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Li W, Wang S, Liu L, Chen J, Lan J, Ding J, Chen Z, Yuan S, Qi Z, Wei M, Ji X. Normobaric Hyperoxia Combined With Endovascular Treatment Based on Temporal Gradient: A Dose-Escalation Study. Stroke 2024; 55:1468-1476. [PMID: 38747162 DOI: 10.1161/strokeaha.123.046106] [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: 12/05/2023] [Accepted: 03/28/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND Normobaric hyperoxia (NBO) has neuroprotective effects in acute ischemic stroke. Thus, we aimed to identify the optimal NBO treatment duration combined with endovascular treatment. METHODS This is a single-center, randomized controlled, open-label, blinded-end point dose-escalation clinical trial. Patients with acute ischemic stroke who had an indication for endovascular treatment at Tianjin Huanhu Hospital were randomly assigned to 4 groups (1:1 ratio) based on NBO therapy duration: (1) control group (1 L/min oxygen for 4 hours); (2) NBO-2h group (10 L/min for 2 hours); (3) NBO-4h group (10 L/min for 4 hours); and (4) NBO-6h group (10 L/min for 6 hours). The primary outcome was cerebral infarction volume at 72 hours after randomization using an intention-to-treat analysis model. The primary safety outcome was the 90-day mortality rate. RESULTS Between June 2022 and September 2023, 100 patients were randomly assigned to the following groups: control group (n=25), NBO-2h group (n=25), NBO-4h group (n=25), and NBO-6h group (n=25). The 72-hour cerebral infarct volumes were 39.4±34.3 mL, 30.6±30.1 mL, 19.7±15.4 mL, and 22.6±22.4 mL, respectively (P=0.013). The NBO-4h and NBO-6h groups both showed statistically significant differences (adjusted P values: 0.011 and 0.027, respectively) compared with the control group. Compared with the control group, both the NBO-4h and NBO-6h groups showed significant differences (P<0.05) in the National Institutes of Health Stroke Scale scores at 24 hours, 72 hours, and 7 days, as well as in the change of the National Institutes of Health Stroke Scale scores from baseline to 24 hours. Additionally, there were no significant differences among the 4 groups in terms of 90-day mortality rate, symptomatic intracranial hemorrhage, early neurological deterioration, or severe adverse events. CONCLUSIONS The effectiveness of NBO therapy was associated with oxygen administration duration. Among patients with acute ischemic stroke who underwent endovascular treatment, NBO therapy for 4 and 6 hours was found to be more effective. Larger-scale multicenter studies are needed to validate these findings. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT05404373.
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Affiliation(s)
- Weili Li
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China (W.L.)
- Beijing Institute of Brain Disorders, Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders (W.L., J.L., M.W., X.J.)
| | - Sifei Wang
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, China (S.W.)
- Department of Neurosurgery, Tianjin Huanhu Hospital, China (S.W., M.W.)
| | - Lan Liu
- School of Statistics, University of Minnesota at Twin Cities, Minneapolis (L.L.)
| | | | - Jing Lan
- Beijing Institute of Brain Disorders, Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders (W.L., J.L., M.W., X.J.)
| | - Jiayue Ding
- Department of Neurology, Tianjin Medical University General Hospital, China (J.D.)
| | - Zhiying Chen
- Department of Neurology, Jiujiang University Affiliated Hospital, China (Z.C.)
| | - Shuhua Yuan
- Cerebrovascular Diseases Research Institute, Xuanwu Hospital (S.Y., Z.Q.), Capital Medical University, Beijing, China
| | - Zhifeng Qi
- Cerebrovascular Diseases Research Institute, Xuanwu Hospital (S.Y., Z.Q.), Capital Medical University, Beijing, China
| | - Ming Wei
- Beijing Institute of Brain Disorders, Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders (W.L., J.L., M.W., X.J.)
- Department of Neurosurgery, Tianjin Huanhu Hospital, China (S.W., M.W.)
| | - Xunming Ji
- Beijing Institute of Brain Disorders, Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders (W.L., J.L., M.W., X.J.)
- Department of Neurosurgery, Xuanwu Hospital (X.J.), Capital Medical University, Beijing, China
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Aliena-Valero A, Hernández-Jiménez M, López-Morales MA, Tamayo-Torres E, Castelló-Ruiz M, Piñeiro D, Ribó M, Salom JB. Cerebroprotective Effects of the TLR4-Binding DNA Aptamer ApTOLL in a Rat Model of Ischemic Stroke and Thrombectomy Recanalization. Pharmaceutics 2024; 16:741. [PMID: 38931862 PMCID: PMC11206667 DOI: 10.3390/pharmaceutics16060741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 05/22/2024] [Accepted: 05/28/2024] [Indexed: 06/28/2024] Open
Abstract
ApTOLL, a TLR4 modulator aptamer, has demonstrated cerebroprotective effects in a permanent ischemic stroke mouse model, as well as safety and efficacy in early phase clinical trials. We carried out reverse translation research according to STAIR recommendations to further characterize the effects and mechanisms of ApTOLL after transient ischemic stroke in rats and to better inform the design of pivotal clinical trials. Adult male rats subjected to transient middle cerebral artery occlusion were treated either with ApTOLL or the vehicle intravenously at different doses and time-points. ApTOLL was compared with TAK-242 (a TLR4 inhibitor). Female rats were also studied. After neurofunctional evaluation, brains were removed for infarct/edema volume, hemorrhagic transformation, and histologic determinations. Peripheral leukocyte populations were assessed via flow cytometry. ApTOLL showed U-shaped dose-dependent cerebroprotective effects. The maximum effective dose (0.45 mg/kg) was cerebroprotective when given both before reperfusion and up to 12 h after reperfusion and reduced the hemorrhagic risk. Similar effects occurred in female rats. Both research and clinical ApTOLL batches induced slightly superior cerebroprotection when compared with TAK-242. Finally, ApTOLL modulated circulating leukocyte levels, reached the brain ischemic tissue to bind resident and infiltrated cell types, and reduced the neutrophil density. These results show the cerebroprotective effects of ApTOLL in ischemic stroke by reducing the infarct/edema volume, neurofunctional impairment, and hemorrhagic risk, as well as the peripheral and local immune response. They provide information about ApTOLL dose effects and its therapeutic time window and target population, as well as its mode of action, which should be considered in the design of pivotal clinical trials.
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Affiliation(s)
- Alicia Aliena-Valero
- Unidad Mixta de Investigación Cerebrovascular, Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain; (A.A.-V.); (M.A.L.-M.); (M.C.-R.)
| | - Macarena Hernández-Jiménez
- AptaTargets S.L., 28035 Madrid, Spain; (D.P.); (M.R.)
- Departamento de Farmacología y Toxicología, Facultad de Medicina, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Mikahela A. López-Morales
- Unidad Mixta de Investigación Cerebrovascular, Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain; (A.A.-V.); (M.A.L.-M.); (M.C.-R.)
- Departamento de Fisioterapia, Universidad de Valencia, 46010 Valencia, Spain
| | - Eva Tamayo-Torres
- Departamento de Fisiología, Universidad de Valencia, 46010 Valencia, Spain;
| | - María Castelló-Ruiz
- Unidad Mixta de Investigación Cerebrovascular, Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain; (A.A.-V.); (M.A.L.-M.); (M.C.-R.)
- Departamento de Biología Celular, Biología Funcional y Antropología Física, Universidad de Valencia, 46100 Valencia, Spain
| | - David Piñeiro
- AptaTargets S.L., 28035 Madrid, Spain; (D.P.); (M.R.)
| | - Marc Ribó
- AptaTargets S.L., 28035 Madrid, Spain; (D.P.); (M.R.)
- Unidad de Ictus, Departamento de Neurología, Hospital Vall d’Hebron, 08035 Barcelona, Spain
| | - Juan B. Salom
- Unidad Mixta de Investigación Cerebrovascular, Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain; (A.A.-V.); (M.A.L.-M.); (M.C.-R.)
- Departamento de Fisiología, Universidad de Valencia, 46010 Valencia, Spain;
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Wang C, Gu HQ, Dong Q, Xu A, Wang N, Yang Y, Wang F, Wang Y. Rationale and design of Treatment of Acute Ischaemic Stroke with Edaravone Dexborneol II (TASTE-2): a multicentre randomised controlled trial. Stroke Vasc Neurol 2024:svn-2023-002938. [PMID: 38471696 DOI: 10.1136/svn-2023-002938] [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: 10/20/2023] [Accepted: 02/07/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Edaravone dexborneol is believed to be a novel cytoprotective drug, demonstrating a synergistic combination of antioxidative and anti-inflammatory properties in animal models. The Treatment of Acute Ischaemic Stroke with Edaravone Dexborneol (TASTE) trial demonstrated its superior efficacy over edaravone alone for acute ischaemic stroke (AIS) patients. However, its efficacy in individuals undergoing endovascular therapy (EVT) remains uncertain. AIM To clarify the rationale and design of the TASTE II (TASTE-2) trial. DESIGN The TASTE-2 is a multicentre, double-blind, randomised, placebo-controlled trial designed to evaluate the efficacy and safety of edaravone dexborneol in patients with AIS and large-vessel occlusion in the anterior circulation. The eligible participants, presenting with a National Institute of Health Stroke Scale score between 6 and 25 (range 0-42, with larger values suggesting severe neurological dysfunction) and an Alberta Stroke Program Early Computed Tomography Score ranging from 6 to 10 (range 0-10, with smaller values suggesting larger infarction) within the initial 24 hours after symptom onset, will be randomly allocated to either the edaravone dexborneol group or the placebo group in equal proportions prior to thrombectomy. The treatment will be continuously administered for a duration of 10-14 days. A follow-up period of 90 days will be implemented for all participants. STUDY OUTCOMES The primary efficacy outcome is defined as achieving favourable functional independence, measured by a modified Rankin Scale of 0-2 at 90 days. The primary safety outcome focuses on the incidence of serious adverse events. DISCUSSION The TASTE-2 trial will provide evidence to determine whether the administration of edaravone dexborneol in AIS patients undergoing EVT could yield significant improvements in neurological function.
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Affiliation(s)
- Chunjuan Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hong-Qiu Gu
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Qiang Dong
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, Shanghai, China
| | - Anding Xu
- Department of Neurology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Ning Wang
- Department of Neurology, The First Affiliated Hospital, Institute of Neuroscience, Fujian Medical University, Fuzhou, China
| | - Yi Yang
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Feng Wang
- State Key Laboratory of Neurology and Oncology Drug Development, Nanjing, China
| | - Yongjun Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Beijing, China
- Chinese Institute for Brain Research, Beijing, China
- Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, China
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Li X, Lu L, Min Y, Fu X, Guo K, Yang W, Li H, Xu H, Guo H, Huang Z. Efficacy and safety of hyperbaric oxygen therapy in acute ischaemic stroke: a systematic review and meta-analysis. BMC Neurol 2024; 24:55. [PMID: 38308217 PMCID: PMC10837997 DOI: 10.1186/s12883-024-03555-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 01/29/2024] [Indexed: 02/04/2024] Open
Abstract
OBJECTIVE This study aims to evaluate the efficacy and safety of adjunctive hyperbaric oxygen therapy (HBOT) in acute ischaemic stroke (AIS) based on existing evidence. METHODS We conducted a comprehensive search through April 15, 2023, of seven major databases for randomized controlled trials (RCTs) comparing adjunctive hyperbaric HBOT with non-HBOT (no HBOT or sham HBOT) treatments for AIS. Data extraction and assessment were independently performed by two researchers. The quality of included studies was evaluated using the tool provided by the Cochrane Collaboration. Meta-analysis was conducted using Rev Man 5.3. RESULTS A total of 8 studies involving 493 patients were included. The meta-analysis showed no statistically significant differences between HBOT and the control group in terms of NIHSS score (MD = -1.41, 95%CI = -7.41 to 4.58), Barthel index (MD = 8.85, 95%CI = -5.84 to 23.54), TNF-α (MD = -5.78, 95%CI = -19.93 to 8.36), sICAM (MD = -308.47, 95%CI = -844.13 to 13227.19), sVCAM (MD = -122.84, 95%CI = -728.26 to 482.58), sE-selectin (MD = 0.11, 95%CI = -21.86 to 22.08), CRP (MD = -5.76, 95%CI = -15.02 to 3.51), adverse event incidence within ≤ 6 months of follow-up (OR = 0.98, 95%CI = 0.25 to 3.79). However, HBOT showed significant improvement in modified Rankin score (MD = 0.10, 95%CI = 0.03 to 0.17), and adverse event incidence at the end of treatment (OR = 0.42, 95%CI = 0.19 to 0.94) compared to the control group. CONCLUSION While our findings do not support the routine use of HBOT for improving clinical outcomes in AIS, further research is needed to explore its potential efficacy within specific therapeutic windows and for different cerebral occlusion scenarios. Therefore, the possibility of HBOT offering clinical benefits for AIS cannot be entirely ruled out.
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Affiliation(s)
- Xuezheng Li
- Postgraduate cultivation base of Guangzhou University of Chinese Medicine, Panyu Central Hospital, Guangzhou Guangdong, China
| | - Lijun Lu
- Postgraduate cultivation base of Guangzhou University of Chinese Medicine, Panyu Central Hospital, Guangzhou Guangdong, China
| | - Yu Min
- Postgraduate cultivation base of Guangzhou University of Chinese Medicine, Panyu Central Hospital, Guangzhou Guangdong, China
- Department of Rehabilitation Medicine, Guangzhou Panyu Central Hospital, No. 8, Fuyu East Road, South Bridge Street, Panyu District, Guangzhou, China
| | - Xuefeng Fu
- Postgraduate cultivation base of Guangzhou University of Chinese Medicine, Panyu Central Hospital, Guangzhou Guangdong, China
| | - Kaifeng Guo
- Department of Rehabilitation Medicine, Guangzhou Panyu Central Hospital, No. 8, Fuyu East Road, South Bridge Street, Panyu District, Guangzhou, China
| | - Wen Yang
- Postgraduate cultivation base of Guangzhou University of Chinese Medicine, Panyu Central Hospital, Guangzhou Guangdong, China
| | - Hao Li
- Postgraduate cultivation base of Guangzhou University of Chinese Medicine, Panyu Central Hospital, Guangzhou Guangdong, China
| | - Haoming Xu
- South China Normal University, Guangzhou Guangdong, China
| | - Hua Guo
- Department of Rehabilitation Medicine, Guangzhou Panyu Central Hospital, No. 8, Fuyu East Road, South Bridge Street, Panyu District, Guangzhou, China
| | - Zhen Huang
- Department of Rehabilitation Medicine, Guangzhou Panyu Central Hospital, No. 8, Fuyu East Road, South Bridge Street, Panyu District, Guangzhou, China.
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Fladt J, Guo J, Specht JL, Wang M, Chan LL, Mctaggart R, Buck BH, Aviv R, Swartz RH, Field TS, Tarpley J, Shah R, Goyal M, Tymianski M, Hill MD, Demchuk A, d'Esterre C, Barber P. Infarct Evolution on MR-DWI After Thrombectomy in Acute Stroke Patients Randomized to Nerinetide or Placebo: The REPERFUSE-NA1 Study. Neurology 2024; 102:e207976. [PMID: 38165335 DOI: 10.1212/wnl.0000000000207976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 09/27/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND AND OBJECTIVES The neuroprotectant nerinetide has shown promise in reducing infarct volumes in primate models of ischemia reperfusion. We hypothesized that early secondary infarct growth after endovascular therapy (EVT) (1) may be a suitable surrogate biomarker for testing neuroprotective compounds, (2) is feasible to assess in the acute setting using sequential MRI, and (3) can be modified by treatment with nerinetide. METHODS REPERFUSE-NA1 was a prospective, multisite MRI substudy of the randomized controlled trial ESCAPE-NA1 (ClinicalTrials.gov NCT02930018) that involved patients with acute disabling large vessel occlusive stroke undergoing EVT within 12 hours of onset who were randomized to receive intravenous nerinetide or placebo. Patients enrolled in REPERFUSE-NA1 underwent sequential MRI <5 hours post-EVT (day 1) and at 24 hours (day 2). The primary outcome was total diffusion-weighted MRI infarct growth early after EVT, defined as the lesion volume difference between day 2 and day 1. The secondary outcome was region-specific infarct growth in different brain tissue compartments. Statistical analyses were performed using the Mann-Whitney U test and multiple linear regression. RESULTS Sixty-seven of 71 patients included had MRI of sufficient quality. The median infarct volume post-EVT was 12.98 mL (IQR, 5.93-28.08) in the nerinetide group and 10.80 mL (IQR, 3.11-24.45) in the control group (p = 0.59). Patients receiving nerinetide showed a median early secondary infarct growth of 5.92 mL (IQR, 1.09-21.30) compared with 10.80 mL (interquartile range [IQR], 2.54-21.81) in patients with placebo (p = 0.30). Intravenous alteplase modified the effect of nerinetide on region-specific infarct growth in white matter and basal ganglia compartments. In patients with no alteplase, the infarct growth rate was reduced by 120% (standard error [SE], 60%) in the white matter (p = 0.03) and by 340% (SE, 140%) in the basal ganglia (p = 0.02) in the nerinetide group compared with placebo after adjusting for confounders. DISCUSSION This study highlights the potential of using MR imaging as a biomarker to estimate the effect of a neuroprotective agent in acute stroke treatment. Patients with acute large vessel occlusive stroke exhibited appreciable early infarct growth both in the gray matter and the white matter after undergoing EVT. Acknowledging relatively small overall infarct volumes in this study, treatment with nerinetide was associated with slightly reduced percentage infarct growth in the white matter and basal ganglia compared with placebo in patients not receiving intravenous alteplase and had no effect on the total early secondary infarct growth. TRIAL REGISTRATION INFORMATION ClinicalTrials.gov NCT02930018. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that for patients with acute large vessel ischemic stroke undergoing EVT, nerinetide did not significantly decrease early post-EVT infarct growth compared with placebo.
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Affiliation(s)
- Joachim Fladt
- From the Calgary Stroke Program (J.F., J.G., J.L.S., M.W., L.L.C., M.G., M.D.H., A.D., C.E., P.B.), Departments of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary,Canada; Stroke Center and Department of Neurology (J.F.), University Hospital Basel and University of Basel, Switzerland; Department of Neurology and Neurosurgery (R.M.), Rhode Island Medical Imaging, Providence, RI; Division of Neurology (B.H.B.), University of Alberta, Edmonton; Department of Radiology (R.A.), Radiation Oncology and Medical Physics, University of Ottawa, The Ottawa Hospital; Department of Medical Imaging (R.H.S.), University of Toronto, Sunnybrook Health Sciences Centre; Vancouver Stroke Program (T.S.F.), University of British Columbia, Canada; Pacific Neuroscience Institute (J.T.), Providence Little Company of Mary Medical Center, Torrance, CA; and UT Erlanger Neurology (R.S.), Chattanooga, TN; NoNO Inc (M.T.), Toronto, Canada
| | - Jen Guo
- From the Calgary Stroke Program (J.F., J.G., J.L.S., M.W., L.L.C., M.G., M.D.H., A.D., C.E., P.B.), Departments of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary,Canada; Stroke Center and Department of Neurology (J.F.), University Hospital Basel and University of Basel, Switzerland; Department of Neurology and Neurosurgery (R.M.), Rhode Island Medical Imaging, Providence, RI; Division of Neurology (B.H.B.), University of Alberta, Edmonton; Department of Radiology (R.A.), Radiation Oncology and Medical Physics, University of Ottawa, The Ottawa Hospital; Department of Medical Imaging (R.H.S.), University of Toronto, Sunnybrook Health Sciences Centre; Vancouver Stroke Program (T.S.F.), University of British Columbia, Canada; Pacific Neuroscience Institute (J.T.), Providence Little Company of Mary Medical Center, Torrance, CA; and UT Erlanger Neurology (R.S.), Chattanooga, TN; NoNO Inc (M.T.), Toronto, Canada
| | - Jacinta L Specht
- From the Calgary Stroke Program (J.F., J.G., J.L.S., M.W., L.L.C., M.G., M.D.H., A.D., C.E., P.B.), Departments of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary,Canada; Stroke Center and Department of Neurology (J.F.), University Hospital Basel and University of Basel, Switzerland; Department of Neurology and Neurosurgery (R.M.), Rhode Island Medical Imaging, Providence, RI; Division of Neurology (B.H.B.), University of Alberta, Edmonton; Department of Radiology (R.A.), Radiation Oncology and Medical Physics, University of Ottawa, The Ottawa Hospital; Department of Medical Imaging (R.H.S.), University of Toronto, Sunnybrook Health Sciences Centre; Vancouver Stroke Program (T.S.F.), University of British Columbia, Canada; Pacific Neuroscience Institute (J.T.), Providence Little Company of Mary Medical Center, Torrance, CA; and UT Erlanger Neurology (R.S.), Chattanooga, TN; NoNO Inc (M.T.), Toronto, Canada
| | - Meng Wang
- From the Calgary Stroke Program (J.F., J.G., J.L.S., M.W., L.L.C., M.G., M.D.H., A.D., C.E., P.B.), Departments of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary,Canada; Stroke Center and Department of Neurology (J.F.), University Hospital Basel and University of Basel, Switzerland; Department of Neurology and Neurosurgery (R.M.), Rhode Island Medical Imaging, Providence, RI; Division of Neurology (B.H.B.), University of Alberta, Edmonton; Department of Radiology (R.A.), Radiation Oncology and Medical Physics, University of Ottawa, The Ottawa Hospital; Department of Medical Imaging (R.H.S.), University of Toronto, Sunnybrook Health Sciences Centre; Vancouver Stroke Program (T.S.F.), University of British Columbia, Canada; Pacific Neuroscience Institute (J.T.), Providence Little Company of Mary Medical Center, Torrance, CA; and UT Erlanger Neurology (R.S.), Chattanooga, TN; NoNO Inc (M.T.), Toronto, Canada
| | - Leona L Chan
- From the Calgary Stroke Program (J.F., J.G., J.L.S., M.W., L.L.C., M.G., M.D.H., A.D., C.E., P.B.), Departments of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary,Canada; Stroke Center and Department of Neurology (J.F.), University Hospital Basel and University of Basel, Switzerland; Department of Neurology and Neurosurgery (R.M.), Rhode Island Medical Imaging, Providence, RI; Division of Neurology (B.H.B.), University of Alberta, Edmonton; Department of Radiology (R.A.), Radiation Oncology and Medical Physics, University of Ottawa, The Ottawa Hospital; Department of Medical Imaging (R.H.S.), University of Toronto, Sunnybrook Health Sciences Centre; Vancouver Stroke Program (T.S.F.), University of British Columbia, Canada; Pacific Neuroscience Institute (J.T.), Providence Little Company of Mary Medical Center, Torrance, CA; and UT Erlanger Neurology (R.S.), Chattanooga, TN; NoNO Inc (M.T.), Toronto, Canada
| | - Ryan Mctaggart
- From the Calgary Stroke Program (J.F., J.G., J.L.S., M.W., L.L.C., M.G., M.D.H., A.D., C.E., P.B.), Departments of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary,Canada; Stroke Center and Department of Neurology (J.F.), University Hospital Basel and University of Basel, Switzerland; Department of Neurology and Neurosurgery (R.M.), Rhode Island Medical Imaging, Providence, RI; Division of Neurology (B.H.B.), University of Alberta, Edmonton; Department of Radiology (R.A.), Radiation Oncology and Medical Physics, University of Ottawa, The Ottawa Hospital; Department of Medical Imaging (R.H.S.), University of Toronto, Sunnybrook Health Sciences Centre; Vancouver Stroke Program (T.S.F.), University of British Columbia, Canada; Pacific Neuroscience Institute (J.T.), Providence Little Company of Mary Medical Center, Torrance, CA; and UT Erlanger Neurology (R.S.), Chattanooga, TN; NoNO Inc (M.T.), Toronto, Canada
| | - Brian H Buck
- From the Calgary Stroke Program (J.F., J.G., J.L.S., M.W., L.L.C., M.G., M.D.H., A.D., C.E., P.B.), Departments of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary,Canada; Stroke Center and Department of Neurology (J.F.), University Hospital Basel and University of Basel, Switzerland; Department of Neurology and Neurosurgery (R.M.), Rhode Island Medical Imaging, Providence, RI; Division of Neurology (B.H.B.), University of Alberta, Edmonton; Department of Radiology (R.A.), Radiation Oncology and Medical Physics, University of Ottawa, The Ottawa Hospital; Department of Medical Imaging (R.H.S.), University of Toronto, Sunnybrook Health Sciences Centre; Vancouver Stroke Program (T.S.F.), University of British Columbia, Canada; Pacific Neuroscience Institute (J.T.), Providence Little Company of Mary Medical Center, Torrance, CA; and UT Erlanger Neurology (R.S.), Chattanooga, TN; NoNO Inc (M.T.), Toronto, Canada
| | - Richard Aviv
- From the Calgary Stroke Program (J.F., J.G., J.L.S., M.W., L.L.C., M.G., M.D.H., A.D., C.E., P.B.), Departments of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary,Canada; Stroke Center and Department of Neurology (J.F.), University Hospital Basel and University of Basel, Switzerland; Department of Neurology and Neurosurgery (R.M.), Rhode Island Medical Imaging, Providence, RI; Division of Neurology (B.H.B.), University of Alberta, Edmonton; Department of Radiology (R.A.), Radiation Oncology and Medical Physics, University of Ottawa, The Ottawa Hospital; Department of Medical Imaging (R.H.S.), University of Toronto, Sunnybrook Health Sciences Centre; Vancouver Stroke Program (T.S.F.), University of British Columbia, Canada; Pacific Neuroscience Institute (J.T.), Providence Little Company of Mary Medical Center, Torrance, CA; and UT Erlanger Neurology (R.S.), Chattanooga, TN; NoNO Inc (M.T.), Toronto, Canada
| | - Richard H Swartz
- From the Calgary Stroke Program (J.F., J.G., J.L.S., M.W., L.L.C., M.G., M.D.H., A.D., C.E., P.B.), Departments of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary,Canada; Stroke Center and Department of Neurology (J.F.), University Hospital Basel and University of Basel, Switzerland; Department of Neurology and Neurosurgery (R.M.), Rhode Island Medical Imaging, Providence, RI; Division of Neurology (B.H.B.), University of Alberta, Edmonton; Department of Radiology (R.A.), Radiation Oncology and Medical Physics, University of Ottawa, The Ottawa Hospital; Department of Medical Imaging (R.H.S.), University of Toronto, Sunnybrook Health Sciences Centre; Vancouver Stroke Program (T.S.F.), University of British Columbia, Canada; Pacific Neuroscience Institute (J.T.), Providence Little Company of Mary Medical Center, Torrance, CA; and UT Erlanger Neurology (R.S.), Chattanooga, TN; NoNO Inc (M.T.), Toronto, Canada
| | - Thalia S Field
- From the Calgary Stroke Program (J.F., J.G., J.L.S., M.W., L.L.C., M.G., M.D.H., A.D., C.E., P.B.), Departments of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary,Canada; Stroke Center and Department of Neurology (J.F.), University Hospital Basel and University of Basel, Switzerland; Department of Neurology and Neurosurgery (R.M.), Rhode Island Medical Imaging, Providence, RI; Division of Neurology (B.H.B.), University of Alberta, Edmonton; Department of Radiology (R.A.), Radiation Oncology and Medical Physics, University of Ottawa, The Ottawa Hospital; Department of Medical Imaging (R.H.S.), University of Toronto, Sunnybrook Health Sciences Centre; Vancouver Stroke Program (T.S.F.), University of British Columbia, Canada; Pacific Neuroscience Institute (J.T.), Providence Little Company of Mary Medical Center, Torrance, CA; and UT Erlanger Neurology (R.S.), Chattanooga, TN; NoNO Inc (M.T.), Toronto, Canada
| | - Jason Tarpley
- From the Calgary Stroke Program (J.F., J.G., J.L.S., M.W., L.L.C., M.G., M.D.H., A.D., C.E., P.B.), Departments of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary,Canada; Stroke Center and Department of Neurology (J.F.), University Hospital Basel and University of Basel, Switzerland; Department of Neurology and Neurosurgery (R.M.), Rhode Island Medical Imaging, Providence, RI; Division of Neurology (B.H.B.), University of Alberta, Edmonton; Department of Radiology (R.A.), Radiation Oncology and Medical Physics, University of Ottawa, The Ottawa Hospital; Department of Medical Imaging (R.H.S.), University of Toronto, Sunnybrook Health Sciences Centre; Vancouver Stroke Program (T.S.F.), University of British Columbia, Canada; Pacific Neuroscience Institute (J.T.), Providence Little Company of Mary Medical Center, Torrance, CA; and UT Erlanger Neurology (R.S.), Chattanooga, TN; NoNO Inc (M.T.), Toronto, Canada
| | - Ruchir Shah
- From the Calgary Stroke Program (J.F., J.G., J.L.S., M.W., L.L.C., M.G., M.D.H., A.D., C.E., P.B.), Departments of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary,Canada; Stroke Center and Department of Neurology (J.F.), University Hospital Basel and University of Basel, Switzerland; Department of Neurology and Neurosurgery (R.M.), Rhode Island Medical Imaging, Providence, RI; Division of Neurology (B.H.B.), University of Alberta, Edmonton; Department of Radiology (R.A.), Radiation Oncology and Medical Physics, University of Ottawa, The Ottawa Hospital; Department of Medical Imaging (R.H.S.), University of Toronto, Sunnybrook Health Sciences Centre; Vancouver Stroke Program (T.S.F.), University of British Columbia, Canada; Pacific Neuroscience Institute (J.T.), Providence Little Company of Mary Medical Center, Torrance, CA; and UT Erlanger Neurology (R.S.), Chattanooga, TN; NoNO Inc (M.T.), Toronto, Canada
| | - Mayank Goyal
- From the Calgary Stroke Program (J.F., J.G., J.L.S., M.W., L.L.C., M.G., M.D.H., A.D., C.E., P.B.), Departments of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary,Canada; Stroke Center and Department of Neurology (J.F.), University Hospital Basel and University of Basel, Switzerland; Department of Neurology and Neurosurgery (R.M.), Rhode Island Medical Imaging, Providence, RI; Division of Neurology (B.H.B.), University of Alberta, Edmonton; Department of Radiology (R.A.), Radiation Oncology and Medical Physics, University of Ottawa, The Ottawa Hospital; Department of Medical Imaging (R.H.S.), University of Toronto, Sunnybrook Health Sciences Centre; Vancouver Stroke Program (T.S.F.), University of British Columbia, Canada; Pacific Neuroscience Institute (J.T.), Providence Little Company of Mary Medical Center, Torrance, CA; and UT Erlanger Neurology (R.S.), Chattanooga, TN; NoNO Inc (M.T.), Toronto, Canada
| | - Michael Tymianski
- From the Calgary Stroke Program (J.F., J.G., J.L.S., M.W., L.L.C., M.G., M.D.H., A.D., C.E., P.B.), Departments of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary,Canada; Stroke Center and Department of Neurology (J.F.), University Hospital Basel and University of Basel, Switzerland; Department of Neurology and Neurosurgery (R.M.), Rhode Island Medical Imaging, Providence, RI; Division of Neurology (B.H.B.), University of Alberta, Edmonton; Department of Radiology (R.A.), Radiation Oncology and Medical Physics, University of Ottawa, The Ottawa Hospital; Department of Medical Imaging (R.H.S.), University of Toronto, Sunnybrook Health Sciences Centre; Vancouver Stroke Program (T.S.F.), University of British Columbia, Canada; Pacific Neuroscience Institute (J.T.), Providence Little Company of Mary Medical Center, Torrance, CA; and UT Erlanger Neurology (R.S.), Chattanooga, TN; NoNO Inc (M.T.), Toronto, Canada
| | - Michael D Hill
- From the Calgary Stroke Program (J.F., J.G., J.L.S., M.W., L.L.C., M.G., M.D.H., A.D., C.E., P.B.), Departments of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary,Canada; Stroke Center and Department of Neurology (J.F.), University Hospital Basel and University of Basel, Switzerland; Department of Neurology and Neurosurgery (R.M.), Rhode Island Medical Imaging, Providence, RI; Division of Neurology (B.H.B.), University of Alberta, Edmonton; Department of Radiology (R.A.), Radiation Oncology and Medical Physics, University of Ottawa, The Ottawa Hospital; Department of Medical Imaging (R.H.S.), University of Toronto, Sunnybrook Health Sciences Centre; Vancouver Stroke Program (T.S.F.), University of British Columbia, Canada; Pacific Neuroscience Institute (J.T.), Providence Little Company of Mary Medical Center, Torrance, CA; and UT Erlanger Neurology (R.S.), Chattanooga, TN; NoNO Inc (M.T.), Toronto, Canada
| | - Andrew Demchuk
- From the Calgary Stroke Program (J.F., J.G., J.L.S., M.W., L.L.C., M.G., M.D.H., A.D., C.E., P.B.), Departments of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary,Canada; Stroke Center and Department of Neurology (J.F.), University Hospital Basel and University of Basel, Switzerland; Department of Neurology and Neurosurgery (R.M.), Rhode Island Medical Imaging, Providence, RI; Division of Neurology (B.H.B.), University of Alberta, Edmonton; Department of Radiology (R.A.), Radiation Oncology and Medical Physics, University of Ottawa, The Ottawa Hospital; Department of Medical Imaging (R.H.S.), University of Toronto, Sunnybrook Health Sciences Centre; Vancouver Stroke Program (T.S.F.), University of British Columbia, Canada; Pacific Neuroscience Institute (J.T.), Providence Little Company of Mary Medical Center, Torrance, CA; and UT Erlanger Neurology (R.S.), Chattanooga, TN; NoNO Inc (M.T.), Toronto, Canada
| | - Christopher d'Esterre
- From the Calgary Stroke Program (J.F., J.G., J.L.S., M.W., L.L.C., M.G., M.D.H., A.D., C.E., P.B.), Departments of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary,Canada; Stroke Center and Department of Neurology (J.F.), University Hospital Basel and University of Basel, Switzerland; Department of Neurology and Neurosurgery (R.M.), Rhode Island Medical Imaging, Providence, RI; Division of Neurology (B.H.B.), University of Alberta, Edmonton; Department of Radiology (R.A.), Radiation Oncology and Medical Physics, University of Ottawa, The Ottawa Hospital; Department of Medical Imaging (R.H.S.), University of Toronto, Sunnybrook Health Sciences Centre; Vancouver Stroke Program (T.S.F.), University of British Columbia, Canada; Pacific Neuroscience Institute (J.T.), Providence Little Company of Mary Medical Center, Torrance, CA; and UT Erlanger Neurology (R.S.), Chattanooga, TN; NoNO Inc (M.T.), Toronto, Canada
| | - Philip Barber
- From the Calgary Stroke Program (J.F., J.G., J.L.S., M.W., L.L.C., M.G., M.D.H., A.D., C.E., P.B.), Departments of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary,Canada; Stroke Center and Department of Neurology (J.F.), University Hospital Basel and University of Basel, Switzerland; Department of Neurology and Neurosurgery (R.M.), Rhode Island Medical Imaging, Providence, RI; Division of Neurology (B.H.B.), University of Alberta, Edmonton; Department of Radiology (R.A.), Radiation Oncology and Medical Physics, University of Ottawa, The Ottawa Hospital; Department of Medical Imaging (R.H.S.), University of Toronto, Sunnybrook Health Sciences Centre; Vancouver Stroke Program (T.S.F.), University of British Columbia, Canada; Pacific Neuroscience Institute (J.T.), Providence Little Company of Mary Medical Center, Torrance, CA; and UT Erlanger Neurology (R.S.), Chattanooga, TN; NoNO Inc (M.T.), Toronto, Canada
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6
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Hernández-Jiménez M, Abad-Santos F, Cotgreave I, Gallego J, Jilma B, Flores A, Jovin TG, Vivancos J, Hernández-Pérez M, Molina CA, Montaner J, Casariego J, Dalsgaard M, Liebeskind DS, Cobo E, Castellanos M, Portela PC, Masjuán J, Moniche F, Tembl JI, Terceño Izaga M, Arenillas JF, Callejas P, Olivot JM, Calviere L, Henon H, Mazighi M, Piñeiro D, Pugliese M, González VM, Moro MA, Garcia-Tornel A, Lizasoain I, Ribo M. Safety and Efficacy of ApTOLL in Patients With Ischemic Stroke Undergoing Endovascular Treatment: A Phase 1/2 Randomized Clinical Trial. JAMA Neurol 2023; 80:779-788. [PMID: 37338893 PMCID: PMC10282959 DOI: 10.1001/jamaneurol.2023.1660] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 03/17/2023] [Indexed: 06/21/2023]
Abstract
Importance ApTOLL is a TLR4 antagonist with proven preclinical neuroprotective effect and a safe profile in healthy volunteers. Objective To assess the safety and efficacy of ApTOLL in combination with endovascular treatment (EVT) for patients with ischemic stroke. Design, Setting, and Participants This phase 1b/2a, double-blind, randomized, placebo-controlled study was conducted at 15 sites in Spain and France from 2020 to 2022. Participants included patients aged 18 to 90 years who had ischemic stroke due to large vessel occlusion and were seen within 6 hours after stroke onset; other criteria were an Alberta Stroke Program Early CT Score of 6 to 10, estimated infarct core volume on baseline computed tomography perfusion of 5 to 70 mL, and the intention to undergo EVT. During the study period, 4174 patients underwent EVT. Interventions In phase 1b, 0.025, 0.05, 0.1, or 0.2 mg/kg of ApTOLL or placebo; in phase 2a, 0.05 or 0.2 mg/kg of ApTOLL or placebo; and in both phases, treatment with EVT and intravenous thrombolysis if indicated. Main Outcomes and Measures The primary end point was the safety of ApTOLL based on death, symptomatic intracranial hemorrhage (sICH), malignant stroke, and recurrent stroke. Secondary efficacy end points included final infarct volume (via MRI at 72 hours), NIHSS score at 72 hours, and disability at 90 days (modified Rankin Scale [mRS] score). Results In phase Ib, 32 patients were allocated evenly to the 4 dose groups. After phase 1b was completed with no safety concerns, 2 doses were selected for phase 2a; these 119 patients were randomized to receive ApTOLL, 0.05 mg/kg (n = 36); ApTOLL, 0.2 mg/kg (n = 36), or placebo (n = 47) in a 1:1:√2 ratio. The pooled population of 139 patients had a mean (SD) age of 70 (12) years, 81 patients (58%) were male, and 58 (42%) were female. The primary end point occurred in 16 of 55 patients (29%) receiving placebo (10 deaths [18.2%], 4 sICH [7.3%], 4 malignant strokes [7.3%], and 2 recurrent strokes [3.6%]); in 15 of 42 patients (36%) receiving ApTOLL, 0.05 mg/kg (11 deaths [26.2%], 3 sICH [7.2%], 2 malignant strokes [4.8%], and 2 recurrent strokes [4.8%]); and in 6 of 42 patients (14%) receiving ApTOLL, 0.2 mg/kg (2 deaths [4.8%], 2 sICH [4.8%], and 3 recurrent strokes [7.1%]). ApTOLL, 0.2 mg/kg, was associated with lower NIHSS score at 72 hours (mean difference log-transformed vs placebo, -45%; 95% CI, -67% to -10%), smaller final infarct volume (mean difference log-transformed vs placebo, -42%; 95% CI, -66% to 1%), and lower degrees of disability at 90 days (common odds ratio for a better outcome vs placebo, 2.44; 95% CI, 1.76 to 5.00). Conclusions and Relevance In acute ischemic stroke, 0.2 mg/kg of ApTOLL administered within 6 hours of onset in combination with EVT was safe and associated with a potential meaningful clinical effect, reducing mortality and disability at 90 days compared with placebo. These preliminary findings await confirmation from larger pivotal trials. Trial Registration ClinicalTrials.gov Identifier: NCT04734548.
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Affiliation(s)
| | - Francisco Abad-Santos
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, Instituto de Investigación Sanitaria La Princesa, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, Madrid, Spain
| | - Ian Cotgreave
- Department of Chemical and Pharmaceutical Safety, Division of Bioeconomy and Health, Research Institutes of Sweden, Södertälje, Sweden
| | | | - Bernd Jilma
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Alan Flores
- Stroke Unit, Hospital Joan XXIII, Tarragona, Spain
| | | | - José Vivancos
- Stroke Unit, Department of Neurology, Hospital La Princesa, Madrid, Spain
| | - María Hernández-Pérez
- Stroke Unit, Department of Neuroscience Hospital Germans Trias I Pujol, Barcelona, Spain
| | - Carlos A. Molina
- Stroke Unit, Department of Neurology, Hospital Vall d’Hebron, Barcelona, Spain
| | - Joan Montaner
- Department of Neurology, Hospital Macarena, Sevilla, Spain
| | | | | | - David S. Liebeskind
- Neurovascular Imaging Research Core, Department of Neurology, UCLA Stroke Center, Los Angeles, California
| | - Erik Cobo
- Statistics and Operations Research, Barcelona-Tech, Barcelona, Spain
| | - Mar Castellanos
- Department of Neurology, Complejo Hospitalario Universitario/Biomedical Research Institute, A Coruña, Spain
| | | | - Jaime Masjuán
- Stroke Unit, Department of Neurology, Ramón y Cajal University Hospital, Departamento de Medicina, Facultad de Medicina, Universidad de Alcalá, Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain
| | - Francisco Moniche
- Stroke Unit, Department of Neurology, Virgen del Rocio University Hospital, Seville, Spain
| | | | - Mikel Terceño Izaga
- Stroke Unit, Department of Neurology, Institut d’Investigació Biomèdica de Girona, Hospital Doctor Josep Trueta de Girona, Spain
| | | | - Patricia Callejas
- Department of Neurology and Stroke Center, University Hospital 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre, Madrid, Spain
| | - Jean Marc Olivot
- Department of Vascular Neurology and Clinical Investigating Center 1435, Toulouse University Hospital, France
| | - Lionel Calviere
- Department of Vascular Neurology and Clinical Investigating Center 1435, Toulouse University Hospital, France
| | - Hilde Henon
- University Lille, Inserm, CHU Lille, U1172, Lille Neuroscience and Cognition, Lille, France
| | - Mikael Mazighi
- Université Paris Cité, INSERM 1148, Department of Neurology, Hopital Lariboisière-APHP Nord, and Interventional Neuroradiology, Hopital Fondation Adolphe Rothschild, FHU Neurovasc, Paris, France
| | | | | | - Victor M. González
- Aptus Biotech, Madrid, Spain
- Grupo de Aptámeros, Departamento de Bioquímica-Investigación, Instituto Ramón y Cajal de Investigación Sanitaria, Ramón y Cajal University Hospital, Madrid, Spain
| | - Maria Angeles Moro
- Unidad de Investigación Neurovascular, Department of Pharmacology and Toxicology, Faculty of Medicine, Universidad Complutense, Instituto de Investigación Hospital 12 de Octubre, Madrid, Spain
- Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain
| | | | - Ignacio Lizasoain
- Unidad de Investigación Neurovascular, Department of Pharmacology and Toxicology, Faculty of Medicine, Universidad Complutense, Instituto de Investigación Hospital 12 de Octubre, Madrid, Spain
| | - Marc Ribo
- aptaTargets, Madrid, Spain
- Stroke Unit, Department of Neurology, Hospital Vall d’Hebron, Barcelona, Spain
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7
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Shimamura M, Yang Chang C, Hayashi H, Baba S, Yoshida S, Nakagami H. Impact of insufficient recovery of cerebral blood flow due to partial reperfusion on the pathophysiology of ischemic stroke in mice. Neurosci Lett 2023; 810:137370. [PMID: 37399972 DOI: 10.1016/j.neulet.2023.137370] [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: 05/05/2023] [Revised: 05/18/2023] [Accepted: 06/30/2023] [Indexed: 07/05/2023]
Abstract
Recent advances in endovascular treatment (EVT) dramatically changed the outcome of ischemic stroke, but partial reperfusion does not improve the outcome as well as no reperfusion. Although partial reperfusion is estimated to be more potential for therapeutic intervention than permanent occlusion due to some blood supply, their pathophysiological difference is still unknown. To answer the question, we analyzed the difference in mice, which were exposed to distal middle cerebral artery occlusion with 14-min common carotid artery (CCA) occlusion (partial reperfusion) or permanent CCA occlusion (no reperfusion). Although the final infarct volume was same between permanent and partial reperfusion, Fluoro-jade C staining showed that neurodegeneration was inhibited both in the severe and moderate ischemic region 3 h after partial reperfusion. Also, partial reperfusion increased the number of TUNEL-positive cells only in the severe ischemic region. IgG extravasation was suppressed at 24 h only in the moderate ischemic region in partial reperfusion. Injected FITC-dextran was observed in the brain parenchyma with BBB leakage at 24 h in partial reperfusion, but not in permanent occlusion. The expression of il1β and il6 mRNA was inhibited in the severe ischemic region. Thus, partial reperfusion showed region-dependent favorable pathophysiology, such as delayed neurodegeneration, suppressed BBB destruction and inflammation, and potential for drug delivery, when compared to permanent occlusion. Further studies on the molecular differences and effectiveness of drugs will shed light on the development of novel treatments for partial reperfusion in ischemic stroke.
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Affiliation(s)
- Munehisa Shimamura
- Department of Gene & Stem Cell Regenerative Therapy, Osaka University Graduate School of Medicine, 565-0871, Japan; Department of Neurology, Osaka University Graduate School of Medicine, Japan.
| | - Chin Yang Chang
- Department of Gene & Stem Cell Regenerative Therapy, Osaka University Graduate School of Medicine, 565-0871, Japan
| | - Hiroki Hayashi
- Department of Health Development and Medicine, Osaka University Graduate School of Medicine, 565-0871, Japan
| | - Satoshi Baba
- Department of Health Development and Medicine, Osaka University Graduate School of Medicine, 565-0871, Japan; Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Japan
| | - Shota Yoshida
- Department of Health Development and Medicine, Osaka University Graduate School of Medicine, 565-0871, Japan; Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Japan
| | - Hironori Nakagami
- Department of Health Development and Medicine, Osaka University Graduate School of Medicine, 565-0871, Japan
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8
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Chen J, Xu S, Lee H, Wu L, He X, Zhao W, Zhang M, Ma Y, Ding Y, Fu Y, Wu C, Li M, Jiang M, Cheng H, Li S, Ma T, Ji X, Wu D. Hypothermic neuroprotection by targeted cold autologous blood transfusion in a non-human primate stroke model. Sci Bull (Beijing) 2023:S2095-9273(23)00392-4. [PMID: 37391345 DOI: 10.1016/j.scib.2023.06.017] [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: 03/02/2023] [Revised: 05/06/2023] [Accepted: 06/12/2023] [Indexed: 07/02/2023]
Abstract
Over decades, nearly all attempts to translate the benefits of therapeutic hypothermia in stroke models of lower-order species to stroke patients have failed. Potentially overlooked reasons may be biological gaps between different species and the mismatched initiation of therapeutic hypothermia in translational studies. Here, we introduce a novel strategy of selective therapeutic hypothermia in a non-human primate ischemia-reperfusion model, in which autologous blood was cooled ex vivo and the cool blood transfusion was administered at the middle cerebral artery just after the onset of reperfusion. Cold autologous blood cooled the targeted brain rapidly to below 34 °C while the rectal temperature remained around 36 °C with the assistance of a heat blanket during a 2-h hypothermic process. Therapeutic hypothermia or extracorporeal-circulation related complications were not observed. Cold autologous blood treatment reduced infarct sizes, preserved white matter integrity, and improved functional outcomes. Together, our results suggest that therapeutic hypothermia, induced by cold autologous blood transfusion, was achieved in a feasible, swift, and safe way in a non-human primate model of stroke. More importantly, this novel hypothermic approach conferred neuroprotection in a clinically relevant model of ischemic stroke due to reduced brain damage and improved neurofunction. This study reveals an underappreciated potential for this novel hypothermic modality for acute ischemic stroke in the era of effective reperfusion.
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Affiliation(s)
- Jian Chen
- Department of Neurosurgery, Xuanwu Hospital, Beijing Institute of Brain Disorders, Capital Medical University, Beijing 100053, China
| | - Shuaili Xu
- China-America Institute of Neuroscience, Xuanwu Hospital, Beijing Institute of Brain Disorders, Capital Medical University, Beijing 100053, China
| | - Hangil Lee
- Department of Neurological Surgery, Wayne State University School of Medicine, Detroit MI 46801, USA
| | - Longfei Wu
- Department of Neurology, Xuanwu Hospital, Beijing Institute of Brain Disorders, Capital Medical University, Beijing 100053, China
| | - Xiaoduo He
- China-America Institute of Neuroscience, Xuanwu Hospital, Beijing Institute of Brain Disorders, Capital Medical University, Beijing 100053, China
| | - Wenbo Zhao
- Department of Neurology, Xuanwu Hospital, Beijing Institute of Brain Disorders, Capital Medical University, Beijing 100053, China
| | - Mo Zhang
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Yanhui Ma
- Department of Anesthesiology, Xuanwu Hospital, Beijing Institute of Brain Disorders, Capital Medical University, Beijing 100053, China
| | - Yuchuan Ding
- Department of Neurological Surgery, Wayne State University School of Medicine, Detroit MI 46801, USA
| | - Yongjuan Fu
- Department of Pathology, Xuanwu Hospital, Beijing Institute of Brain Disorders, Capital Medical University, Beijing 100053, China
| | - Chuanjie Wu
- Department of Neurology, Xuanwu Hospital, Beijing Institute of Brain Disorders, Capital Medical University, Beijing 100053, China
| | - Ming Li
- Department of Neurosurgery, Xuanwu Hospital, Beijing Institute of Brain Disorders, Capital Medical University, Beijing 100053, China; Beijing Key Laboratory of Hypoxia Conditioning Translational Medicine, Beijing 100053, China
| | - Miuwen Jiang
- Interdisciplinary Innovation Institute of Medicine and Engineering, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Biological Science and Medical Engineering, Beihang University, Beijing 100083, China
| | - Huakun Cheng
- Department of Neurosurgery, Heilongjiang Provincial Hospital, Harbin 1500036, China
| | - Shengli Li
- Department of Laboratory Animal Science, Capital Medical University, Beijing 100069, China
| | - Ting Ma
- Department of Anesthesiology, Xuanwu Hospital, Beijing Institute of Brain Disorders, Capital Medical University, Beijing 100053, China.
| | - Xunming Ji
- Department of Neurosurgery, Xuanwu Hospital, Beijing Institute of Brain Disorders, Capital Medical University, Beijing 100053, China; Beijing Key Laboratory of Hypoxia Conditioning Translational Medicine, Beijing 100053, China; Interdisciplinary Innovation Institute of Medicine and Engineering, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Biological Science and Medical Engineering, Beihang University, Beijing 100083, China.
| | - Di Wu
- China-America Institute of Neuroscience, Xuanwu Hospital, Beijing Institute of Brain Disorders, Capital Medical University, Beijing 100053, China.
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9
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Karandikar P, Gerstl JVE, Kappel AD, Won SY, Dubinski D, Garcia-Segura ME, Gessler FA, See AP, Peruzzotti-Jametti L, Bernstock JD. SUMOtherapeutics for Ischemic Stroke. Pharmaceuticals (Basel) 2023; 16:ph16050673. [PMID: 37242456 DOI: 10.3390/ph16050673] [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: 03/28/2023] [Revised: 04/25/2023] [Accepted: 04/27/2023] [Indexed: 05/28/2023] Open
Abstract
The small, ubiquitin-like modifier (SUMO) is a post-translational modifier with a profound influence on several key biological processes, including the mammalian stress response. Of particular interest are its neuroprotective effects, first recognized in the 13-lined ground squirrel (Ictidomys tridecemlineatus), in the context of hibernation torpor. Although the full scope of the SUMO pathway is yet to be elucidated, observations of its importance in managing neuronal responses to ischemia, maintaining ion gradients, and the preconditioning of neural stem cells make it a promising therapeutic target for acute cerebral ischemia. Recent advances in high-throughput screening have enabled the identification of small molecules that can upregulate SUMOylation, some of which have been validated in pertinent preclinical models of cerebral ischemia. Accordingly, the present review aims to summarize current knowledge and highlight the translational potential of the SUMOylation pathway in brain ischemia.
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Affiliation(s)
- Paramesh Karandikar
- T. H. Chan School of Medicine, University of Massachusetts, Worcester, MA 01655, USA
| | - Jakob V E Gerstl
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02215, USA
| | - Ari D Kappel
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02215, USA
- Department of Neurosurgery, Boston Children's Hospital, Boston, MA 02215, USA
| | - Sae-Yeon Won
- Department of Neurosurgery, University Medicine Rostock, 18057 Rostock, Germany
| | - Daniel Dubinski
- Department of Neurosurgery, University Medicine Rostock, 18057 Rostock, Germany
| | - Monica Emili Garcia-Segura
- Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0QQ, UK
- NIHR Biomedical Research Centre, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Florian A Gessler
- Department of Neurosurgery, University Medicine Rostock, 18057 Rostock, Germany
| | - Alfred Pokmeng See
- Department of Neurosurgery, Boston Children's Hospital, Boston, MA 02215, USA
| | - Luca Peruzzotti-Jametti
- Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0QQ, UK
- NIHR Biomedical Research Centre, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Joshua D Bernstock
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02215, USA
- Department of Neurosurgery, University Medicine Rostock, 18057 Rostock, Germany
- Koch Institute for Integrated Cancer Research, MIT, Cambridge, MA 02142, USA
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10
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Schneider AM, Regenhardt RW, Dmytriw AA, Patel AB, Hirsch JA, Buchan AM. Cerebroprotection in the endovascular era: an update. J Neurol Neurosurg Psychiatry 2023; 94:267-271. [PMID: 36600581 DOI: 10.1136/jnnp-2022-330379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 11/19/2022] [Indexed: 12/12/2022]
Abstract
Despite advances in clinical diagnosis and increasing numbers of patients eligible for revascularisation, ischaemic stroke remains a significant public health concern accounting for 3.3 million deaths annually. In addition to recanalisation therapy, patient outcomes could be improved through cerebroprotection, but all translational attempts have remained unsuccessful. In this narrative review, we discuss potential reasons for those failures. We then outline the diverse, multicellular effects of ischaemic stroke and the complex temporal sequences of the pathophysiological cascade during and following ischaemia, reperfusion, and recovery. This evidence is linked with findings from prior cerebroprotective trials and interpreted for the modern endovascular era. Future cerebroprotective agents that are multimodal and multicellular, promoting cellular and metabolic health to different targets at time points that are most responsive to treatment, might prove more successful.
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Affiliation(s)
- Anna M Schneider
- Acute Stroke Programme, Radcliffe Department of Medicine, University of Oxford, Oxford, UK.,Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Robert W Regenhardt
- Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Adam A Dmytriw
- Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Aman B Patel
- Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Joshua Adam Hirsch
- Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Alastair M Buchan
- Acute Stroke Programme, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
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11
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Rajendram P, Ikram A, Fisher M. Combined Therapeutics: Future Opportunities for Co-therapy with Thrombectomy. Neurotherapeutics 2023; 20:693-704. [PMID: 36943636 PMCID: PMC10275848 DOI: 10.1007/s13311-023-01369-1] [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] [Accepted: 03/14/2023] [Indexed: 03/23/2023] Open
Abstract
Stroke is an urgent public health issue with millions of patients worldwide living with its devastating effects. The advent of thrombolysis and endovascular thrombectomy has transformed the hyperacute care of these patients. However, a significant proportion of patients receiving these therapies still goes on to have unfavorable outcomes and many more remain ineligible for these therapies based on our current guidelines. The future of stroke care will depend on an expansion of the scope of thrombolysis and endovascular thrombectomy to patients outside traditional time windows, more distal occlusions, and large vessel occlusions with mild clinical deficits, for whom clinical trial results have not proven therapeutic efficacy. Novel cytoprotective therapies targeting the ischemic cascade and reperfusion injury therapy, in combination with our existing treatment modalities, should be explored to further improve outcomes for these patients with acute ischemic stroke. In this review, we will review the current status of thrombolysis and thrombectomy, suggest additional data that is needed to enhance these therapies, and discuss how cytoprotection might be combined with thrombectomy.
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Affiliation(s)
- Phavalan Rajendram
- Division of Stroke and Cerebrovascular Diseases, Department of Neurology, Harvard Medical School, Beth Israel Deaconess Medical Center, Palmer Building Room 127, 330 Brookline Avenue, Boston, MA, 02215-5400, USA.
| | - Asad Ikram
- Division of Stroke and Cerebrovascular Diseases, Department of Neurology, Harvard Medical School, Beth Israel Deaconess Medical Center, Palmer Building Room 127, 330 Brookline Avenue, Boston, MA, 02215-5400, USA
| | - Marc Fisher
- Division of Stroke and Cerebrovascular Diseases, Department of Neurology, Harvard Medical School, Beth Israel Deaconess Medical Center, Palmer Building Room 127, 330 Brookline Avenue, Boston, MA, 02215-5400, USA
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12
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Beresewicz-Haller M. Hippocampal region-specific endogenous neuroprotection as an approach in the search for new neuroprotective strategies in ischemic stroke. Fiction or fact? Neurochem Int 2023; 162:105455. [PMID: 36410452 DOI: 10.1016/j.neuint.2022.105455] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 11/03/2022] [Accepted: 11/17/2022] [Indexed: 11/23/2022]
Abstract
Ischemic stroke is the leading cause of death and long-term disability worldwide, and, while considerable progress has been made in understanding its pathophysiology, the lack of effective treatments remains a major concern. In that context, receiving more and more consideration as a promising therapeutic method is the activation of natural adaptive mechanisms (endogenous neuroprotection) - an approach that seeks to enhance and/or stimulate the endogenous processes of plasticity and protection of the neuronal system that trigger the brain's intrinsic capacity for self-defence. Ischemic preconditioning is a classic example of endogenous neuroprotection, being the process by which one or more brief, non-damaging episodes of ischemia-reperfusion (I/R) induce tissue resistance to subsequent prolonged, damaging ischemia. Another less-known example is resistance to an I/R episode mounted by the hippocampal region consisting of CA2, CA3, CA4 and the dentate gyrus (here abbreviated to CA2-4, DG). This can be contrasted with the ischemia-vulnerable CA1 region. There is not yet a good understanding of these different sensitivities of the hippocampal regions, and hence of the endogenous neuroprotection characteristic of CA2-4, DG. However, this region is widely reported to have properties distinct from CA1, and capable of generating resistance to an I/R episode. These include activation of neurotrophic and neuroprotective factors, greater activation of anti-excitotoxic and anti-oxidant mechanisms, increased plasticity potential, a greater energy reserve and improved mitochondrial function. This review seeks to summarize properties of CA2-4, DG in the context of endogenous neuroprotection, and then to assess the potential utility of these properties to therapeutic approaches. In so doing, it appears to represent the first such addressing of the issue of ischemia resistance attributable to CA2-4, DG.
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13
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Hernández-Jiménez M, Abad-Santos F, Cotgreave I, Gallego J, Jilma B, Flores A, Jovin TG, Vivancos J, Molina CA, Montaner J, Casariego J, Dalsgaard M, Hernández-Pérez M, Liebeskind DS, Cobo E, Ribo M. APRIL: A double-blind, placebo-controlled, randomized, Phase Ib/IIa clinical study of ApTOLL for the treatment of acute ischemic stroke. Front Neurol 2023; 14:1127585. [PMID: 36908619 PMCID: PMC9999729 DOI: 10.3389/fneur.2023.1127585] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 01/30/2023] [Indexed: 02/26/2023] Open
Abstract
In the reperfusion era, a new paradigm of treating patients with endovascular treatment (EVT) and neuroprotective drugs is emerging as a promising therapeutic option for patients with acute ischemic stroke (AIS). In this context, ApTOLL, a Toll-like receptor 4 (TLR4) antagonist with proven neuroprotective effect in preclinical models of stroke and a very good pharmacokinetic and safety profile in healthy volunteers, is a promising first-in-class aptamer with the potential to address this huge unmet need. This protocol establishes the clinical trial procedures to conduct a Phase Ib/IIa clinical study (APRIL) to assess ApTOLL tolerability, safety, pharmacokinetics, and biological effect in patients with AIS who are eligible for EVT. This will be a multicenter, double-blind, randomized, placebo-controlled, Phase Ib/IIa clinical study to evaluate the administration of ApTOLL together with EVT in patients with AIS. The study population will be composed of men and non-pregnant women with confirmed AIS with a <6h window from symptoms onset to ApTOLL/placebo administration. The trial is currently being conducted and is divided into two parts: Phase Ib and Phase IIa. In Phase Ib, 32 patients will be allocated to four dose ascending levels to select, based on safety criteria, the best two doses to be administered in the following Phase IIa in which 119 patients will be randomized to three arms of treatment (dose A, dose B, and placebo). Identification of the trial EudraCT: 2020-002059-38 and ClinicalTrials.gov Identifier: NCT04734548 https://clinicaltrials.gov/ct2/show/NCT04734548?term=ApTOLL&cond=Stroke&draw=2&rank=1.
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Affiliation(s)
| | - Francisco Abad-Santos
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria La Princesa (IP), Universidad Autónoma de Madrid (UAM), Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Ian Cotgreave
- Division of Bioeconomy and Health, Department of Chemical and Pharmaceutical Safety, Research Institutes of Sweden, Södertälje, Sweden
| | | | - Bernd Jilma
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Alan Flores
- Stroke Unit, Hospital Joan XXIII, Tarragona, Spain
| | - Tudor G Jovin
- Cooper Neurological Institute, Camden, AR, United States
| | - José Vivancos
- Stroke Unit, Department of Neurology, Hospital La Princesa, Madrid, Spain
| | - Carlos A Molina
- Stroke Unit, Department of Neurology, Hospital Vall d'Hebron, Barcelona, Spain
| | - Joan Montaner
- Department of Neurology, Hospital Macarena, Sevilla, Spain
| | | | | | - María Hernández-Pérez
- Stroke Unit, Department of Neurology, Hospital Germans Trias I Pujol, Barcelona, Spain
| | - David S Liebeskind
- Neurovascular Imaging Research Core, Department of Neurology, UCLA Stroke Center, Los Angeles, CA, United States
| | - Erik Cobo
- Statistics and Operations Research, Barcelona-Tech (UPC), Barcelona, Spain
| | - Marc Ribo
- AptaTargets S.L., Madrid, Spain.,Stroke Unit, Department of Neurology, Hospital Vall d'Hebron, Barcelona, Spain
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14
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How can imaging in acute ischemic stroke help us to understand tissue fate in the era of endovascular treatment and cerebroprotection? Neuroradiology 2022; 64:1697-1707. [PMID: 35854136 DOI: 10.1007/s00234-022-03001-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 06/21/2022] [Indexed: 10/17/2022]
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15
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Li W, Qi Z, Ma Q, Ding J, Wu C, Song H, Yang Q, Duan J, Liu L, Kang H, Wu L, Ji K, Zhao W, Li C, Sun C, Li N, Fisher M, Ji X, Liu KJ. Normobaric Hyperoxia Combined With Endovascular Treatment for Patients With Acute Ischemic Stroke: A Randomized Controlled Clinical Trial. Neurology 2022; 99:e824-e834. [PMID: 35715198 DOI: 10.1212/wnl.0000000000200775] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 04/08/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND AND OBJECTIVES To investigate the safety and efficacy of normobaric hyperoxia (NBO) combined with endovascular treatment (EVT) in patients with acute ischemic stroke (AIS). METHODS In this single-center, proof-of-concept, assessor-blinded, randomized, controlled pilot study, patients with AIS in the acute anterior circulation with large vessel occlusion who had an indication for EVT were randomly assigned to the EVT group or the NBO + EVT group. The NBO + EVT group was given 100% oxygen through a face mask initiated before vascular recanalization (10L/min for 4 hours), while the EVT group was given room air. The primary endpoint was infarct volume measured by MRI within 24-48 hours after randomization. RESULTS A total of 231 patients were screened, and 86 patients were randomized into a ratio of 1:1 (EVT group, n = 43; NBO + EVT group, n = 43). The median infarction volume of the NBO + EVT group at 24-48 hours after randomization was significantly smaller than that of the EVT group (median 20.1 vs 37.7 mL, p < 0.01). The median mRS score at 90 days was 2 for the NBO + EVT group when compared with 3 for the EVT group (adjusted value 1.8, 95% CI 1.3-4.2; p = 0.038). Compared with the EVT group, the NBO + EVT group had a lower incidence of symptomatic intracranial hemorrhagic (7% vs 12%), mortality (9% vs 16%), and adverse events (33% vs 42%); however, such a difference was not statistically significant. DISCUSSION NBO in combination with EVT seems to be a safe and feasible treatment strategy that could significantly reduce infarct volume, improve short-term neurobehavioral test score, and enhance clinical outcomes at 90 days when compared with EVT alone in patients with AIS. These observations need to be further confirmed by a large, multicenter, randomized clinical trial. CLINICAL TRIALS REGISTRATION NCT03620370. CLASSIFICATION OF EVIDENCE This pilot study provides Class I evidence that NBO combined with standard EVT decreases infarction volume in patients with acute anterior circulation stroke.
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Affiliation(s)
- Weili Li
- From the Cerebrovascular Diseases Research Institute (W.L., Z.Q., X.J.) and the Departments of Neurology (Q.M., Jiayue Ding, C.W., H.S., L.W., K.J., W.Z., C.S., N.L.), Radiology (Q.Y.), Emergency (Jiangang Duan, C.L.), and Neurosurgery (X.J.), Xuanwu Hospital of Capital Medical University, Beijing; Beijing Institute of Brain Disorders, Laboratory of Brain Disorders, Ministry of Science and Technology (W.L., X.J.), Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China; School of Statistics (L.L.), University of Minnesota at Twin Cities, Minneapolis; Department of Internal Medicine (H.K.), University of New Mexico, Albuquerque; Department of Neurology (M.F.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Department of Pharmaceutical Sciences (K.J.L.), University of New Mexico Health Sciences Center, Albuquerque
| | - Zhifeng Qi
- From the Cerebrovascular Diseases Research Institute (W.L., Z.Q., X.J.) and the Departments of Neurology (Q.M., Jiayue Ding, C.W., H.S., L.W., K.J., W.Z., C.S., N.L.), Radiology (Q.Y.), Emergency (Jiangang Duan, C.L.), and Neurosurgery (X.J.), Xuanwu Hospital of Capital Medical University, Beijing; Beijing Institute of Brain Disorders, Laboratory of Brain Disorders, Ministry of Science and Technology (W.L., X.J.), Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China; School of Statistics (L.L.), University of Minnesota at Twin Cities, Minneapolis; Department of Internal Medicine (H.K.), University of New Mexico, Albuquerque; Department of Neurology (M.F.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Department of Pharmaceutical Sciences (K.J.L.), University of New Mexico Health Sciences Center, Albuquerque
| | - Qingfeng Ma
- From the Cerebrovascular Diseases Research Institute (W.L., Z.Q., X.J.) and the Departments of Neurology (Q.M., Jiayue Ding, C.W., H.S., L.W., K.J., W.Z., C.S., N.L.), Radiology (Q.Y.), Emergency (Jiangang Duan, C.L.), and Neurosurgery (X.J.), Xuanwu Hospital of Capital Medical University, Beijing; Beijing Institute of Brain Disorders, Laboratory of Brain Disorders, Ministry of Science and Technology (W.L., X.J.), Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China; School of Statistics (L.L.), University of Minnesota at Twin Cities, Minneapolis; Department of Internal Medicine (H.K.), University of New Mexico, Albuquerque; Department of Neurology (M.F.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Department of Pharmaceutical Sciences (K.J.L.), University of New Mexico Health Sciences Center, Albuquerque
| | - Jiayue Ding
- From the Cerebrovascular Diseases Research Institute (W.L., Z.Q., X.J.) and the Departments of Neurology (Q.M., Jiayue Ding, C.W., H.S., L.W., K.J., W.Z., C.S., N.L.), Radiology (Q.Y.), Emergency (Jiangang Duan, C.L.), and Neurosurgery (X.J.), Xuanwu Hospital of Capital Medical University, Beijing; Beijing Institute of Brain Disorders, Laboratory of Brain Disorders, Ministry of Science and Technology (W.L., X.J.), Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China; School of Statistics (L.L.), University of Minnesota at Twin Cities, Minneapolis; Department of Internal Medicine (H.K.), University of New Mexico, Albuquerque; Department of Neurology (M.F.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Department of Pharmaceutical Sciences (K.J.L.), University of New Mexico Health Sciences Center, Albuquerque
| | - Chuanjie Wu
- From the Cerebrovascular Diseases Research Institute (W.L., Z.Q., X.J.) and the Departments of Neurology (Q.M., Jiayue Ding, C.W., H.S., L.W., K.J., W.Z., C.S., N.L.), Radiology (Q.Y.), Emergency (Jiangang Duan, C.L.), and Neurosurgery (X.J.), Xuanwu Hospital of Capital Medical University, Beijing; Beijing Institute of Brain Disorders, Laboratory of Brain Disorders, Ministry of Science and Technology (W.L., X.J.), Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China; School of Statistics (L.L.), University of Minnesota at Twin Cities, Minneapolis; Department of Internal Medicine (H.K.), University of New Mexico, Albuquerque; Department of Neurology (M.F.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Department of Pharmaceutical Sciences (K.J.L.), University of New Mexico Health Sciences Center, Albuquerque
| | - Haiqing Song
- From the Cerebrovascular Diseases Research Institute (W.L., Z.Q., X.J.) and the Departments of Neurology (Q.M., Jiayue Ding, C.W., H.S., L.W., K.J., W.Z., C.S., N.L.), Radiology (Q.Y.), Emergency (Jiangang Duan, C.L.), and Neurosurgery (X.J.), Xuanwu Hospital of Capital Medical University, Beijing; Beijing Institute of Brain Disorders, Laboratory of Brain Disorders, Ministry of Science and Technology (W.L., X.J.), Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China; School of Statistics (L.L.), University of Minnesota at Twin Cities, Minneapolis; Department of Internal Medicine (H.K.), University of New Mexico, Albuquerque; Department of Neurology (M.F.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Department of Pharmaceutical Sciences (K.J.L.), University of New Mexico Health Sciences Center, Albuquerque
| | - Qi Yang
- From the Cerebrovascular Diseases Research Institute (W.L., Z.Q., X.J.) and the Departments of Neurology (Q.M., Jiayue Ding, C.W., H.S., L.W., K.J., W.Z., C.S., N.L.), Radiology (Q.Y.), Emergency (Jiangang Duan, C.L.), and Neurosurgery (X.J.), Xuanwu Hospital of Capital Medical University, Beijing; Beijing Institute of Brain Disorders, Laboratory of Brain Disorders, Ministry of Science and Technology (W.L., X.J.), Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China; School of Statistics (L.L.), University of Minnesota at Twin Cities, Minneapolis; Department of Internal Medicine (H.K.), University of New Mexico, Albuquerque; Department of Neurology (M.F.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Department of Pharmaceutical Sciences (K.J.L.), University of New Mexico Health Sciences Center, Albuquerque
| | - Jiangang Duan
- From the Cerebrovascular Diseases Research Institute (W.L., Z.Q., X.J.) and the Departments of Neurology (Q.M., Jiayue Ding, C.W., H.S., L.W., K.J., W.Z., C.S., N.L.), Radiology (Q.Y.), Emergency (Jiangang Duan, C.L.), and Neurosurgery (X.J.), Xuanwu Hospital of Capital Medical University, Beijing; Beijing Institute of Brain Disorders, Laboratory of Brain Disorders, Ministry of Science and Technology (W.L., X.J.), Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China; School of Statistics (L.L.), University of Minnesota at Twin Cities, Minneapolis; Department of Internal Medicine (H.K.), University of New Mexico, Albuquerque; Department of Neurology (M.F.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Department of Pharmaceutical Sciences (K.J.L.), University of New Mexico Health Sciences Center, Albuquerque
| | - Lan Liu
- From the Cerebrovascular Diseases Research Institute (W.L., Z.Q., X.J.) and the Departments of Neurology (Q.M., Jiayue Ding, C.W., H.S., L.W., K.J., W.Z., C.S., N.L.), Radiology (Q.Y.), Emergency (Jiangang Duan, C.L.), and Neurosurgery (X.J.), Xuanwu Hospital of Capital Medical University, Beijing; Beijing Institute of Brain Disorders, Laboratory of Brain Disorders, Ministry of Science and Technology (W.L., X.J.), Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China; School of Statistics (L.L.), University of Minnesota at Twin Cities, Minneapolis; Department of Internal Medicine (H.K.), University of New Mexico, Albuquerque; Department of Neurology (M.F.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Department of Pharmaceutical Sciences (K.J.L.), University of New Mexico Health Sciences Center, Albuquerque
| | - Huining Kang
- From the Cerebrovascular Diseases Research Institute (W.L., Z.Q., X.J.) and the Departments of Neurology (Q.M., Jiayue Ding, C.W., H.S., L.W., K.J., W.Z., C.S., N.L.), Radiology (Q.Y.), Emergency (Jiangang Duan, C.L.), and Neurosurgery (X.J.), Xuanwu Hospital of Capital Medical University, Beijing; Beijing Institute of Brain Disorders, Laboratory of Brain Disorders, Ministry of Science and Technology (W.L., X.J.), Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China; School of Statistics (L.L.), University of Minnesota at Twin Cities, Minneapolis; Department of Internal Medicine (H.K.), University of New Mexico, Albuquerque; Department of Neurology (M.F.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Department of Pharmaceutical Sciences (K.J.L.), University of New Mexico Health Sciences Center, Albuquerque
| | - Longfei Wu
- From the Cerebrovascular Diseases Research Institute (W.L., Z.Q., X.J.) and the Departments of Neurology (Q.M., Jiayue Ding, C.W., H.S., L.W., K.J., W.Z., C.S., N.L.), Radiology (Q.Y.), Emergency (Jiangang Duan, C.L.), and Neurosurgery (X.J.), Xuanwu Hospital of Capital Medical University, Beijing; Beijing Institute of Brain Disorders, Laboratory of Brain Disorders, Ministry of Science and Technology (W.L., X.J.), Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China; School of Statistics (L.L.), University of Minnesota at Twin Cities, Minneapolis; Department of Internal Medicine (H.K.), University of New Mexico, Albuquerque; Department of Neurology (M.F.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Department of Pharmaceutical Sciences (K.J.L.), University of New Mexico Health Sciences Center, Albuquerque
| | - Kangxiang Ji
- From the Cerebrovascular Diseases Research Institute (W.L., Z.Q., X.J.) and the Departments of Neurology (Q.M., Jiayue Ding, C.W., H.S., L.W., K.J., W.Z., C.S., N.L.), Radiology (Q.Y.), Emergency (Jiangang Duan, C.L.), and Neurosurgery (X.J.), Xuanwu Hospital of Capital Medical University, Beijing; Beijing Institute of Brain Disorders, Laboratory of Brain Disorders, Ministry of Science and Technology (W.L., X.J.), Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China; School of Statistics (L.L.), University of Minnesota at Twin Cities, Minneapolis; Department of Internal Medicine (H.K.), University of New Mexico, Albuquerque; Department of Neurology (M.F.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Department of Pharmaceutical Sciences (K.J.L.), University of New Mexico Health Sciences Center, Albuquerque.
| | - Wenbo Zhao
- From the Cerebrovascular Diseases Research Institute (W.L., Z.Q., X.J.) and the Departments of Neurology (Q.M., Jiayue Ding, C.W., H.S., L.W., K.J., W.Z., C.S., N.L.), Radiology (Q.Y.), Emergency (Jiangang Duan, C.L.), and Neurosurgery (X.J.), Xuanwu Hospital of Capital Medical University, Beijing; Beijing Institute of Brain Disorders, Laboratory of Brain Disorders, Ministry of Science and Technology (W.L., X.J.), Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China; School of Statistics (L.L.), University of Minnesota at Twin Cities, Minneapolis; Department of Internal Medicine (H.K.), University of New Mexico, Albuquerque; Department of Neurology (M.F.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Department of Pharmaceutical Sciences (K.J.L.), University of New Mexico Health Sciences Center, Albuquerque
| | - Chuanhui Li
- From the Cerebrovascular Diseases Research Institute (W.L., Z.Q., X.J.) and the Departments of Neurology (Q.M., Jiayue Ding, C.W., H.S., L.W., K.J., W.Z., C.S., N.L.), Radiology (Q.Y.), Emergency (Jiangang Duan, C.L.), and Neurosurgery (X.J.), Xuanwu Hospital of Capital Medical University, Beijing; Beijing Institute of Brain Disorders, Laboratory of Brain Disorders, Ministry of Science and Technology (W.L., X.J.), Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China; School of Statistics (L.L.), University of Minnesota at Twin Cities, Minneapolis; Department of Internal Medicine (H.K.), University of New Mexico, Albuquerque; Department of Neurology (M.F.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Department of Pharmaceutical Sciences (K.J.L.), University of New Mexico Health Sciences Center, Albuquerque
| | - Chenghe Sun
- From the Cerebrovascular Diseases Research Institute (W.L., Z.Q., X.J.) and the Departments of Neurology (Q.M., Jiayue Ding, C.W., H.S., L.W., K.J., W.Z., C.S., N.L.), Radiology (Q.Y.), Emergency (Jiangang Duan, C.L.), and Neurosurgery (X.J.), Xuanwu Hospital of Capital Medical University, Beijing; Beijing Institute of Brain Disorders, Laboratory of Brain Disorders, Ministry of Science and Technology (W.L., X.J.), Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China; School of Statistics (L.L.), University of Minnesota at Twin Cities, Minneapolis; Department of Internal Medicine (H.K.), University of New Mexico, Albuquerque; Department of Neurology (M.F.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Department of Pharmaceutical Sciences (K.J.L.), University of New Mexico Health Sciences Center, Albuquerque
| | - Na Li
- From the Cerebrovascular Diseases Research Institute (W.L., Z.Q., X.J.) and the Departments of Neurology (Q.M., Jiayue Ding, C.W., H.S., L.W., K.J., W.Z., C.S., N.L.), Radiology (Q.Y.), Emergency (Jiangang Duan, C.L.), and Neurosurgery (X.J.), Xuanwu Hospital of Capital Medical University, Beijing; Beijing Institute of Brain Disorders, Laboratory of Brain Disorders, Ministry of Science and Technology (W.L., X.J.), Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China; School of Statistics (L.L.), University of Minnesota at Twin Cities, Minneapolis; Department of Internal Medicine (H.K.), University of New Mexico, Albuquerque; Department of Neurology (M.F.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Department of Pharmaceutical Sciences (K.J.L.), University of New Mexico Health Sciences Center, Albuquerque
| | - Marc Fisher
- From the Cerebrovascular Diseases Research Institute (W.L., Z.Q., X.J.) and the Departments of Neurology (Q.M., Jiayue Ding, C.W., H.S., L.W., K.J., W.Z., C.S., N.L.), Radiology (Q.Y.), Emergency (Jiangang Duan, C.L.), and Neurosurgery (X.J.), Xuanwu Hospital of Capital Medical University, Beijing; Beijing Institute of Brain Disorders, Laboratory of Brain Disorders, Ministry of Science and Technology (W.L., X.J.), Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China; School of Statistics (L.L.), University of Minnesota at Twin Cities, Minneapolis; Department of Internal Medicine (H.K.), University of New Mexico, Albuquerque; Department of Neurology (M.F.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Department of Pharmaceutical Sciences (K.J.L.), University of New Mexico Health Sciences Center, Albuquerque
| | - Xunming Ji
- From the Cerebrovascular Diseases Research Institute (W.L., Z.Q., X.J.) and the Departments of Neurology (Q.M., Jiayue Ding, C.W., H.S., L.W., K.J., W.Z., C.S., N.L.), Radiology (Q.Y.), Emergency (Jiangang Duan, C.L.), and Neurosurgery (X.J.), Xuanwu Hospital of Capital Medical University, Beijing; Beijing Institute of Brain Disorders, Laboratory of Brain Disorders, Ministry of Science and Technology (W.L., X.J.), Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China; School of Statistics (L.L.), University of Minnesota at Twin Cities, Minneapolis; Department of Internal Medicine (H.K.), University of New Mexico, Albuquerque; Department of Neurology (M.F.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Department of Pharmaceutical Sciences (K.J.L.), University of New Mexico Health Sciences Center, Albuquerque.
| | - Ke Jian Liu
- From the Cerebrovascular Diseases Research Institute (W.L., Z.Q., X.J.) and the Departments of Neurology (Q.M., Jiayue Ding, C.W., H.S., L.W., K.J., W.Z., C.S., N.L.), Radiology (Q.Y.), Emergency (Jiangang Duan, C.L.), and Neurosurgery (X.J.), Xuanwu Hospital of Capital Medical University, Beijing; Beijing Institute of Brain Disorders, Laboratory of Brain Disorders, Ministry of Science and Technology (W.L., X.J.), Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China; School of Statistics (L.L.), University of Minnesota at Twin Cities, Minneapolis; Department of Internal Medicine (H.K.), University of New Mexico, Albuquerque; Department of Neurology (M.F.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Department of Pharmaceutical Sciences (K.J.L.), University of New Mexico Health Sciences Center, Albuquerque
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16
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Yan Y, Zhang X, An X, Fan W, Liang J, Luo B, Ren H, Huang Y. The application and perspective of hyperbaric oxygen therapy in acute ischemic stroke: From the bench to a starter? Front Neurol 2022; 13:928802. [PMID: 35989933 PMCID: PMC9389005 DOI: 10.3389/fneur.2022.928802] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 07/18/2022] [Indexed: 11/18/2022] Open
Abstract
Stroke has become a significant cause of death and disability globally. Along with the transition of the world's aging population, the incidence of acute ischemic stroke is increasing year by year. Even with effective treatment modalities, patients are not guaranteed to have a good prognosis. The treatment model combining intravenous thrombolysis/endovascular therapy and neuroprotection is gradually being recognized. After the clinical translation of pharmacological neuroprotective agents failed, non-pharmacological physical neuroprotective agents have rekindled hope. We performed a literature review using the National Center for Biotechnology Information (NCBI) PubMed database for studies that focused on the application of hyperbaric oxygen therapy in acute ischemic stroke. In this review, we present the history and mechanisms of hyperbaric oxygen therapy, focusing on the current status, outcomes, current challenges, perspective, safety, and complications of the application of hyperbaric oxygen in animal experiments and human clinical trials. Hyperbaric oxygen therapy, a non-pharmacological treatment, can improve the oxygenation level at the ischemic lesions in increased dissolved oxygen and oxygen diffusion radius to achieve salvage of neurological function, giving a new meaning to acute ischemic stroke.
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Affiliation(s)
- Yujia Yan
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin, China
| | - Xiqiang Zhang
- Department of Neurosurgery, Third People's Hospital of Xining City, Xining, China
| | - Xingwei An
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China
- Tianjin Center for Brain Science, Tianjin, China
| | - Wanpeng Fan
- Department of Neurosurgery, Third People's Hospital of Xining City, Xining, China
| | - Jingbo Liang
- Department of Neurosurgery, Third People's Hospital of Xining City, Xining, China
| | - Bin Luo
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin, China
| | - Hecheng Ren
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin, China
- *Correspondence: Hecheng Ren
| | - Ying Huang
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin, China
- Ying Huang
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17
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Ronaldson PT, Davis TP. Transport Mechanisms at the Blood-Brain Barrier and in Cellular Compartments of the Neurovascular Unit: Focus on CNS Delivery of Small Molecule Drugs. Pharmaceutics 2022; 14:1501. [PMID: 35890396 PMCID: PMC9324459 DOI: 10.3390/pharmaceutics14071501] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/13/2022] [Accepted: 07/15/2022] [Indexed: 02/06/2023] Open
Abstract
Ischemic stroke is a primary origin of morbidity and mortality in the United States and around the world. Indeed, several research projects have attempted to discover new drugs or repurpose existing therapeutics to advance stroke pharmacotherapy. Many of these preclinical stroke studies have reported positive results for neuroprotective agents; however, only one compound (3K3A-activated protein C (3K3A-APC)) has advanced to Phase III clinical trial evaluation. One reason for these many failures is the lack of consideration of transport mechanisms at the blood-brain barrier (BBB) and neurovascular unit (NVU). These endogenous transport processes function as a "gateway" that is a primary determinant of efficacious brain concentrations for centrally acting drugs. Despite the knowledge that some neuroprotective agents (i.e., statins and memantine) are substrates for these endogenous BBB transporters, preclinical stroke studies have largely ignored the role of transporters in CNS drug disposition. Here, we review the current knowledge on specific BBB transporters that either limit drug uptake into the brain (i.e., ATP-binding cassette (ABC) transporters) or can be targeted for optimized drug delivery (i.e., solute carrier (SLC) transporters). Additionally, we highlight the current knowledge on transporter expression in astrocytes, microglia, pericytes, and neurons with an emphasis on transport mechanisms in these cell types that can influence drug distribution within the brain.
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Affiliation(s)
- Patrick T. Ronaldson
- Department of Pharmacology, College of Medicine, University of Arizona, Tucson, AZ 85724-5050, USA;
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18
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Sekino N, Selim M, Shehadah A. Sepsis-associated brain injury: underlying mechanisms and potential therapeutic strategies for acute and long-term cognitive impairments. J Neuroinflammation 2022; 19:101. [PMID: 35488237 PMCID: PMC9051822 DOI: 10.1186/s12974-022-02464-4] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 04/14/2022] [Indexed: 12/29/2022] Open
Abstract
Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. Sepsis causes cerebral dysfunction in the short and long term and induces disruption of the blood–brain barrier (BBB), neuroinflammation, hypoperfusion, and accumulation of amyloid β (Aβ) and tau protein in the brain. White matter changes and brain atrophy can be detected using brain imaging, but unfortunately, there is no specific treatment that directly addresses the underlying mechanisms of cognitive impairments in sepsis. Here, we review the underlying mechanisms of sepsis-associated brain injury, with a focus on BBB dysfunction and Aβ and tau protein accumulation in the brain. We also describe the neurological manifestations and imaging findings of sepsis-associated brain injury, and finally, we propose potential therapeutic strategies for acute and long-term cognitive impairments associated with sepsis. In the acute phase of sepsis, we suggest using antibiotics (such as rifampicin), targeting proinflammatory cytokines, and preventing ischemic injuries and hypoperfusion. In the late phase of sepsis, we suggest targeting neuroinflammation, BBB dysfunction, Aβ and tau protein phosphorylation, glycogen synthase kinase-3 beta (GSK3β), and the receptor for advanced glycation end products (RAGE). These proposed strategies are meant to bring new mechanism-based directions for future basic and clinical research aimed at preventing or ameliorating acute and long-term cognitive impairments in patients with sepsis.
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Affiliation(s)
- Nobufumi Sekino
- Department of Medicine, Translational Therapeutics Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215, USA
| | - Magdy Selim
- Department of Neurology, Stroke and Cerebrovascular Diseases Division, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, CLS-641, Boston, MA, 02215, USA
| | - Amjad Shehadah
- Department of Neurology, Stroke and Cerebrovascular Diseases Division, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, CLS-641, Boston, MA, 02215, USA.
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19
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In-Vivo and Ex-Vivo Brain Uptake Studies of Peptidomimetic Neurolysin Activators in Healthy and Stroke Animals. Pharm Res 2022; 39:1587-1598. [PMID: 35239135 DOI: 10.1007/s11095-022-03218-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 02/25/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Neurolysin (Nln) is a peptidase that functions to preserve the brain following ischemic stroke by hydrolyzing various neuropeptides. Nln activation has emerged as an attractive drug discovery target for treatment of ischemic stroke. Among first-in-class peptidomimetic Nln activators, we selected three lead compounds (9d, 10c, 11a) for quantitative pharmacokinetic analysis to provide valuable information for subsequent preclinical development. METHODS Pharmacokinetic profile of these compounds was studied in healthy and ischemic stroke-induced mice after bolus intravenous administration. Brain concentration and brain uptake clearance (Kin) was calculated from single time point analysis. The inter-relationship between LogP with in-vitro and in-vivo permeability was studied to determine CNS penetration. Brain slice uptake method was used to study tissue binding, whereas P-gp-mediated transport was evaluated to understand the potential brain efflux of these compounds. RESULTS According to calculated parameters, all three compounds showed a detectable amount in the brain after intravenous administration at 4 mg/kg; however, 11a had the highest brain concentration and brain uptake clearance. A strong correlation was documented between in-vitro and in-vivo permeability data. The efflux ratio of 10c was ~6-fold higher compared to 11a and correlated well with its lower Kin value. In experimental stroke animals, the Kin of 11a was significantly higher in ischemic vs. contralateral and intact hemispheres, though it remained below its A50 value required to activate Nln. CONCLUSIONS Collectively, these preclinical pharmacokinetic studies reveal promising BBB permeability of 11a and indicate that it can serve as an excellent lead for developing improved drug-like Nln activators.
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20
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Jurcau A, Ardelean AI. Oxidative Stress in Ischemia/Reperfusion Injuries following Acute Ischemic Stroke. Biomedicines 2022; 10:biomedicines10030574. [PMID: 35327376 PMCID: PMC8945353 DOI: 10.3390/biomedicines10030574] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/25/2022] [Accepted: 02/28/2022] [Indexed: 02/04/2023] Open
Abstract
Recanalization therapy is increasingly used in the treatment of acute ischemic stroke. However, in about one third of these patients, recanalization is followed by ischemia/reperfusion injuries, and clinically to worsening of the neurological status. Much research has focused on unraveling the involved mechanisms in order to prevent or efficiently treat these injuries. What we know so far is that oxidative stress and mitochondrial dysfunction are significantly involved in the pathogenesis of ischemia/reperfusion injury. However, despite promising results obtained in experimental research, clinical studies trying to interfere with the oxidative pathways have mostly failed. The current article discusses the main mechanisms leading to ischemia/reperfusion injuries, such as mitochondrial dysfunction, excitotoxicity, and oxidative stress, and reviews the clinical trials with antioxidant molecules highlighting recent developments and future strategies.
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Affiliation(s)
- Anamaria Jurcau
- Department of Psycho-Neurosciences and Rehabilitation, Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania
- Department of Neurology, Clinical Municipal Hospital Oradea, Louis Pasteur Street nr 26, 410054 Oradea, Romania
- Correspondence: ; Tel.: +40-744-600-833
| | - Adriana Ioana Ardelean
- Department of Preclinical Sciences, Faculty of Medicine and Pharmacy, University of Oradea, Universitatii Street nr 1, 410087 Oradea, Romania;
- Department of Cardiology, Clinical Emergency County Hospital Oradea, Gh. Doja Street nr 65, 410169 Oradea, Romania
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21
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Blood-Brain Barrier Transporters: Opportunities for Therapeutic Development in Ischemic Stroke. Int J Mol Sci 2022; 23:ijms23031898. [PMID: 35163820 PMCID: PMC8836701 DOI: 10.3390/ijms23031898] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/02/2022] [Accepted: 02/04/2022] [Indexed: 12/20/2022] Open
Abstract
Globally, stroke is a leading cause of death and long-term disability. Over the past decades, several efforts have attempted to discover new drugs or repurpose existing therapeutics to promote post-stroke neurological recovery. Preclinical stroke studies have reported successes in identifying novel neuroprotective agents; however, none of these compounds have advanced beyond a phase III clinical trial. One reason for these failures is the lack of consideration of blood-brain barrier (BBB) transport mechanisms that can enable these drugs to achieve efficacious concentrations in ischemic brain tissue. Despite the knowledge that drugs with neuroprotective properties (i.e., statins, memantine, metformin) are substrates for endogenous BBB transporters, preclinical stroke research has not extensively studied the role of transporters in central nervous system (CNS) drug delivery. Here, we review current knowledge on specific BBB uptake transporters (i.e., organic anion transporting polypeptides (OATPs in humans; Oatps in rodents); organic cation transporters (OCTs in humans; Octs in rodents) that can be targeted for improved neuroprotective drug delivery. Additionally, we provide state-of-the-art perspectives on how transporter pharmacology can be integrated into preclinical stroke research. Specifically, we discuss the utility of in vivo stroke models to transporter studies and considerations (i.e., species selection, co-morbid conditions) that will optimize the translational success of stroke pharmacotherapeutic experiments.
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22
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Pharmacological brain cytoprotection in acute ischaemic stroke — renewed hope in the reperfusion era. Nat Rev Neurol 2022; 18:193-202. [PMID: 35079135 PMCID: PMC8788909 DOI: 10.1038/s41582-021-00605-6] [Citation(s) in RCA: 67] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2021] [Indexed: 11/08/2022]
Abstract
For over 40 years, attempts to develop treatments that protect neurons and other brain cells against the cellular and biochemical consequences of cerebral ischaemia in acute ischaemic stroke (AIS) have been unsuccessful. However, the advent of intravenous thrombolysis and endovascular thrombectomy has taken us into a new era of treatment for AIS in which highly effective reperfusion therapy is widely available. In this context, cytoprotective treatments should be revisited as adjunctive treatment to reperfusion therapy. Renewed efforts should focus on developing new drugs that target multiple aspects of the ischaemic cascade, and previously developed drugs should be reconsidered if they produced robust cytoprotective effects in preclinical models and their safety profiles were reasonable in previous clinical trials. Several development pathways for cytoprotection as an adjunct to reperfusion can be envisioned. In this Review, we outline the targets for cytoprotective therapy and discuss considerations for future drug development, highlighting the recent ESCAPE-NA1 trial of nerinetide, which produced the most promising results to date. We review new types of clinical trial to evaluate whether cytoprotective drugs can slow infarct growth prior to reperfusion and/or ameliorate the consequences of reperfusion, such as haemorrhagic transformation. We also highlight how advanced brain imaging can help to identify patients with salvageable ischaemic tissue who are likely to benefit from cytoprotective therapy. In this Review, Fisher and Savitz consider how the era of reperfusion therapy in ischaemic stroke provides new hope for the development of cytoprotective therapies to further improve outcomes, highlighting how promising recent findings can be built on to benefit patients. Highly successful reperfusion therapy with intravenous thrombolysis and endovascular thrombectomy is now widely available for the treatment of acute ischaemic stroke, making cytoprotective therapy a viable additional treatment approach. Previous attempts to develop cytoprotective therapy have been unsuccessful, but this approach should now be reconsidered as an adjunctive therapy to thrombolysis and thrombectomy. New cytoprotective drugs should be developed to target multiple aspects of the ischaemic cascade, and previously developed drugs should be reconsidered. Trials should be conducted to evaluate the effects of cytoprotective drugs when administered before or after reperfusion therapy or both. Advanced brain imaging should be used to select patients who are most likely to benefit from cytoprotective treatment for enrolment in new trials.
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23
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Kannan A, Delgardo M, Pennington-FitzGerald W, Jiang EX, Christophe BR, Connolly ES. Pharmacological management of cerebral ischemia in the elderly. Expert Opin Pharmacother 2020; 22:897-906. [PMID: 33382005 DOI: 10.1080/14656566.2020.1856815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction: For elderly adults in the United States, stroke is the fifth leading cause of death of which ischemic strokes comprise a vast majority. Optimal pharmacological management of elderly ischemic stroke patients involves both reperfusion and supportive care. Recent research into pharmacological management has focused on vascular, immunomodulatory, cytoprotective, and alternative agents, some of which have shown limited success in clinical trials. However, no treatments have been established as a reliable mode for management of cerebral ischemia for elderly adults beyond acute thrombolysis.Areas covered: The authors conducted a literature search for ischemic stroke management in the elderly and a search for human drug studies for managing ischemic stroke on clinicaltrials.gov. Here, they describe recent progress in the pharmacological management of cerebral ischemia in the elderly.Expert opinion: Many drug classes (antihypertensive, cytoprotective and immunomodulatory, and alternative agents) have been explored with limited success in managing ischemic stroke, though some have shown preventative benefits. We generally observed a broad gap in evidence on elderly patients from studies across all drug classes, necessitating further studies to gain an understanding of effective management of ischemic stroke in this large demographic of patients.
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Affiliation(s)
- Adithya Kannan
- Department of Neurological Surgery, Columbia University Medical Center, New York, NY, USA
| | - Mychael Delgardo
- Department of Neurological Surgery, Columbia University Medical Center, New York, NY, USA
| | | | - Enoch X Jiang
- Department of Neurological Surgery, Columbia University Medical Center, New York, NY, USA
| | - Brandon R Christophe
- Department of Neurological Surgery, Columbia University Medical Center, New York, NY, USA
| | - E Sander Connolly
- Department of Neurological Surgery, Columbia University Medical Center, New York, NY, USA
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24
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Wu D, Chen J, Hussain M, Wu L, Shi J, Wu C, Ma Y, Zhang M, Yang Q, Fu Y, Duan Y, Ma C, Yan F, Zhu Z, He X, Yao T, Song M, Zhi X, Wang C, Cai L, Li C, Li S, Zhang Y, Ding Y, Ji X. Selective intra-arterial brain cooling improves long-term outcomes in a non-human primate model of embolic stroke: Efficacy depending on reperfusion status. J Cereb Blood Flow Metab 2020; 40:1415-1426. [PMID: 32126876 PMCID: PMC7308521 DOI: 10.1177/0271678x20903697] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Nearly all stroke neuroprotection modalities, including selective intra-arterial cooling (SI-AC), have failed to be translated from bench to bed side. Potentially overlooked reasons may be biological gaps, inadequate attention to reperfusion states and mismatched attention to neurological benefits. To advance stroke translation, we describe a novel thrombus-based stroke model in adult rhesus macaques. Intra-arterial thrombolysis with tissue plasminogen activator leads to three clinically relevant outcomes - complete, partial, and no recanalization based on digital subtraction angiography. We also find reperfusion as a prerequisite for SI-AC-induced benefits, in which models with complete or partial reperfusion exhibit significantly reduced infarct volumes, mitigated neurological deficits, improved upper limb motor dysfunction in both acute and chronic stages; however, no further neuroprotection is observed in those without reperfusion. In summary, we discover reperfusion as a crucial regulator of SI-AC-induced neuroprotection and provide insights of long-term functional benefits in behavior and imaging levels. Our findings could be important not only for the translational prerequisite and potential molecular targets, but also for this thrombus-thrombolysis model in monkeys as a powerful tool for further translational stroke studies.
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Affiliation(s)
- Di Wu
- Department of Neurology and China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Hypoxia Conditioning Translational Medicine, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Jian Chen
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Mohammed Hussain
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Longfei Wu
- Department of Neurology and China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Hypoxia Conditioning Translational Medicine, Beijing, China
| | - Jingfei Shi
- Department of Neurology and China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Chuanjie Wu
- Department of Neurology and China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Hypoxia Conditioning Translational Medicine, Beijing, China
| | - Yanhui Ma
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Mo Zhang
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Qi Yang
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yongjuan Fu
- Department of Pathology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yunxia Duan
- Department of Neurology and China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Cui Ma
- Interdisciplinary Innovation Institute of Medicine and Engineering, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Feng Yan
- Department of Neurology and China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zixin Zhu
- Department of Neurology and China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xiaoduo He
- Department of Neurology and China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Tianqi Yao
- Department of Neurology and China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Ming Song
- Interdisciplinary Innovation Institute of Medicine and Engineering, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Xinglong Zhi
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Chunxiu Wang
- Department of Neurology and China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Lipeng Cai
- Department of Neurology and China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Chuanhui Li
- Department of Neurology and China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Shengli Li
- Department of Neurology and China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yongbiao Zhang
- Brainnetome Center, Institute of Automation, Chinese Academy of Sciences, Beijing, China
| | - Yuchuan Ding
- Department of Neurology and China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China.,Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Xunming Ji
- Department of Neurology and China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Hypoxia Conditioning Translational Medicine, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
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25
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Shimamura M, Nakagami H, Sasaki T, Morishita R, Mochizuki H. [Current status and perspectives in the development of therapeutic agents targeting post-ischemic inflammation in the acute stage of stroke]. Rinsho Shinkeigaku 2020; 60:253-259. [PMID: 32238749 DOI: 10.5692/clinicalneurol.cn-001401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We have developed a partial peptide of RANKL (receptor activator of NF-κB ligand) that suppresses TLR (toll-like receptor)-related inflammation via RANKL/RANK (receptor activator of nuclear factor-κB) signals in the acute phase of ischemic stroke. This peptide has been found to be a therapeutic agent for ischemic stroke that can be used in combination with tPA in a mouse model. Based on the findings, we are working on translational research to aim for clinical application of this peptide through collaboration with pharmacy companies. However, the problem is that the need for development of medication in the acute stage of ischemic stroke is currently low in pharmaceutical companies due to the failure of many investigational drugs in the past. To overcome the problem, we are examining the effects of this peptide in other diseases included in the company's priority areas and explaining the environmental changes in the clinical trials due to the development of endovascular treatment in the acute stage of ischemic stroke.
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Affiliation(s)
- Munehisa Shimamura
- Department of Neurology, Osaka University.,Department of Health Development and Medicine, Graduate School of Medicine, Osaka University
| | - Hironori Nakagami
- Department of Health Development and Medicine, Graduate School of Medicine, Osaka University
| | | | - Ryuichi Morishita
- Department of Clinical Gene Therapy, Graduate School of Medicine, Osaka University
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26
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Abstract
Despite thousands of neuroprotectants demonstrating promise in preclinical trials, a neuroprotective therapeutic has yet to be approved for the treatment of acute brain injuries such as stroke or traumatic brain injury. Developing a more detailed understanding of models and populations demonstrating "neurological resilience" in spite of brain injury can give us important insights into new translational therapies. Resilience is the process of active adaptation to a stressor. In the context of neuroprotection, models of preconditioning and unique animal models of extreme physiology (such as hibernating species) reliably demonstrate resilience in the laboratory setting. In the clinical setting, resilience is observed in young patients and can be found in those with specific genetic polymorphisms. These important examples of resilience can help transform and extend the current neuroprotective framework from simply countering the injurious cascade into one that anticipates, monitors, and optimizes patients' physiological responses from the time of injury throughout the process of recovery. This review summarizes the underpinnings of key adaptations common to models of resilience and how this understanding can be applied to new neuroprotective approaches.
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Affiliation(s)
- Neel S Singhal
- Department of Neurology, University of California-San Francisco, 555 South Mission Bay Blvd, San Francisco, CA, 94158, USA.
| | - Chung-Huan Sun
- Department of Neurology, University of California-San Francisco, 555 South Mission Bay Blvd, San Francisco, CA, 94158, USA
| | - Evan M Lee
- Cardiovascular Research Institute, University of California-San Francisco, 555 South Mission Bay Blvd, San Francisco, CA, 94158, USA
- Department of Physiology, University of California-San Francisco, 555 South Mission Bay Blvd, San Francisco, CA, 94158, USA
| | - Dengke K Ma
- Cardiovascular Research Institute, University of California-San Francisco, 555 South Mission Bay Blvd, San Francisco, CA, 94158, USA
- Department of Physiology, University of California-San Francisco, 555 South Mission Bay Blvd, San Francisco, CA, 94158, USA
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27
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Feng H, Hu L, Zhu H, Tao L, Wu L, Zhao Q, Gao Y, Gong Q, Mao F, Li X, Zhou H, Li J, Zhang H. Repurposing antimycotic ciclopirox olamine as a promising anti-ischemic stroke agent. Acta Pharm Sin B 2020; 10:434-446. [PMID: 32140390 PMCID: PMC7049605 DOI: 10.1016/j.apsb.2019.08.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 07/18/2019] [Accepted: 07/19/2019] [Indexed: 02/06/2023] Open
Abstract
Ischemic stroke is a severe disorder resulting from acute cerebral thrombosis. Here we demonstrated that post-ischemic treatment with ciclopirox olamine (CPX), a potent antifungal clinical drug, alleviated brain infarction, neurological deficits and brain edema in a classic rat model of ischemic stroke. Single dose post-ischemic administration of CPX provided a long-lasting neuroprotective effect, which can be further enhanced by multiple doses administration of CPX. CPX also effectively reversed ischemia-induced neuronal loss, glial activation as well as blood–brain barrier (BBB) damage. Employing quantitative phosphoproteomic analysis, 130 phosphosites in 122 proteins were identified to be significantly regulated by CPX treatment in oxygen glucose deprivation (OGD)-exposed SH-SY5Y cells, which revealed that phosphokinases and cell cycle-related phosphoproteins were largely influenced. Subsequently, we demonstrated that CPX markedly enhanced the AKT (protein kinase B, PKB/AKT) and GSK3β (glycogen synthase kinase 3β) phosphorylation in OGD-exposed SH-SY5Y cells, and regulated the cell cycle progression and nitric oxide (NO) release in lipopolysaccharide (LPS)-induced BV-2 cells, which may contribute to its ameliorative effects against ischemia-associated neuronal death and microglial inflammation. Our study suggests that CPX could be a promising compound to reduce multiple ischemic injuries; however, further studies will be needed to clarify the molecular mechanisms involved.
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Wu L, Wu D, Yang T, Xu J, Chen J, Wang L, Xu S, Zhao W, Wu C, Ji X. Hypothermic neuroprotection against acute ischemic stroke: The 2019 update. J Cereb Blood Flow Metab 2020; 40:461-481. [PMID: 31856639 PMCID: PMC7026854 DOI: 10.1177/0271678x19894869] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 11/14/2019] [Accepted: 11/18/2019] [Indexed: 02/06/2023]
Abstract
Acute ischemic stroke is a leading cause of death and disability worldwide. Therapeutic hypothermia has long been considered as one of the most robust neuroprotective strategies. Although the neuroprotective effects of hypothermia have only been confirmed in patients with global cerebral ischemia after cardiac arrest and in neonatal hypoxic ischemic encephalopathy, establishing standardized protocols and strictly controlling the key parameters may extend its application in other brain injuries, such as acute ischemic stroke. In this review, we discuss the potential neuroprotective effects of hypothermia, its drawbacks evidenced in previous studies, and its potential clinical application for acute ischemic stroke especially in the era of reperfusion. Based on the different conditions between bench and bedside settings, we demonstrate the importance of vascular recanalization for neuroprotection of hypothermia by analyzing numerous literatures regarding hypothermia in focal cerebral ischemia. Then, we make a thorough analysis of key parameters of hypothermia and introduce novel hypothermic therapies. We advocate in favor of the process of clinical translation of intra-arterial selective cooling infusion in the era of reperfusion and provide insights into the prospects of hypothermia in acute ischemic stroke.
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Affiliation(s)
- Longfei Wu
- Department of Neurology and China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Di Wu
- Department of Neurology and China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Tuo Yang
- Department of Neurology, Pittsburgh Institute of Brain Disorders and Recovery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jin Xu
- Department of Library, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jian Chen
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Luling Wang
- Department of Neurology and China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Shuaili Xu
- Department of Neurology and China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Wenbo Zhao
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Chuanjie Wu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xunming Ji
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
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Williams EI, Betterton RD, Davis TP, Ronaldson PT. Transporter-Mediated Delivery of Small Molecule Drugs to the Brain: A Critical Mechanism That Can Advance Therapeutic Development for Ischemic Stroke. Pharmaceutics 2020; 12:pharmaceutics12020154. [PMID: 32075088 PMCID: PMC7076465 DOI: 10.3390/pharmaceutics12020154] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 02/10/2020] [Accepted: 02/11/2020] [Indexed: 12/28/2022] Open
Abstract
Ischemic stroke is the 5th leading cause of death in the United States. Despite significant improvements in reperfusion therapies, stroke patients still suffer from debilitating neurocognitive deficits. This indicates an essential need to develop novel stroke treatment paradigms. Endogenous uptake transporters expressed at the blood-brain barrier (BBB) provide an excellent opportunity to advance stroke therapy via optimization of small molecule neuroprotective drug delivery to the brain. Examples of such uptake transporters include organic anion transporting polypeptides (OATPs in humans; Oatps in rodents) and organic cation transporters (OCTs in humans; Octs in rodents). Of particular note, small molecule drugs that have neuroprotective properties are known substrates for these transporters and include 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (i.e., statins) for OATPs/Oatps and 1-amino-3,5-dimethyladamantane (i.e., memantine) for OCTs/Octs. Here, we review current knowledge on specific BBB transporters that can be targeted for improvement of ischemic stroke treatment and provide state-of-the-art perspectives on the rationale for considering BBB transport properties during discovery/development of stroke therapeutics.
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The potential of drug repurposing combined with reperfusion therapy in cerebral ischemic stroke: A supplementary strategy to endovascular thrombectomy. Life Sci 2019; 236:116889. [PMID: 31610199 DOI: 10.1016/j.lfs.2019.116889] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 09/09/2019] [Accepted: 09/18/2019] [Indexed: 11/21/2022]
Abstract
Stroke is the major cause of adult disability and the second or third leading cause of death in developed countries. The treatment options for stroke (thrombolysis or thrombectomy) are restricted to a small subset of patients with acute ischemic stroke because of the limited time for an efficacious response and the strict criteria applied to minimize the risk of cerebral hemorrhage. Attempts to develop new treatments, such as neuroprotectants, for acute ischemic stroke have been costly and time-consuming and to date have yielded disappointing results. The repurposing approved drugs known to be relatively safe, such as statins and minocycline, may provide a less costly and more rapid alternative to new drug discovery in this clinical condition. Because adequate perfusion is thought to be vital for a neuroprotectant to be effective, endovascular thrombectomy (EVT) with advanced imaging modalities offers the possibility of documenting reperfusion in occluded large cerebral vessels. An examination of established medications that possess neuroprotective characters using in a large-vessel occlusive disorder with EVT may speed the identification of new and more broadly efficacious medications for the treatment of ischemic stroke. These approaches are highlighted in this review along with a critical assessment of drug repurposing combined with reperfusion therapy as a supplementary means for halting or mitigating stroke-induced brain damage.
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Baron JC. Protecting the ischaemic penumbra as an adjunct to thrombectomy for acute stroke. Nat Rev Neurol 2019; 14:325-337. [PMID: 29674752 DOI: 10.1038/s41582-018-0002-2] [Citation(s) in RCA: 106] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
After ischaemic stroke, brain damage can be curtailed by rescuing the 'ischaemic penumbra' - that is, the severely hypoperfused, at-risk but not yet infarcted tissue. Current evidence-based treatments involve restoration of blood flow so as to salvage the penumbra before it evolves into irreversibly damaged tissue, termed the 'core'. Intravenous thrombolysis (IVT) can salvage the penumbra if given within 4.5 h after stroke onset; however, the early recanalization rate is only ~30%. Direct removal of the occluding clot by mechanical thrombectomy considerably improves outcomes over IVT alone, but despite early recanalization in > 80% of cases, ~50% of patients who receive this treatment do not enjoy functional independence, usually because the core is already too large at the time of recanalization. Novel therapies aiming to 'freeze' the penumbra - that is, prevent core growth until recanalization is complete - hold potential as adjuncts to mechanical thrombectomy. This Review focuses on nonpharmacological approaches that aim to restore the physiological balance between oxygen delivery to and oxygen demand of the penumbra. Particular emphasis is placed on normobaric oxygen therapy, hypothermia and sensory stimulation. Preclinical evidence and early pilot clinical trials are critically reviewed, and future directions, including clinical translation and trial design issues, are discussed.
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Affiliation(s)
- Jean-Claude Baron
- Department of Neurology, Hôpital Sainte-Anne, Université Paris 5, INSERM U894, Paris, France.
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Caroff J, King RM, Mitchell JE, Marosfoi M, Licwinko JR, Gray-Edwards HL, Puri AS, Merrill TL, Gounis MJ. Focal cooling of brain parenchyma in a transient large vessel occlusion model: proof-of-concept. J Neurointerv Surg 2019; 12:209-213. [PMID: 31363042 DOI: 10.1136/neurintsurg-2019-015179] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 07/09/2019] [Accepted: 07/12/2019] [Indexed: 01/04/2023]
Abstract
INTRODUCTION The neuroprotective benefit of therapeutic hypothermia (TH) has been demonstrated, but systemic side effects and time required to achieve effective TH in acute ischemic stroke (AIS) care limits clinical use. We investigate rapid and localized cooling using a novel insulated catheter in an ischemia-reperfusion model. METHODS In phase I (n=4), cold saline was delivered to the canine internal carotid artery via an insulated catheter. Temperature was measured using intracerebral thermocouples. The coolant flow rate was varied to meet a target temperature of 31-32°C in the hemisphere infused. In phase II (n=8), a temporary middle cerebral artery occlusion was created. Five dogs underwent localized TH at the optimal flow rate from phase I, and the remaining animals were untreated controls. Cooling was initiated 5 min before recanalization and continued for an additional 20 min following 45 min of occlusion duration. The outcome was infarct volume and neurological function. RESULTS Ipsilateral tissue cooling rates were 2.2±2.5°C/min at a flow rate of 20-40 mL/min with an observed minimum of 23.8°C. Tissue cooling was localized to the ipsilateral side of the infusion with little impact on temperatures of the core or contralateral hemisphere of the brain. In phase II, animals tolerated TH with minimal systemic impact. Infarct volume in treated animals was 0.2±0.2 cm3, which was smaller than in sham animals (3.8±1.0 cm3) as well as six untreated historical control animals (4.0±2.8 cm3) (p=0.013). CONCLUSIONS Proof-of-concept data show that localised brain TH can be quickly and safely achieved through a novel insulated catheter. The small infarct volumes suggest potential benefit for this approach.
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Affiliation(s)
- Jildaz Caroff
- Interventional Neuroradiology, NEURI Center, Bicêtre Hospital, Le Kremlin- Bicêtre, France
| | - Robert M King
- New England Center for Stroke Research, Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts, USA.,Department of Biomedical Engineering, Worcester Polytechnic Institute, Worcester, MA, USA
| | | | - Miklos Marosfoi
- New England Center for Stroke Research, Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | | | - Heather L Gray-Edwards
- New England Center for Stroke Research, Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Ajit S Puri
- New England Center for Stroke Research, Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Thomas L Merrill
- FocalCool, Mullica Hill, New Jersey, USA.,Department of Mechanical Engineering, Rowan University, Glassboro, NJ, USA
| | - Matthew J Gounis
- New England Center for Stroke Research, Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
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Robinson T. Reperfusion in the brain: is time important? The DAWN and DEFUSE-3 trials. Cardiovasc Res 2019; 114:e28-e29. [PMID: 29590391 DOI: 10.1093/cvr/cvy053] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- Thompson Robinson
- Department of Cardiovascular Sciences, University of Leicester, BHF Cardiovascular Research Centre, The Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK
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Savitz SI, Baron JC, Fisher M, Albers GW, Arbe-Barnes S, Boltze J, Broderick J, Broschat KO, Elkind MSV, En’Wezoh D, Furlan AJ, Gorelick PB, Grotta J, Hancock AM, Hess DC, Holt W, Houser G, Hsia AW, Kim WK, Korinek WS, Le Moan N, Liberman M, Lilienfeld S, Luby M, Lynch JK, Mansi C, Simpkins AN, Nadareishvili Z, Nogueira RG, Pryor KE, Sanossian N, Schwamm LH, Selim M, Sheth KN, Spilker J, Solberg Y, Steinberg GK, Stice S, Tymianski M, Wechsler LR, Yoo AJ. Stroke Treatment Academic Industry Roundtable X. Stroke 2019; 50:1026–1031. [DOI: 10.1161/strokeaha.118.023927] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Sean I. Savitz
- From the Institute for Stroke and Cerebrovascular Disease, The University of Texas Health Science Center at Houston, (S.I.S.)
| | - Jean-Claude Baron
- Department of Neurology, Hôpital Sainte-Anne, University Paris Descartes, INSERM U1266, France (J.-C.B.)
| | - Marc Fisher
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.F.)
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Seyedsaadat SM, F. Kallmes D. Memantine for the treatment of ischemic stroke: experimental benefits and clinical lack of studies. Rev Neurosci 2019; 30:203-220. [DOI: 10.1515/revneuro-2018-0025] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 04/19/2018] [Indexed: 01/19/2023]
Abstract
AbstractStroke is an important cause of mortality and disability worldwide. Immediately after stroke onset, the ischemic cascade initiates and deleteriously affects neural cells. Time to reperfusion therapy is a critical determinant of functional recovery in stroke patients. Although recent trials have shown the significant efficacy of endovascular thrombectomy, either alone or with intravenous tissue plasminogen activator, in improving the functional outcomes of stroke patients with large vessel occlusion, hours can pass before patients receive reperfusion therapy. Moreover, many patients do not meet the eligibility criteria to receive reperfusion treatments. Therefore, an adjunct and alternative agent that can protect ischemic neuronal tissue during the hyperacute phase until reperfusion therapy can be administered may prevent further brain damage and enhance functional recovery. Memantine is a US Food and Drug Administration approved drug for the treatment of Alzheimer’s disease. Memantine blocks overstimulated N-methyl-d-aspartate receptors and prevents neurotoxicity caused by massive glutamate release. Preclinical studies show that memantine decreases infarction volume and improves neurologic outcomes. However, few clinical studies have evaluated the safety and efficacy of memantine in stroke patients. This review article summarizes the current evidence for the role of memantine in the treatment of ischemic stroke and highlights areas for future research.
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Shi L, Rocha M, Leak RK, Zhao J, Bhatia TN, Mu H, Wei Z, Yu F, Weiner SL, Ma F, Jovin TG, Chen J. A new era for stroke therapy: Integrating neurovascular protection with optimal reperfusion. J Cereb Blood Flow Metab 2018; 38:2073-2091. [PMID: 30191760 PMCID: PMC6282224 DOI: 10.1177/0271678x18798162] [Citation(s) in RCA: 119] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Recent advances in stroke reperfusion therapies have led to remarkable improvement in clinical outcomes, but many patients remain severely disabled, due in part to the lack of effective neuroprotective strategies. In this review, we show that 95% of published preclinical studies on "neuroprotectants" (1990-2018) reported positive outcomes in animal models of ischemic stroke, while none translated to successful Phase III trials. There are many complex reasons for this failure in translational research, including that the majority of clinical trials did not test early delivery of neuroprotectants in combination with successful reperfusion. In contrast to the clinical trials, >80% of recent preclinical studies examined the neuroprotectant in animal models of transient ischemia with complete reperfusion. Furthermore, only a small fraction of preclinical studies included long-term functional assessments, aged animals of both genders, and models with stroke comorbidities. Recent clinical trials demonstrate that 70%-80% of patients treated with endovascular thrombectomy achieve successful reperfusion. These successes revive the opportunity to retest previously failed approaches, including cocktail drugs that target multiple injury phases and different cell types. It is our hope that neurovascular protectants can be retested in future stroke research studies with specific criteria outlined in this review to increase translational successes.
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Affiliation(s)
- Ligen Shi
- 1 Pittsburgh Institute of Brain Disorders & Recovery and Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,2 Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang, China
| | - Marcelo Rocha
- 3 Department of Neurology, UPMC Stroke Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - Rehana K Leak
- 4 Graduate School of Pharmaceutical Sciences, Duquesne University, Pittsburgh, PA, USA
| | - Jingyan Zhao
- 1 Pittsburgh Institute of Brain Disorders & Recovery and Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Tarun N Bhatia
- 4 Graduate School of Pharmaceutical Sciences, Duquesne University, Pittsburgh, PA, USA
| | - Hongfeng Mu
- 1 Pittsburgh Institute of Brain Disorders & Recovery and Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Zhishuo Wei
- 1 Pittsburgh Institute of Brain Disorders & Recovery and Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Fang Yu
- 1 Pittsburgh Institute of Brain Disorders & Recovery and Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Susan L Weiner
- 4 Graduate School of Pharmaceutical Sciences, Duquesne University, Pittsburgh, PA, USA
| | - Feifei Ma
- 1 Pittsburgh Institute of Brain Disorders & Recovery and Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Tudor G Jovin
- 3 Department of Neurology, UPMC Stroke Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jun Chen
- 1 Pittsburgh Institute of Brain Disorders & Recovery and Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,5 Geriatric Research, Educational and Clinical Center, Veterans Affairs Pittsburgh Health Care System, Pittsburgh, PA, USA
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Jeong HG, Kim BJ, Choi JC, Hong KS, Yang MH, Jung C, Han MK, Bae HJ. Posttreatment National Institutes of Health Stroke Scale Is Superior to the Initial Score or Thrombolysis in Cerebral Ischemia for 3-Month Outcome. Stroke 2018. [DOI: 10.1161/strokeaha.117.020587] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Han-Gil Jeong
- From the Department of Neurology and Cerebrovascular Center (H.-G.J., B.J.K., M.H.Y., M.-K.H., H.-J.B.) and Department of Radiology (C.J.), Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Department of Neurology, Jeju National University, Republic of Korea (J.C.C.); and Department of Neurology, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea (K.-S.H.)
| | - Beom Joon Kim
- From the Department of Neurology and Cerebrovascular Center (H.-G.J., B.J.K., M.H.Y., M.-K.H., H.-J.B.) and Department of Radiology (C.J.), Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Department of Neurology, Jeju National University, Republic of Korea (J.C.C.); and Department of Neurology, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea (K.-S.H.)
| | - Jay Chol Choi
- From the Department of Neurology and Cerebrovascular Center (H.-G.J., B.J.K., M.H.Y., M.-K.H., H.-J.B.) and Department of Radiology (C.J.), Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Department of Neurology, Jeju National University, Republic of Korea (J.C.C.); and Department of Neurology, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea (K.-S.H.)
| | - Keun-Sik Hong
- From the Department of Neurology and Cerebrovascular Center (H.-G.J., B.J.K., M.H.Y., M.-K.H., H.-J.B.) and Department of Radiology (C.J.), Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Department of Neurology, Jeju National University, Republic of Korea (J.C.C.); and Department of Neurology, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea (K.-S.H.)
| | - Mi Hwa Yang
- From the Department of Neurology and Cerebrovascular Center (H.-G.J., B.J.K., M.H.Y., M.-K.H., H.-J.B.) and Department of Radiology (C.J.), Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Department of Neurology, Jeju National University, Republic of Korea (J.C.C.); and Department of Neurology, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea (K.-S.H.)
| | - Cheolkyu Jung
- From the Department of Neurology and Cerebrovascular Center (H.-G.J., B.J.K., M.H.Y., M.-K.H., H.-J.B.) and Department of Radiology (C.J.), Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Department of Neurology, Jeju National University, Republic of Korea (J.C.C.); and Department of Neurology, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea (K.-S.H.)
| | - Moon-Ku Han
- From the Department of Neurology and Cerebrovascular Center (H.-G.J., B.J.K., M.H.Y., M.-K.H., H.-J.B.) and Department of Radiology (C.J.), Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Department of Neurology, Jeju National University, Republic of Korea (J.C.C.); and Department of Neurology, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea (K.-S.H.)
| | - Hee-Joon Bae
- From the Department of Neurology and Cerebrovascular Center (H.-G.J., B.J.K., M.H.Y., M.-K.H., H.-J.B.) and Department of Radiology (C.J.), Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Department of Neurology, Jeju National University, Republic of Korea (J.C.C.); and Department of Neurology, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea (K.-S.H.)
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Bernstock JD, Ye D, Smith JA, Lee YJ, Gessler FA, Yasgar A, Kouznetsova J, Jadhav A, Wang Z, Pluchino S, Zheng W, Simeonov A, Hallenbeck JM, Yang W. Quantitative high-throughput screening identifies cytoprotective molecules that enhance SUMO conjugation via the inhibition of SUMO-specific protease (SENP)2. FASEB J 2018; 32:1677-1691. [PMID: 29146736 PMCID: PMC5892725 DOI: 10.1096/fj.201700711r] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 11/06/2017] [Indexed: 12/18/2022]
Abstract
The development of novel neuroprotective treatments for acute stroke has been fraught with failures, which supports the view of ischemic brain damage as a highly complex multifactorial process. Post-translational modifications such as small ubiquitin-like modifier (SUMO)ylation have emerged as critical molecular regulatory mechanisms in states of both homeostasis and ischemic stress, as evidenced by our previous work. Accordingly, the clinical significance of the selective control of the global SUMOylation process has become apparent in studies of ischemic pathobiology and pathophysiology. Herein, we describe a process capable of identifying and characterizing small molecules with the potential of targeting the SUMO system through inhibition of SUMO deconjugation in an effort to develop novel stroke therapies.-Bernstock, J. D., Ye, D., Smith, J. A., Lee, Y.-J., Gessler, F. A., Yasgar, A., Kouznetsova, J., Jadhav, A., Wang, Z., Pluchino, S., Zheng, W., Simeonov, A., Hallenbeck, J. M., Yang, W. Quantitative high-throughput screening identifies cytoprotective molecules that enhance SUMO-conjugation via the inhibition of SUMO-specific protease (SENP)2.
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Affiliation(s)
- Joshua D. Bernstock
- Stroke Branch, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health, Bethesda, Maryland, USA
- Division of Stem Cell Neurobiology, Department of Clinical Neurosciences, Wellcome Trust-Medical Research Council Stem Cell Institute and National Institute of Health Research Biomedical Research Centre, University of Cambridge, United Kingdom
- UAB School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Daniel Ye
- Stroke Branch, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health, Bethesda, Maryland, USA
| | - Jayden A. Smith
- Division of Stem Cell Neurobiology, Department of Clinical Neurosciences, Wellcome Trust-Medical Research Council Stem Cell Institute and National Institute of Health Research Biomedical Research Centre, University of Cambridge, United Kingdom
| | - Yang-Ja Lee
- Stroke Branch, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health, Bethesda, Maryland, USA
| | - Florian A. Gessler
- Division of Stem Cell Neurobiology, Department of Clinical Neurosciences, Wellcome Trust-Medical Research Council Stem Cell Institute and National Institute of Health Research Biomedical Research Centre, University of Cambridge, United Kingdom
| | - Adam Yasgar
- National Center for Advancing Translational Sciences, National Institutes of Health, Bethesda, Maryland, USA; and
| | - Jennifer Kouznetsova
- National Center for Advancing Translational Sciences, National Institutes of Health, Bethesda, Maryland, USA; and
| | - Ajit Jadhav
- National Center for Advancing Translational Sciences, National Institutes of Health, Bethesda, Maryland, USA; and
| | - Zhuoran Wang
- Center for Perioperative Organ Protection, Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Stefano Pluchino
- Division of Stem Cell Neurobiology, Department of Clinical Neurosciences, Wellcome Trust-Medical Research Council Stem Cell Institute and National Institute of Health Research Biomedical Research Centre, University of Cambridge, United Kingdom
| | - Wei Zheng
- National Center for Advancing Translational Sciences, National Institutes of Health, Bethesda, Maryland, USA; and
| | - Anton Simeonov
- National Center for Advancing Translational Sciences, National Institutes of Health, Bethesda, Maryland, USA; and
| | - John M. Hallenbeck
- Stroke Branch, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health, Bethesda, Maryland, USA
| | - Wei Yang
- Center for Perioperative Organ Protection, Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA
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Bernstock JD, Ye DG, Lee YJ, Gessler F, Friedman GK, Zheng W, Hallenbeck JM. Drugging SUMOylation for neuroprotection and oncotherapy. Neural Regen Res 2018; 13:415-416. [PMID: 29623920 PMCID: PMC5900498 DOI: 10.4103/1673-5374.228718] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Joshua D Bernstock
- Stroke Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health (NINDS/NIH), Bethesda, MD, USA; Department of Clinical Neurosciences - Division of Stem Cell Neurobiology, Wellcome Trust-Medical Research Council Stem Cell Institute and NIHR Biomedical Research Centre, University of Cambridge, UK
| | - Daniel G Ye
- Stroke Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health (NINDS/NIH), Bethesda, MD, USA
| | - Yang-Ja Lee
- Stroke Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health (NINDS/NIH), Bethesda, MD, USA
| | - Florian Gessler
- Department of Clinical Neurosciences - Division of Stem Cell Neurobiology, Wellcome Trust-Medical Research Council Stem Cell Institute and NIHR Biomedical Research Centre, University of Cambridge, UK
| | - Gregory K Friedman
- Department of Pediatrics, Division of Pediatric Hematology and Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Wei Zheng
- National Center for Advancing Translational Sciences, National Institutes of Health (NCATS/NIH), Bethesda, MD, USA
| | - John M Hallenbeck
- Stroke Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health (NINDS/NIH), Bethesda, MD, USA
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40
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Poli S, Baron JC, Singhal AB, Härtig F. Normobaric hyperoxygenation: a potential neuroprotective therapy for acute ischemic stroke? Expert Rev Neurother 2017; 17:1131-1134. [PMID: 28872934 DOI: 10.1080/14737175.2017.1376657] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Sven Poli
- a Department of Neurology & Stroke , University Hospital Tübingen and Hertie Institute for Clinical Brain Research , Tübingen , Germany
| | - Jean-Claude Baron
- b Department of Neurology , Hopital Sainte-Anne, University Paris Descartes, INSERM U894 , Paris , France
| | - Aneesh B Singhal
- c Department of Neurology, ACC-729C , Massachusetts General Hospital, Harvard Medical School , Boston , USA
| | - Florian Härtig
- a Department of Neurology & Stroke , University Hospital Tübingen and Hertie Institute for Clinical Brain Research , Tübingen , Germany
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