nighoghossian
- Dept of Stroke Medicine and Department of Neuroradiology; Université Lyon 1; CREATIS, CNRS UMR 5220-INSERM U1044 ; Hospices Civils de Lyon ; Lyon, France
| | - Josune Orbe
- Inserm UMR-S U919, University Caen Normandie, GIP Cyceron, Caen, France.,Inserm UMR-S U919, University Caen Normandie, GIP Cyceron, Caen, France
| | - Jose Antonio Paramo
- Laboratory of Atherothrombosis, Program of Cardiovascular Diseases, CIMA-University of Navarra, Pamplona, Spain
| | - Jean-Jacques Parienti
- Departments of Biostatistics and Clinical Research, Centre Hospitalier Universitaire (CHU), Caen ; EA4655 Risques Microbiens, Université de Caen Normandie, Caen, France
| | - Nancy J Rothwell
- University of Manchester, Faculty of Medical and Health Sciences, Manchester, United Kingdom
| | - Marina Rubio
- Inserm UMR-S U919, University Caen Normandie, GIP Cyceron, Caen, France
| | - Christian Waeber
- Dept of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA.,School of Pharmacy and Dept. of Pharmacology/Therapeutics, University College Cork, Ireland
| | - Alan R Young
- Inserm UMR-S U919, University Caen Normandie, GIP Cyceron, Caen, France
| | - Emmanuel Touzé
- Inserm UMR-S U919, University Caen Normandie, GIP Cyceron, Caen, France.,Department of Neurology, CHU Côte de Nacre, Caen
| | - Denis Vivien
- Inserm UMR-S U919, University Caen Normandie, GIP Cyceron, Caen, France
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Briens A, Gauberti M, Parcq J, Montaner J, Vivien D, de lizarrondo SM. Nano-zymography Using Laser-Scanning Confocal Microscopy Unmasks Proteolytic Activity of Cell-Derived Microparticles. Am J Cancer Res 2016; 6:610-26. [PMID: 27022410 PMCID: PMC4805657 DOI: 10.7150/thno.13757] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 01/27/2016] [Indexed: 12/31/2022] Open
Abstract
Cell-derived microparticles (MPs) are nano-sized vesicles released by activated cells in the extracellular milieu. They act as vectors of biological activity by carrying membrane-anchored and cytoplasmic constituents of the parental cells. Although detection and characterization of cell-derived MPs may be of high diagnostic and prognostic values in a number of human diseases, reliable measurement of their size, number and biological activity still remains challenging using currently available methods. In the present study, we developed a protocol to directly image and functionally characterize MPs using high-resolution laser-scanning confocal microscopy. Once trapped on annexin-V coated micro-wells, we developed several assays using fluorescent reporters to measure their size, detect membrane antigens and evaluate proteolytic activity (nano-zymography). In particular, we demonstrated the applicability and specificity of this method to detect antigens and proteolytic activities of tissue-type plasminogen activator (tPA), urokinase and plasmin at the surface of engineered MPs from transfected cell-lines. Furthermore, we were able to identify a subset of tPA-bearing fibrinolytic MPs using plasma samples from a cohort of ischemic stroke patients who received thrombolytic therapy and in an experimental model of thrombin-induced ischemic stroke in mice. Overall, this method is promising for functional characterization of cell-derived MPs.
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