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Kelly P, Lemmens R, Weimar C, Walsh C, Purroy F, Barber M, Collins R, Cronin S, Czlonkowska A, Desfontaines P, De Pauw A, Evans NR, Fischer U, Fonseca C, Forbes J, Hill MD, Jatuzis D, Kõrv J, Kraft P, Kruuse C, Lynch C, McCabe D, Mikulik R, Murphy S, Nederkoorn P, O'Donnell M, Sandercock P, Schroeder B, Shim G, Tobin K, Williams DJ, Price C. Long-term colchicine for the prevention of vascular recurrent events in non-cardioembolic stroke (CONVINCE): a randomised controlled trial. Lancet 2024:S0140-6736(24)00968-1. [PMID: 38857611 DOI: 10.1016/s0140-6736(24)00968-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 04/30/2024] [Accepted: 05/07/2024] [Indexed: 06/12/2024]
Abstract
BACKGROUND Anti-inflammatory therapy with long-term colchicine prevented vascular recurrence in coronary disease. Unlike coronary disease, which is typically caused by atherosclerosis, ischaemic stroke is caused by diverse mechanisms including atherosclerosis and small vessel disease or is frequently due to an unknown cause. We aimed to investigate the hypothesis that long-term colchicine would reduce recurrent events after ischaemic stroke. METHODS We did a randomised, parallel-group, open-label, blinded endpoint assessed trial comparing long-term colchicine (0·5 mg orally per day) plus guideline-based usual care with usual care only. Hospital-based patients with non-severe, non-cardioembolic ischaemic stroke or high-risk transient ischaemic attack were eligible. The primary endpoint was a composite of first fatal or non-fatal recurrent ischaemic stroke, myocardial infarction, cardiac arrest, or hospitalisation (defined as an admission to an inpatient unit or a visit to an emergency department that resulted in at least a 24 h stay [or a change in calendar date if the hospital admission or discharge times were not available]) for unstable angina. The p value for significance was 0·048 to adjust for two prespecified interim analyses conducted by the data monitoring committee, for which the steering committee and trial investigators remained blinded. The trial was registered at ClinicalTrials.gov (NCT02898610) and is completed. FINDINGS 3154 patients were randomly assigned between Dec 19, 2016, and Nov 21, 2022, with the last follow-up on Jan 31, 2024. The trial finished before the anticipated number of outcomes was accrued (367 outcomes planned) due to budget constraints attributable to the COVID-19 pandemic. Ten patients withdrew consent for analysis of their data, leaving 3144 patients in the intention-to-treat analysis: 1569 (colchicine and usual care) and 1575 (usual care alone). A primary endpoint occurred in 338 patients, 153 (9·8%) of 1569 patients allocated to colchicine and usual care and 185 (11·7%) of 1575 patients allocated to usual care alone (incidence rates 3·32 vs 3·92 per 100 person-years, hazard ratio 0·84; 95% CI 0·68-1·05, p=0·12). Although no between-group difference in C-reactive protein (CRP) was observed at baseline, patients treated with colchicine had lower CRP at 28 days and at 1, 2, and 3 years (p<0·05 for all timepoints). The rates of serious adverse events were similar in both groups. INTERPRETATION Although no statistically significant benefit was observed on the primary intention-to-treat analysis, the findings provide new evidence supporting the rationale for anti-inflammatory therapy in further randomised trials. FUNDING Health Research Board Ireland, Deutsche Forschungsgemeinschaft (German Research Foundation), and Fonds Wetenschappelijk Onderzoek Vlaanderen (Research Foundation Flanders), Belgium.
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Affiliation(s)
- Peter Kelly
- Mater Misericordiae University Hospital, Dublin, Ireland; School of Medicine, University College Dublin, Dublin, Ireland; Health Research Board Stroke Clinical Trials Network Ireland, Dublin, Ireland.
| | - Robin Lemmens
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium; Department of Neurosciences, Department of Experimental Neurology, and Leuven Research Institute for Neuroscience and Disease (LIND), KU Leuven-University of Leuven, Leuven, Belgium
| | - Christian Weimar
- Institute for Medical Informatics, Biometry, and Epidemiology, University Hospital, University Duisburg-Essen, Essen, Germany
| | - Cathal Walsh
- TCD Biostatistics Unit, Discipline of Public Health and Primary Care, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Francisco Purroy
- Stroke Unit, Department of Neurology, Hospitalt Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Biomedical Research Institute of Lleida, Universitat de Lleida, Lleida, Spain
| | | | - Ronan Collins
- Health Research Board Stroke Clinical Trials Network Ireland, Dublin, Ireland; Department of Neurology and Department of Geriatric and Stroke Medicine, Tallaght University Hospital-The Adelaide and Meath Hospital, Dublin, Ireland incorporating the National Children's Hospital and Academic Unit of Neurology, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Simon Cronin
- Cork University Hospital, Cork, Ireland; School of Medicine, University College Cork, Cork, Ireland
| | | | | | | | | | - Urs Fischer
- Department of Neurology, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Catarina Fonseca
- Department of Neurosciences and Mental Health (Neurology), Hospital Santa Maria-CHLN, Centro de Estudos Egas Moniz, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - John Forbes
- Health Research Board Stroke Clinical Trials Network Ireland, Dublin, Ireland; School of Medicine, University of Limerick, Limerick, Ireland
| | - Michael D Hill
- Department of Clinical Neurosciences & Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary and Foothills Medical Centre, Calgary, AB, Canada
| | - Dalius Jatuzis
- Centre of Neurology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Janika Kõrv
- Department of Neurology and Neurosurgery, University of Tartu, Tartu, Estonia
| | | | - Christina Kruuse
- Department of Neurology, Herlev and Gentofte Hospital, and Department of Brain and Spinal Cord Injury, Rigshospitalet Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Catherine Lynch
- Health Research Board Stroke Clinical Trials Network Ireland, Dublin, Ireland
| | - Dominick McCabe
- Health Research Board Stroke Clinical Trials Network Ireland, Dublin, Ireland; Department of Neurology and Department of Geriatric and Stroke Medicine, Tallaght University Hospital-The Adelaide and Meath Hospital, Dublin, Ireland incorporating the National Children's Hospital and Academic Unit of Neurology, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Robert Mikulik
- International Clinical Research Center and Department of Neurology, St Anne's University Hospital and Masaryk University Brno, Brno, Czech Republic
| | - Sean Murphy
- Mater Misericordiae University Hospital, Dublin, Ireland; School of Medicine, University College Dublin, Dublin, Ireland; Health Research Board Stroke Clinical Trials Network Ireland, Dublin, Ireland; RCSI University of Medicine and Health Sciences and Beaumont Hospital, Dublin, Ireland
| | - Paul Nederkoorn
- Department of Neurology, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Martin O'Donnell
- Health Research Board Stroke Clinical Trials Network Ireland, Dublin, Ireland; HRB Clinical Research Facility, University of Galway, Galway, Ireland
| | - Peter Sandercock
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | | | - Gek Shim
- University Hospital of North Durham, Durham, UK
| | - Katrina Tobin
- Health Research Board Stroke Clinical Trials Network Ireland, Dublin, Ireland
| | - David J Williams
- Health Research Board Stroke Clinical Trials Network Ireland, Dublin, Ireland; RCSI University of Medicine and Health Sciences and Beaumont Hospital, Dublin, Ireland
| | - Christopher Price
- Population Health Sciences Institute, Newcastle University, Newcastle, UK
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Hervella P, Alonso-Alonso ML, Sampedro-Viana A, Rodríguez-Yáñez M, López-Dequidt I, Pumar JM, Ouro A, Romaus-Sanjurjo D, Campos F, Sobrino T, Castillo J, Leira Y, Iglesias-Rey R. Differential blood-based biomarkers of subcortical and deep brain small vessel disease. Ther Adv Neurol Disord 2024; 17:17562864241243274. [PMID: 38827243 PMCID: PMC11143814 DOI: 10.1177/17562864241243274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 03/13/2024] [Indexed: 06/04/2024] Open
Abstract
Background Cerebral small vessel disease is the most common cause of lacunar strokes (LS). Understanding LS pathogenesis is vital for predicting disease severity, prognosis, and developing therapies. Objectives To research molecular profiles that differentiate LS in deep brain structures from those in subcortical white matter. Design Prospective case-control study involving 120 patients with imaging-confirmed LS and a 120 control group. Methods We examined the relationship between Alzheimer's disease biomarkers [amyloid beta (Aβ1-40, Aβ1-42)], serum inflammatory marker (interleukin-6, IL-6), and endothelial dysfunction markers [soluble tumor necrosis factor-like weak inducer of apoptosis, and pentraxin-3 (sTWEAK, PTX3)] with respect to LS occurring in deep brain structures and subcortical white matter. In addition, we investigated links between LS, leukoaraiosis presence (white matter hyperintensities, WMHs), and functional outcomes at 3 months. Poor outcome was defined as a modified Rankin scale >2 at 3 months. Results Significant differences were observed in levels of IL-6, PTX3, and sTWEAK between patients with deep lacunar infarcts and those with recent small subcortical infarcts (20.8 versus 15.6 pg/mL, p < 0.001; 7221.3 versus 4624.4 pg/mL, p < 0.0001; 2528.5 versus 1660.5 pg/mL, p = 0.001). Patients with poor outcomes at 3 months displayed notably higher concentrations of these biomarkers compared to those with good outcomes. By contrast, Aβ1-40 and Aβ1-42 were significantly lower in patients with deep LS (p < 0.0001). Aβ1-42 levels were significantly higher in patients with LS in subcortical white matter who had poor outcomes. WMH severity only showed a significant association with deep LS and correlated with sTWEAK (p < 0.0001). Conclusion The pathophysiological mechanisms of lacunar infarcts in deep brain structures seem different from those in the subcortical white matter. As a result, specific therapeutic and preventive strategies should be explored.
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Affiliation(s)
- Pablo Hervella
- Neuroimaging and Biotechnology Laboratory, Clinical Neurosciences Research Laboratory, Health Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
| | - Maria Luz Alonso-Alonso
- Neuroimaging and Biotechnology Laboratory, Clinical Neurosciences Research Laboratory, Health Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
| | - Ana Sampedro-Viana
- Neuroimaging and Biotechnology Laboratory, Clinical Neurosciences Research Laboratory, Health Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
| | - Manuel Rodríguez-Yáñez
- Stroke Unit, Department of Neurology, Hospital Clínico Universitario, Santiago de Compostela, Spain
| | - Iria López-Dequidt
- Stroke Unit, Department of Neurology, Hospital Clínico Universitario, Santiago de Compostela, Spain
- Hospital Clínico Universitario de Ferrol, Ferrol, Spain
| | - José M. Pumar
- Neuroimaging and Biotechnology Laboratory, Health Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
- Department of Neuroradiology, Hospital Clínico Universitario, Health Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
| | - Alberto Ouro
- NeuroAging Laboratory, Clinical Neurosciences Research Laboratory, Health Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas, Instituto de Salud Carlos III, Madrid, Spain
| | - Daniel Romaus-Sanjurjo
- NeuroAging Laboratory, Clinical Neurosciences Research Laboratory, Health Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas, Instituto de Salud Carlos III, Madrid, Spain
| | - Francisco Campos
- Translational Stroke Laboratory, Clinical Neurosciences Research Laboratory, Health Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
| | - Tomás Sobrino
- NeuroAging Laboratory, Clinical Neurosciences Research Laboratory, Health Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas, Instituto de Salud Carlos III, Madrid, Spain
| | - José Castillo
- Neuroimaging and Biotechnology Laboratory, Clinical Neurosciences Research Laboratory, Health Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
| | - Yago Leira
- Hospital Clínico Universitario, Rúa Travesa da Choupana, s/n 15706 Santiago de Compostela, Spain
- NeuroAging Laboratory, Clinical Neurosciences Research Laboratory, Health Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
- Periodontology Unit, Faculty of Medicine and Odontology, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Ramón Iglesias-Rey
- Hospital Clínico Universitario, Rúa Travesa da Choupana, s/n 15706 Santiago de Compostela, Spain
- Neuroimaging and Biotechnology Laboratory, Clinical Neurosciences Research Laboratory, Health Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
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Naranjo Á, Álvarez-Soria MJ, Aranda-Villalobos P, Martínez-Rodríguez AM, Martínez-Lara E, Siles E. Hydroxytyrosol, a Promising Supplement in the Management of Human Stroke: An Exploratory Study. Int J Mol Sci 2024; 25:4799. [PMID: 38732018 PMCID: PMC11084205 DOI: 10.3390/ijms25094799] [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: 03/20/2024] [Revised: 04/24/2024] [Accepted: 04/24/2024] [Indexed: 05/13/2024] Open
Abstract
Hydroxytyrosol (HT) is a bioactive olive oil phenol with beneficial effects in a number of pathological situations. We have previously demonstrated that an HT-enriched diet could serve as a beneficial therapeutic approach to attenuate ischemic-stroke-associated damage in mice. Our exploratory pilot study examined this effect in humans. Particularly, a nutritional supplement containing 15 mg of HT/day was administered to patients 24 h after the onset of stroke, for 45 days. Biochemical and oxidative-stress-related parameters, blood pressure levels, serum proteome, and neurological and functional outcomes were evaluated at 45 and 90 days and compared to a control group. The main findings were that the daily administration of HT after stroke could: (i) favor the decrease in the percentage of glycated hemoglobin and diastolic blood pressure, (ii) control the increase in nitric oxide and exert a plausible protective effect in oxidative stress, (iii) modulate the evolution of the serum proteome and, particularly, the expression of apolipoproteins, and (iv) be beneficial for certain neurological and functional outcomes. Although a larger trial is necessary, this study suggests that HT could be a beneficial nutritional complement in the management of human stroke.
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Affiliation(s)
- Ángela Naranjo
- Departamento de Biología Experimental, Universidad de Jaén, 23071 Jaén, Spain;
| | | | | | | | | | - Eva Siles
- Departamento de Biología Experimental, Universidad de Jaén, 23071 Jaén, Spain;
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Zietz A, Gorey S, Kelly PJ, Katan M, McCabe JJ. Targeting inflammation to reduce recurrent stroke. Int J Stroke 2024; 19:379-387. [PMID: 37800305 DOI: 10.1177/17474930231207777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
BACKGROUND Approximately one in four stroke patients suffer from recurrent vascular events, underlying the necessity to improve secondary stroke prevention strategies. Immune mechanisms are causally associated with coronary atherosclerosis. However, stroke is a heterogeneous disease and the relative contribution of inflammation across stroke mechanisms is not well understood. The optimal design of future randomized control trials (RCTs) of anti-inflammatory therapies to prevent recurrence after stroke must be informed by a clear understanding of the prognostic role of inflammation according to stroke subtype and individual patient factors. AIM In this narrative review, we discuss (1) inflammatory pathways in the etiology of ischemic stroke subtypes; (2) the evidence on inflammatory markers and vascular recurrence after stroke; and (3) review RCT evidence of anti-inflammatory agents for vascular prevention. SUMMARY OF REVIEW Experimental work, genetic epidemiological data, and plaque-imaging studies all implicate inflammation in atherosclerotic stroke. However, emerging evidence also suggests that inflammatory mechanisms are also important in other stroke mechanisms. Advanced neuroimaging techniques support the role of neuroinflammation in blood-brain barrier dysfunction in cerebral small vessel disease (cSVD). Systemic inflammatory processes also promote atrial cardiopathy, incident and recurrent atrial fibrillation (AF). Although several inflammatory markers have been associated with recurrence after stroke, interleukin-6 (IL-6) and high-sensitivity C-reactive protein (hsCRP) are presently the most promising markers to identify patients at increased vascular risk. Several RCTs have shown that anti-inflammatory therapies reduce vascular risk, including stroke, in coronary artery disease (CAD). Some, but not all of these trials, selected patients on the basis of elevated hsCRP. Although unproven after stroke, targeting inflammation to reduce recurrence is a compelling strategy and several RCTs are ongoing. CONCLUSION Evidence points toward the importance of inflammation across multiple stroke etiologies and potential benefit of anti-inflammatory targets in secondary stroke prevention. Taking the heterogeneous stroke etiologies into account, the use of serum biomarkers could be useful to identify patients with residual inflammatory risk and perform biomarker-led patient selection for future RCTs.
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Affiliation(s)
- Annaelle Zietz
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
- Neurology and Neurorehabilitation, University Department of Geriatric Medicine Felix Platter, University of Basel, Basel, Switzerland
| | - Sarah Gorey
- Health Research Board (HRB) Stroke Clinical Trials Network Ireland (SCTNI), Dublin, Ireland
- School of Medicine, University College Dublin (UCD), Dublin, Ireland
- Department of Geriatric Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Peter J Kelly
- Health Research Board (HRB) Stroke Clinical Trials Network Ireland (SCTNI), Dublin, Ireland
- School of Medicine, University College Dublin (UCD), Dublin, Ireland
- Department of Neurology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Mira Katan
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - John J McCabe
- Health Research Board (HRB) Stroke Clinical Trials Network Ireland (SCTNI), Dublin, Ireland
- School of Medicine, University College Dublin (UCD), Dublin, Ireland
- Department of Geriatric Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
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5
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McCabe JJ, Walsh C, Gorey S, Harris K, Hervella P, Iglesias-Rey R, Jern C, Li L, Miyamoto N, Montaner J, Pedersen A, Purroy FF, Rothwell PM, Sudlow CL, Ueno Y, Vicente-Pascual M, Whiteley WN, Woodward M, Kelly PJ. C-Reactive Protein, Interleukin-6, and Vascular Recurrence According to Stroke Subtype: An Individual Participant Data Meta-Analysis. Neurology 2024; 102:e208016. [PMID: 38165328 DOI: 10.1212/wnl.0000000000208016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 10/26/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Anti-inflammatory therapies reduce major adverse cardiovascular events (MACE) in coronary artery disease but remain unproven after stroke. Establishing the subtype-specific association between inflammatory markers and recurrence risk is essential for optimal selection of patients in randomized trials (RCTs) of anti-inflammatory therapies for secondary stroke prevention. METHODS Using individual participant data (IPD) identified from a systematic review, we analyzed the association between high-sensitivity C-reactive protein, interleukin-6 (IL-6), and vascular recurrence after ischemic stroke or transient ischemic attack. The prespecified coprimary end points were (1) any recurrent MACE (first major coronary event, recurrent stroke, or vascular death) and (2) any recurrent stroke (ischemic, hemorrhagic, or unspecified) after sample measurement. Analyses were performed stratified by stroke mechanism, per quarter and per biomarker unit increase after loge transformation. We then did study-level meta-analysis with comparable published studies not providing IPD. Preferred Reporting Items for Systematic Review and Meta-Analyses IPD guidelines were followed. RESULTS IPD was obtained from 10 studies (8,420 patients). After adjustment for vascular risk factors and statins/antithrombotic therapy, IL-6 was associated with recurrent MACE in stroke caused by large artery atherosclerosis (LAA) (risk ratio [RR] 2.30, 95% CI 1.21-4.36, p = 0.01), stroke of undetermined cause (UND) (RR 1.78, 1.19-2.66, p = 0.005), and small vessel occlusion (SVO) (RR 1.71, 0.99-2.96, p = 0.053) (quarter 4 [Q4] vs quarter 1 [Q1]). No association was observed for stroke due to cardioembolism or other determined cause. Similar results were seen for recurrent stroke and when analyzed per loge unit increase for MACE (LAA, RR 1.26 [1.06-1.50], p = 0.009; SVO, RR 1.22 [1.01-1.47], p = 0.04; UND, RR 1.18 [1.04-1.34], p = 0.01). High-sensitivity CRP was associated with recurrent MACE in UND stroke only (Q4 vs Q1 RR 1.45 [1.04-2.03], p = 0.03). Findings were consistent on study-level meta-analysis of the IPD results with 2 other comparable studies (20,136 patients). DISCUSSION Our data provide new evidence for the selection of patients in future RCTs of anti-inflammatory therapy in stroke due to large artery atherosclerosis, small vessel occlusion, and undetermined etiology according to inflammatory marker profile.
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Affiliation(s)
- John J McCabe
- From the Health Research Board (HRB) Stroke Clinical Trials Network Ireland (SCTNI) (J.J.M., C.W., S.G., P.J.K.), Dublin; School of Medicine (J.J.M., S.G., P.J.K.), University College Dublin (UCD); Stroke Service (J.J.M., S.G.), Department of Geriatric Medicine and Department of Neurology (P.J.K.), Mater Misericordiae University Hospital, Dublin; Health Research Institute and Mathematics Applications Consortium for Science and Industry (MACSI) (C.W.), Department of Mathematics and Statistics, University of Limerick, Ireland; George Institute for Global Health (K.H.), University of New South Wales, Sydney, Australia; Neuroimaging and Biotechnology Laboratory (NOBEL) (P.H., R.I.-R.), Clinical Neuroscience Research Laboratory, Health Research Institute of Santiago de Compostela, Spain; Department of Laboratory Medicine (C.J., A.P.), Institute of Biomedicine, the Sahlgrenska Academy, University of Gothenburg; Department of Clinical Genetics and Genomics (C.J., A.P.), Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden; Wolfson Centre for the Prevention of Stroke and Dementia (L.L., P.M.R.) and Nuffield Department of Population Health (W.N.W.), University of Oxford, United Kingdom; Department of Neurology (N.M., Y.U.), Juntendo University School of Medicine, Tokyo, Japan; Department of Neurology (J.M.), Hospital Universitari Vall d'Hebron, Barcelona; Institute de Biomedicine of Seville (J.M.), IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville, Neurology; Virgen Macarena Hospital (J.M.), Neurology, Sevilla; Neurovascular Research Laboratory (J.M.), Vall d'Hebron Institute of Research, Universitat Autònoma de Barcelona; Department of Neurology (F.F.P., M.V.-P.), Hospital Universitari Arnau de Vilanova; Department of Clinical Neurosciences (F.F.P., M.V.-P.), Institut Reserca Biomèdica Lleida, University of Lleida, Spain; Centre for Medical Informatics (C.L.S., W.N.W.), Usher Institute of Population Health Sciences and Informatics; Centre for Clinical Brain Sciences (C.L.S.), University of Edinburgh; and George Institute for Global Health (M.W.), Imperial College London, United Kingdom
| | - Cathal Walsh
- From the Health Research Board (HRB) Stroke Clinical Trials Network Ireland (SCTNI) (J.J.M., C.W., S.G., P.J.K.), Dublin; School of Medicine (J.J.M., S.G., P.J.K.), University College Dublin (UCD); Stroke Service (J.J.M., S.G.), Department of Geriatric Medicine and Department of Neurology (P.J.K.), Mater Misericordiae University Hospital, Dublin; Health Research Institute and Mathematics Applications Consortium for Science and Industry (MACSI) (C.W.), Department of Mathematics and Statistics, University of Limerick, Ireland; George Institute for Global Health (K.H.), University of New South Wales, Sydney, Australia; Neuroimaging and Biotechnology Laboratory (NOBEL) (P.H., R.I.-R.), Clinical Neuroscience Research Laboratory, Health Research Institute of Santiago de Compostela, Spain; Department of Laboratory Medicine (C.J., A.P.), Institute of Biomedicine, the Sahlgrenska Academy, University of Gothenburg; Department of Clinical Genetics and Genomics (C.J., A.P.), Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden; Wolfson Centre for the Prevention of Stroke and Dementia (L.L., P.M.R.) and Nuffield Department of Population Health (W.N.W.), University of Oxford, United Kingdom; Department of Neurology (N.M., Y.U.), Juntendo University School of Medicine, Tokyo, Japan; Department of Neurology (J.M.), Hospital Universitari Vall d'Hebron, Barcelona; Institute de Biomedicine of Seville (J.M.), IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville, Neurology; Virgen Macarena Hospital (J.M.), Neurology, Sevilla; Neurovascular Research Laboratory (J.M.), Vall d'Hebron Institute of Research, Universitat Autònoma de Barcelona; Department of Neurology (F.F.P., M.V.-P.), Hospital Universitari Arnau de Vilanova; Department of Clinical Neurosciences (F.F.P., M.V.-P.), Institut Reserca Biomèdica Lleida, University of Lleida, Spain; Centre for Medical Informatics (C.L.S., W.N.W.), Usher Institute of Population Health Sciences and Informatics; Centre for Clinical Brain Sciences (C.L.S.), University of Edinburgh; and George Institute for Global Health (M.W.), Imperial College London, United Kingdom
| | - Sarah Gorey
- From the Health Research Board (HRB) Stroke Clinical Trials Network Ireland (SCTNI) (J.J.M., C.W., S.G., P.J.K.), Dublin; School of Medicine (J.J.M., S.G., P.J.K.), University College Dublin (UCD); Stroke Service (J.J.M., S.G.), Department of Geriatric Medicine and Department of Neurology (P.J.K.), Mater Misericordiae University Hospital, Dublin; Health Research Institute and Mathematics Applications Consortium for Science and Industry (MACSI) (C.W.), Department of Mathematics and Statistics, University of Limerick, Ireland; George Institute for Global Health (K.H.), University of New South Wales, Sydney, Australia; Neuroimaging and Biotechnology Laboratory (NOBEL) (P.H., R.I.-R.), Clinical Neuroscience Research Laboratory, Health Research Institute of Santiago de Compostela, Spain; Department of Laboratory Medicine (C.J., A.P.), Institute of Biomedicine, the Sahlgrenska Academy, University of Gothenburg; Department of Clinical Genetics and Genomics (C.J., A.P.), Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden; Wolfson Centre for the Prevention of Stroke and Dementia (L.L., P.M.R.) and Nuffield Department of Population Health (W.N.W.), University of Oxford, United Kingdom; Department of Neurology (N.M., Y.U.), Juntendo University School of Medicine, Tokyo, Japan; Department of Neurology (J.M.), Hospital Universitari Vall d'Hebron, Barcelona; Institute de Biomedicine of Seville (J.M.), IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville, Neurology; Virgen Macarena Hospital (J.M.), Neurology, Sevilla; Neurovascular Research Laboratory (J.M.), Vall d'Hebron Institute of Research, Universitat Autònoma de Barcelona; Department of Neurology (F.F.P., M.V.-P.), Hospital Universitari Arnau de Vilanova; Department of Clinical Neurosciences (F.F.P., M.V.-P.), Institut Reserca Biomèdica Lleida, University of Lleida, Spain; Centre for Medical Informatics (C.L.S., W.N.W.), Usher Institute of Population Health Sciences and Informatics; Centre for Clinical Brain Sciences (C.L.S.), University of Edinburgh; and George Institute for Global Health (M.W.), Imperial College London, United Kingdom
| | - Katie Harris
- From the Health Research Board (HRB) Stroke Clinical Trials Network Ireland (SCTNI) (J.J.M., C.W., S.G., P.J.K.), Dublin; School of Medicine (J.J.M., S.G., P.J.K.), University College Dublin (UCD); Stroke Service (J.J.M., S.G.), Department of Geriatric Medicine and Department of Neurology (P.J.K.), Mater Misericordiae University Hospital, Dublin; Health Research Institute and Mathematics Applications Consortium for Science and Industry (MACSI) (C.W.), Department of Mathematics and Statistics, University of Limerick, Ireland; George Institute for Global Health (K.H.), University of New South Wales, Sydney, Australia; Neuroimaging and Biotechnology Laboratory (NOBEL) (P.H., R.I.-R.), Clinical Neuroscience Research Laboratory, Health Research Institute of Santiago de Compostela, Spain; Department of Laboratory Medicine (C.J., A.P.), Institute of Biomedicine, the Sahlgrenska Academy, University of Gothenburg; Department of Clinical Genetics and Genomics (C.J., A.P.), Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden; Wolfson Centre for the Prevention of Stroke and Dementia (L.L., P.M.R.) and Nuffield Department of Population Health (W.N.W.), University of Oxford, United Kingdom; Department of Neurology (N.M., Y.U.), Juntendo University School of Medicine, Tokyo, Japan; Department of Neurology (J.M.), Hospital Universitari Vall d'Hebron, Barcelona; Institute de Biomedicine of Seville (J.M.), IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville, Neurology; Virgen Macarena Hospital (J.M.), Neurology, Sevilla; Neurovascular Research Laboratory (J.M.), Vall d'Hebron Institute of Research, Universitat Autònoma de Barcelona; Department of Neurology (F.F.P., M.V.-P.), Hospital Universitari Arnau de Vilanova; Department of Clinical Neurosciences (F.F.P., M.V.-P.), Institut Reserca Biomèdica Lleida, University of Lleida, Spain; Centre for Medical Informatics (C.L.S., W.N.W.), Usher Institute of Population Health Sciences and Informatics; Centre for Clinical Brain Sciences (C.L.S.), University of Edinburgh; and George Institute for Global Health (M.W.), Imperial College London, United Kingdom
| | - Pablo Hervella
- From the Health Research Board (HRB) Stroke Clinical Trials Network Ireland (SCTNI) (J.J.M., C.W., S.G., P.J.K.), Dublin; School of Medicine (J.J.M., S.G., P.J.K.), University College Dublin (UCD); Stroke Service (J.J.M., S.G.), Department of Geriatric Medicine and Department of Neurology (P.J.K.), Mater Misericordiae University Hospital, Dublin; Health Research Institute and Mathematics Applications Consortium for Science and Industry (MACSI) (C.W.), Department of Mathematics and Statistics, University of Limerick, Ireland; George Institute for Global Health (K.H.), University of New South Wales, Sydney, Australia; Neuroimaging and Biotechnology Laboratory (NOBEL) (P.H., R.I.-R.), Clinical Neuroscience Research Laboratory, Health Research Institute of Santiago de Compostela, Spain; Department of Laboratory Medicine (C.J., A.P.), Institute of Biomedicine, the Sahlgrenska Academy, University of Gothenburg; Department of Clinical Genetics and Genomics (C.J., A.P.), Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden; Wolfson Centre for the Prevention of Stroke and Dementia (L.L., P.M.R.) and Nuffield Department of Population Health (W.N.W.), University of Oxford, United Kingdom; Department of Neurology (N.M., Y.U.), Juntendo University School of Medicine, Tokyo, Japan; Department of Neurology (J.M.), Hospital Universitari Vall d'Hebron, Barcelona; Institute de Biomedicine of Seville (J.M.), IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville, Neurology; Virgen Macarena Hospital (J.M.), Neurology, Sevilla; Neurovascular Research Laboratory (J.M.), Vall d'Hebron Institute of Research, Universitat Autònoma de Barcelona; Department of Neurology (F.F.P., M.V.-P.), Hospital Universitari Arnau de Vilanova; Department of Clinical Neurosciences (F.F.P., M.V.-P.), Institut Reserca Biomèdica Lleida, University of Lleida, Spain; Centre for Medical Informatics (C.L.S., W.N.W.), Usher Institute of Population Health Sciences and Informatics; Centre for Clinical Brain Sciences (C.L.S.), University of Edinburgh; and George Institute for Global Health (M.W.), Imperial College London, United Kingdom
| | - Ramon Iglesias-Rey
- From the Health Research Board (HRB) Stroke Clinical Trials Network Ireland (SCTNI) (J.J.M., C.W., S.G., P.J.K.), Dublin; School of Medicine (J.J.M., S.G., P.J.K.), University College Dublin (UCD); Stroke Service (J.J.M., S.G.), Department of Geriatric Medicine and Department of Neurology (P.J.K.), Mater Misericordiae University Hospital, Dublin; Health Research Institute and Mathematics Applications Consortium for Science and Industry (MACSI) (C.W.), Department of Mathematics and Statistics, University of Limerick, Ireland; George Institute for Global Health (K.H.), University of New South Wales, Sydney, Australia; Neuroimaging and Biotechnology Laboratory (NOBEL) (P.H., R.I.-R.), Clinical Neuroscience Research Laboratory, Health Research Institute of Santiago de Compostela, Spain; Department of Laboratory Medicine (C.J., A.P.), Institute of Biomedicine, the Sahlgrenska Academy, University of Gothenburg; Department of Clinical Genetics and Genomics (C.J., A.P.), Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden; Wolfson Centre for the Prevention of Stroke and Dementia (L.L., P.M.R.) and Nuffield Department of Population Health (W.N.W.), University of Oxford, United Kingdom; Department of Neurology (N.M., Y.U.), Juntendo University School of Medicine, Tokyo, Japan; Department of Neurology (J.M.), Hospital Universitari Vall d'Hebron, Barcelona; Institute de Biomedicine of Seville (J.M.), IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville, Neurology; Virgen Macarena Hospital (J.M.), Neurology, Sevilla; Neurovascular Research Laboratory (J.M.), Vall d'Hebron Institute of Research, Universitat Autònoma de Barcelona; Department of Neurology (F.F.P., M.V.-P.), Hospital Universitari Arnau de Vilanova; Department of Clinical Neurosciences (F.F.P., M.V.-P.), Institut Reserca Biomèdica Lleida, University of Lleida, Spain; Centre for Medical Informatics (C.L.S., W.N.W.), Usher Institute of Population Health Sciences and Informatics; Centre for Clinical Brain Sciences (C.L.S.), University of Edinburgh; and George Institute for Global Health (M.W.), Imperial College London, United Kingdom
| | - Christina Jern
- From the Health Research Board (HRB) Stroke Clinical Trials Network Ireland (SCTNI) (J.J.M., C.W., S.G., P.J.K.), Dublin; School of Medicine (J.J.M., S.G., P.J.K.), University College Dublin (UCD); Stroke Service (J.J.M., S.G.), Department of Geriatric Medicine and Department of Neurology (P.J.K.), Mater Misericordiae University Hospital, Dublin; Health Research Institute and Mathematics Applications Consortium for Science and Industry (MACSI) (C.W.), Department of Mathematics and Statistics, University of Limerick, Ireland; George Institute for Global Health (K.H.), University of New South Wales, Sydney, Australia; Neuroimaging and Biotechnology Laboratory (NOBEL) (P.H., R.I.-R.), Clinical Neuroscience Research Laboratory, Health Research Institute of Santiago de Compostela, Spain; Department of Laboratory Medicine (C.J., A.P.), Institute of Biomedicine, the Sahlgrenska Academy, University of Gothenburg; Department of Clinical Genetics and Genomics (C.J., A.P.), Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden; Wolfson Centre for the Prevention of Stroke and Dementia (L.L., P.M.R.) and Nuffield Department of Population Health (W.N.W.), University of Oxford, United Kingdom; Department of Neurology (N.M., Y.U.), Juntendo University School of Medicine, Tokyo, Japan; Department of Neurology (J.M.), Hospital Universitari Vall d'Hebron, Barcelona; Institute de Biomedicine of Seville (J.M.), IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville, Neurology; Virgen Macarena Hospital (J.M.), Neurology, Sevilla; Neurovascular Research Laboratory (J.M.), Vall d'Hebron Institute of Research, Universitat Autònoma de Barcelona; Department of Neurology (F.F.P., M.V.-P.), Hospital Universitari Arnau de Vilanova; Department of Clinical Neurosciences (F.F.P., M.V.-P.), Institut Reserca Biomèdica Lleida, University of Lleida, Spain; Centre for Medical Informatics (C.L.S., W.N.W.), Usher Institute of Population Health Sciences and Informatics; Centre for Clinical Brain Sciences (C.L.S.), University of Edinburgh; and George Institute for Global Health (M.W.), Imperial College London, United Kingdom
| | - Linxin Li
- From the Health Research Board (HRB) Stroke Clinical Trials Network Ireland (SCTNI) (J.J.M., C.W., S.G., P.J.K.), Dublin; School of Medicine (J.J.M., S.G., P.J.K.), University College Dublin (UCD); Stroke Service (J.J.M., S.G.), Department of Geriatric Medicine and Department of Neurology (P.J.K.), Mater Misericordiae University Hospital, Dublin; Health Research Institute and Mathematics Applications Consortium for Science and Industry (MACSI) (C.W.), Department of Mathematics and Statistics, University of Limerick, Ireland; George Institute for Global Health (K.H.), University of New South Wales, Sydney, Australia; Neuroimaging and Biotechnology Laboratory (NOBEL) (P.H., R.I.-R.), Clinical Neuroscience Research Laboratory, Health Research Institute of Santiago de Compostela, Spain; Department of Laboratory Medicine (C.J., A.P.), Institute of Biomedicine, the Sahlgrenska Academy, University of Gothenburg; Department of Clinical Genetics and Genomics (C.J., A.P.), Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden; Wolfson Centre for the Prevention of Stroke and Dementia (L.L., P.M.R.) and Nuffield Department of Population Health (W.N.W.), University of Oxford, United Kingdom; Department of Neurology (N.M., Y.U.), Juntendo University School of Medicine, Tokyo, Japan; Department of Neurology (J.M.), Hospital Universitari Vall d'Hebron, Barcelona; Institute de Biomedicine of Seville (J.M.), IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville, Neurology; Virgen Macarena Hospital (J.M.), Neurology, Sevilla; Neurovascular Research Laboratory (J.M.), Vall d'Hebron Institute of Research, Universitat Autònoma de Barcelona; Department of Neurology (F.F.P., M.V.-P.), Hospital Universitari Arnau de Vilanova; Department of Clinical Neurosciences (F.F.P., M.V.-P.), Institut Reserca Biomèdica Lleida, University of Lleida, Spain; Centre for Medical Informatics (C.L.S., W.N.W.), Usher Institute of Population Health Sciences and Informatics; Centre for Clinical Brain Sciences (C.L.S.), University of Edinburgh; and George Institute for Global Health (M.W.), Imperial College London, United Kingdom
| | - Nobukazu Miyamoto
- From the Health Research Board (HRB) Stroke Clinical Trials Network Ireland (SCTNI) (J.J.M., C.W., S.G., P.J.K.), Dublin; School of Medicine (J.J.M., S.G., P.J.K.), University College Dublin (UCD); Stroke Service (J.J.M., S.G.), Department of Geriatric Medicine and Department of Neurology (P.J.K.), Mater Misericordiae University Hospital, Dublin; Health Research Institute and Mathematics Applications Consortium for Science and Industry (MACSI) (C.W.), Department of Mathematics and Statistics, University of Limerick, Ireland; George Institute for Global Health (K.H.), University of New South Wales, Sydney, Australia; Neuroimaging and Biotechnology Laboratory (NOBEL) (P.H., R.I.-R.), Clinical Neuroscience Research Laboratory, Health Research Institute of Santiago de Compostela, Spain; Department of Laboratory Medicine (C.J., A.P.), Institute of Biomedicine, the Sahlgrenska Academy, University of Gothenburg; Department of Clinical Genetics and Genomics (C.J., A.P.), Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden; Wolfson Centre for the Prevention of Stroke and Dementia (L.L., P.M.R.) and Nuffield Department of Population Health (W.N.W.), University of Oxford, United Kingdom; Department of Neurology (N.M., Y.U.), Juntendo University School of Medicine, Tokyo, Japan; Department of Neurology (J.M.), Hospital Universitari Vall d'Hebron, Barcelona; Institute de Biomedicine of Seville (J.M.), IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville, Neurology; Virgen Macarena Hospital (J.M.), Neurology, Sevilla; Neurovascular Research Laboratory (J.M.), Vall d'Hebron Institute of Research, Universitat Autònoma de Barcelona; Department of Neurology (F.F.P., M.V.-P.), Hospital Universitari Arnau de Vilanova; Department of Clinical Neurosciences (F.F.P., M.V.-P.), Institut Reserca Biomèdica Lleida, University of Lleida, Spain; Centre for Medical Informatics (C.L.S., W.N.W.), Usher Institute of Population Health Sciences and Informatics; Centre for Clinical Brain Sciences (C.L.S.), University of Edinburgh; and George Institute for Global Health (M.W.), Imperial College London, United Kingdom
| | - Joan Montaner
- From the Health Research Board (HRB) Stroke Clinical Trials Network Ireland (SCTNI) (J.J.M., C.W., S.G., P.J.K.), Dublin; School of Medicine (J.J.M., S.G., P.J.K.), University College Dublin (UCD); Stroke Service (J.J.M., S.G.), Department of Geriatric Medicine and Department of Neurology (P.J.K.), Mater Misericordiae University Hospital, Dublin; Health Research Institute and Mathematics Applications Consortium for Science and Industry (MACSI) (C.W.), Department of Mathematics and Statistics, University of Limerick, Ireland; George Institute for Global Health (K.H.), University of New South Wales, Sydney, Australia; Neuroimaging and Biotechnology Laboratory (NOBEL) (P.H., R.I.-R.), Clinical Neuroscience Research Laboratory, Health Research Institute of Santiago de Compostela, Spain; Department of Laboratory Medicine (C.J., A.P.), Institute of Biomedicine, the Sahlgrenska Academy, University of Gothenburg; Department of Clinical Genetics and Genomics (C.J., A.P.), Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden; Wolfson Centre for the Prevention of Stroke and Dementia (L.L., P.M.R.) and Nuffield Department of Population Health (W.N.W.), University of Oxford, United Kingdom; Department of Neurology (N.M., Y.U.), Juntendo University School of Medicine, Tokyo, Japan; Department of Neurology (J.M.), Hospital Universitari Vall d'Hebron, Barcelona; Institute de Biomedicine of Seville (J.M.), IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville, Neurology; Virgen Macarena Hospital (J.M.), Neurology, Sevilla; Neurovascular Research Laboratory (J.M.), Vall d'Hebron Institute of Research, Universitat Autònoma de Barcelona; Department of Neurology (F.F.P., M.V.-P.), Hospital Universitari Arnau de Vilanova; Department of Clinical Neurosciences (F.F.P., M.V.-P.), Institut Reserca Biomèdica Lleida, University of Lleida, Spain; Centre for Medical Informatics (C.L.S., W.N.W.), Usher Institute of Population Health Sciences and Informatics; Centre for Clinical Brain Sciences (C.L.S.), University of Edinburgh; and George Institute for Global Health (M.W.), Imperial College London, United Kingdom
| | - Annie Pedersen
- From the Health Research Board (HRB) Stroke Clinical Trials Network Ireland (SCTNI) (J.J.M., C.W., S.G., P.J.K.), Dublin; School of Medicine (J.J.M., S.G., P.J.K.), University College Dublin (UCD); Stroke Service (J.J.M., S.G.), Department of Geriatric Medicine and Department of Neurology (P.J.K.), Mater Misericordiae University Hospital, Dublin; Health Research Institute and Mathematics Applications Consortium for Science and Industry (MACSI) (C.W.), Department of Mathematics and Statistics, University of Limerick, Ireland; George Institute for Global Health (K.H.), University of New South Wales, Sydney, Australia; Neuroimaging and Biotechnology Laboratory (NOBEL) (P.H., R.I.-R.), Clinical Neuroscience Research Laboratory, Health Research Institute of Santiago de Compostela, Spain; Department of Laboratory Medicine (C.J., A.P.), Institute of Biomedicine, the Sahlgrenska Academy, University of Gothenburg; Department of Clinical Genetics and Genomics (C.J., A.P.), Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden; Wolfson Centre for the Prevention of Stroke and Dementia (L.L., P.M.R.) and Nuffield Department of Population Health (W.N.W.), University of Oxford, United Kingdom; Department of Neurology (N.M., Y.U.), Juntendo University School of Medicine, Tokyo, Japan; Department of Neurology (J.M.), Hospital Universitari Vall d'Hebron, Barcelona; Institute de Biomedicine of Seville (J.M.), IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville, Neurology; Virgen Macarena Hospital (J.M.), Neurology, Sevilla; Neurovascular Research Laboratory (J.M.), Vall d'Hebron Institute of Research, Universitat Autònoma de Barcelona; Department of Neurology (F.F.P., M.V.-P.), Hospital Universitari Arnau de Vilanova; Department of Clinical Neurosciences (F.F.P., M.V.-P.), Institut Reserca Biomèdica Lleida, University of Lleida, Spain; Centre for Medical Informatics (C.L.S., W.N.W.), Usher Institute of Population Health Sciences and Informatics; Centre for Clinical Brain Sciences (C.L.S.), University of Edinburgh; and George Institute for Global Health (M.W.), Imperial College London, United Kingdom
| | - Francisco F Purroy
- From the Health Research Board (HRB) Stroke Clinical Trials Network Ireland (SCTNI) (J.J.M., C.W., S.G., P.J.K.), Dublin; School of Medicine (J.J.M., S.G., P.J.K.), University College Dublin (UCD); Stroke Service (J.J.M., S.G.), Department of Geriatric Medicine and Department of Neurology (P.J.K.), Mater Misericordiae University Hospital, Dublin; Health Research Institute and Mathematics Applications Consortium for Science and Industry (MACSI) (C.W.), Department of Mathematics and Statistics, University of Limerick, Ireland; George Institute for Global Health (K.H.), University of New South Wales, Sydney, Australia; Neuroimaging and Biotechnology Laboratory (NOBEL) (P.H., R.I.-R.), Clinical Neuroscience Research Laboratory, Health Research Institute of Santiago de Compostela, Spain; Department of Laboratory Medicine (C.J., A.P.), Institute of Biomedicine, the Sahlgrenska Academy, University of Gothenburg; Department of Clinical Genetics and Genomics (C.J., A.P.), Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden; Wolfson Centre for the Prevention of Stroke and Dementia (L.L., P.M.R.) and Nuffield Department of Population Health (W.N.W.), University of Oxford, United Kingdom; Department of Neurology (N.M., Y.U.), Juntendo University School of Medicine, Tokyo, Japan; Department of Neurology (J.M.), Hospital Universitari Vall d'Hebron, Barcelona; Institute de Biomedicine of Seville (J.M.), IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville, Neurology; Virgen Macarena Hospital (J.M.), Neurology, Sevilla; Neurovascular Research Laboratory (J.M.), Vall d'Hebron Institute of Research, Universitat Autònoma de Barcelona; Department of Neurology (F.F.P., M.V.-P.), Hospital Universitari Arnau de Vilanova; Department of Clinical Neurosciences (F.F.P., M.V.-P.), Institut Reserca Biomèdica Lleida, University of Lleida, Spain; Centre for Medical Informatics (C.L.S., W.N.W.), Usher Institute of Population Health Sciences and Informatics; Centre for Clinical Brain Sciences (C.L.S.), University of Edinburgh; and George Institute for Global Health (M.W.), Imperial College London, United Kingdom
| | - Peter M Rothwell
- From the Health Research Board (HRB) Stroke Clinical Trials Network Ireland (SCTNI) (J.J.M., C.W., S.G., P.J.K.), Dublin; School of Medicine (J.J.M., S.G., P.J.K.), University College Dublin (UCD); Stroke Service (J.J.M., S.G.), Department of Geriatric Medicine and Department of Neurology (P.J.K.), Mater Misericordiae University Hospital, Dublin; Health Research Institute and Mathematics Applications Consortium for Science and Industry (MACSI) (C.W.), Department of Mathematics and Statistics, University of Limerick, Ireland; George Institute for Global Health (K.H.), University of New South Wales, Sydney, Australia; Neuroimaging and Biotechnology Laboratory (NOBEL) (P.H., R.I.-R.), Clinical Neuroscience Research Laboratory, Health Research Institute of Santiago de Compostela, Spain; Department of Laboratory Medicine (C.J., A.P.), Institute of Biomedicine, the Sahlgrenska Academy, University of Gothenburg; Department of Clinical Genetics and Genomics (C.J., A.P.), Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden; Wolfson Centre for the Prevention of Stroke and Dementia (L.L., P.M.R.) and Nuffield Department of Population Health (W.N.W.), University of Oxford, United Kingdom; Department of Neurology (N.M., Y.U.), Juntendo University School of Medicine, Tokyo, Japan; Department of Neurology (J.M.), Hospital Universitari Vall d'Hebron, Barcelona; Institute de Biomedicine of Seville (J.M.), IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville, Neurology; Virgen Macarena Hospital (J.M.), Neurology, Sevilla; Neurovascular Research Laboratory (J.M.), Vall d'Hebron Institute of Research, Universitat Autònoma de Barcelona; Department of Neurology (F.F.P., M.V.-P.), Hospital Universitari Arnau de Vilanova; Department of Clinical Neurosciences (F.F.P., M.V.-P.), Institut Reserca Biomèdica Lleida, University of Lleida, Spain; Centre for Medical Informatics (C.L.S., W.N.W.), Usher Institute of Population Health Sciences and Informatics; Centre for Clinical Brain Sciences (C.L.S.), University of Edinburgh; and George Institute for Global Health (M.W.), Imperial College London, United Kingdom
| | - Cathie L Sudlow
- From the Health Research Board (HRB) Stroke Clinical Trials Network Ireland (SCTNI) (J.J.M., C.W., S.G., P.J.K.), Dublin; School of Medicine (J.J.M., S.G., P.J.K.), University College Dublin (UCD); Stroke Service (J.J.M., S.G.), Department of Geriatric Medicine and Department of Neurology (P.J.K.), Mater Misericordiae University Hospital, Dublin; Health Research Institute and Mathematics Applications Consortium for Science and Industry (MACSI) (C.W.), Department of Mathematics and Statistics, University of Limerick, Ireland; George Institute for Global Health (K.H.), University of New South Wales, Sydney, Australia; Neuroimaging and Biotechnology Laboratory (NOBEL) (P.H., R.I.-R.), Clinical Neuroscience Research Laboratory, Health Research Institute of Santiago de Compostela, Spain; Department of Laboratory Medicine (C.J., A.P.), Institute of Biomedicine, the Sahlgrenska Academy, University of Gothenburg; Department of Clinical Genetics and Genomics (C.J., A.P.), Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden; Wolfson Centre for the Prevention of Stroke and Dementia (L.L., P.M.R.) and Nuffield Department of Population Health (W.N.W.), University of Oxford, United Kingdom; Department of Neurology (N.M., Y.U.), Juntendo University School of Medicine, Tokyo, Japan; Department of Neurology (J.M.), Hospital Universitari Vall d'Hebron, Barcelona; Institute de Biomedicine of Seville (J.M.), IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville, Neurology; Virgen Macarena Hospital (J.M.), Neurology, Sevilla; Neurovascular Research Laboratory (J.M.), Vall d'Hebron Institute of Research, Universitat Autònoma de Barcelona; Department of Neurology (F.F.P., M.V.-P.), Hospital Universitari Arnau de Vilanova; Department of Clinical Neurosciences (F.F.P., M.V.-P.), Institut Reserca Biomèdica Lleida, University of Lleida, Spain; Centre for Medical Informatics (C.L.S., W.N.W.), Usher Institute of Population Health Sciences and Informatics; Centre for Clinical Brain Sciences (C.L.S.), University of Edinburgh; and George Institute for Global Health (M.W.), Imperial College London, United Kingdom
| | - Yuji Ueno
- From the Health Research Board (HRB) Stroke Clinical Trials Network Ireland (SCTNI) (J.J.M., C.W., S.G., P.J.K.), Dublin; School of Medicine (J.J.M., S.G., P.J.K.), University College Dublin (UCD); Stroke Service (J.J.M., S.G.), Department of Geriatric Medicine and Department of Neurology (P.J.K.), Mater Misericordiae University Hospital, Dublin; Health Research Institute and Mathematics Applications Consortium for Science and Industry (MACSI) (C.W.), Department of Mathematics and Statistics, University of Limerick, Ireland; George Institute for Global Health (K.H.), University of New South Wales, Sydney, Australia; Neuroimaging and Biotechnology Laboratory (NOBEL) (P.H., R.I.-R.), Clinical Neuroscience Research Laboratory, Health Research Institute of Santiago de Compostela, Spain; Department of Laboratory Medicine (C.J., A.P.), Institute of Biomedicine, the Sahlgrenska Academy, University of Gothenburg; Department of Clinical Genetics and Genomics (C.J., A.P.), Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden; Wolfson Centre for the Prevention of Stroke and Dementia (L.L., P.M.R.) and Nuffield Department of Population Health (W.N.W.), University of Oxford, United Kingdom; Department of Neurology (N.M., Y.U.), Juntendo University School of Medicine, Tokyo, Japan; Department of Neurology (J.M.), Hospital Universitari Vall d'Hebron, Barcelona; Institute de Biomedicine of Seville (J.M.), IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville, Neurology; Virgen Macarena Hospital (J.M.), Neurology, Sevilla; Neurovascular Research Laboratory (J.M.), Vall d'Hebron Institute of Research, Universitat Autònoma de Barcelona; Department of Neurology (F.F.P., M.V.-P.), Hospital Universitari Arnau de Vilanova; Department of Clinical Neurosciences (F.F.P., M.V.-P.), Institut Reserca Biomèdica Lleida, University of Lleida, Spain; Centre for Medical Informatics (C.L.S., W.N.W.), Usher Institute of Population Health Sciences and Informatics; Centre for Clinical Brain Sciences (C.L.S.), University of Edinburgh; and George Institute for Global Health (M.W.), Imperial College London, United Kingdom
| | - Mikel Vicente-Pascual
- From the Health Research Board (HRB) Stroke Clinical Trials Network Ireland (SCTNI) (J.J.M., C.W., S.G., P.J.K.), Dublin; School of Medicine (J.J.M., S.G., P.J.K.), University College Dublin (UCD); Stroke Service (J.J.M., S.G.), Department of Geriatric Medicine and Department of Neurology (P.J.K.), Mater Misericordiae University Hospital, Dublin; Health Research Institute and Mathematics Applications Consortium for Science and Industry (MACSI) (C.W.), Department of Mathematics and Statistics, University of Limerick, Ireland; George Institute for Global Health (K.H.), University of New South Wales, Sydney, Australia; Neuroimaging and Biotechnology Laboratory (NOBEL) (P.H., R.I.-R.), Clinical Neuroscience Research Laboratory, Health Research Institute of Santiago de Compostela, Spain; Department of Laboratory Medicine (C.J., A.P.), Institute of Biomedicine, the Sahlgrenska Academy, University of Gothenburg; Department of Clinical Genetics and Genomics (C.J., A.P.), Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden; Wolfson Centre for the Prevention of Stroke and Dementia (L.L., P.M.R.) and Nuffield Department of Population Health (W.N.W.), University of Oxford, United Kingdom; Department of Neurology (N.M., Y.U.), Juntendo University School of Medicine, Tokyo, Japan; Department of Neurology (J.M.), Hospital Universitari Vall d'Hebron, Barcelona; Institute de Biomedicine of Seville (J.M.), IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville, Neurology; Virgen Macarena Hospital (J.M.), Neurology, Sevilla; Neurovascular Research Laboratory (J.M.), Vall d'Hebron Institute of Research, Universitat Autònoma de Barcelona; Department of Neurology (F.F.P., M.V.-P.), Hospital Universitari Arnau de Vilanova; Department of Clinical Neurosciences (F.F.P., M.V.-P.), Institut Reserca Biomèdica Lleida, University of Lleida, Spain; Centre for Medical Informatics (C.L.S., W.N.W.), Usher Institute of Population Health Sciences and Informatics; Centre for Clinical Brain Sciences (C.L.S.), University of Edinburgh; and George Institute for Global Health (M.W.), Imperial College London, United Kingdom
| | - Will N Whiteley
- From the Health Research Board (HRB) Stroke Clinical Trials Network Ireland (SCTNI) (J.J.M., C.W., S.G., P.J.K.), Dublin; School of Medicine (J.J.M., S.G., P.J.K.), University College Dublin (UCD); Stroke Service (J.J.M., S.G.), Department of Geriatric Medicine and Department of Neurology (P.J.K.), Mater Misericordiae University Hospital, Dublin; Health Research Institute and Mathematics Applications Consortium for Science and Industry (MACSI) (C.W.), Department of Mathematics and Statistics, University of Limerick, Ireland; George Institute for Global Health (K.H.), University of New South Wales, Sydney, Australia; Neuroimaging and Biotechnology Laboratory (NOBEL) (P.H., R.I.-R.), Clinical Neuroscience Research Laboratory, Health Research Institute of Santiago de Compostela, Spain; Department of Laboratory Medicine (C.J., A.P.), Institute of Biomedicine, the Sahlgrenska Academy, University of Gothenburg; Department of Clinical Genetics and Genomics (C.J., A.P.), Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden; Wolfson Centre for the Prevention of Stroke and Dementia (L.L., P.M.R.) and Nuffield Department of Population Health (W.N.W.), University of Oxford, United Kingdom; Department of Neurology (N.M., Y.U.), Juntendo University School of Medicine, Tokyo, Japan; Department of Neurology (J.M.), Hospital Universitari Vall d'Hebron, Barcelona; Institute de Biomedicine of Seville (J.M.), IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville, Neurology; Virgen Macarena Hospital (J.M.), Neurology, Sevilla; Neurovascular Research Laboratory (J.M.), Vall d'Hebron Institute of Research, Universitat Autònoma de Barcelona; Department of Neurology (F.F.P., M.V.-P.), Hospital Universitari Arnau de Vilanova; Department of Clinical Neurosciences (F.F.P., M.V.-P.), Institut Reserca Biomèdica Lleida, University of Lleida, Spain; Centre for Medical Informatics (C.L.S., W.N.W.), Usher Institute of Population Health Sciences and Informatics; Centre for Clinical Brain Sciences (C.L.S.), University of Edinburgh; and George Institute for Global Health (M.W.), Imperial College London, United Kingdom
| | - Mark Woodward
- From the Health Research Board (HRB) Stroke Clinical Trials Network Ireland (SCTNI) (J.J.M., C.W., S.G., P.J.K.), Dublin; School of Medicine (J.J.M., S.G., P.J.K.), University College Dublin (UCD); Stroke Service (J.J.M., S.G.), Department of Geriatric Medicine and Department of Neurology (P.J.K.), Mater Misericordiae University Hospital, Dublin; Health Research Institute and Mathematics Applications Consortium for Science and Industry (MACSI) (C.W.), Department of Mathematics and Statistics, University of Limerick, Ireland; George Institute for Global Health (K.H.), University of New South Wales, Sydney, Australia; Neuroimaging and Biotechnology Laboratory (NOBEL) (P.H., R.I.-R.), Clinical Neuroscience Research Laboratory, Health Research Institute of Santiago de Compostela, Spain; Department of Laboratory Medicine (C.J., A.P.), Institute of Biomedicine, the Sahlgrenska Academy, University of Gothenburg; Department of Clinical Genetics and Genomics (C.J., A.P.), Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden; Wolfson Centre for the Prevention of Stroke and Dementia (L.L., P.M.R.) and Nuffield Department of Population Health (W.N.W.), University of Oxford, United Kingdom; Department of Neurology (N.M., Y.U.), Juntendo University School of Medicine, Tokyo, Japan; Department of Neurology (J.M.), Hospital Universitari Vall d'Hebron, Barcelona; Institute de Biomedicine of Seville (J.M.), IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville, Neurology; Virgen Macarena Hospital (J.M.), Neurology, Sevilla; Neurovascular Research Laboratory (J.M.), Vall d'Hebron Institute of Research, Universitat Autònoma de Barcelona; Department of Neurology (F.F.P., M.V.-P.), Hospital Universitari Arnau de Vilanova; Department of Clinical Neurosciences (F.F.P., M.V.-P.), Institut Reserca Biomèdica Lleida, University of Lleida, Spain; Centre for Medical Informatics (C.L.S., W.N.W.), Usher Institute of Population Health Sciences and Informatics; Centre for Clinical Brain Sciences (C.L.S.), University of Edinburgh; and George Institute for Global Health (M.W.), Imperial College London, United Kingdom
| | - Peter J Kelly
- From the Health Research Board (HRB) Stroke Clinical Trials Network Ireland (SCTNI) (J.J.M., C.W., S.G., P.J.K.), Dublin; School of Medicine (J.J.M., S.G., P.J.K.), University College Dublin (UCD); Stroke Service (J.J.M., S.G.), Department of Geriatric Medicine and Department of Neurology (P.J.K.), Mater Misericordiae University Hospital, Dublin; Health Research Institute and Mathematics Applications Consortium for Science and Industry (MACSI) (C.W.), Department of Mathematics and Statistics, University of Limerick, Ireland; George Institute for Global Health (K.H.), University of New South Wales, Sydney, Australia; Neuroimaging and Biotechnology Laboratory (NOBEL) (P.H., R.I.-R.), Clinical Neuroscience Research Laboratory, Health Research Institute of Santiago de Compostela, Spain; Department of Laboratory Medicine (C.J., A.P.), Institute of Biomedicine, the Sahlgrenska Academy, University of Gothenburg; Department of Clinical Genetics and Genomics (C.J., A.P.), Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden; Wolfson Centre for the Prevention of Stroke and Dementia (L.L., P.M.R.) and Nuffield Department of Population Health (W.N.W.), University of Oxford, United Kingdom; Department of Neurology (N.M., Y.U.), Juntendo University School of Medicine, Tokyo, Japan; Department of Neurology (J.M.), Hospital Universitari Vall d'Hebron, Barcelona; Institute de Biomedicine of Seville (J.M.), IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville, Neurology; Virgen Macarena Hospital (J.M.), Neurology, Sevilla; Neurovascular Research Laboratory (J.M.), Vall d'Hebron Institute of Research, Universitat Autònoma de Barcelona; Department of Neurology (F.F.P., M.V.-P.), Hospital Universitari Arnau de Vilanova; Department of Clinical Neurosciences (F.F.P., M.V.-P.), Institut Reserca Biomèdica Lleida, University of Lleida, Spain; Centre for Medical Informatics (C.L.S., W.N.W.), Usher Institute of Population Health Sciences and Informatics; Centre for Clinical Brain Sciences (C.L.S.), University of Edinburgh; and George Institute for Global Health (M.W.), Imperial College London, United Kingdom
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6
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Zhang Y, Yang Y, Li H, Feng Q, Ge W, Xu X. Investigating the Potential Mechanisms and Therapeutic Targets of Inflammatory Cytokines in Post-stroke Depression. Mol Neurobiol 2024; 61:132-147. [PMID: 37592185 DOI: 10.1007/s12035-023-03563-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 08/07/2023] [Indexed: 08/19/2023]
Abstract
Post-stroke depression (PSD) affects approximately one-third of stroke survivors, severely impacting general recovery and quality of life. Despite extensive studies, the exact mechanisms underlying PSD remain elusive. However, emerging evidence implicates proinflammatory cytokines, including interleukin-1β, interleukin-6, tumor necrosis factor-alpha, and interleukin-18, play critical roles in PSD development. These cytokines contribute to PSD through various mechanisms, including hypothalamic-pituitary-adrenal (HPA) axis dysfunction, neurotransmitter alterations, neurotrophic factor changes, gut microbiota imbalances, and genetic predispositions. This review is aimed at exploring the role of cytokines in stroke and PSD while identifying their potential as specific therapeutic targets for managing PSD. A more profound understanding of the mechanisms regulating inflammatory cytokine expression and anti-inflammatory cytokines like interleukin-10 in PSD may facilitate the development of innovative interventions to improve outcomes for stroke survivors experiencing depression.
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Affiliation(s)
- Yutong Zhang
- Department of Neurology, the First Affiliated Hospital of Soochow University, Suzhou, 215000, China
| | - Yuehua Yang
- Department of Neurology, Suzhou Yongding Hospital, Suzhou, 215028, China
| | - Hao Li
- Department of Neurology, the First Affiliated Hospital of Soochow University, Suzhou, 215000, China
| | - Qian Feng
- Department of Neurology, the First Affiliated Hospital of Soochow University, Suzhou, 215000, China
| | - Wei Ge
- Department of Neurology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221600, China.
| | - Xingshun Xu
- Department of Neurology, the First Affiliated Hospital of Soochow University, Suzhou, 215000, China.
- Institute of Neuroscience, Soochow University, Suzhou, 215123, China.
- Jiangsu Key Laboratory of Neuropsychiatric Diseases, Soochow University, Suzhou, 215123, Jiangsu, China.
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7
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Gu H, Yang K, Li J, Lin J, Jing J, Xiong Y, Zhao X, Wang Y, Liu L, Meng X, Jiang Y, Li H, Wang Y, Li Z. Mediation effect of stroke recurrence in the association between post-stroke interleukin-6 and functional disability. CNS Neurosci Ther 2023; 29:3579-3587. [PMID: 37287421 PMCID: PMC10580327 DOI: 10.1111/cns.14289] [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: 03/10/2023] [Revised: 05/15/2023] [Accepted: 05/23/2023] [Indexed: 06/09/2023] Open
Abstract
AIM Post-stroke inflammation increases the risk of functional disability through enlarged cerebral infarct size directly and follow-up stroke event indirectly. We aimed to use post-stroke proinflammatory cytokine interleukin-6 (IL-6) as a marker of inflammatory burden and quantify post-stroke inflammation's direct and indirect effect on functional disability. METHODS We analyzed patients with acute ischemic stroke admitted to 169 hospitals in the Third China National Stroke Registry. Blood samples were collected within 24 h of admission. Stroke recurrence and functional outcome measured by the modified Rankin scale (mRS) were assessed via face-to-face interviews at 3 months. Functional disability was defined as an mRS score ≥2. Mediation analyses under the counterfactual framework were performed to examine the potential causal chain in which stroke recurrence may mediate the relationship between IL-6 and functional outcome. RESULTS Among the 7053 analyzed patients, the median (interquartile range [IQR]) NIHSS score was 3 (1-5), and the median (IQR) level of IL-6 was 2.61 (1.60-4.73) pg/mL. Stroke recurrence was observed in 458 (6.5%) patients, and functional disability was seen in 1708 (24.2%) patients at the 90-day follow-up. Per stand deviation (4.26 pg/mL) increase in the concentration of IL-6 was associated with an increased risk of stroke recurrence (adjusted odds ratio [aOR], 1.19; 95% CI, 1.09-1.29) and disability (aOR, 1.22; 95% CI, 1.15-1.30) within 90 days. Mediation analyses revealed that 18.72% (95% CI, 9.26%-28.18%) of the relationship between IL-6 and functional disability was mediated by stroke recurrence. CONCLUSIONS Stroke recurrence mediates less than 20% of the association between IL-6 and functional outcome at 90 days among patients with acute ischemic stroke. In addition to typical secondary prevention strategies for preventing stroke recurrence, more attention should be paid to novel anti-inflammatory therapy to improve functional outcomes directly.
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Affiliation(s)
- Hong‐Qiu Gu
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Kai‐Xuan Yang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Jie‐Jie Li
- Vascular Neurology, Department of Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Jin‐Xi Lin
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Jing Jing
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Yun‐Yun Xiong
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Xing‐Quan Zhao
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- Vascular Neurology, Department of Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical SciencesBeijingChina
| | - Yi‐Long Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- Vascular Neurology, Department of Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Li‐Ping Liu
- Neuro‐Intensive Care Unit, Department of Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Xia Meng
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Yong Jiang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Hao Li
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Yong‐Jun Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- Vascular Neurology, Department of Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical SciencesBeijingChina
| | - Zi‐Xiao Li
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- Vascular Neurology, Department of Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical SciencesBeijingChina
- Chinese Institute for Brain ResearchBeijingChina
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8
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Yu J, Zhu H, Taheri S, Lee JY, Diamond DM, Kirstein C, Kindy MS. Serum amyloid A-dependent inflammasome activation and acute injury in a mouse model of experimental stroke. RESEARCH SQUARE 2023:rs.3.rs-3258406. [PMID: 37720021 PMCID: PMC10503850 DOI: 10.21203/rs.3.rs-3258406/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
Serum amyloid A (SAA) proteins increase dramatically in the blood following inflammation. Recently, SAAs are increased in humans following stroke and in ischemic animal models. However, the impact of SAAs on whether this signal is critical in the ischemic brain remains unknown. Therefore, we investigated the role of SAA and SAA signaling in the ischemic brain. Wildtype and SAA deficient mice were exposed to middle cerebral artery occlusion and reperfusion, examined for the impact of infarct volumes, behavioral changes, inflammatory markers, TUNEL staining, and BBB changes. The underlying mechanisms were investigated using SAA deficient mice, transgenic mice and viral vectors. SAA levels were significantly increase following MCAo and mice deficient in SAAs showed reduced infarct volumes and improved behavioral outcomes. SAA deficient mice showed a reduction in TUNEL staining, inflammation and decreased glial activation. Mice lacking acute phase SAAs demonstrated a reduction in expression of the NLRP3 inflammasome and SAA/NLRP3 KO mice showed improvement. Restoration of SAA expression via SAA tg mice or adenoviral expression reestablished the detrimental effects of SAA. A reduction in BBB permeability was seen in the SAA KO mice and anti-SAA antibody treatment reduced the effects on ischemic injury. SAA signaling plays a critical role in regulating NLRP3-induced inflammation and glial activation in the ischemic brain. Blocking this signal will be a promising approach for treating ischemic stroke.
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Affiliation(s)
- Jin Yu
- University of South Florida
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9
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Jaime Garcia D, Chagnot A, Wardlaw JM, Montagne A. A Scoping Review on Biomarkers of Endothelial Dysfunction in Small Vessel Disease: Molecular Insights from Human Studies. Int J Mol Sci 2023; 24:13114. [PMID: 37685924 PMCID: PMC10488088 DOI: 10.3390/ijms241713114] [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: 07/23/2023] [Revised: 08/19/2023] [Accepted: 08/21/2023] [Indexed: 09/10/2023] Open
Abstract
Small vessel disease (SVD) is a highly prevalent disorder of the brain's microvessels and a common cause of dementia as well as ischaemic and haemorrhagic strokes. Though much about the underlying pathophysiology of SVD remains poorly understood, a wealth of recently published evidence strongly suggests a key role of microvessel endothelial dysfunction and a compromised blood-brain barrier (BBB) in the development and progression of the disease. Understanding the causes and downstream consequences associated with endothelial dysfunction in this pathological context could aid in the development of effective diagnostic and prognostic tools and provide promising avenues for potential therapeutic interventions. In this scoping review, we aim to summarise the findings from clinical studies examining the role of the molecular mechanisms underlying endothelial dysfunction in SVD, focussing on biochemical markers of endothelial dysfunction detectable in biofluids, including cell adhesion molecules, BBB transporters, cytokines/chemokines, inflammatory markers, coagulation factors, growth factors, and markers involved in the nitric oxide cascade.
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Affiliation(s)
- Daniela Jaime Garcia
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh EH16 4SB, UK; (D.J.G.); (J.M.W.)
- UK Dementia Research Institute, University of Edinburgh, Edinburgh EH16 4SB, UK;
| | - Audrey Chagnot
- UK Dementia Research Institute, University of Edinburgh, Edinburgh EH16 4SB, UK;
| | - Joanna M. Wardlaw
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh EH16 4SB, UK; (D.J.G.); (J.M.W.)
- UK Dementia Research Institute, University of Edinburgh, Edinburgh EH16 4SB, UK;
| | - Axel Montagne
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh EH16 4SB, UK; (D.J.G.); (J.M.W.)
- UK Dementia Research Institute, University of Edinburgh, Edinburgh EH16 4SB, UK;
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10
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Li H, Wang H, Fu Q, Liu Y, Song B, Zhao J, Lin J. Association of Bun/Cr ratio-based dehydration status with infarct volumes and stroke severity in acute ischemic stroke. Clin Neurol Neurosurg 2023; 229:107741. [PMID: 37119656 DOI: 10.1016/j.clineuro.2023.107741] [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: 03/16/2023] [Revised: 04/15/2023] [Accepted: 04/18/2023] [Indexed: 05/01/2023]
Abstract
BACKGROUND Only a few clinical research had previously investigated the dehydration status to predict the evolution of the ischemic core. The aim of this study is to clarify the association between blood urea nitrogen (BUN)/creatinine (Cr)ratio-based dehydration and infarct volume measured using DWI (Diffusion-weighted imaging) at admission in patients with AIS (Acute Ischemic Stroke). METHODS We retrospectively recruited a total of 203 consecutive patients who were hospitalized through emergency or outpatient services within 72 h of acute ischemic stroke onset between October 2015 and September 2019. Stroke severity was measured by assessing the National Institutes of Health Stroke Scale (NIHSS) on admission. Infarct volume was measured using DWI with MATLAB software. RESULTS In this study, 203 patients who met the study criteria were enrolled. Patients in the dehydration group (Bun/Cr ratio>15) had a higher median NIHSS score (6(IQR:4-10) VS. 5(3-7); P = 0.0015)and larger DWI infarct volume (1.55 ml (IQR:0.51-6.79) VS. (0.37 ml (0.05-1.22); P < 0.001) on admission compared with patients in normal group. Further, a statistically significant correlation was found between DWI infarct volumes and NIHSS score with nonparametric Spearman rank correlation (r = 0.77; P < 0.001). The median NIHSS scores for the DWI infarct volumes quartiles were 3 ml (IQR, 2-4), 5 ml (4-7), 6 ml (5-8), and12 ml (8-17) from lowest to highest. However, the second quartile group did not show any significant correlation with the third quartile group (P = 0.4268). Multivariable linear and logistic regression analyses were used to test dehydration (Bun/Cr ratio>15), representing a predictor of infarct volume and stroke severity. CONCLUSION Bun/Cr ratio-based dehydration is associated with larger volumes of ischemic tissue measured using DWI and worse neurological deficit assessed by the NIHSS score in acute ischemic stroke.
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Affiliation(s)
- Huanyin Li
- Department of Neurology, Minhang Hospital, Fudan University, Shanghai 201101, China.
| | - Hao Wang
- Department of Radiology, Minhang Hospital, Fudan University, Shanghai 201101, China.
| | - Qingyin Fu
- Department of Ultrasonography, Minhang Hospital, Fudan University, Shanghai 201101, China.
| | - Yang Liu
- Department of Neurology, Minhang Hospital, Fudan University, Shanghai 201101, China.
| | - Bin Song
- Department of Radiology, Minhang Hospital, Fudan University, Shanghai 201101, China.
| | - Jing Zhao
- Department of Neurology, Minhang Hospital, Fudan University, Shanghai 201101, China.
| | - Jixian Lin
- Department of Neurology, Minhang Hospital, Fudan University, Shanghai 201101, China.
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11
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Guan Y, Cao YL, Liu JW, Liu LT, Zheng YJ, Ma XF, Zhai FG. Ginsenoside Rg1 attenuates cerebral ischemia-reperfusion injury through inhibiting the inflammatory activation of microglia. Exp Cell Res 2023; 426:113552. [PMID: 36914061 DOI: 10.1016/j.yexcr.2023.113552] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 03/03/2023] [Accepted: 03/10/2023] [Indexed: 03/13/2023]
Abstract
It is recognized that the cerebral ischemia/reperfusion (I/R) injury triggers inflammatory activation of microglia and supports microglia-driven neuronal damage. Our previous studies have shown that ginsenoside Rg1 had a significant protective effect on focal cerebral I/R injury in middle cerebral artery occlusion (MCAO) rats. However, the mechanism still needs further clarification. Here, we firstly reported that ginsenoside Rg1 effectively suppressed the inflammatory activation of brain microglia cells under I/R conditions depending on the inhibition of Toll-likereceptor4 (TLR4) proteins. In vivo experiments showed that the ginsenoside Rg1 administration could significantly improve the cognitive function of MCAO rats, and in vitro experimental data showed that ginsenoside Rg1 significantly alleviated neuronal damage via inhibiting the inflammatory response in microglia cells co-cultured under oxygen and glucose deprivation/reoxygenation (OGD/R) condition in gradient dependent. The mechanism study showed that the effect of ginsenoside Rg1 depends on the suppression of TLR4/MyD88/NF-κB and TLR4/TRIF/IRF-3 pathways in microglia cells. In a word, our research shows that ginsenoside Rg1 has great application potential in attenuating the cerebral I/R injury by targeting TLR4 protein in the microglia cells.
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Affiliation(s)
- Yue Guan
- Department of Clinical Medicine, Heilongjiang Nursing College, Harbin, 150001, Heilongjiang Province, China
| | - Yan-Li Cao
- School of Pharmacy, Mudanjiang Medical University, Mudanjiang, 157011, Heilongjiang Province, China
| | - Jia-Wei Liu
- School of Pharmacy, Mudanjiang Medical University, Mudanjiang, 157011, Heilongjiang Province, China
| | - Lan-Tao Liu
- Graduate School of Mudanjiang Medical University, Mudanjiang, 157011, Heilongjiang Province, China
| | - Yu-Jia Zheng
- Department of Rehabilitation Science, Kobe University Graduate School of Health Sciences, 7-10-2 Tomogaoka, Suma-ku, Kobe, 654-0142, Japan
| | - Xue-Fei Ma
- School of Pharmacy, Mudanjiang Medical University, Mudanjiang, 157011, Heilongjiang Province, China; Department of Pharmacology, Baicheng Medical College, Baicheng, 137701, Jilin Province, China
| | - Feng-Guo Zhai
- Department of Pharmacology, Mudanjiang Medical University, Mudanjiang, 157011, Heilongjiang Province, China; Institute of Natural Medicine, Mudanjiang Medical University, Mudanjiang, 157011, Heilongjiang Province, China.
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12
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Low vitamin D status is associated with inflammatory response in older patients with cerebral small vessel disease. J Neuroimmunol 2023; 377:578057. [PMID: 36921477 DOI: 10.1016/j.jneuroim.2023.578057] [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: 12/15/2022] [Revised: 02/18/2023] [Accepted: 02/25/2023] [Indexed: 03/11/2023]
Abstract
OBJECTIVES This study aimed to determine the association of the NF-κB inflammatory signaling pathway with vitamin D status in older cerebral small vessel disease (SVD) patients. METHODS We measured serum 25(OH)D, pro-and anti-inflammatory cytokines, and mRNA levels of the vitamin D-activating enzyme, CYP27B1, as well as NF-kB, COX-2, the chemokine-CCL2, IL-1β, IL-6, TNF-α, TGF-β, and IL-10, in cerebral SVD patients aged ≥60 years presenting with vascular dementia and age and gender-matched healthy controls. RESULTS Low vitamin D status (insufficiency: serum 25(OH)D 12-20 ng/ml; deficiency: ≤12 ng/ml) was more prevalent among patients compared to controls. The mRNA levels of NF-kB, COX-2, CCL2, IL-1β, and IL-6, and serum levels of pro-inflammatory cytokines (IL-1α, IL-1β, IL-6, and TNF-α) were significantly higher in cases compared to controls. There was a significant correlation between CYP27B1 and NF-kB, COX-2, CCL2, and IL-1β gene expression. Serum IL-1α, IL-1β, and IL-6 concentrations and the expression of CCL-2, NF-kB2, and NF-kB3 genes were higher in vitamin D-deficient subjects compared to vitamin D-sufficient subjects. There was a significant negative correlation between serum 25(OH)D and IL-1α, IL-6, and TNF-α, and a positive correlation between 25(OH)D and IL-10. CONCLUSION Low vitamin D is associated with an inflammatory response via NF-kB signaling, which could play a role in the etio-pathogenesis of SVD. Further large-scale studies are required to validate our findings.
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Tirandi A, Sgura C, Carbone F, Montecucco F, Liberale L. Inflammatory biomarkers of ischemic stroke. Intern Emerg Med 2023; 18:723-732. [PMID: 36745280 PMCID: PMC10082112 DOI: 10.1007/s11739-023-03201-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 01/09/2023] [Indexed: 02/07/2023]
Abstract
Ischemic stroke remains the second leading cause of death and among the major causes of morbidity worldwide. Therapeutic options are currently limited to early reperfusion strategies, while pharmacological neuroprotective strategies despite showing promising results in the experimental setting constantly failed to enter the clinical arena. Inflammation plays an important role in the pathophysiology of ischemic stroke and mediators of inflammation have been longtime investigated as possible prognostic marker and therapeutic target for stroke patients. Here, we summarized available evidence on the role of cytokines, soluble adhesion molecules and adipokines in the pathophysiology, prognosis and therapy of ischemic stroke.
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Affiliation(s)
- Amedeo Tirandi
- Department of Internal Medicine, University of Genoa, Viale Benedetto XV, 6, 16132, Genoa, Italy
| | - Cosimo Sgura
- Department of Internal Medicine, University of Genoa, Viale Benedetto XV, 6, 16132, Genoa, Italy
| | - Federico Carbone
- Department of Internal Medicine, University of Genoa, Viale Benedetto XV, 6, 16132, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino Genoa, Italian Cardiovascular Network, Largo Rosanna Benzi 10, 16132, Genoa, Italy
| | - Fabrizio Montecucco
- Department of Internal Medicine, University of Genoa, Viale Benedetto XV, 6, 16132, Genoa, Italy.
- IRCCS Ospedale Policlinico San Martino Genoa, Italian Cardiovascular Network, Largo Rosanna Benzi 10, 16132, Genoa, Italy.
| | - Luca Liberale
- Department of Internal Medicine, University of Genoa, Viale Benedetto XV, 6, 16132, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino Genoa, Italian Cardiovascular Network, Largo Rosanna Benzi 10, 16132, Genoa, Italy
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Zheng Y, Lim MJR, Tan BYQ, Chan BPL, Paliwal P, Jonathan OJY, Bharatendu C, Chan ACY, Yeo LLL, Vijayan J, Hong CS, Chee YH, Wong LYH, Chen J, Chong VYF, Dong Y, Tan CH, Sunny S, Teoh HL, Sinha AK, Sharma VK. Role of plaque inflammation in symptomatic carotid stenosis. Front Neurol 2023; 14:1086465. [PMID: 36761341 PMCID: PMC9902904 DOI: 10.3389/fneur.2023.1086465] [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: 11/01/2022] [Accepted: 01/09/2023] [Indexed: 01/25/2023] Open
Abstract
Objective Prior studies have shown that plaque inflammation on FDG-PET and the symptomatic carotid atheroma inflammation lumen-stenosis (SCAIL) score were associated with recurrent ischemic events, but the findings have thus far not been widely validated. Therefore, we aimed to validate the findings of prior studies. Methods A single-center prospective cohort study that recruited patients with (1) recent TIA or ischemic stroke within the past 30 days, (2) ipsilateral carotid artery stenosis of ≥50%, and (3) were not considered for early carotid revascularization. The (1) maximum standardized uptake value (SUVmax) of the symptomatic carotid plaque, (2) the SCAIL score, and (3) stenosis severity of the symptomatic carotid artery were measured for all patients. The outcomes were (1) a 90-day ipsilateral ischemic stroke and (2) a 90-day ipsilateral symptomatic TIA or major adverse cardiovascular event (MACE). Results Among the 131 patients included in the study, the commonest cardiovascular risk factor was hypertension (95 patients, 72.5%), followed by diabetes mellitus (77 patients, 58.8%) and being a current smoker (64 patients, 48.9%). The median (IQR) duration between the index cerebral ischemic event and recruitment to the study was 1 (0, 2.5) days. The median (IQR) duration between the index cerebral ischemic event and FDG-PET was 5 (4, 7) days. A total of 14 (10.7%) patients had a 90-day stroke, and 41 (31.3%) patients had a 90-day TIA or MACE. On comparison of the predictive performances of the SCAIL score and SUVmax, SUVmax was found to be superior to the SCAIL score for predicting both 90-day ipsilateral ischemic stroke (AUC: SCAIL = 0.79, SUVmax = 0.92; p < 0.001; 95% CI = 0.072, 0.229) and 90-day TIA or MACE (AUC: SCAIL = 0.76, SUVmax = 0.84; p = 0.009; 95% CI = 0.020, 0.143). Conclusion Plaque inflammation as quantified on FDG-PET may serve as a reliable biomarker for risk stratification among patients with ECAD and recent TIA or ischemic stroke. Future studies should evaluate whether patients with significant plaque inflammation as quantified on FDG-PET benefit from carotid revascularization and/or anti-inflammatory therapy.
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Affiliation(s)
- Yilong Zheng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Mervyn Jun Rui Lim
- Division of Neurosurgery, National University Health System, Singapore, Singapore
| | - Benjamin Yong-Qiang Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore,Division of Neurology, National University Health System, Singapore, Singapore
| | | | | | | | - Chandra Bharatendu
- Division of Neurology, National University Health System, Singapore, Singapore
| | | | | | - Joy Vijayan
- Division of Neurology, National University Health System, Singapore, Singapore
| | - Chiew S. Hong
- Division of Neurology, National University Health System, Singapore, Singapore
| | - Young Heng Chee
- Division of Neurology, National University Health System, Singapore, Singapore
| | - Lily Y. H. Wong
- Division of Neurology, National University Health System, Singapore, Singapore
| | - Jintao Chen
- Division of Neurology, National University Health System, Singapore, Singapore
| | | | - Yanhong Dong
- Alice Lee Centre for Nursing Studies, Singapore, Singapore
| | - Chi Hsien Tan
- Division of Neurology, National University Health System, Singapore, Singapore
| | - Sibi Sunny
- Division of Neurology, National University Health System, Singapore, Singapore
| | - Hock Luen Teoh
- Division of Neurology, National University Health System, Singapore, Singapore
| | - Arvind Kumar Sinha
- Department of Diagnostic Imaging, National University Health System, Singapore, Singapore
| | - Vijay Kumar Sharma
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore,Division of Neurology, National University Health System, Singapore, Singapore,*Correspondence: Vijay Kumar Sharma ✉
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15
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Zheng L, Meng L, Liang H, Yang J. Sanhua decoction: Current understanding of a traditional herbal recipe for stroke. Front Neurosci 2023; 17:1149833. [PMID: 37123364 PMCID: PMC10133510 DOI: 10.3389/fnins.2023.1149833] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 03/27/2023] [Indexed: 05/02/2023] Open
Abstract
Both thrombolytic and endovascular therapies are optimal treatment options for patients with acute ischemic stroke, but only less than half of these patients can benefit from these treatments. Traditional Chinese medicine has a long history of successfully managing ischemic stroke using both herbal and physical therapeutics. Among herbal recipes, Sanhua decoction (SHD) is one of the classical prescriptions for ischemic stroke. The present review aimed to summarize evidence from both clinical and basic research to demonstrate its efficacy in managing ischemic stroke and the potential mechanisms underlying its therapeutic effects, which will provide evidence on the therapeutic effect of this herbal recipe and guide future studies on this recipe. SHD is composed of four herbs, Rheum palmatum L. [Polygonaceae], Magnolia officinalis Rehder & E.H.Wilson [Magnoliaceae], Citrus × aurantium L. [Rutaceae], Hansenia weberbaueriana (Fedde ex H.Wolff) Pimenov & Kljuykov [Apiaceae]. We found that the majority of clinical studies on SHD are case reports and they showed positive therapeutic effect of SHD on both acute and chronic ischemic stroke. There are over 40 bioactive compounds identified in SHD, but few experimental studies have examined their individual molecular mechanisms. As an extract of SHD, it improves neurological functions through suppressing inflammation, protecting the blood brain barrier from degradation, restoring the number of neural stem cells, inhibiting apoptosis and brain edema, scavenging oxygen free radicals, and regulating the brain-gut axis. These will lay the theoretical foundation for future studies on this prescription and its clinical application. Future research may need to confirm its clinical efficacy in large-scale clinical trials and to disentangle its bioactive compounds and their potential mechanisms.
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Affiliation(s)
- Lanlan Zheng
- Department of Neurology, Shanghai Jiangong Hospital, Shanghai, China
| | - Linglei Meng
- Department of Neurology, Shanghai Jiangong Hospital, Shanghai, China
| | - Huazheng Liang
- Clinical Research Center for Anesthesiology and Perioperative Medicine, Shanghai Fourth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
- Translational Research Institute of Brain and Brain-Like Intelligence, Shanghai Fourth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
- Department of Anesthesiology and Perioperative Medicine, Shanghai Fourth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
- Monash Suzhou Research Institute, Suzhou Industrial Park, Suzhou, Jiangsu, China
- Huazheng Liang,
| | - Jiandao Yang
- Department of Neurology, Shanghai Jiangong Hospital, Shanghai, China
- *Correspondence: Jiandao Yang,
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Monsour M, Croci DM, Agazzi S, Borlongan CV. Contemplating IL-6, a double-edged sword cytokine: Which side to use for stroke pathology? CNS Neurosci Ther 2022; 29:493-497. [PMID: 36478506 PMCID: PMC9873516 DOI: 10.1111/cns.14041] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 11/02/2022] [Accepted: 11/09/2022] [Indexed: 12/12/2022] Open
Abstract
Interleukin (IL)-6 is a unique cytokine due to its dual signaling, with one pathway being pro-inflammatory (trans) and the other homeostatic (classical). Both of these pathways have been implicated in neuroinflammation following stroke, with initial inflammatory mechanisms being protective and later anti-inflammatory signaling promoting ischemic tissue recovery. IL-6 plays a major role in stroke pathology. However, given these distinctive IL-6 signaling consequences, IL-6 is a difficult cytokine to target for stroke therapies. Recent research suggests that the ratio between the pro-inflammatory binary IL6:sIL6R complex and the inactive ternary IL6:sIL6R:sgp130 complex may be a novel way to measure IL-6 signaling at different time points following ischemic injury. This ratio may approximate functional consequences on individualized stroke therapies, allowing clinicians to determine whether IL-6 agonists or antagonists should be used at specific time points.
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Affiliation(s)
- Molly Monsour
- University of South Florida Morsani College of MedicineTampaFloridaUSA
| | - Davide M. Croci
- Department of Neurosurgery and Brain RepairUniversity of South Florida, Morsani College of MedicineTampaFloridaUSA
| | - Siviero Agazzi
- Department of Neurosurgery and Brain RepairUniversity of South Florida, Morsani College of MedicineTampaFloridaUSA
| | - Cesar V. Borlongan
- Center of Excellence for Aging and Brain RepairUniversity of South Florida Morsani College of MedicineTampaFloridaUSA
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17
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Zhang W, Zhang L, Wang WJ, Ma S, Wang M, Yao M, Li R, Li WW, Zhao X, Hu D, Ding Y, Wang J. Network pharmacology and in vitro experimental verification to explore the mechanism of Sanhua decoction in the treatment of ischaemic stroke. PHARMACEUTICAL BIOLOGY 2022; 60:119-130. [PMID: 34985385 PMCID: PMC8741256 DOI: 10.1080/13880209.2021.2019281] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
CONTEXT Stroke is an illness with high morbidity, disability and mortality that presents a major clinical challenge. Sanhua decoction (SHD) has been widely used to treat ischaemic stroke in the clinic. However, the potential mechanism of SHD remains unknown. OBJECTIVE To elucidate the multitarget mechanism of SHD in ischaemic stroke through network pharmacology and bioinformatics analyses. MATERIALS AND METHODS Network pharmacology and experimental validation approach was used to investigate the bioactive ingredients, critical targets and potential mechanisms of SHD against ischaemic stroke. Four herbal names of SHD, 'ischemic stroke' or 'stroke' was used as a keyword to search the relevant databases. SH-SY5Y cells were treated with various concentrations of SHD (12.5, 25, 50 or 100 μg/mL) for 4 h, exposed to oxygen and glucose deprivation (OGD) for 1 h, then reoxygenation for 24 h. The cell viability was detected by MTT, the lactate dehydrogenase (LDH) was evaluated by ELISA, and protein expression was detected by western blots. RESULTS SHD treatment increased the survival rate from 65.9 ± 4.3 to 85.56 ± 5.7%. The median effective dose (ED50) was 47.1 μg/mL, the LDH decreased from 288.0 ± 12.0 to 122.8 ± 9.1 U/L and the cell apoptosis rate decreased from 33.6 ± 1.8 to 16.3 ± 1.2%. Western blot analysis revealed that SHD increased the levels of p-PI3k, p-Akt and p-CREB1, and decreased the expression of TNF-α and IL-6. DISCUSSION AND CONCLUSIONS This study suggests that SHD protects against cerebral ischaemic injury via regulation of the PI3K/Akt/CREB1 and TNF pathways.
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Affiliation(s)
- Wei Zhang
- Department of Pharmacy, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Li Zhang
- Department of Emergency, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Wen jun Wang
- Department of Pharmacy, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Shanbo Ma
- Department of Pharmacy, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Mingming Wang
- Department of Pharmacy, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Minna Yao
- Department of Pharmacy, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Ruili Li
- Department of Pharmacy, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Wei wei Li
- Department of Pharmacy, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Xian Zhao
- Department of Pharmacy, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Dongmei Hu
- Department of Pharmacy, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Yi Ding
- Department of Pharmacy, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
- Yi Ding Department of Pharmacy, Xijing Hospital, Fourth Military Medical University, Xi’an710032, Shaanxi Province, China
| | - Jingwen Wang
- Department of Pharmacy, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
- CONTACT Jingwen Wang
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d’Annunzio A, Arboix A, García-Eroles L, Sánchez-López MJ. Vertigo in Acute Stroke Is a Predictor of Brain Location but Is Not Related to Early Outcome: The Experience of Sagrat Cor Hospital of Barcelona Stroke Registry. Biomedicines 2022; 10:2830. [PMID: 36359352 PMCID: PMC9687911 DOI: 10.3390/biomedicines10112830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 10/28/2022] [Accepted: 11/03/2022] [Indexed: 08/30/2023] Open
Abstract
BACKGROUND Vertigo is an uncommon symptom among acute stroke victims. Knowledge about the clinical profile, the brain location, and the early outcome in stroke patients with cerebrovascular diseases and vertigo remains limited. OBJECTIVES In this study, the effects of vertigo on cerebral topography and early prognosis in cerebrovascular diseases were investigated. METHODS A comparative analysis in terms of demographics, risk factors, clinical characteristics, stroke subtypes, cerebral and vascular topography, and early outcome was performed between patients with presence or absence of vertigo on a sample of 3743 consecutive acute stroke patients available from a 24-year ongoing single-center hospital-based stroke registry. RESULTS Vertigo was present in 147 patients (3.9%). Multiple logistic regression analysis showed that variables independently associated with vertigo were: location in the cerebellum (OR 5.59, CI 95% 3.24-9.64), nausea or vomiting (OR 4.48, CI 95% 2.95-6.82), medulla (OR 2.87, CI 95% 1.31-6.30), pons (OR 2.39, CI 95% 1.26-4.51), basilar artery (OR 2.36, CI 95% 1.33-4.17), ataxia (OR 2.33, CI 95% 1.41-3.85), and headache (OR 2.31, CI 95% 1.53-3.49). CONCLUSION The study confirmed that the presence of vertigo was not related with increased in-hospital mortality or poor prognosis at hospital discharge. Vertigo is mainly related to non-lacunar vertebrobasilar stroke with topographic localization in the cerebellum and/or brainstem.
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Affiliation(s)
- Angela d’Annunzio
- Department of Neurology, Hospital Universitari Sagrat Cor, Quirónsalud, Universitat de Barcelona, 08029 Barcelona, Catalunya, Spain
| | - Adrià Arboix
- Department of Neurology, Hospital Universitari Sagrat Cor, Quirónsalud, Universitat de Barcelona, 08029 Barcelona, Catalunya, Spain
| | - Luís García-Eroles
- Department of Neurology, Hospital Universitari Sagrat Cor, Quirónsalud, Universitat de Barcelona, 08029 Barcelona, Catalunya, Spain
| | - María-José Sánchez-López
- Medical Library, Hospital Universitari Sagrat Cor, Quirónsalud, Universitat de Barcelona, 08029 Barcelona, Catalunya, Spain
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Macri E, Azhar Y. Prevention of Neurologic Disease with Fasting. Semin Neurol 2022; 42:549-557. [PMID: 36216359 DOI: 10.1055/a-1957-8449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Fasting has been widely studied in both prevention and treatment of many neurologic disorders. Some conditions may be prevented with any type of fasting, while some may require a stricter regimen. Fasting reduces weight, fasting blood glucose, and insulin resistance, and favorably alters the gut biome and the immune system. This article discusses various versions of fasting that have been studied as well as the known and theoretical mechanisms of how fasting effects the body and the brain. This article will then review evidence supporting the potential preventive and treatment effects of fasting in specific neurologic disorders including ameliorating the symptoms of Parkinson's disease, improving cognition in Alzheimer's disease, reducing migraine frequency and intensity, and reducing seizure frequency in epilepsy.
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Affiliation(s)
- Elizabeth Macri
- Department of Neurology, The University of New Mexico, Albuquerque, New Mexico
| | - Yusra Azhar
- Department of Neurology, The University of New Mexico, Albuquerque, New Mexico
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20
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Shen Y, Li F, Cao L, Wang Y, Xiao J, Zhou X, Tian T. Hip Osteoarthritis and the Risk of Lacunar Stroke: A Two-Sample Mendelian Randomization Study. Genes (Basel) 2022; 13:genes13091584. [PMID: 36140752 PMCID: PMC9498627 DOI: 10.3390/genes13091584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 08/26/2022] [Accepted: 09/01/2022] [Indexed: 11/16/2022] Open
Abstract
Whether hip osteoarthritis (OA) could increase the risk of lacunar stroke (LS) is not well understood. This two-sample Mendelian randomization (MR) study aimed to investigate in depth the effect of genetically predicted hip OA on LS risk. Hip OA-related instrumental variables (IVs) were selected from a genome-wide association study (GWAS) of 393,873 individuals. The summary data of LS were obtained from a GWAS meta-analysis, including 16,030 cases and 248,929 controls. We used the inverse-variance weighted (IVW) as the primary MR analysis method. Moreover, the weighted-median, MR-Egger regression, and the MR pleiotropy residual sum and outlier (MR-PRESSO) test were supplementary methods. The sensitivity analysis was performed using the leave-one-out test. We identified the positive causal relationship between hip OA and the risk of LS (odds ratio [OR] = 1.20, 95% confidence interval [CI]: 1.07, 1.36; p = 0.002 using the IVW method). The weighted median method provided similar results. There was no evidence of directed pleiotropy, and sensitivity analysis results were stable, suggesting the robustness of our study. This study showed a causal effect of hip OA on the risk of LS, and more efforts should be made to explore the potential mechanisms in the future.
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Affiliation(s)
- Yi Shen
- Department of Epidemiology & Health Statistics, School of Public Health, Nantong University, Nantong 226019, China
| | - Fuju Li
- Department of Epidemiology & Health Statistics, School of Public Health, Nantong University, Nantong 226019, China
| | - Lina Cao
- Department of Epidemiology & Health Statistics, School of Public Health, Nantong University, Nantong 226019, China
| | - Yunyun Wang
- Department of Epidemiology & Health Statistics, School of Public Health, Nantong University, Nantong 226019, China
| | - Jing Xiao
- Department of Epidemiology & Health Statistics, School of Public Health, Nantong University, Nantong 226019, China
| | - Xiaoyi Zhou
- Center for Disease Control and Prevention of Nantong, Nantong 226007, China
- Correspondence: (X.Z.); (T.T.); Tel.: +86-1891-439-6755 (X.Z.); +86-1599-655-5458 (T.T.)
| | - Tian Tian
- Department of Epidemiology & Health Statistics, School of Public Health, Nantong University, Nantong 226019, China
- Correspondence: (X.Z.); (T.T.); Tel.: +86-1891-439-6755 (X.Z.); +86-1599-655-5458 (T.T.)
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21
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Li T, Liesz A. Immunity in Stroke: The Next Frontier. Thromb Haemost 2022; 122:1454-1460. [PMID: 35688450 DOI: 10.1055/s-0042-1748890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Translational stroke research has long been focusing on neuroprotective strategies to prevent secondary tissue injury and promote recovery after acute ischemic brain injury. The inflammatory response to stroke has more recently emerged as a key pathophysiological pathway contributing to stroke outcome. It is now accepted that the inflammatory response is functionally involved in all phases of the ischemic stroke pathophysiology. The immune response is therefore considered a breakthrough target for ischemic stroke treatment. On one side, stroke induces a local neuroinflammatory response, in which the inflammatory activation of glial, endothelial and brain-invading cells contributes to lesion progression after stroke. On the other side, ischemic brain injury perturbs systemic immune homeostasis and results in long-lasting changes of systemic immunity. Here, we briefly summarize current concepts in local neuroinflammation and the systemic immune responses after stroke, and highlight two promising therapeutic strategies for poststroke inflammation.
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Affiliation(s)
- Ting Li
- Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Munich, Germany.,Gansu Key Laboratory of Biomonitoring and Bioremediation for Environmental Pollution, School of Life Sciences, Lanzhou University, Lanzhou, China
| | - Arthur Liesz
- Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
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22
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Li J, Lin J, Pan Y, Wang M, Meng X, Li H, Wang Y, Zhao X, Qin H, Liu L, Wang Y. Interleukin-6 and YKL-40 predicted recurrent stroke after ischemic stroke or TIA: analysis of 6 inflammation biomarkers in a prospective cohort study. J Neuroinflammation 2022; 19:131. [PMID: 35761288 PMCID: PMC9235241 DOI: 10.1186/s12974-022-02467-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 04/19/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Contribution of individual and combined inflammatory markers in prognosis after stroke was still undefined. We aimed to investigate the association of systemic and local vascular inflammatory markers and recurrent stroke as well as impact on poor functional outcome. METHODS In this pre-specified substudy of the Third China National Stroke Registry (CNSR-III), 10,472 consecutive acute ischemic stroke or TIA patients with available centralized-measured levels of Interleukin-6 (IL-6), high sensitive C-reactive protein (hsCRP), IL-1 receptor antagonist (IL-1Ra), lipoprotein-associated phospholipase A2 mass (Lp-PLA2) and activity (Lp-PLA2-A), and YKL-40 from 171 sites were enrolled. The primary outcomes consisted of stroke recurrence and poor functional outcome defined as modified Rankin Scale (mRS) score of 2-6 within 1 year. RESULTS There were 1026 (9.8%) and 2395 (23.4%) patients with recurrent stroke and poor functional outcome within 1 year. The highest quartiles of IL-6 (adjusted HR, 1.36; 95% CI 1.13-1.64; P = 0.001), hsCRP (adjusted HR, 1.41; 95% CI 1.17-1.69; P = 0.0003) and YKL-40 (adjusted HR, 1.28; 95% CI 1.06-1.56; P = 0.01) were associated with increased risk of recurrent stroke; and the highest quartiles of IL-6 (adjusted OR 1.93; 95% CI 1.64-2.27; P < 0.0001), IL-1Ra (adjusted OR 1.60; 95% CI 1.37-1.87; P < 0.0001), hsCRP (adjusted OR 1.60; 95% CI 1.37-1.86; P < 0.0001) and YKL-40 (adjusted OR 1.21; 95% CI 1.03-1.42; P = 0.02) were correlated with increased risk of poor functional outcome. In the multivariate stepwise regression analysis including all markers with backward selection, elevated levels of IL-6 or YKL-40 were associated with recurrent stroke (IL6: OR, 1.34; 95% CI 1.19-1.52; P < 0.0001; YKL-40: OR, 1.01; 95% CI 1.01-1.03; P = 0.004) and poor functional outcome (IL6: OR, 1.68; 95% CI 1.46-1.93; P < 0.0001; YKL-40: OR, 1.02; 95% CI 1.01-1.03; P = 0.0001). Adding IL-6 and YKL-40 significantly increased the area under the receiver operating characteristic curves for the prediction models of Essen Stroke Risk Score (0.03, P < 0.0001) and Totaled Health Risks in Vascular Events Score (0.07, P < 0.0001), and yielded continuous net reclassification improvement (19.0%, P < 0.0001; 33.0, P < 0.0001). CONCLUSIONS In the patients with ischemic stroke or TIA, IL-6 and YKL-40 were independently associated with recurrent stroke and poor functional outcome, and improved risk classification of clinical risk algorithms.
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Affiliation(s)
- Jiejie Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 Road Nansihuanxi, Fengtai District, Beijing, 100075, China
| | - Jinxi Lin
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yuesong Pan
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Mengxing Wang
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xia Meng
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Hao Li
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 Road Nansihuanxi, Fengtai District, Beijing, 100075, China
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 Road Nansihuanxi, Fengtai District, Beijing, 100075, China
| | - Haiqiang Qin
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 Road Nansihuanxi, Fengtai District, Beijing, 100075, China
| | - Liping Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 Road Nansihuanxi, Fengtai District, Beijing, 100075, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 Road Nansihuanxi, Fengtai District, Beijing, 100075, China. .,China National Clinical Research Center for Neurological Diseases, Beijing, China. .,Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, 2019RU018, China. .,Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Beijing, China. .,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.
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23
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Duan R, Wang N, Shang Y, Li H, Liu Q, Li L, Zhao X. TNF-α (G-308A) Polymorphism, Circulating Levels of TNF-α and IGF-1: Risk Factors for Ischemic Stroke—An Updated Meta-Analysis. Front Aging Neurosci 2022; 14:831910. [PMID: 35370618 PMCID: PMC8966404 DOI: 10.3389/fnagi.2022.831910] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 01/27/2022] [Indexed: 12/13/2022] Open
Abstract
Objective Accumulated studies have explored gene polymorphisms and circulating levels of tumor necrosis factor (TNF)-α and insulin-like growth factor (IGF)-1 in the etiology of ischemic stroke (IS). Of the numerous etiopathological factors for IS, a single-nucleotide polymorphism (SNP) rs1800629 located in the TNF-α gene promoter region and increased levels of TNF-α were found to be associated with IS in different ethnic backgrounds. However, the published results are inconsistent and inconclusive. The primary objective of this meta-analysis was to investigate the concordance between rs1800629 polymorphism and IS. A secondary aim was to explore circulating levels of TNF-α and IGF-1 with IS in different ethnic backgrounds and different sourced specimens. Methods In this study, we examined whether rs1800629 genetic variant and levels of TNF-α and IGF-1 were related to the etiology of IS by performing a meta-analysis. Relevant case-control studies were retrieved by database searching and systematically selected according to established inclusion criteria. Results A total of 47 articles were identified that explored the relationship between the rs1800629 polymorphism and levels of TNF-α and IGF-1 with IS risk susceptibility. Statistical analyses revealed a significant association between the rs1800629 polymorphism and levels of TNF-α and IGF-1 with IS pathogenesis. Conclusion Our findings demonstrated that the TNF-α rs1800629 polymorphism, the increased levels of TNF-α, and decreased levels of IGF-1 were involved in the etiology of IS.
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Affiliation(s)
- Ranran Duan
- Department of Neurology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Na Wang
- Department of Neurorehabilitation, Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yanan Shang
- Department of Psychiatry, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hengfen Li
- Department of Psychiatry, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qian Liu
- Department of Psychiatry, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Li Li
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- *Correspondence: Li Li,
| | - Xiaofeng Zhao
- Department of Psychiatry, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Xiaofeng Zhao,
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24
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Bicciato G, Arnold M, Gebhardt A, Katan M. Precision medicine in secondary prevention of ischemic stroke: how may blood-based biomarkers help in clinical routine? An expert opinion. Curr Opin Neurol 2022; 35:45-54. [PMID: 34839341 DOI: 10.1097/wco.0000000000001011] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW One in eight patients unfortunately suffers a new stroke within 5 years of their first stroke, even today. Research in precision medicine could lead to a more individualized treatment allocation, possibly achieving lower recurrence rates of ischemic stroke. In this narrative review, we aim to discuss potential clinical implementation of several promising candidate blood biomarkers. RECENT FINDINGS We discuss specifically some promising blood-based biomarkers, which may improve the identification of underlying causes as well as risk stratification of patients according to their specific cerebrovascular risk factor pattern. SUMMARY Multimodal profiling of ischemic stroke patients by means of blood biomarkers, in addition to established clinical and neuroradiological data, may allow in the future a refinement of decision algorithms for treatment allocation in secondary ischemic stroke prevention.
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Affiliation(s)
- Giulio Bicciato
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
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25
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The Potential Impact of Neuroimaging and Translational Research on the Clinical Management of Lacunar Stroke. Int J Mol Sci 2022; 23:ijms23031497. [PMID: 35163423 PMCID: PMC8835925 DOI: 10.3390/ijms23031497] [Citation(s) in RCA: 70] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/20/2022] [Accepted: 01/24/2022] [Indexed: 12/21/2022] Open
Abstract
Lacunar infarcts represent one of the most frequent subtypes of ischemic strokes and may represent the first recognizable manifestation of a progressive disease of the small perforating arteries, capillaries, and venules of the brain, defined as cerebral small vessel disease. The pathophysiological mechanisms leading to a perforating artery occlusion are multiple and still not completely defined, due to spatial resolution issues in neuroimaging, sparsity of pathological studies, and lack of valid experimental models. Recent advances in the endovascular treatment of large vessel occlusion may have diverted attention from the management of patients with small vessel occlusions, often excluded from clinical trials of acute therapy and secondary prevention. However, patients with a lacunar stroke benefit from early diagnosis, reperfusion therapy, and secondary prevention measures. In addition, there are new developments in the knowledge of this entity that suggest potential benefits of thrombolysis in an extended time window in selected patients, as well as novel therapeutic approaches targeting different pathophysiological mechanisms involved in small vessel disease. This review offers a comprehensive update in lacunar stroke pathophysiology and clinical perspective for managing lacunar strokes, in light of the latest insights from imaging and translational studies.
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26
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Rodríguez-Granillo GA, Cirio JJ, Ciardi C, Caballero ML, Fontana L, Pérez N, Ingino CA, Lylyk P. Epicardial and periaortic fat characteristics in ischemic stroke: Relationship with stroke etiology and calcification burden. Eur J Radiol 2021; 146:110102. [PMID: 34922116 DOI: 10.1016/j.ejrad.2021.110102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 11/24/2021] [Accepted: 12/08/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE We explored epicardial (EAT) and periaortic (PAT) adipose tissue characteristics in patients with acute ischemic stroke (AIS), and the relationship with stroke etiology, calcification burden, and inflammation. METHOD We included a retrospective cohort of consecutive patients admitted with AIS between 2015 and 2020 who underwent a chest computed tomography. We calculated volumes and attenuation of EAT and PAT, and coronary artery (CAC), and thoracic aortic (TAC) calcification. Admission's neutrophil/lymphocyte ratio (NLR) was recorded. Stroke severity was assessed using the National Institute of Health Stroke Scale (NIHSS), and patients were discriminated between cardioembolic (CE), non-CE, and embolic strokes of uncertain source (ESUS). RESULTS A total of 182 patients were included. EAT (non-CE 127.4 ± 47.1 cm3; CE 133.3 ± 56.7 cm3; ESUS 121.6 ± 63.5 cm3, p > 0.05) and PAT (non-CE 37.4 ± 18.6 cm3; CE 40.4 ± 17.2 cm3; ESUS 34.5 ± 14.1 cm3, p > 0.05) volumes were similar between stroke etiologies. Patients with CE stroke had higher PAT attenuation (PAT = non-CE -84.4 ± 7.0 HU; CE -78.1 ± 9.9 HU; ESUS -82.3 ± 9.3 HU, p < 0.001). Using multiple linear regression, albeit weak, we found a significant relationship between NLR and PAT attenuation [Beta 0.24; (95% CI 0.04-0.51), p < 0.05). Despite similar volume, PAT attenuation was higher (p < 0.01) among demised patients. CONCLUSION In this study, we identified higher periaortic fat attenuation, despite similar fat volume, in patients with CE stroke.
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Affiliation(s)
- Gaston A Rodríguez-Granillo
- Department of Cardiovascular Imaging, Instituto Medico ENERI, Clinica La Sagrada Familia, Buenos Aires, Argentina.
| | - Juan J Cirio
- Stroke Unit, Instituto Medico ENERI, Clinica La Sagrada Familia, Buenos Aires, Argentina
| | - Celina Ciardi
- Stroke Unit, Instituto Medico ENERI, Clinica La Sagrada Familia, Buenos Aires, Argentina
| | - Maria Laura Caballero
- Stroke Unit, Instituto Medico ENERI, Clinica La Sagrada Familia, Buenos Aires, Argentina
| | - Lucia Fontana
- Department of Cardiovascular Imaging, Instituto Medico ENERI, Clinica La Sagrada Familia, Buenos Aires, Argentina
| | - Nicolás Pérez
- Department of Interventional Neuroradiology, Instituto Medico ENERI, Clinica La Sagrada Familia, Buenos Aires, Argentina
| | - Carlos A Ingino
- Department of Cardiology, Instituto Medico ENERI, Clinica La Sagrada Familia, Buenos Aires, Argentina
| | - Pedro Lylyk
- Department of Interventional Neuroradiology, Instituto Medico ENERI, Clinica La Sagrada Familia, Buenos Aires, Argentina
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27
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Bian HJ, Xu SY, Li HQ, Jia JQ, Ye L, Shu S, Xia SN, Gu Y, Zhu X, Xu Y, Cao X. JLX001 ameliorates cerebral ischemia injury by modulating microglial polarization and compromising NLRP3 inflammasome activation via the NF-κB signaling pathway. Int Immunopharmacol 2021; 101:108325. [PMID: 34740080 DOI: 10.1016/j.intimp.2021.108325] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 10/15/2021] [Accepted: 10/27/2021] [Indexed: 02/07/2023]
Abstract
Ischemic stroke is a devastating disease with high morbidity and mortality rates, and the proinflammatory microglia-mediated inflammatory response directly affects stroke outcome. Previous studies have reported that JLX001, a novel compound with a structure similar to that of cyclovirobuxine D (CVB-D), exerts antiapoptotic, anti-inflammatory and antioxidative effects on ischemia-induced brain injury. However, the role of JLX001 in microglial polarization and nucleotide-binding oligomerization domain (NOD)-like receptor family pyrin domain-containing 3 (NLRP3) inflammasome regulation after ischemic stroke has not been fully investigated. In this study, we used the middle cerebral artery occlusion (MCAO) method to establish a focal cerebral ischemia model and found that JLX001 attenuated the brain infarct size and improved cerebral damage. Moreover, the expression levels of proinflammatory cytokines (interleukin [IL]-1β and tumor necrosis factor [TNF]-α) were significantly reduced while those of the anti-inflammatory cytokine IL-10 were increased in the JLX001-treated group. Immunofluorescence staining and flow cytometry revealed an increased number of anti-inflammatory phenotypic microglia and a reduced number of proinflammatory phenotypic microglia in JLX001-treated MCAO mice. Western blotting analysis showed that JLX001 inhibited the expression of NLRP3 and proteins related to the NLRP3 inflammasome axis in vivo. Furthermore, JLX001 reduced the number of NLRP3/Iba1 cells in ischemic penumbra tissues. Finally, mechanistic analysis revealed that JLX001 significantly inhibited the expression of proteins related to the NF-κB signaling pathway. Additionally, pyrrolidine dithiocarbamate (PDTC), an NF-κB inhibitor, ameliorated cerebral ischemia-reperfusion injury by suppressing microglial polarization towards the proinflammatory phenotype and NLRP3 activation in vivo, further suggesting that these protective effects of JLX001 were mediated by inhibition of the NF-κB signaling pathway. These results suggest that JLX001 is a promising therapeutic approach for ischemic stroke.
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Affiliation(s)
- Hui-Jie Bian
- Department of Neurology, Drum Tower Hospital, Medical School and The State Key Laboratory of Pharmaceutical Biotechnology, Institute of Brain Science, Nanjing University, Nanjing 210008, China; Department of Neurology, Nanjing Drum Tower Hospital Clinical College of Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing 210008, China
| | - Si-Yi Xu
- Department of Neurology, Drum Tower Hospital, Medical School and The State Key Laboratory of Pharmaceutical Biotechnology, Institute of Brain Science, Nanjing University, Nanjing 210008, China
| | - Hui-Qin Li
- Department of Neurology, Drum Tower Hospital, Medical School and The State Key Laboratory of Pharmaceutical Biotechnology, Institute of Brain Science, Nanjing University, Nanjing 210008, China
| | - Jun-Qiu Jia
- Department of Neurology, Drum Tower Hospital, Medical School and The State Key Laboratory of Pharmaceutical Biotechnology, Institute of Brain Science, Nanjing University, Nanjing 210008, China
| | - Lei Ye
- Department of Neurology, Drum Tower Hospital, Medical School and The State Key Laboratory of Pharmaceutical Biotechnology, Institute of Brain Science, Nanjing University, Nanjing 210008, China
| | - Shu Shu
- Department of Neurology, Drum Tower Hospital, Medical School and The State Key Laboratory of Pharmaceutical Biotechnology, Institute of Brain Science, Nanjing University, Nanjing 210008, China
| | - Sheng-Nan Xia
- Department of Neurology, Drum Tower Hospital, Medical School and The State Key Laboratory of Pharmaceutical Biotechnology, Institute of Brain Science, Nanjing University, Nanjing 210008, China
| | - Yue Gu
- Department of Neurology, Drum Tower Hospital, Medical School and The State Key Laboratory of Pharmaceutical Biotechnology, Institute of Brain Science, Nanjing University, Nanjing 210008, China
| | - Xiong Zhu
- Jiangsu Jinglixin Pharmaceutical Technology Company Limited, Nanjing 211100, China
| | - Yun Xu
- Department of Neurology, Drum Tower Hospital, Medical School and The State Key Laboratory of Pharmaceutical Biotechnology, Institute of Brain Science, Nanjing University, Nanjing 210008, China; Department of Neurology, Nanjing Drum Tower Hospital Clinical College of Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing 210008, China; Jiangsu Key Laboratory for Molecular Medicine, Medical School of Nanjing University, Nanjing 210008, China; Jiangsu Province Stroke Center for Diagnosis and Therapy, Nanjing 210008, China.
| | - Xiang Cao
- Department of Neurology, Drum Tower Hospital, Medical School and The State Key Laboratory of Pharmaceutical Biotechnology, Institute of Brain Science, Nanjing University, Nanjing 210008, China; Department of Neurology, Nanjing Drum Tower Hospital Clinical College of Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing 210008, China; Jiangsu Key Laboratory for Molecular Medicine, Medical School of Nanjing University, Nanjing 210008, China; Jiangsu Province Stroke Center for Diagnosis and Therapy, Nanjing 210008, China.
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28
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Biomarkers Predictive of Long-Term Outcome After Ischemic Stroke: A Meta-Analysis. World Neurosurg 2021; 163:e1-e42. [PMID: 34728391 DOI: 10.1016/j.wneu.2021.10.157] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 10/24/2021] [Accepted: 10/25/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND PURPOSE The goal of this study was to systematically review the utility of serum biomarkers in the setting of ischemic stroke (IS) to predict long-term outcome. METHODS A systematic literature review was performed using the PubMed and MEDLINE databases for studies published between 1986-2018. All studies assessing long-term functional outcome (defined as 30 days or greater) following IS with respect to serum biomarkers were included. Data were extracted and pooled using a meta-analysis of odds ratios. RESULTS Of the total 2928 articles in the original literature search, 183 studies were ultimately selected. A total of 127 serum biomarkers were included. Biomarkers were grouped into several categories: inflammatory (32), peptide/enzymatic (30), oxidative/metabolic (28), hormone/steroid based (23), and hematologic/vascular (14). The most commonly studied biomarkers in each category were found to be CRP, S100β, albumin, copeptin, and D-dimer. With the exception of S100β, all were found to be statistically associated with >30-day outcome after ischemic stroke. CONCLUSIONS Serum-based biomarkers have the potential to predict functional outcome in IS patients. This meta-analysis has identified CRP, albumin, copeptin, and D-dimer to be significantly associated with long-term outcome after IS. These biomarkers have the potential to serve as a platform for prognosticating stroke outcomes after 30 days. These serum biomarkers, some of which are routinely ordered, can be combined with imaging biomarkers and used in artificial intelligence algorithms to provide refined predictive outcomes after injury. Ultimately these tools will assist physicians in providing guidance to families with regards to long-term independence of patients.
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Colchicine Use and Risks of Stroke Recurrence in Acute Non-Cardiogenic Ischemic Stroke Patients: A Population-Based Cohort Study. J Pers Med 2021; 11:jpm11090935. [PMID: 34575712 PMCID: PMC8470154 DOI: 10.3390/jpm11090935] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 09/15/2021] [Accepted: 09/17/2021] [Indexed: 12/24/2022] Open
Abstract
Background: The objective is to study whether the cardiovascular protective effects of colchicines could be applied to non-cardiogenic ischemic stroke (IS) patients. Patients and Methods: Non-cardiogenic IS patients were identified from the National Health Insurance Research Database. Eligible patients were divided into chronic and non-chronic use categories based on their long-term status of colchicine use. The non-chronic use category was subdivided into (1) non-user and (2) new user groups while the chronic use category was divided into (3) former user and (4) long-term user groups according to the patient's recent status of colchicine use. Inverse probability of treatment weights for propensity scores was used to balance the baseline characteristics. The primary outcome was recurrent IS, which was compared within the non-chronic use and chronic use categories. Results: In the non-chronic use category, the number of patients was 355,498 and 912 in the non-user and new user groups, respectively. In the chronic use category, the number of patients was 4737 and 4354 in the former user and long-term user groups, respectively. In the non-chronic use category, patients in the new user group had a marginally lower risk of recurrent IS at 6-months (subdistribution hazard ratio [SHR], 0.95; 95% confidence interval [CI], 0.94-0.97) and 2-years (SHR, 0.92; 95% CI, 0.91-0.93) follow up. In the chronic use category, patients in the long-term user group also had a marginally lower risk of recurrent IS at 6-months (SHR, 0.87; 95% CI, 0.86-0.88) and 2-years (SHR, 0.87; 95% CI, 0.86-0.88) follow up. The effect of colchicine on the reduced risk of recurrent IS was more favorable in patients who also used statins. Conclusions: Recent colchicine use in acute non-cardiogenic IS patients is associated with marginal fewer incidences of recurrent IS. Patients with concurrent statin use may have more profound protective effects.
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Coveney S, McCabe JJ, Murphy S, Belton O, Gray C, Cassidy T, Dolan E, de Gaetano M, Harbison J, Horgan G, Marnane M, Merwick A, Noone I, Williams DJ, Kelly PJ. Dose-Dependent Association of Inflammatory Cytokines with Carotid Atherosclerosis in Transient Ischaemic Attack: Implications for Clinical Trials. Cerebrovasc Dis 2021; 51:178-187. [PMID: 34496366 DOI: 10.1159/000517739] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 06/08/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The 5-year recurrence risk after ischaemic stroke and transient ischaemic attack (TIA) is 25-30%. Although inflammation may be a target for prevention trials, the contribution of plaque inflammation to acute cerebrovascular events remains unclear. We investigated the association of acute inflammatory cytokines and high-sensitivity C-reactive protein (CRP) with recently symptomatic carotid atherosclerosis in a prospective cohort study. METHODS Blood and Imaging markers of TIA BIO-TIA) is a multicentre prospective study of imaging and inflammatory markers in patients with TIA. Exclusion criteria were infection and other co-morbid illnesses associated with inflammation. CRP and serum cytokines (interleukin [IL]-6, IL-1β, IL-8, IL-10, IL-12, interferon-γ [IFN-γ] and tumour necrosis factor-α [TNF-α]) were measured. All patients had carotid imaging. RESULTS Two hundred and thirty-eight TIA cases and 64 controls (TIA mimics) were included. Forty-nine (20.6%) cases had symptomatic internal carotid artery stenosis. Pro-inflammatory cytokine levels increased in a dose-dependent manner across controls, TIA without carotid stenosis (CS), and TIA with CS (IL-1β, ptrend = 0.03; IL-6, ptrend < 0.0001; IL-8, ptrend = 0.01; interferon (IFN)-γ, ptrend = 0.005; TNF-α, ptrend = 0.003). Results were unchanged when DWI-positive cases were excluded. On multivariable linear regression, only age (p = 0.01) and CS (p = 0.04) independently predicted log-IL-6. On multivariable Cox regression, CRP was the only independent predictor of 90-day stroke recurrence (adjusted hazard ratio per 1-unit increase 1.03 [95% CI: 1.01-1.05], p = 0.003). CONCLUSION Symptomatic carotid atherosclerosis was associated with elevated cytokines in TIA patients after controlling for other sources of inflammation. High-sensitivity CRP was associated with recurrent ischaemic stroke at 90 days. These findings implicate acute plaque inflammation in the pathogenesis of cerebral thromboembolism and support a rationale for randomized trials of anti-inflammatory therapy for stroke patients, who were excluded from coronary trials.
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Affiliation(s)
- Sarah Coveney
- Stroke Service, Mater University Hospital and University College Dublin, Dublin, Ireland.,Health Research Board Stroke Clinical Trials Network, Dublin, Ireland
| | - John J McCabe
- Stroke Service, Mater University Hospital and University College Dublin, Dublin, Ireland.,Health Research Board Stroke Clinical Trials Network, Dublin, Ireland
| | - Sean Murphy
- Stroke Service, Mater University Hospital and University College Dublin, Dublin, Ireland.,Health Research Board Stroke Clinical Trials Network, Dublin, Ireland
| | - Orina Belton
- University College Dublin, Conway Institute, Dublin, Ireland
| | - Cleona Gray
- Vascular Imaging Department, Mater University Hospital, Dublin, Ireland
| | - Tim Cassidy
- Health Research Board Stroke Clinical Trials Network, Dublin, Ireland.,Medicine for the Older Person, St Vincent's University Hospital, Dublin, Ireland
| | - Eamon Dolan
- Health Research Board Stroke Clinical Trials Network, Dublin, Ireland.,Medicine for the Older Person, Connolly Hospital Blanchardstown, Dublin, Ireland
| | | | - Joe Harbison
- Health Research Board Stroke Clinical Trials Network, Dublin, Ireland.,Stroke Service, St James' Hospital and Trinity College Dublin, Dublin, Ireland
| | - Gillian Horgan
- Stroke Service, Mater University Hospital and University College Dublin, Dublin, Ireland.,Health Research Board Stroke Clinical Trials Network, Dublin, Ireland
| | - Michael Marnane
- Stroke Service, Mater University Hospital and University College Dublin, Dublin, Ireland.,Health Research Board Stroke Clinical Trials Network, Dublin, Ireland
| | - Aine Merwick
- Health Research Board Stroke Clinical Trials Network, Dublin, Ireland.,Cork University Hospital, Cork, Ireland
| | - Imelda Noone
- Health Research Board Stroke Clinical Trials Network, Dublin, Ireland.,Medicine for the Older Person, St Vincent's University Hospital, Dublin, Ireland
| | - David J Williams
- Health Research Board Stroke Clinical Trials Network, Dublin, Ireland.,Department of Stroke and Geriatric Medicine, RCSI University of Medicine and Health Sciences and Beaumont Hospital, Dublin, Ireland
| | - Peter J Kelly
- Stroke Service, Mater University Hospital and University College Dublin, Dublin, Ireland.,Health Research Board Stroke Clinical Trials Network, Dublin, Ireland
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Abstract
New therapeutic approaches are required for secondary prevention of residual vascular risk after stroke. Diverse sources of evidence support a causal role for inflammation in the pathogenesis of stroke. Randomized controlled trials of anti-inflammatory agents have reported benefit for secondary prevention in patients with coronary disease. We review the data from observational studies supporting a role for inflammation in pathogenesis of stroke, overview randomized controlled trials of anti-inflammatory therapy in cardiac disease and discuss the potential implications for stroke prevention therapy.
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Affiliation(s)
- Peter J Kelly
- Stroke Service, Mater University Hospital and University College Dublin, Ireland (P.J.K.).,Health Research Board Stroke Clinical Trials Network Ireland (P.J.K.)
| | - Robin Lemmens
- KU Leuven - University of Leuven, Department of Neurosciences, Experimental Neurology, Belgium (R.L.).,VIB, Center for Brain & Disease Research, Laboratory of Neurobiology, Leuven, Belgium (R.L.).,Department of Neurology, University Hospitals Leuven, Belgium (R.L.)
| | - Georgios Tsivgoulis
- Second Department of Neurology, "Attikon" University Hospital, National & Kapodistrian University of Athens, Greece (G.T.)
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32
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Patoulias D, Stavropoulos K, Imprialos K, Athyros V, Grassos H, Doumas M, Faselis C. Inflammatory Markers in Cardiovascular Disease; Lessons Learned and Future Perspectives. Curr Vasc Pharmacol 2021; 19:323-342. [PMID: 32188386 DOI: 10.2174/1570161118666200318104434] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 02/24/2020] [Accepted: 02/24/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Cardiovascular disease (CVD) still remains the leading cause of morbidity and mortality worldwide. It is now established that inflammation plays a crucial role in atherosclerosis and atherothrombosis, and thus, it is closely linked to cardiovascular disease. OBJECTIVE The aim of the present review is to summarize and critically appraise the most relevant evidence regarding the potential use of inflammatory markers in the field of CVD. METHODS We conducted a comprehensive research of the relevant literature, searching MEDLINE from its inception until November 2018, primarily for meta-analyses, randomized controlled trials and observational studies. RESULTS Established markers of inflammation, mainly C-reactive protein, have yielded significant results both for primary and secondary prevention of CVD. Newer markers, such as lipoprotein-associated phospholipase A2, lectin-like oxidized low-density lipoprotein receptor-1, cytokines, myeloperoxidase, cell adhesion molecules, matrix metalloproteinases, and the CD40/CD40 ligand system, have been largely evaluated in human studies, enrolling both individuals from the general population and patients with established CVD. Some markers have yielded conflicting results; however, others are now recognized not only as promising biomarkers of CVD, but also as potential therapeutic targets, establishing the role of anti-inflammatory and pleiotropic drugs in CVD. CONCLUSION There is significant evidence regarding the role of consolidated and novel inflammatory markers in the field of diagnosis and prognosis of CVD. However, multimarker model assessment, validation of cut-off values and cost-effectiveness analyses are required in order for those markers to be integrated into daily clinical practice.
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Affiliation(s)
- Dimitrios Patoulias
- Second Propedeutic Department of Internal Medicine, Aristotle University, Thessaloniki, Greece
| | | | - Konstantinos Imprialos
- Second Propedeutic Department of Internal Medicine, Aristotle University, Thessaloniki, Greece
| | - Vasilios Athyros
- Second Propedeutic Department of Internal Medicine, Aristotle University, Thessaloniki, Greece
| | | | - Michael Doumas
- Second Propedeutic Department of Internal Medicine, Aristotle University, Thessaloniki, Greece
| | - Charles Faselis
- VA Medical Center, and George Washington University, Washington, DC 20422, United States
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Kelly P, Weimar C, Lemmens R, Murphy S, Purroy F, Arsovska A, Bornstein NM, Czlonkowska A, Fischer U, Fonseca AC, Forbes J, Hill MD, Jatuzis D, Kõrv J, Kruuse C, Mikulik R, J Nederkoorn P, O’Donnell M, Sandercock P, Tanne D, Tsivgoulis G, Walsh C, Williams D, Zedde M, Price CI. Colchicine for prevention of vascular inflammation in Non-CardioEmbolic stroke (CONVINCE) - study protocol for a randomised controlled trial. Eur Stroke J 2021; 6:222-228. [PMID: 34414298 PMCID: PMC8370082 DOI: 10.1177/2396987320972566] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 10/11/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Inflammation contributes to unstable atherosclerotic plaque and stroke. In randomised trials in patients with coronary disease, canukinumab (an interleukin-1B antagonist) and colchicine (a tubulin inhibitor with pleiotropic anti-inflammatory effects) reduced recurrent vascular events.Hypothesis: Anti-inflammatory therapy with low-dose colchicine plus usual care will reduce recurrent vascular events in patients with non-severe, non-cardioembolic stroke and TIA compared with usual care alone. DESIGN CONVINCE is a multi-centre international (in 17 countries) Prospective, Randomised Open-label, Blinded-Endpoint assessment (PROBE) controlled Phase 3 clinical trial in 3154 participants. The intervention is colchicine 0.5 mg/day and usual care versus usual care alone (antiplatelet, lipid-lowering, antihypertensive treatment, lifestyle advice). Included patients are at least 40 years, with non-severe ischaemic stroke (modified Rankin score ≤3) or high-risk TIA (ABCD2 > 3, or positive DWI, or cranio-cervical artery stenosis) within 72 hours-28 days of randomisation, with qualifying stroke/TIA most likely caused by large artery stenosis, lacunar disease, or cryptogenic embolism. Exclusions are stroke/TIA caused by cardio-embolism or other defined cause (e.g. dissection), contra-indication to colchicine (including potential drug interactions), or incapacity for participation in a clinical trial. The anticipated median follow-up will be 36 months. The primary analysis will be by intention-to-treat. OUTCOME The primary outcome is time to first recurrent ischaemic stroke, myocardial infarction, cardiac arrest, or hospitalisation with unstable angina (non-fatal or fatal). SUMMARY CONVINCE will provide high-quality randomised data on the efficacy and safety of anti-inflammatory therapy with colchicine for secondary prevention after stroke. SCHEDULE First-patient first-visit was December 2016. Recruitment to complete in 2021, follow-up to complete in 2023.
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Affiliation(s)
- Peter Kelly
- Mater University Hospital and University College Dublin, Ireland
- Health Research Board Stroke Clinical Trials Network, Ireland
| | - Christian Weimar
- Institut für Medizinische Informatik, Biometrie und Epidemiologie, Universitätsklinikum Essen, University Duisburg-Essen, Essen, Germany
| | - Robin Lemmens
- VIB, Center for Brain & Disease Research, Laboratory of Neurobiology, Leuven, Belgium
- University Hospitals Leuven, Department of Neurology, Leuven, Belgium
| | - Sean Murphy
- Mater University Hospital and University College Dublin, Ireland
- Health Research Board Stroke Clinical Trials Network, Ireland
| | - Francisco Purroy
- Stroke Unit, Department of Neurology, Hospitalt Universitari Arnau de Vilanova de Lleida, Spain
- Universitat de Lleida, Biomedical Research Institute of Lleida (IRBLleida) , Universitat de Lleida (UdL), Spain
| | - Anita Arsovska
- University Clinic of Neurology, Medical Faculty, University “Ss Cyril and Methodius”, Skopje, North Macedonia
| | | | - Anna Czlonkowska
- Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Urs Fischer
- Stroke Centre and Clinical Trial Unit, University of Bern, Bern, Switzerland
| | - Ana Catarina Fonseca
- Department of Neurology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - John Forbes
- School of Medicine, University of Limerick, Limerick, Ireland
| | - Michael D Hill
- University of Calgary & Foothills Medical Centre, Calgary, Alberta, Canada
| | - Dalius Jatuzis
- Centre of Neurology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Lithuania
| | - Janika Kõrv
- Department of Neurology and Neurosurgery, University of Tartu, Tartu, Estonia
| | | | - Robert Mikulik
- International Clinical Research Center and Neurology Department, St. Anne’s University Hospital and Masaryk University Brno, Czech Republic
| | - Paul J Nederkoorn
- Amsterdam University Medical Centers (AUMC), Department of Neurology | Location AMC, Amsterdam, The Netherlands
| | - Martin O’Donnell
- HRB Clinical Research Facility Galway and National University of Ireland Galway, Ireland
| | | | - David Tanne
- Centre for Clinical Brain Sciences, University of Edinburgh UK
| | - Georgios Tsivgoulis
- Second Department of Neurology, “Attikon” Hospital, National and Kapodistrian, University of Athens, School of Medicine, Athens, Greece
| | - Cathal Walsh
- Mathematics Applications Consortium for Science and Industry and Health Research Institute, University of Limerick, Ireland
| | - David Williams
- RCSI University of Medicine and Health Sciences and Beaumont Hospital, Dublin, Ireland
| | - Marialuisa Zedde
- Neurology Unit, Stroke Unit, Azienda Unità Sanitaria locale-IRCCS di Reggio Emilia, Italy
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Lin SY, Wang YY, Chang CY, Wu CC, Chen WY, Liao SL, Chen CJ. TNF-α Receptor Inhibitor Alleviates Metabolic and Inflammatory Changes in a Rat Model of Ischemic Stroke. Antioxidants (Basel) 2021; 10:antiox10060851. [PMID: 34073455 PMCID: PMC8228519 DOI: 10.3390/antiox10060851] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 05/14/2021] [Accepted: 05/24/2021] [Indexed: 11/25/2022] Open
Abstract
Hyperglycemia and inflammation, with their augmented interplay, are involved in cases of stroke with poor outcomes. Interrupting this vicious cycle thus has the potential to prevent stroke disease progression. Tumor necrosis factor-α (TNF-α) is an emerging molecule, which has inflammatory and metabolic roles. Studies have shown that TNF-α receptor inhibitor R-7050 possesses neuroprotective, antihyperglycemic, and anti-inflammatory effects. Using a rat model of permanent cerebral ischemia, pretreatment with R-7050 offered protection against poststroke neurological deficits, brain infarction, edema, oxidative stress, and caspase 3 activation. In the injured cortical tissues, R-7050 reversed the activation of TNF receptor-I (TNFRI), NF-κB, and interleukin-6 (IL-6), as well as the reduction of zonula occludens-1 (ZO-1). In the in vitro study on bEnd.3 endothelial cells, R-7050 reduced the decline of ZO-1 levels after TNF-α-exposure. R-7050 also reduced the metabolic alterations occurring after ischemic stroke, such as hyperglycemia and increased plasma corticosterone, free fatty acids, C reactive protein, and fibroblast growth factor-15 concentrations. In the gastrocnemius muscles of rats with stroke, R-7050 improved activated TNFRI/NF-κB, oxidative stress, and IL-6 pathways, as well as impaired insulin signaling. Overall, our findings highlight a feasible way to combat stroke disease based on an anti-TNF therapy that involves anti-inflammatory and metabolic mechanisms.
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Affiliation(s)
- Shih-Yi Lin
- Center for Geriatrics and Gerontology, Taichung Veterans General Hospital, Taichung City 407, Taiwan;
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei City 112, Taiwan;
| | - Ya-Yu Wang
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei City 112, Taiwan;
- Department of Family Medicine, Taichung Veterans General Hospital, Taichung City 407, Taiwan
| | - Cheng-Yi Chang
- Department of Surgery, Feng Yuan Hospital, Taichung City 420, Taiwan;
| | - Chih-Cheng Wu
- Department of Anesthesiology, Taichung Veterans General Hospital, Taichung City 407, Taiwan;
- Department of Financial Engineering, Providence University, Taichung City 433, Taiwan
- Department of Data Science and Big Data Analytics, Providence University, Taichung City 433, Taiwan
| | - Wen-Ying Chen
- Department of Veterinary Medicine, National Chung-Hsing University, Taichung City 402, Taiwan;
| | - Su-Lan Liao
- Department of Medical Research, Taichung Veterans General Hospital, Taichung City 407, Taiwan;
| | - Chun-Jung Chen
- Department of Medical Research, Taichung Veterans General Hospital, Taichung City 407, Taiwan;
- Department of Medical Laboratory Science and Biotechnology, China Medical University, Taichung City 404, Taiwan
- Correspondence: ; Tel.: +886-4-2359-2525 (ext. 4022)
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Coveney S, Murphy S, Belton O, Cassidy T, Crowe M, Dolan E, de Gaetano M, Harbison J, Horgan G, Marnane M, McCabe JJ, Merwick A, Noone I, Williams D, Kelly PJ. Inflammatory cytokines, high-sensitivity C-reactive protein, and risk of one-year vascular events, death, and poor functional outcome after stroke and transient ischemic attack. Int J Stroke 2021; 17:163-171. [DOI: 10.1177/1747493021995595] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Inflammation driven by pro-inflammatory cytokines is a new therapeutic target in coronary disease. Few data exist on the association of key upstream cytokines and post-stroke recurrence. In a prospective cohort study, we investigated the association between pivotal cytokines, high-sensitivity C-reactive protein (hsCRP) and one-year outcomes. Methods BIO-STROKETIA is a multi-center prospective cohort study of non-severe ischemic stroke (modified Rankin score ≤ 3) and transient ischemic attack. Controls were patients with transient symptoms attending transient ischemic attack clinics with non-ischemic final diagnosis. Exclusion criteria were severe stroke, infection, and other pro-inflammatory disease; hsCRP and cytokines (interleukin (IL) 6, IL-1β, IL-8, IL-10, IL-12, interferon-γ (IFN-γ), tumor-necrosis factor-α (TNF-α)) were measured. The primary outcome was one-year recurrent stroke/coronary events (fatal and non-fatal). Results In this study, 680 patients (439 stroke, 241 transient ischemic attack) and 68 controls were included. IL-6, IL-1β, IL-8, IFN-γ, TNF-α, and hsCRP were higher in stroke/transient ischemic attack cases (p ≤ 0.01 for all). On multivariable Cox regression, IL-6, IL-8, and hsCRP independently predicted one-year recurrent vascular events (adjusted hazard ratios (aHR) per-quartile increase IL-6 1.31, confidence interval (CI) 1.02–1.68, p = 0.03; IL-8 1.47, CI 1.15–1.89, p = 0.002; hsCRP 1.28, CI 1.01–1.62, p = 0.04). IL-6 (aHR 1.98, CI 1.26–3.14, p = 0.003) and hsCRP (aHR 1.81, CI 1.20–2.74, p = 0.005) independently predicted one-year fatality. IL-6 and hsCRP (adjusted odds ratio per-unit increase 1.02, CI 1.01–1.04) predicted poor functional outcome, with a trend for IL-1β (p = 0.054). Conclusion Baseline inflammatory cytokines independently predicted late recurrence, supporting a rationale for randomized trials of anti-inflammatory agents for prevention after stroke and suggesting that targeted therapy to high-risk patients with high baseline inflammation may be beneficial.
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Affiliation(s)
- S Coveney
- Stroke Service, Mater University Hospital and University College Dublin, Dublin, Ireland
- Health Research Board Stroke Clinical Trials Network, Ireland
| | - S Murphy
- Stroke Service, Mater University Hospital and University College Dublin, Dublin, Ireland
- Health Research Board Stroke Clinical Trials Network, Ireland
| | - O Belton
- University College Dublin, Conway Institute, Dublin, Ireland
| | - T Cassidy
- Health Research Board Stroke Clinical Trials Network, Ireland
- Medicine for the Older Person, St Vincent's University Hospital, Dublin, Ireland
| | - M Crowe
- Health Research Board Stroke Clinical Trials Network, Ireland
- Medicine for the Older Person, St Vincent's University Hospital, Dublin, Ireland
| | - E Dolan
- Health Research Board Stroke Clinical Trials Network, Ireland
- Medicine for the Older Person, Connolly Hospital Blanchardstown, Dublin, Ireland
| | - M de Gaetano
- University College Dublin, Conway Institute, Dublin, Ireland
| | - J Harbison
- Health Research Board Stroke Clinical Trials Network, Ireland
- Stroke Service, St James’ Hospital and Trinity College Dublin, Ireland
| | - G Horgan
- Stroke Service, Mater University Hospital and University College Dublin, Dublin, Ireland
- Health Research Board Stroke Clinical Trials Network, Ireland
| | - M Marnane
- Stroke Service, Mater University Hospital and University College Dublin, Dublin, Ireland
- Health Research Board Stroke Clinical Trials Network, Ireland
| | - JJ McCabe
- Stroke Service, Mater University Hospital and University College Dublin, Dublin, Ireland
- Health Research Board Stroke Clinical Trials Network, Ireland
| | - A Merwick
- Health Research Board Stroke Clinical Trials Network, Ireland
- Stroke Department, Cork University Hospital, Cork, Ireland
| | - I Noone
- Health Research Board Stroke Clinical Trials Network, Ireland
- Medicine for the Older Person, St Vincent's University Hospital, Dublin, Ireland
| | - D Williams
- Health Research Board Stroke Clinical Trials Network, Ireland
- Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland
| | - PJ Kelly
- Stroke Service, Mater University Hospital and University College Dublin, Dublin, Ireland
- Health Research Board Stroke Clinical Trials Network, Ireland
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Yao X, Yang W, Ren Z, Zhang H, Shi D, Li Y, Yu Z, Guo Q, Yang G, Gu Y, Zhao H, Ren K. Neuroprotective and Angiogenesis Effects of Levetiracetam Following Ischemic Stroke in Rats. Front Pharmacol 2021; 12:638209. [PMID: 34054520 PMCID: PMC8161206 DOI: 10.3389/fphar.2021.638209] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 04/27/2021] [Indexed: 01/02/2023] Open
Abstract
Objective: The present study explored whether levetiracetam (LEV) could protect against experimental brain ischemia and enhance angiogenesis in rats, and investigated the potential mechanisms in vivo and in vitro. Methods: The middle cerebral artery was occluded for 60 min to induce middle cerebral artery occlusion (MCAO). The Morris water maze was used to measure cognitive ability. The rotation test was used to assess locomotor function. T2-weighted MRI was used to assess infarct volume. The neuronal cells in the cortex area were stained with cresyl purple. The anti-inflammatory effects of LEV on microglia were observed by immunohistochemistry. Enzyme-linked immunosorbent assays (ELISA) were used to measure the production of pro-inflammatory cytokines. Western blotting was used to detect the levels of heat shock protein 70 (HSP70), vascular endothelial growth factor (VEGF), and hypoxia-inducible factor-1α (HIF-1α) in extracts from the ischemic cortex. Flow cytometry was used to observe the effect of LEV on neuronal cell apoptosis. Results: LEV treatment significantly increased the density of the surviving neurons in the cerebral cortex and reduced the infarct size (17.8 ± 3.3% vs. 12.9 ± 1.4%, p < 0.01) after MCAO. Concurrently, the time required to reach the platform for LEV-treated rats was shorter than that in the saline group on day 11 after MCAO (p < 0.01). LEV treatment prolonged the rotarod retention time on day 14 after MCAO (84.5 ± 6.7 s vs. 59.1 ± 6.2 s on day 14 compared with the saline-treated groups, p < 0.01). It also suppressed the activation of microglia and inhibited TNF-α and Il-1β in the ischemic brain (135.6 ± 5.2 pg/ml vs. 255.3 ± 12.5 pg/ml, 18.5 ± 1.3 pg/ml vs. 38.9 ± 2.3 pg/ml on day 14 compared with the saline-treated groups, p < 0.01). LEV treatment resulted in a significant increase in HIF-1α, VEGF, and HSP70 levels in extracts from the ischemic cerebral cortex. At the same time, LEV reduced neuronal cell cytotoxicity and apoptosis induced by an ischemic stroke (p < 0.01). Conclusion: LEV treatment promoted angiogenesis and functional recovery after cerebral ischemia in rats. These effects seem to be mediated through anti-inflammatory and antiapoptotic activities, as well as inducing the expression of HSP70, VEGF, and HIF-1α.
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Affiliation(s)
- Xiang Yao
- Department of Radiology, Xiang'an Hospital of Xiamen University, Xiamen, China
| | - Wenping Yang
- Division of Neurology, Department of Geriatrics, Jiangsu Province Hospital, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zhendong Ren
- Department of Radiology, Xiang'an Hospital of Xiamen University, Xiamen, China
| | - Haoran Zhang
- Department of Radiology, Xiang'an Hospital of Xiamen University, Xiamen, China
| | - Dafa Shi
- Department of Radiology, Xiang'an Hospital of Xiamen University, Xiamen, China
| | - Yanfei Li
- Department of Radiology, Xiang'an Hospital of Xiamen University, Xiamen, China
| | - Ziyang Yu
- Department of Radiology, Xiang'an Hospital of Xiamen University, Xiamen, China
| | - Qiu Guo
- Department of Radiology, Xiang'an Hospital of Xiamen University, Xiamen, China
| | - Guangwei Yang
- Hospital (T.C.M) Affiliated to Southwest Medical University, Luzhou, China
| | - Yingjiang Gu
- Hospital (T.C.M) Affiliated to Southwest Medical University, Luzhou, China
| | - Hairong Zhao
- School of Medicine, Xiamen University, Xiamen, China
| | - Ke Ren
- Department of Radiology, Xiang'an Hospital of Xiamen University, Xiamen, China
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Hansen RB, Laursen CCH, Nawaz N, Madsen JS, Nielsen HH, Kruuse C, Møller A, Degn M, Lambertsen KL. Leukocyte TNFR1 and TNFR2 Expression Contributes to the Peripheral Immune Response in Cases with Ischemic Stroke. Cells 2021; 10:cells10040861. [PMID: 33918875 PMCID: PMC8069317 DOI: 10.3390/cells10040861] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/24/2021] [Accepted: 04/01/2021] [Indexed: 11/23/2022] Open
Abstract
Tumor necrosis factor receptor 1 and 2 (TNFR1 and TNFR2) have been found in brain parenchyma of stroke patients, and plasma levels are increased in the acute phase of stroke. We evaluated associations between TNFR1 and TNFR2 plasma levels and stroke severity, infarct size, and functional outcome. Furthermore, we examined cellular expression of TNFR1 and TNFR2 on leukocyte subpopulations to explore the origin of the increased receptor levels. Blood samples were taken from 33 acute ischemic stroke patients and 10 healthy controls. TNFR1 and TNFR2 plasma concentrations were measured and correlated against the Scandinavian Stroke Scale at admission, infarct volume, and the modified Rankin Scale score three months after stroke onset. Classical, intermediate, and non-classical monocytes as well as neutrophils were purified, and cellular expression of TNFR1 and TNFR2 was examined using flow cytometry. TNFR1 and TNFR2 plasma levels were both increased after ischemic stroke, but we found no correlation with patient outcome measurements. Compared to healthy controls, ischemic stroke patients had decreased non-classical monocyte and neutrophil populations expressing TNFR1 and increased neutrophils expressing TNFR2, and decreased non-classical populations co-expressing both TNFR1 and TNFR2. This study supports the hypothesis of an acute immunological response orchestrated by the peripheral immune system following an ischemic stroke. However, the origin of the increased TNFR1 and TNFR2 plasma levels could not be clearly linked to peripheral monocytes or neutrophils. Future studies are needed and will help clarify the potential role as treatment target.
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Affiliation(s)
- Rikke B. Hansen
- Department of Neurobiology Research, Institute of Molecular Medicine, University of Southern Denmark, 5000 Odense, Denmark; (R.B.H.); (C.C.H.L.); (N.N.); (H.H.N.)
- Department of Neurology, Odense University Hospital, 5000 Odense, Denmark
| | - Cathrine C. H. Laursen
- Department of Neurobiology Research, Institute of Molecular Medicine, University of Southern Denmark, 5000 Odense, Denmark; (R.B.H.); (C.C.H.L.); (N.N.); (H.H.N.)
- Brain Research—Inter-Disciplinary Guided Excellence (BRIDGE), Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark
| | - Niala Nawaz
- Department of Neurobiology Research, Institute of Molecular Medicine, University of Southern Denmark, 5000 Odense, Denmark; (R.B.H.); (C.C.H.L.); (N.N.); (H.H.N.)
- Department of Neurology, Odense University Hospital, 5000 Odense, Denmark
| | - Jonna S. Madsen
- Department of Biochemistry and Immunology, Lillebaelt Hospital, University Hospital of Southern Denmark, 7100 Vejle, Denmark;
- Department of Regional Health Research, University of Southern Denmark, 5000 Odense, Denmark
| | - Helle H. Nielsen
- Department of Neurobiology Research, Institute of Molecular Medicine, University of Southern Denmark, 5000 Odense, Denmark; (R.B.H.); (C.C.H.L.); (N.N.); (H.H.N.)
- Department of Neurology, Odense University Hospital, 5000 Odense, Denmark
- Brain Research—Inter-Disciplinary Guided Excellence (BRIDGE), Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark
| | - Christina Kruuse
- Department of Clinical Medicine, University of Copenhagen, 2100 Copenhagen, Denmark;
- Department of Neurology, Herlev Gentofte Hospital, 2730 Herlev, Denmark
| | - Arne Møller
- Department of Nuclear Medicine and PET Center, Aarhus University Hospital, 8200 Aarhus, Denmark;
- Institute of Clinical Medicine, Center of Functionally Integrative Neuroscience, 8000 Aarhus, Denmark
| | - Matilda Degn
- Pediatric Oncology Laboratory, Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, 2100 Copenhagen, Denmark
- Correspondence: (M.D.); (K.L.L.); Tel.: +45-6061-0084 (M.D.); +45-6550-3806 (K.L.L.)
| | - Kate L. Lambertsen
- Department of Neurobiology Research, Institute of Molecular Medicine, University of Southern Denmark, 5000 Odense, Denmark; (R.B.H.); (C.C.H.L.); (N.N.); (H.H.N.)
- Department of Neurology, Odense University Hospital, 5000 Odense, Denmark
- Brain Research—Inter-Disciplinary Guided Excellence (BRIDGE), Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark
- OPEN—Open Patient data Explorative Network, Department of Clinical Research, Odense University Hospital, University of Southern Denmark, 5000 Odense, Denmark
- Correspondence: (M.D.); (K.L.L.); Tel.: +45-6061-0084 (M.D.); +45-6550-3806 (K.L.L.)
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Huang Z, Wan C, Wang Y, Qiao P, Zou Q, Ma J, Liu Z, Cai Z. Anti-Cognitive Decline by Yinxing-Mihuan-Oral-Liquid via Activating CREB/BDNF Signaling and Inhibiting Neuroinflammatory Process. Exp Aging Res 2021; 47:273-287. [PMID: 33499761 DOI: 10.1080/0361073x.2021.1878756] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND: Cognitive decline in the normal aging process is one of the most common and prominent problems. Delaying and alleviating cognitive impairment is an important strategy of anti-aging. This study is to aim at investigating the effects of Yinxing-Mihuan-Oral-Liquid(GMOL) on the CREB/BDNF signaling in the normal aging process.METHODS: SD rats were randomly divided into GMOL group and control group. The Morris water maze (MWM) was introduced for behavioral test. Immunohistochemistry and immunofluorescence were used for cAMP response element binding protein 1(CREB1), p-CREB(Ser133), brain-derived neurotrophic factor(BDNF), synaptophysin(SYP) and glial fibrillary acidic protein(GFAP). Western blot was conducted for investigating the levels of CREB1 and p-CREB(Ser133), BDNF, SYP, GFAP and interleukin 6(IL-6). RESULTS: Our data showed that compared with the control group, GMOL group had higher expression of memory-related proteins, decreased inflammatory factors, and enhanced spatial learning and memory ability.CONCLUSION: The study results show that GMOL ameliorates cognitive impairment of the normal aged SD rats via enhancing the expression of memory biomarkers and inhibiting inflammatory process. The potential neuroprotective role of GMOL in the process of aging may be related to mitigating cognitive decline via activating CREB/BDNF signaling and inhibiting inflammatory process.
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Affiliation(s)
- Zhenting Huang
- Chongqing Key Laboratory of Neurodegenerative Diseases, Chongqing, China.,Department of Neurology, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing, China
| | - Chengqun Wan
- Chongqing Key Laboratory of Neurodegenerative Diseases, Chongqing, China.,Department of Neurology, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing, China
| | - Yangyang Wang
- Chongqing Key Laboratory of Neurodegenerative Diseases, Chongqing, China.,Department of Neurology, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing, China
| | - Peifeng Qiao
- Chongqing Key Laboratory of Neurodegenerative Diseases, Chongqing, China.,Department of Neurology, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing, China
| | - Qian Zou
- Chongqing Key Laboratory of Neurodegenerative Diseases, Chongqing, China.,Department of Neurology, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing, China
| | - Jingxi Ma
- Chongqing Key Laboratory of Neurodegenerative Diseases, Chongqing, China.,Department of Neurology, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing, China
| | - Zhou Liu
- Department of Neurology, Guangdong Key Laboratory of Age-Related Cardiac and Cerebral Diseases, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Zhiyou Cai
- Chongqing Key Laboratory of Neurodegenerative Diseases, Chongqing, China.,Department of Neurology, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing, China
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McCabe JJ, O'Reilly E, Coveney S, Collins R, Healy L, McManus J, Mulcahy R, Moynihan B, Cassidy T, Hsu F, Worrall B, Murphy S, O'Donnell M, Kelly PJ. Interleukin-6, C-reactive protein, fibrinogen, and risk of recurrence after ischaemic stroke: Systematic review and meta-analysis. Eur Stroke J 2021; 6:62-71. [PMID: 33817336 PMCID: PMC7995315 DOI: 10.1177/2396987320984003] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 12/06/2020] [Indexed: 01/02/2023] Open
Abstract
Background Recent randomised trials showed benefit for anti-inflammatory therapies in coronary disease but excluded stroke. The prognostic value of blood inflammatory markers after stroke is uncertain and guidelines do not recommend their routine measurement for risk stratification. Methods We performed a systematic review and meta-analysis of studies investigating the association of C-reactive protein (CRP), interleukin-6 (IL-6) and fibrinogen and risk of recurrent stroke or major vascular events (MVEs). We searched EMBASE and Ovid Medline until 10/1/19. Random-effects meta-analysis was performed for studies reporting comparable effect measures. Results Of 2,515 reports identified, 39 met eligibility criteria (IL-6, n = 10; CRP, n = 33; fibrinogen, n = 16). An association with recurrent stroke was reported in 12/26 studies (CRP), 2/11 (fibrinogen) and 3/6 (IL-6). On random-effects meta-analysis of comparable studies, CRP was associated with an increased risk of recurrent stroke [pooled hazard ratio (HR) per 1 standard-deviation (SD) increase in loge-CRP (1.14, 95% CI 1.06-1.22, p < 0.01)] and MVEs (pooled HR 1.21, CI 1.10-1.34, p < 0.01). Fibrinogen was also associated with recurrent stroke (HR 1.26, CI 1.07-1.47, p < 0.01) and MVEs (HR 1.31, 95% CI 1.15-1.49, p < 0.01). Trends were identified for IL-6 for recurrent stroke (HR per 1-SD increase 1.17, CI 0.97-1.41, p = 0.10) and MVEs (HR 1.22, CI 0.96-1.55, p = 0.10). Conclusion Despite evidence suggesting an association between inflammatory markers and post-stroke vascular recurrence, substantial methodological heterogeneity was apparent between studies. Individual-patient pooled analysis and standardisation of methods are needed to determine the prognostic role of blood inflammatory markers and to improve patient selection for randomised trials of inflammatory therapies.
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Affiliation(s)
- J J McCabe
- Health Research Board (HRB) Stroke Clinical Trials Network Ireland (SCTNI), Dublin, Ireland.,Neurovascular Unit for Applied Translational and Therapeutics Research, Catherine McAuley Centre, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland.,Medicine for the Elderly Department/Stroke Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - E O'Reilly
- Health Research Board (HRB) Stroke Clinical Trials Network Ireland (SCTNI), Dublin, Ireland
| | - S Coveney
- Health Research Board (HRB) Stroke Clinical Trials Network Ireland (SCTNI), Dublin, Ireland.,Neurovascular Unit for Applied Translational and Therapeutics Research, Catherine McAuley Centre, Dublin, Ireland.,Department of Geriatric Medicine, Tallaght University Hospital, Dublin, Ireland
| | - R Collins
- Health Research Board (HRB) Stroke Clinical Trials Network Ireland (SCTNI), Dublin, Ireland.,Department of Geriatric Medicine, Tallaght University Hospital, Dublin, Ireland
| | - L Healy
- Health Research Board (HRB) Stroke Clinical Trials Network Ireland (SCTNI), Dublin, Ireland.,Department of Geriatric Medicine, Cork University Hospital, Cork, Ireland
| | - J McManus
- Health Research Board (HRB) Stroke Clinical Trials Network Ireland (SCTNI), Dublin, Ireland.,Department of Geriatric Medicine, University Hospital Limerick, Ireland
| | - R Mulcahy
- Health Research Board (HRB) Stroke Clinical Trials Network Ireland (SCTNI), Dublin, Ireland.,Department of Geriatric Medicine, Waterford University Hospital, Waterford, Ireland
| | - B Moynihan
- Health Research Board (HRB) Stroke Clinical Trials Network Ireland (SCTNI), Dublin, Ireland.,Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - T Cassidy
- School of Medicine, University College Dublin, Dublin, Ireland.,Department of Geriatric and Stroke Medicine, St Vincent's University Hospital, Dublin, Ireland
| | - F Hsu
- The Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - B Worrall
- Departments of Neurology and Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - S Murphy
- Health Research Board (HRB) Stroke Clinical Trials Network Ireland (SCTNI), Dublin, Ireland.,Neurovascular Unit for Applied Translational and Therapeutics Research, Catherine McAuley Centre, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland.,Medicine for the Elderly Department/Stroke Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - M O'Donnell
- Health Research Board (HRB) Stroke Clinical Trials Network Ireland (SCTNI), Dublin, Ireland.,Department of Geriatric Medicine, University Hospital Galway, Galway, Ireland.,Department of Translational Medicine, National University of Ireland Galway, Ireland
| | - P J Kelly
- Health Research Board (HRB) Stroke Clinical Trials Network Ireland (SCTNI), Dublin, Ireland.,Neurovascular Unit for Applied Translational and Therapeutics Research, Catherine McAuley Centre, Dublin, Ireland.,Department of Neurology/Stroke Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
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40
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McCabe JJ, Giannotti N, McNulty J, Collins S, Coveney S, Murphy S, Barry M, Harbison J, Cronin S, Williams D, Horgan G, Dolan E, Cassidy T, McDonnell C, Kavanagh E, Foley S, O'Connell M, Marnane M, Kelly P. Cohort profile: BIOVASC-late, a prospective multicentred study of imaging and blood biomarkers of carotid plaque inflammation and risk of late vascular recurrence after non-severe stroke in Ireland. BMJ Open 2020; 10:e038607. [PMID: 32690537 PMCID: PMC7371237 DOI: 10.1136/bmjopen-2020-038607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
PURPOSE Inflammation is important in stroke. Anti-inflammatory therapy reduces vascular events in coronary patients. 18F-fluorodeoxyglucose positron emission tomography (18F-FDG-PET) identifies plaque inflammation-related metabolism. However, long-term prospective cohort studies investigating the association between carotid plaque inflammation, identified on 18F-FDG PET and the risk of recurrent vascular events, have not yet been undertaken in patients with stroke. PARTICIPANTS The Biomarkers Imaging Vulnerable Atherosclerosis in Symptomatic Carotid disease (BIOVASC) study and Dublin Carotid Atherosclerosis Study (DUCASS) are two prospective multicentred observational cohort studies, employing near-identical methodologies, which recruited 285 patients between 2008 and 2016 with non-severe stroke/transient ischaemic attack and ipsilateral carotid stenosis (50%-99%). Patients underwent coregistered carotid 18F-FDG PET/CT angiography and phlebotomy for measurement of inflammatory cytokines. Plaque 18F-FDG-uptake is expressed as maximum standardised uptake value (SUVmax) and tissue-to-background ratio. The BIOVASC-Late study is a follow-up study (median 7 years) of patients recruited to the DUCASS/BIOVASC cohorts. FINDINGS TO DATE We have reported that 18F-FDG-uptake in atherosclerotic plaques of patients with symptomatic carotid stenosis predicts early recurrent stroke, independent of luminal narrowing. The incorporation of 18F-FDG plaque uptake into a clinical prediction model also improves discrimination of early recurrent stroke, when compared with risk stratification by luminal stenosis alone. However, the relationship between 18F-FDG-uptake and late vascular events has not been investigated to date. FUTURE PLANS The primary aim of BIOVASC-Late is to investigate the association between SUVmax in symptomatic 'culprit' carotid plaque (as a marker of systemic inflammatory atherosclerosis) and the composite outcome of any late major vascular event (recurrent ischaemic stroke, coronary event or vascular death). Secondary aims are to investigate associations between: (1) SUVmax in symptomatic plaque, and individual vascular endpoints (2) SUVmax in asymptomatic contralateral carotid plaque and SUVmax in ipsilateral symptomatic plaque (3) SUVmax in asymptomatic carotid plaque and major vascular events (4) inflammatory cytokines and vascular events.
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Affiliation(s)
- John Joseph McCabe
- Health Research Board Stroke Clinical Trials Network Ireland (HRB SCTNI), Dublin, Ireland
- Neurovascular Clinical Science Unit, Stroke Service and Department of Neurology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Nicola Giannotti
- Radiography & Diagnostic Imaging, School of Medicine, University College Dublin, Dublin, Ireland
| | - Jonathan McNulty
- Radiography & Diagnostic Imaging, School of Medicine, University College Dublin, Dublin, Ireland
| | - Sean Collins
- Health Research Board Stroke Clinical Trials Network Ireland (HRB SCTNI), Dublin, Ireland
| | - Sarah Coveney
- Health Research Board Stroke Clinical Trials Network Ireland (HRB SCTNI), Dublin, Ireland
- Neurovascular Clinical Science Unit, Stroke Service and Department of Neurology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Sean Murphy
- Health Research Board Stroke Clinical Trials Network Ireland (HRB SCTNI), Dublin, Ireland
- Neurovascular Clinical Science Unit, Stroke Service and Department of Neurology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Mary Barry
- Vascular Surgery, St Vincent's University Hospital, Dublin, Ireland
| | - Joseph Harbison
- Health Research Board Stroke Clinical Trials Network Ireland (HRB SCTNI), Dublin, Ireland
- Stroke Service, St James Hospital, Dublin, Ireland
| | - Simon Cronin
- Health Research Board Stroke Clinical Trials Network Ireland (HRB SCTNI), Dublin, Ireland
- Department of Neurology, Cork University Hospital Group, Cork, Ireland
| | - David Williams
- Health Research Board Stroke Clinical Trials Network Ireland (HRB SCTNI), Dublin, Ireland
- Department of Stroke, Beaumont Hospital, Dublin, Ireland
| | - Gillian Horgan
- Health Research Board Stroke Clinical Trials Network Ireland (HRB SCTNI), Dublin, Ireland
- Neurovascular Clinical Science Unit, Stroke Service and Department of Neurology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Eamon Dolan
- Health Research Board Stroke Clinical Trials Network Ireland (HRB SCTNI), Dublin, Ireland
- Department of Geriatric Medicine, James Connolly Memorial Hospital, Dublin, Ireland
| | - Tim Cassidy
- Health Research Board Stroke Clinical Trials Network Ireland (HRB SCTNI), Dublin, Ireland
- Geriatric Medicine, St Vincent's University Hospital, Dublin, Ireland
| | - Ciaran McDonnell
- Department of Vascular Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Eoin Kavanagh
- Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Shane Foley
- Radiography & Diagnostic Imaging, School of Medicine, University College Dublin, Dublin, Ireland
| | - Martin O'Connell
- Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Michael Marnane
- Health Research Board Stroke Clinical Trials Network Ireland (HRB SCTNI), Dublin, Ireland
- Neurovascular Clinical Science Unit, Stroke Service and Department of Neurology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Peter Kelly
- Health Research Board Stroke Clinical Trials Network Ireland (HRB SCTNI), Dublin, Ireland
- Neurovascular Clinical Science Unit, Stroke Service and Department of Neurology, Mater Misericordiae University Hospital, Dublin, Ireland
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Clausen BH, Wirenfeldt M, Høgedal SS, Frich LH, Nielsen HH, Schrøder HD, Østergaard K, Finsen B, Kristensen BW, Lambertsen KL. Characterization of the TNF and IL-1 systems in human brain and blood after ischemic stroke. Acta Neuropathol Commun 2020; 8:81. [PMID: 32503645 PMCID: PMC7273684 DOI: 10.1186/s40478-020-00957-y] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 05/27/2020] [Indexed: 01/17/2023] Open
Abstract
Preclinical and clinical proof-of-concept studies have suggested the effectiveness of pharmacological modulation of inflammatory cytokines in ischemic stroke. Experimental evidence shows that targeting tumor necrosis factor (TNF) and interleukin (IL)-1 holds promise, and these cytokines are considered prime targets in the development of new stroke therapies. So far, however, information on the cellular expression of TNF and IL-1 in the human ischemic brain is sparse.We studied 14 cases of human post-mortem ischemic stroke, representing 21 specimens of infarcts aged 1 to > 8 days. We characterized glial and leukocyte reactions in the infarct/peri-infarct (I/PI) and normal-appearing tissue (NAT) and the cellular location of TNF, TNF receptor (TNFR)1 and TNFR2, IL-1α, IL-1β, and IL-1 receptor antagonist (IL-1Ra). The immunohistochemically stained tissue sections received a score reflecting the number of immunoreactive cells and the intensity of the immunoreactivity (IR) in individual cells where 0 = no immunoreactive cells, 1 = many intermediately to strongly immunoreactive cells, and 2 = numerous and intensively immunoreactive cells. Additionally, we measured blood TNF, TNFR, and IL-1 levels in surviving ischemic stroke patients within the first 8 h and again at 72 h after symptom onset and compared levels to healthy controls.We observed IL-1α and IL-1β IR in neurons, glia, and macrophages in all specimens. IL-1Ra IR was found in glia, in addition to macrophages. TNF IR was initially found in neurons located in I/PI and NAT but increased in glia in older infarcts. TNF IR increased in macrophages in all specimens. TNFR1 IR was found in neurons and glia and macrophages, while TNFR2 was expressed only by glia in I/PI and NAT, and by macrophages in I/PI. Our results suggest that TNF and IL-1 are expressed by subsets of cells and that TNFR2 is expressed in areas with increased astrocytic reactivity. In ischemic stroke patients, we demonstrate that plasma TNFR1 and TNFR2 levels increased in the acute phase after symptom onset compared to healthy controls, whereas TNF, IL-1α, IL-1β, and IL-1Ra did not change.Our findings of increased brain cytokines and plasma TNFR1 and TNFR2 support the hypothesis that targeting post-stroke inflammation could be a promising add-on therapy in ischemic stroke patients.
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Affiliation(s)
- Bettina H. Clausen
- Department of Neurobiology Research, Institute of Molecular Medicine, University of Southern Denmark, J.B. Winsloewsvej 21, st, DK-5000 Odense C, Denmark
- BRIDGE, Inter-Disciplinary Guided Excellence, Department of Clinical Research, University of Southern Denmark, DK-5000 Odense C, Denmark
| | - Martin Wirenfeldt
- BRIDGE, Inter-Disciplinary Guided Excellence, Department of Clinical Research, University of Southern Denmark, DK-5000 Odense C, Denmark
- Department of Pathology, Odense University Hospital, Odense, J.B. Winsloewsvej 15, DK-5000 Odense C, Denmark
| | - Sofie S. Høgedal
- Department of Neurology, Odense University Hospital, J.B. Winsloewsvej 4, DK-5000 Odense C, Denmark
| | - Lars H. Frich
- Orthopedic Research Unit, University of Southern Denmark, DK-5000 Odense C, Denmark
- OPEN, Open Patient data Explorative Network, Odense University Hospital, Department of Clinical Research, University of Southern Denmark, J.B. Winsloewsvej 9a, DK-5000 Odense, Denmark
| | - Helle H. Nielsen
- Department of Neurobiology Research, Institute of Molecular Medicine, University of Southern Denmark, J.B. Winsloewsvej 21, st, DK-5000 Odense C, Denmark
- BRIDGE, Inter-Disciplinary Guided Excellence, Department of Clinical Research, University of Southern Denmark, DK-5000 Odense C, Denmark
- Department of Neurology, Odense University Hospital, J.B. Winsloewsvej 4, DK-5000 Odense C, Denmark
| | - Henrik D. Schrøder
- Department of Pathology, Odense University Hospital, Odense, J.B. Winsloewsvej 15, DK-5000 Odense C, Denmark
| | - Kamilla Østergaard
- Department of Neurobiology Research, Institute of Molecular Medicine, University of Southern Denmark, J.B. Winsloewsvej 21, st, DK-5000 Odense C, Denmark
| | - Bente Finsen
- Department of Neurobiology Research, Institute of Molecular Medicine, University of Southern Denmark, J.B. Winsloewsvej 21, st, DK-5000 Odense C, Denmark
- BRIDGE, Inter-Disciplinary Guided Excellence, Department of Clinical Research, University of Southern Denmark, DK-5000 Odense C, Denmark
| | - Bjarne W. Kristensen
- BRIDGE, Inter-Disciplinary Guided Excellence, Department of Clinical Research, University of Southern Denmark, DK-5000 Odense C, Denmark
- Department of Pathology, Odense University Hospital, Odense, J.B. Winsloewsvej 15, DK-5000 Odense C, Denmark
| | - Kate L. Lambertsen
- Department of Neurobiology Research, Institute of Molecular Medicine, University of Southern Denmark, J.B. Winsloewsvej 21, st, DK-5000 Odense C, Denmark
- BRIDGE, Inter-Disciplinary Guided Excellence, Department of Clinical Research, University of Southern Denmark, DK-5000 Odense C, Denmark
- Department of Neurology, Odense University Hospital, J.B. Winsloewsvej 4, DK-5000 Odense C, Denmark
- OPEN, Open Patient data Explorative Network, Odense University Hospital, Department of Clinical Research, University of Southern Denmark, J.B. Winsloewsvej 9a, DK-5000 Odense, Denmark
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42
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Li L, Lou W, Li H, Zhu Y, Huang X. Upregulated C-C Motif Chemokine Ligand 2 Promotes Ischemic Stroke via Chemokine Signaling Pathway. Ann Vasc Surg 2020; 68:476-486. [PMID: 32422289 DOI: 10.1016/j.avsg.2020.04.047] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 04/01/2020] [Accepted: 04/18/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND This study aims to evaluate the potential effect and the underlying mechanism of C-C motif chemokine ligand 2 (CCL2) in ischemic stroke. METHODS An integrated bioinformatics analysis was performed to identify the differentially expressed (DE) genes and their related pathways in ischemic stroke. In vivo study of a rat model of middle cerebral artery occlusion (MCAO) was further established to assess the effect of CCL2 on severity of neurologic impairments. The expression levels of proinflammatory cytokines were also evaluated using the ELISA assay, and Western blot was also used to determine the expression of CCL2 and other DE proteins in the related pathways. RESULTS A total of 88 DE genes were identified from the microarray dataset of ischemic stroke. The bioinformatics analysis revealed that CCL2 was highly expressed in ischemic stroke tissue and promoted the ischemic stroke progression via activation of the chemokine signaling pathway and cytokine-cytokine receptor interaction pathway. The in vivo study of the ischemic stroke rat model also showed that the CCL2 expression was elevated in the MCAO/R rats, with significant neurological impairments and ischemic infarct area in the brain tissue being observed. The administration of CCL2 inhibitors significantly inhibited the inflammatory response, attenuated the neurological impairments, and decreased the ischemic infarct area in the MCAO/R rats. Furthermore, the downregulation of CCL2 also inhibited the expression of the pathway-related proteins including CCL7, CCR2, CXCL16, and TNF-α. CONCLUSIONS These results indicate that the CCL2/chemokine signaling pathway is responsible for ischemic stroke progression and might represent a potential therapeutic target for ischemic stroke treatment.
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Affiliation(s)
- Lin Li
- Department of Rehabilitation Medicine, Zhejiang Hospital, Hangzhou, People's Republic of China
| | - Weimin Lou
- Department of Rehabilitation Medicine, Zhejiang Hospital, Hangzhou, People's Republic of China
| | - Hailong Li
- Department of Rehabilitation Medicine, Zhejiang Hospital, Hangzhou, People's Republic of China
| | - Yuehong Zhu
- Department of Rehabilitation Medicine, Zhejiang Hospital, Hangzhou, People's Republic of China
| | - Xiong'ang Huang
- Department of Rehabilitation Medicine, Zhejiang Hospital, Hangzhou, People's Republic of China.
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43
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Pawluk H, Woźniak A, Grześk G, Kołodziejska R, Kozakiewicz M, Kopkowska E, Grzechowiak E, Kozera G. The Role of Selected Pro-Inflammatory Cytokines in Pathogenesis of Ischemic Stroke. Clin Interv Aging 2020; 15:469-484. [PMID: 32273689 PMCID: PMC7110925 DOI: 10.2147/cia.s233909] [Citation(s) in RCA: 104] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 02/13/2020] [Indexed: 12/29/2022] Open
Abstract
Stroke is currently one of the most common causes of death and disability in the world, and its pathophysiology is a complex process, involving the oxidative stress and inflammatory reaction. Unfortunately, no biochemical factors useful in the diagnostics and treatment of stroke have been clearly established to date. Therefore, researchers are increasingly interested in the inflammatory response triggered by cerebral ischemia and its role in the development of cerebral infarction. This article gives an overview of the available literature data concerning the role of pro-inflammatory cytokines in acute stroke. Detailed analysis of their role in cerebral circulation disturbances can also suggest certain immune response regulatory mechanisms aimed to reduce damage to the nervous tissue in the course of stroke.
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Affiliation(s)
- Hanna Pawluk
- Department of Medical Biology and Biochemistry, Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | - Alina Woźniak
- Department of Medical Biology and Biochemistry, Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | - Grzegorz Grześk
- 2nd Department of Cardiology, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | - Renata Kołodziejska
- Department of Medical Biology and Biochemistry, Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | - Mariusz Kozakiewicz
- Department of Geriatrics, Division of Biochemistry and Biogerontology, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | - Ewa Kopkowska
- Department of Medical Biology and Biochemistry, Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | - Elżbieta Grzechowiak
- Department of Neurology, Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | - Grzegorz Kozera
- Department of Neurology, Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
- Medical Stimulation Center, Medical University of Gdańsk, Gdańsk, Poland
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44
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Parikh NS, Merkler AE, Iadecola C. Inflammation, Autoimmunity, Infection, and Stroke: Epidemiology and Lessons From Therapeutic Intervention. Stroke 2020; 51:711-718. [PMID: 32078460 DOI: 10.1161/strokeaha.119.024157] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Neal S Parikh
- From the Department of Neurology, Columbia University Medical College (N.S.P.), Weill Cornell Medicine, New York, NY.,Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute (N.S.P., A.E.M., C.I.), Weill Cornell Medicine, New York, NY.,Department of Neurology (N.S.P., A.E.M., C.I.), Weill Cornell Medicine, New York, NY
| | - Alexander E Merkler
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute (N.S.P., A.E.M., C.I.), Weill Cornell Medicine, New York, NY.,Department of Neurology (N.S.P., A.E.M., C.I.), Weill Cornell Medicine, New York, NY
| | - Costantino Iadecola
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute (N.S.P., A.E.M., C.I.), Weill Cornell Medicine, New York, NY.,Department of Neurology (N.S.P., A.E.M., C.I.), Weill Cornell Medicine, New York, NY
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45
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Altendahl M, Maillard P, Harvey D, Cotter D, Walters S, Wolf A, Singh B, Kakarla V, Azizkhanian I, Sheth SA, Xiao G, Fox E, You M, Leng M, Elashoff D, Kramer JH, Decarli C, Elahi F, Hinman JD. An IL-18-centered inflammatory network as a biomarker for cerebral white matter injury. PLoS One 2020; 15:e0227835. [PMID: 31978079 PMCID: PMC6980497 DOI: 10.1371/journal.pone.0227835] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 12/30/2019] [Indexed: 12/16/2022] Open
Abstract
Chronic systemic sterile inflammation is implicated in the pathogenesis of cerebrovascular disease and white matter injury. Non-invasive blood markers for risk stratification and dissection of inflammatory molecular substrates in vivo are lacking. We sought to identify whether an interconnected network of inflammatory biomarkers centered on IL-18 and all previously associated with white matter lesions could detect overt and antecedent white matter changes in two populations at risk for cerebral small vessel disease. In a cohort of 167 older adults (mean age: 76, SD 7.1, 83 females) that completed a cognitive battery, physical examination, and blood draw in parallel with MR imaging including DTI, we measured cerebral white matter hyperintensities (WMH) and free water (FW). Concurrently, serum levels of a biologic network of inflammation molecules including MPO, GDF-15, RAGE, ST2, IL-18, and MCP-1 were measured. The ability of a log-transformed population mean-adjusted inflammatory composite score (ICS) to associate with MR variables was demonstrated in an age and total intracranial volume adjusted model. In this cohort, ICS was significantly associated with WMH (β = 0.222, p = 0.013), FW (β = 0.3, p = 0.01), and with the number of vascular risk factor diagnoses (r = 0.36, p<0.001). In a second cohort of 131 subjects presenting for the evaluation of acute neurologic deficits concerning for stroke, we used serum levels of 11 inflammatory biomarkers in an unbiased principal component analysis which identified a single factor significantly associated with WMH. This single factor was strongly correlated with the six component ICS identified in the first cohort and was associated with WMH in a generalized linear regression model adjusted for age and gender (p = 0.027) but not acute stroke. A network of inflammatory molecules driven by IL-18 is associated with overt and antecedent white matter injury resulting from cerebrovascular disease and may be a promising peripheral biomarker for vascular white matter injury.
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Affiliation(s)
- Marie Altendahl
- Memory & Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, United States of America
| | - Pauline Maillard
- Department of Neurology and Center for Neurosciences, University of California, Davis, CA, United States of America
| | - Danielle Harvey
- Department of Public Health Sciences, University of California, Davis, CA, United States of America
| | - Devyn Cotter
- Memory & Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, United States of America
| | - Samantha Walters
- Memory & Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, United States of America
| | - Amy Wolf
- Memory & Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, United States of America
| | - Baljeet Singh
- Department of Neurology and Center for Neurosciences, University of California, Davis, CA, United States of America
| | - Visesha Kakarla
- Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America
| | - Ida Azizkhanian
- School of Medicine, New York Medical College, Vahalla, NY, United States of America
| | - Sunil A. Sheth
- University of Texas Health McGovern School of Medicine, Department of Neurology, Houston, TX, United States of America
| | - Guanxi Xiao
- Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America
| | - Emily Fox
- Memory & Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, United States of America
| | - Michelle You
- Memory & Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, United States of America
| | - Mei Leng
- Department of Medicine Statistics Core, Department of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America
| | - David Elashoff
- Department of Medicine Statistics Core, Department of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America
| | - Joel H. Kramer
- Memory & Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, United States of America
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, United States of America
| | - Charlie Decarli
- Department of Neurology and Center for Neurosciences, University of California, Davis, CA, United States of America
| | - Fanny Elahi
- Memory & Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, United States of America
| | - Jason D. Hinman
- Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America
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Ohyama K, Watanabe M, Nosaki Y, Hara T, Iwai K, Mokuno K. Correlation Between Skeletal Muscle Mass Deficit and Poor Functional Outcome in Patients with Acute Ischemic Stroke. J Stroke Cerebrovasc Dis 2020; 29:104623. [PMID: 31952978 DOI: 10.1016/j.jstrokecerebrovasdis.2019.104623] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 11/28/2019] [Accepted: 12/22/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND AND AIMS To date, the correlation between sarcopenia, which exists before a stroke, and acute stroke outcome remains partially understood. This study aims to evaluate the skeletal muscle mass deficit using the bioelectrical impedance analysis in patients with acute ischemic stroke. METHODS We enrolled 164 geriatric patients with acute ischemic stroke (108 males and 56 females) who underwent the bioelectrical impedance analysis. We evaluated clinical outcomes and their impact on patients with the skeletal muscle mass deficit determined using the skeletal muscle mass index. RESULTS The skeletal muscle mass deficit was obtained using the bioelectrical impedance analysis in 101 patients. Patients with the skeletal muscle mass deficit determined by the skeletal muscle mass index exhibited severe neurological impairment and functional status on admission; moreover, they tended to display poor functional outcome and prolonged hospital stay. Logistic regression analysis revealed that the skeletal muscle mass deficit remained an independent poor outcome predictor. CONCLUSIONS This study establishes the presence of the skeletal muscle mass deficit in over half patients with acute ischemic stroke. Furthermore, the skeletal muscle mass deficit correlates with neurological impairment owing to stroke with poorer functional prognosis.
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Affiliation(s)
- Ken Ohyama
- Department of Neurology, Toyohashi Municipal Hospital, Toyohashi, Japan.
| | - Maki Watanabe
- Department of Neurology, Toyohashi Municipal Hospital, Toyohashi, Japan
| | - Yasunobu Nosaki
- Department of Neurology, Toyohashi Municipal Hospital, Toyohashi, Japan
| | - Takashi Hara
- Department of Neurology, Toyohashi Municipal Hospital, Toyohashi, Japan
| | - Katsushige Iwai
- Department of Neurology, Toyohashi Municipal Hospital, Toyohashi, Japan
| | - Kenji Mokuno
- Department of Neurology, Toyohashi Municipal Hospital, Toyohashi, Japan
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47
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Wang P, Fan J, Yuan L, Nan Y, Nan S. Serum Neurofilament Light Predicts Severity and Prognosis in Patients with Ischemic Stroke. Neurotox Res 2020; 37:987-995. [PMID: 31898161 DOI: 10.1007/s12640-019-00159-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 12/12/2019] [Accepted: 12/22/2019] [Indexed: 12/13/2022]
Abstract
Serum neurofilaments are markers of axonal injury. We investigated whether serum neurofilament light (sNfL) is a potential prognostic marker of functional outcome in Chinese patients with acute ischemic stroke (AIS). From May 2015 to December 2018, consecutive patients with AIS from the Department of Neurology of the Second Hospital of Jilin University were included. sNfL concentration was tested at baseline, and stroke severity was analyzed at admission using the NIHSS score. Functional outcome was assessed at discharge by the modified Rankin scale (mRS). The sNfL concentration was tested in 343 patients with a median value of 17.8 (IQR, 13.4-25.2) pg/ml. sNfL concentration paralleled lesion size (P = 0.035). At admission, 174 patients were defined as moderate-to-high stroke (NIHSS ≥ 5); the sNfL concentration in those patients were higher than that observed in patients with minor clinical severity [21.2 (IQR, 15.1-31.7) vs. 14.9 (11.8-19.4) pg/ml, P < 0.001]. For each 1 quartile increase of sNfL concentration, the unadjusted and adjusted risk of moderate-to-high stroke increased by 202% (with the OR of 3.04 (95% CI 2.15-4.32), P < 0.001) and 102% [2.02 (1.10-3.16), P = 0.001), respectively. At discharge, 85 patients (24.8%) had poor functional outcome (mRS, 3-6); the sNfL concentration in those patients were higher than that observed in patients with good outcome [24.1 (IQR, 18.8-33.9) vs. 15.7 (11.9-21.8) pg/ml, P < 0.001]. For each 1 quartile increase of sNfL concentration, the unadjusted and adjusted risk of poor outcome increased by 236% [with the OR of 3.36 (95% CI 2.23-5.06), P < 0.001] and 102% [2.29 (1.37-3.82), P < 0.001], respectively. The results show sNfL is meaningful blood biomarker to monitor stroke severity and functional outcome in ischemic stroke, suggesting that sNfL may play a role in stroke progression.
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Affiliation(s)
- Peng Wang
- Department of Neurology, The Second Hospital of Jilin University, No.218, Ziqiang Street, Nanguan District, Changchun, 130041, Jilin Province, People's Republic of China
| | - Jia Fan
- Department of Neurology, The Second Hospital of Jilin University, No.218, Ziqiang Street, Nanguan District, Changchun, 130041, Jilin Province, People's Republic of China
| | - Ling Yuan
- Pharmacy College of Ningxia Medical University, Yinchuan, Ningxia, People's Republic of China
| | - Yi Nan
- Traditional Chinese Medicine College of Ningxia Medical University, Yinchuan, Ningxia, People's Republic of China
| | - Shanji Nan
- Department of Neurology, The Second Hospital of Jilin University, No.218, Ziqiang Street, Nanguan District, Changchun, 130041, Jilin Province, People's Republic of China.
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IL-1α and IL-6 predict vascular events or death in patients with cerebral small vessel disease-Data from the SHEF-CSVD study. Adv Med Sci 2019; 64:258-266. [PMID: 30844663 DOI: 10.1016/j.advms.2019.02.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 09/02/2018] [Accepted: 02/21/2019] [Indexed: 11/20/2022]
Abstract
PURPOSE The natural clinical course of cerebral small vessel disease (CSVD) was not thoroughly described. The aim of this single center cohort study was to establish biochemical predictors of vascular events and death in CSVD patients during a 24-month follow-up. PATIENTS AND METHODS A total of 130 functionally independent patients with marked MRI features of CSVD and recent lacunar stroke (n = 52,LS), vascular Parkinsonism (n = 28,VaP) or dementia (n = 50,VaD) were prospectively recruited. Serum markers of endothelial dysfunction, inflammation and hemostasis were determined at baseline. The primary outcome was defined as occurrence of death or any vascular events during the observation. RESULTS The mean age was 72 ± 8.1 years, and 37.6% of the patients were women. The mean follow-up time was 22.3 ± 4.3 months, and 84.6% of patients had extensive white matter lesions on baseline MRI. The overall mortality rate was 6.9%, and vascular events or death occurred in 27% of the patients. Kaplan-Meier survival curves revealed no significant differences between CSVD groups (log rank p = 0.49). Cox regression analysis revealed that IL-1α (HR 1.4; 95%CI 1.09-1.8), IL-6 (1.4;1.1-2.2), hs-CRP (1.1;1.06-1.9), homocysteine (1.4;1.1-1.8), fibrinogen (1.4;1.05-2), and d-dimer (2.7;1.6-4.5) were significantly associated with the primary outcome. IL-1α (1.3;1.07-1.8), IL-6 (1.4;1.02-2.2), d-dimer (2.8;1.6-5) and homocysteine (1.4;1.1-1.8) remained significant after adjusting for age, sex and CSVD radiological markers. CONCLUSIONS Our study demonstrated the important prognostic role of various circulation markers of inflammation in individuals with different clinical signs and radiological markers of CSVD. The strongest association occurred between IL-1α, IL-6 and recurrent stroke, other vascular events and death.
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Shi K, Tian DC, Li ZG, Ducruet AF, Lawton MT, Shi FD. Global brain inflammation in stroke. Lancet Neurol 2019; 18:1058-1066. [PMID: 31296369 DOI: 10.1016/s1474-4422(19)30078-x] [Citation(s) in RCA: 430] [Impact Index Per Article: 86.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 02/11/2019] [Accepted: 02/11/2019] [Indexed: 01/21/2023]
Abstract
Stroke, including acute ischaemic stroke and intracerebral haemorrhage, results in neuronal cell death and the release of factors such as damage-associated molecular patterns (DAMPs) that elicit localised inflammation in the injured brain region. Such focal brain inflammation aggravates secondary brain injury by exacerbating blood-brain barrier damage, microvascular failure, brain oedema, oxidative stress, and by directly inducing neuronal cell death. In addition to inflammation localised to the injured brain region, a growing body of evidence suggests that inflammatory responses after a stroke occur and persist throughout the entire brain. Global brain inflammation might continuously shape the evolving pathology after a stroke and affect the patients' long-term neurological outcome. Future efforts towards understanding the mechanisms governing the emergence of so-called global brain inflammation would facilitate modulation of this inflammation as a potential therapeutic strategy for stroke.
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Affiliation(s)
- Kaibin Shi
- Tianjin Medical University General Hospital, Tianjin, China; Department of Neurology, and Department of Neurosurgery, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - De-Cai Tian
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Tianjin Medical University General Hospital, Tianjin, China
| | - Zhi-Guo Li
- Tianjin Medical University General Hospital, Tianjin, China
| | - Andrew F Ducruet
- Department of Neurology, and Department of Neurosurgery, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Michael T Lawton
- Department of Neurology, and Department of Neurosurgery, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Fu-Dong Shi
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Tianjin Medical University General Hospital, Tianjin, China.
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Mengel A, Ulm L, Hotter B, Harms H, Piper SK, Grittner U, Montaner J, Meisel C, Meisel A, Hoffmann S. Biomarkers of immune capacity, infection and inflammation are associated with poor outcome and mortality after stroke - the PREDICT study. BMC Neurol 2019; 19:148. [PMID: 31269910 PMCID: PMC6607590 DOI: 10.1186/s12883-019-1375-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 06/23/2019] [Indexed: 02/20/2023] Open
Abstract
Background Almost 40% of stroke patients have a poor outcome at 3 months after the index event. Predictors for stroke outcome in the early acute phase may help to tailor stroke treatment. Infection and inflammation are considered to influence stroke outcome. Methods In a prospective multicenter study in Germany and Spain, including 486 patients with acute ischemic stroke, we used multivariable regression analysis to investigate the association of poor outcome with monocytic HLA-DR (mHLA-DR) expression, interleukin 6 (IL-6), interleukin 10 (IL-10), tumor necrosis factor alpha (TNF-alpha) and lipopolysaccharide-binding protein (LBP) as markers for immunodepression, inflammation and infection. Outcome was assessed at 3 months after stroke via a structured telephone interview using the modified Rankin Scale (mRS). Poor outcome was defined as a mRS score of 3 or higher which included death. Furthermore, a time-to-event analysis for death within 3 months was performed. Results Three-month outcome data was available for 391 patients. Female sex, older age, diabetes mellitus, atrial fibrillation, stroke-associated pneumonia (SAP) and higher National Institute of Health Stroke Scale (NIHSS) score as well as lower mHLA-DR levels, higher IL-6 and LBP-levels at day 1 were associated with poor outcome at 3 months in bivariate analysis. Furthermore, multivariable analysis revealed that lower mHLA-DR expression was associated with poor outcome. Female sex, older age, atrial fibrillation, SAP, higher NIHSS score, lower mHLA-DR expression and higher IL-6 levels were associated with shorter survival time in bivariate analysis. In multivariable analysis, SAP and higher IL-6 levels on day 1 were associated with shorter survival time. Conclusions SAP, lower mHLA-DR-expression and higher IL-6 levels on day one are associated with poor outcome and shorter survival time at 3 months after stroke onset. Trial registration www.clinicaltrials.gov, NCT01079728, March 3, 2010.
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Affiliation(s)
- A Mengel
- Department of Neurology Berlin, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10115, Berlin, Germany. .,Department of Neurology and Stroke, Universitätsklinik Tuebingen, Hoppe-Seyler-Str.3, 72076, Tuebingen, Germany.
| | - L Ulm
- Department of Neurology Berlin, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10115, Berlin, Germany.,Center for Clinical Research, The University of Queensland, Herston, Queensland, 4029, Australia
| | - B Hotter
- Department of Neurology Berlin, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10115, Berlin, Germany.,Center for Stroke Research Berlin, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10115, Berlin, Germany
| | - H Harms
- Department of Neurology Berlin, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10115, Berlin, Germany
| | - S K Piper
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin Institute of Health, Charitéplatz 1, D-10117, Berlin, Germany.,Berlin Institute of Health (BIH), Anna-Louisa-Karsch 2, 10178, Berlin, Germany
| | - U Grittner
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin Institute of Health, Charitéplatz 1, D-10117, Berlin, Germany.,Berlin Institute of Health (BIH), Anna-Louisa-Karsch 2, 10178, Berlin, Germany
| | - J Montaner
- Neurovascular Research Laboratory, Vall d'Hebron Institut de Recerca, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - C Meisel
- NeuroCure Clinical Research Center Berlin, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10115, Berlin, Germany
| | - A Meisel
- Department of Neurology Berlin, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10115, Berlin, Germany.,Center for Stroke Research Berlin, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10115, Berlin, Germany.,NeuroCure Clinical Research Center Berlin, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10115, Berlin, Germany
| | - S Hoffmann
- Department of Neurology Berlin, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10115, Berlin, Germany.,NeuroCure Clinical Research Center Berlin, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10115, Berlin, Germany
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