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Quadros-Mennella PS, Lucin KM, White RE. What can the common fruit fly teach us about stroke?: lessons learned from the hypoxic tolerant Drosophila melanogaster. Front Cell Neurosci 2024; 18:1347980. [PMID: 38584778 PMCID: PMC10995290 DOI: 10.3389/fncel.2024.1347980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 03/08/2024] [Indexed: 04/09/2024] Open
Abstract
Stroke, resulting in hypoxia and glucose deprivation, is a leading cause of death and disability worldwide. Presently, there are no treatments that reduce neuronal damage and preserve function aside from tissue plasminogen activator administration and rehabilitation therapy. Interestingly, Drosophila melanogaster, the common fruit fly, demonstrates robust hypoxic tolerance, characterized by minimal effects on survival and motor function following systemic hypoxia. Due to its organized brain, conserved neurotransmitter systems, and genetic similarity to humans and other mammals, uncovering the mechanisms of Drosophila's tolerance could be a promising approach for the development of new therapeutics. Interestingly, a key facet of hypoxic tolerance in Drosophila is organism-wide metabolic suppression, a response involving multiple genes and pathways. Specifically, studies have demonstrated that pathways associated with oxidative stress, insulin, hypoxia-inducible factors, NFκB, Wnt, Hippo, and Notch, all potentially contribute to Drosophila hypoxic tolerance. While manipulating the oxidative stress response and insulin signaling pathway has similar outcomes in Drosophila hypoxia and the mammalian middle cerebral artery occlusion (MCAO) model of ischemia, effects of Notch pathway manipulation differ between Drosophila and mammals. Additional research is warranted to further explore how other pathways implicated in hypoxic tolerance in Drosophila, such as NFκB, and Hippo, may be utilized to benefit mammalian response to ischemia. Together, these studies demonstrate that exploration of the hypoxic response in Drosophila may lead to new avenues of research for stroke treatment in humans.
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Affiliation(s)
| | - Kurt M. Lucin
- Department of Biology, Eastern Connecticut State University, Willimantic, CT, United States
| | - Robin E. White
- Department of Biology, Westfield State University, Westfield, MA, United States
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2
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Mersha MD, Hubbard R, Zeiler SR. Alternate Day Fasting Leads to Improved Post-Stroke Motor Recovery in Mice. Neurorehabil Neural Repair 2024; 38:187-196. [PMID: 38425047 DOI: 10.1177/15459683241232680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
BACKGROUND Caloric restriction promotes neuroplasticity and recovery after neurological injury. In mice, we tested the hypothesis that caloric restriction can act post-stroke to enhance training-associated motor recovery. METHODS Mice were trained to perform a skilled prehension task. We then induced a photothrombotic stroke in the caudal forelimb area, after which we retrained animals on the prehension task following an 8-day delay. Mice underwent either ad libitum feeding or alternate day fasting beginning 1-day after stroke and persisting for either 7 days or the entire post-stroke training period until sacrifice. RESULTS Prior studies have shown that post-stroke recovery of prehension can occur if animals receive rehabilitative training during an early sensitive period but is incomplete if rehabilitative training is delayed. In contrast, we show complete recovery of prehension, despite a delay in rehabilitative training, when mice underwent alternate day fasting beginning 1-day post-stroke and persisting for either 7 days or the entire post-stroke training period until sacrifice. Recovery was independent of weight loss. Stroke volumes were similar across groups. CONCLUSIONS Post-stroke caloric restriction led to recovery of motor function independent of a protective effect on stroke volume. Prehension recovery improved even after ad libitum feeding was reinstituted suggesting that the observed motor recovery was not merely a motivational response. These data add to the growing evidence that post-stroke caloric restriction can enhance recovery.
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Affiliation(s)
- Mahlet D Mersha
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
| | - Robert Hubbard
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
| | - Steven R Zeiler
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
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3
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Hakon J, Quattromani MJ, Sjölund C, Talhada D, Kim B, Moyanova S, Mastroiacovo F, Di Menna L, Olsson R, Englund E, Nicoletti F, Ruscher K, Bauer AQ, Wieloch T. Inhibiting metabotropic glutamate receptor 5 after stroke restores brain function and connectivity. Brain 2024; 147:186-200. [PMID: 37656990 PMCID: PMC10766240 DOI: 10.1093/brain/awad293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 06/12/2023] [Accepted: 08/04/2023] [Indexed: 09/03/2023] Open
Abstract
Stroke results in local neural disconnection and brain-wide neuronal network dysfunction leading to neurological deficits. Beyond the hyper-acute phase of ischaemic stroke, there is no clinically-approved pharmacological treatment that alleviates sensorimotor impairments. Functional recovery after stroke involves the formation of new or alternative neuronal circuits including existing neural connections. The type-5 metabotropic glutamate receptor (mGluR5) has been shown to modulate brain plasticity and function and is a therapeutic target in neurological diseases outside of stroke. We investigated whether mGluR5 influences functional recovery and network reorganization rodent models of focal ischaemia. Using multiple behavioural tests, we observed that treatment with negative allosteric modulators (NAMs) of mGluR5 (MTEP, fenobam and AFQ056) for 12 days, starting 2 or 10 days after stroke, restored lost sensorimotor functions, without diminishing infarct size. Recovery was evident within hours after initiation of treatment and progressed over the subsequent 12 days. Recovery was prevented by activation of mGluR5 with the positive allosteric modulator VU0360172 and accelerated in mGluR5 knock-out mice compared with wild-type mice. After stroke, multisensory stimulation by enriched environments enhanced recovery, a result prevented by VU0360172, implying a role of mGluR5 in enriched environment-mediated recovery. Additionally, MTEP treatment in conjunction with enriched environment housing provided an additive recovery enhancement compared to either MTEP or enriched environment alone. Using optical intrinsic signal imaging, we observed brain-wide disruptions in resting-state functional connectivity after stroke that were prevented by mGluR5 inhibition in distinct areas of contralesional sensorimotor and bilateral visual cortices. The levels of mGluR5 protein in mice and in tissue samples of stroke patients were unchanged after stroke. We conclude that neuronal circuitry subserving sensorimotor function after stroke is depressed by a mGluR5-dependent maladaptive plasticity mechanism that can be restored by mGluR5 inhibition. Post-acute stroke treatment with mGluR5 NAMs combined with rehabilitative training may represent a novel post-acute stroke therapy.
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Affiliation(s)
- Jakob Hakon
- Division of Neurosurgery, Department of Clinical Sciences, Laboratory for Experimental Brain Research, Lund University, Lund 221 84, Sweden
| | - Miriana J Quattromani
- Division of Neurosurgery, Department of Clinical Sciences, Laboratory for Experimental Brain Research, Lund University, Lund 221 84, Sweden
| | - Carin Sjölund
- Division of Neurosurgery, Department of Clinical Sciences, Laboratory for Experimental Brain Research, Lund University, Lund 221 84, Sweden
| | - Daniela Talhada
- Division of Neurosurgery, Department of Clinical Sciences, Laboratory for Experimental Brain Research, Lund University, Lund 221 84, Sweden
| | - Byungchan Kim
- Department of Radiology, Washington University, Saint Louis, MO 63110, USA
| | - Slavianka Moyanova
- Department of Molecular Pathology, IRCCS Neuromed, 86077 Pozzilli, Italy
| | | | - Luisa Di Menna
- Department of Molecular Pathology, IRCCS Neuromed, 86077 Pozzilli, Italy
| | - Roger Olsson
- Department of Experimental Medical Sciences, Chemical Biology & Therapeutics, Lund University, Lund 221 84, Sweden
| | - Elisabet Englund
- Division of Pathology, Department of Clinical Sciences, Lund University, Lund 221 84, Sweden
| | - Ferdinando Nicoletti
- Department of Molecular Pathology, IRCCS Neuromed, 86077 Pozzilli, Italy
- Department of Physiology and Pharmacology, University of Rome La Sapienza, 00185 Rome, Italy
| | - Karsten Ruscher
- Division of Neurosurgery, Department of Clinical Sciences, Laboratory for Experimental Brain Research, Lund University, Lund 221 84, Sweden
| | - Adam Q Bauer
- Department of Radiology, Washington University, Saint Louis, MO 63110, USA
| | - Tadeusz Wieloch
- Division of Neurosurgery, Department of Clinical Sciences, Laboratory for Experimental Brain Research, Lund University, Lund 221 84, Sweden
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4
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Baig SS, Kamarova M, Bell SM, Ali AN, Su L, Dimairo M, Dawson J, Redgrave JN, Majid A. tVNS in Stroke: A Narrative Review on the Current State and the Future. Stroke 2023; 54:2676-2687. [PMID: 37646161 DOI: 10.1161/strokeaha.123.043414] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Ischemic stroke is a leading cause of disability and there is a paucity of therapeutic strategies that promote functional recovery after stroke. Transcutaneous vagus nerve stimulation (tVNS) has shown promising evidence as a tool to reduce infarct size in animal models of hyperacute stroke. In chronic stroke, tVNS paired with limb movements has been shown to enhance neurological recovery. In this review, we summarize the current evidence for tVNS in preclinical models and clinical trials in humans. We highlight the mechanistic pathways involved in the beneficial effects of tVNS. We critically evaluate the current gaps in knowledge and recommend the key areas of research required to translate tVNS into clinical practice in acute and chronic stroke.
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Affiliation(s)
- Sheharyar S Baig
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience, University of Sheffield, United Kingdom (S.S.B., M.K., S.M.B., A.N.A., L.S., J.N.R., A.M.)
| | - Marharyta Kamarova
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience, University of Sheffield, United Kingdom (S.S.B., M.K., S.M.B., A.N.A., L.S., J.N.R., A.M.)
| | - Simon M Bell
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience, University of Sheffield, United Kingdom (S.S.B., M.K., S.M.B., A.N.A., L.S., J.N.R., A.M.)
| | - Ali N Ali
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience, University of Sheffield, United Kingdom (S.S.B., M.K., S.M.B., A.N.A., L.S., J.N.R., A.M.)
| | - Li Su
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience, University of Sheffield, United Kingdom (S.S.B., M.K., S.M.B., A.N.A., L.S., J.N.R., A.M.)
| | - Munya Dimairo
- School of Health and Related Research, University of Sheffield, United Kingdom (M.D.)
| | - Jesse Dawson
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Queen Elizabeth University Hospital, United Kingdom (J.D.)
| | - Jessica N Redgrave
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience, University of Sheffield, United Kingdom (S.S.B., M.K., S.M.B., A.N.A., L.S., J.N.R., A.M.)
| | - Arshad Majid
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience, University of Sheffield, United Kingdom (S.S.B., M.K., S.M.B., A.N.A., L.S., J.N.R., A.M.)
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5
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Ward N. The prospects for poststroke neural repair with vagal nerve stimulation. J Neurol Neurosurg Psychiatry 2023; 94:255-256. [PMID: 36693721 PMCID: PMC10086478 DOI: 10.1136/jnnp-2022-330831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 01/13/2023] [Indexed: 01/25/2023]
Affiliation(s)
- Nick Ward
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK .,Department of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
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6
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Clinically Applicable Experimental Design and Considerations for Stroke Recovery Preclinical Studies. Methods Mol Biol 2023; 2616:369-377. [PMID: 36715946 DOI: 10.1007/978-1-0716-2926-0_25] [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: 01/31/2023]
Abstract
Development of stroke recovery therapies is an active field of research and represents an opportunity to reduce the global impact of stroke as the leading cause of acquired, long-term disability in adults. The negative outcomes of recent large-scale clinical trials have highlighted deficiencies in the translational process and endanger the trajectory of post-stroke recovery research. Because of this, a number of strategies have been recommended by experts to better navigate the translational pipeline. To assist the field in advancing to the next stage for successful clinical translation, the goal of this chapter is to discuss concepts relevant to the experimental design of in vivo preclinical pharmacological studies to make them clinically relevant and informative for future trials.
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7
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Schwarz A, Al-Haj Husain A, Einaudi L, Thürlimann E, Läderach J, Awai Easthope C, Held JPO, Luft AR. Reliability and Validity of a Wearable Sensing System and Online Gait Analysis Report in Persons after Stroke. SENSORS (BASEL, SWITZERLAND) 2023; 23:624. [PMID: 36679424 PMCID: PMC9862973 DOI: 10.3390/s23020624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 12/29/2022] [Accepted: 01/03/2023] [Indexed: 06/17/2023]
Abstract
The restoration of gait and mobility after stroke is an important and challenging therapy goal due to the complexity of the potentially impaired functions. As a result, precise and clinically feasible assessment methods are required for personalized gait rehabilitation after stroke. The aim of this study is to investigate the reliability and validity of a sensor-based gait analysis system in stroke survivors with different severities of gait deficits. For this purpose, 28 chronic stroke survivors (9 women, ages: 62.04 ± 11.68 years) with mild to moderate walking impairments performed a set of ambulatory assessments (3× 10MWT, 1× 6MWT per session) twice while being equipped with a sensor suit. The derived gait reports provided information about speed, step length, step width, swing and stance phases, as well as joint angles of the hip, knee, and ankle, which we analyzed for test-retest reliability and hypothesis testing. Further, test-retest reliability resulted in a mean ICC of 0.78 (range: 0.46-0.88) for walking 10 m and a mean ICC of 0.90 (range: 0.63-0.99) for walking 6 min. Additionally, all gait parameters showed moderate-to-strong correlations with clinical scales reflecting lower limb function. These results support the applicability of this sensor-based gait analysis system for individuals with stroke-related walking impairments.
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Affiliation(s)
- Anne Schwarz
- Vascular Neurology and Neurorehabilitation, Department of Neurology, University of Zurich, 8091 Zurich, Switzerland
| | - Adib Al-Haj Husain
- Vascular Neurology and Neurorehabilitation, Department of Neurology, University of Zurich, 8091 Zurich, Switzerland
| | - Lorenzo Einaudi
- Vascular Neurology and Neurorehabilitation, Department of Neurology, University of Zurich, 8091 Zurich, Switzerland
| | - Eva Thürlimann
- Vascular Neurology and Neurorehabilitation, Department of Neurology, University of Zurich, 8091 Zurich, Switzerland
| | - Julia Läderach
- Cereneo Foundation, Center for Interdisciplinary Research (CEFIR), 6354 Vitznau, Switzerland
| | - Chris Awai Easthope
- Cereneo Foundation, Center for Interdisciplinary Research (CEFIR), 6354 Vitznau, Switzerland
| | - Jeremia P. O. Held
- Vascular Neurology and Neurorehabilitation, Department of Neurology, University of Zurich, 8091 Zurich, Switzerland
- Rehabilitation Center Triemli Zurich, Valens Clinics, 8063 Zurich, Switzerland
| | - Andreas R. Luft
- Vascular Neurology and Neurorehabilitation, Department of Neurology, University of Zurich, 8091 Zurich, Switzerland
- Cereneo, Center for Neurology and Rehabilitation, 6354 Vitznau, Switzerland
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8
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Sanders ZB, Fleming MK, Smejka T, Marzolla MC, Zich C, Rieger SW, Lührs M, Goebel R, Sampaio-Baptista C, Johansen-Berg H. Self-modulation of motor cortex activity after stroke: a randomized controlled trial. Brain 2022; 145:3391-3404. [PMID: 35960166 PMCID: PMC9586541 DOI: 10.1093/brain/awac239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 06/01/2022] [Accepted: 06/20/2022] [Indexed: 11/14/2022] Open
Abstract
Real-time functional MRI neurofeedback allows individuals to self-modulate their ongoing brain activity. This may be a useful tool in clinical disorders that are associated with altered brain activity patterns. Motor impairment after stroke has previously been associated with decreased laterality of motor cortex activity. Here we examined whether chronic stroke survivors were able to use real-time fMRI neurofeedback to increase laterality of motor cortex activity and assessed effects on motor performance and on brain structure and function. We carried out a randomized, double-blind, sham-controlled trial (ClinicalTrials.gov: NCT03775915) in which 24 chronic stroke survivors with mild to moderate upper limb impairment experienced three training days of either Real (n = 12) or Sham (n = 12) neurofeedback. Assessments of brain structure, brain function and measures of upper-limb function were carried out before and 1 week after neurofeedback training. Additionally, measures of upper-limb function were repeated 1 month after neurofeedback training. Primary outcome measures were (i) changes in lateralization of motor cortex activity during movements of the stroke-affected hand throughout neurofeedback training days; and (ii) changes in motor performance of the affected limb on the Jebsen Taylor Test (JTT). Stroke survivors were able to use Real neurofeedback to increase laterality of motor cortex activity within (P = 0.019), but not across, training days. There was no group effect on the primary behavioural outcome measure, which was average JTT performance across all subtasks (P = 0.116). Secondary analysis found improvements in the performance of the gross motor subtasks of the JTT in the Real neurofeedback group compared to Sham (P = 0.010). However, there were no improvements on the Action Research Arm Test or the Upper Extremity Fugl-Meyer score (both P > 0.5). Additionally, decreased white-matter asymmetry of the corticospinal tracts was detected 1 week after neurofeedback training (P = 0.008), indicating that the tracts become more similar with Real neurofeedback. Changes in the affected corticospinal tract were positively correlated with participants neurofeedback performance (P = 0.002). Therefore, here we demonstrate that chronic stroke survivors are able to use functional MRI neurofeedback to self-modulate motor cortex activity in comparison to a Sham control, and that training is associated with improvements in gross hand motor performance and with white matter structural changes.
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Affiliation(s)
- Zeena-Britt Sanders
- Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford OX3 9DU, UK
| | - Melanie K Fleming
- Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford OX3 9DU, UK
| | - Tom Smejka
- Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford OX3 9DU, UK
| | - Marilien C Marzolla
- Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford OX3 9DU, UK
| | - Catharina Zich
- Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford OX3 9DU, UK
| | - Sebastian W Rieger
- Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford OX3 9DU, UK
| | - Michael Lührs
- Department of Cognitive Neuroscience, Maastricht University, 6229 EV Maastricht, The Netherlands
- Research Department, Brain Innovation B.V., 6229 EV Maastricht, The Netherlands
| | - Rainer Goebel
- Department of Cognitive Neuroscience, Maastricht University, 6229 EV Maastricht, The Netherlands
- Research Department, Brain Innovation B.V., 6229 EV Maastricht, The Netherlands
| | - Cassandra Sampaio-Baptista
- Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford OX3 9DU, UK
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow G61 1QH, UK
| | - Heidi Johansen-Berg
- Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford OX3 9DU, UK
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9
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Dietz RM, Dingman AL, Herson PS. Cerebral ischemia in the developing brain. J Cereb Blood Flow Metab 2022; 42:1777-1796. [PMID: 35765984 PMCID: PMC9536116 DOI: 10.1177/0271678x221111600] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 04/29/2022] [Accepted: 05/27/2022] [Indexed: 11/16/2022]
Abstract
Brain ischemia affects all ages, from neonates to the elderly population, and is a leading cause of mortality and morbidity. Multiple preclinical rodent models involving different ages have been developed to investigate the effect of ischemia during different times of key brain maturation events. Traditional models of developmental brain ischemia have focused on rodents at postnatal day 7-10, though emerging models in juvenile rodents (postnatal days 17-25) indicate that there may be fundamental differences in neuronal injury and functional outcomes following focal or global cerebral ischemia at different developmental ages, as well as in adults. Here, we consider the timing of injury in terms of excitation/inhibition balance, oxidative stress, inflammatory responses, blood brain barrier integrity, and white matter injury. Finally, we review translational strategies to improve function after ischemic brain injury, including new ideas regarding neurorestoration, or neural repair strategies that restore plasticity, at delayed time points after ischemia.
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Affiliation(s)
- Robert M Dietz
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
- Department of Anesthesiology, University of Colorado School of Medicine, Aurora, CO, USA
- Neuronal Injury Program, University of Colorado School of Medicine, Aurora, CO, USA
| | - Andra L Dingman
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
- Neuronal Injury Program, University of Colorado School of Medicine, Aurora, CO, USA
| | - Paco S Herson
- Department of Neurological Surgery, The Ohio State University College of Medicine, Columbus, OH, USA
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10
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Ranganathan R, Doherty C, Gussert M, Kaplinski E, Koje M, Krishnan C. Scientific basis and active ingredients of current therapeutic interventions for stroke rehabilitation. Restor Neurol Neurosci 2022; 40:97-107. [DOI: 10.3233/rnn-211243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Despite tremendous advances in the treatment and management of stroke, restoring motor and functional outcomes after stroke continues to be a major clinical challenge. Given the wide range of approaches used in motor rehabilitation, several commentaries have highlighted the lack of a clear scientific basis for different interventions as one critical factor that has led to suboptimal study outcomes. Objective: To understand the content of current therapeutic interventions in terms of their active ingredients. Methods: We conducted an analysis of randomized controlled trials in stroke rehabilitation over a 2-year period from 2019-2020. Results: There were three primary findings: (i) consistent with prior reports, most studies did not provide an explicit rationale for why the treatment would be expected to work, (ii) most therapeutic interventions mentioned multiple active ingredients and there was not a close correspondence between the active ingredients mentioned versus the active ingredients measured in the study, and (iii) multimodal approaches that involved more than one therapeutic approach tended to be combined in an ad-hoc fashion, indicating the lack of a targeted approach. Conclusion: These results highlight the need for strengthening cross-disciplinary connections between basic science and clinical studies, and the need for structured development and testing of therapeutic approaches to find more effective treatment interventions.
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Affiliation(s)
- Rajiv Ranganathan
- Department of Kinesiology, Michigan State University, East Lansing, MI, USA
- Department of Mechanical Engineering, Michigan State University, East Lansing, MI, USA
| | - Carson Doherty
- Department of Kinesiology, Michigan State University, East Lansing, MI, USA
| | - Michael Gussert
- Department of Kinesiology, Michigan State University, East Lansing, MI, USA
| | - Eva Kaplinski
- Department of Kinesiology, Michigan State University, East Lansing, MI, USA
| | - Mary Koje
- Neuromuscular and Rehabilitation Robotics Laboratory (NeuRRo Lab), Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Chandramouli Krishnan
- Neuromuscular and Rehabilitation Robotics Laboratory (NeuRRo Lab), Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
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11
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Erler KS, Wu R, DiCarlo JA, Petrilli MF, Gochyyev P, Hochberg LR, Kautz SA, Schwamm LH, Cramer SC, Finklestein SP, Lin DJ. Association of Modified Rankin Scale With Recovery Phenotypes in Patients With Upper Extremity Weakness After Stroke. Neurology 2022; 98:e1877-e1885. [PMID: 35277444 PMCID: PMC9109148 DOI: 10.1212/wnl.0000000000200154] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 01/18/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Precise measurement of outcomes is essential for stroke trials and clinical care. Prior research has highlighted conceptual differences between global outcome measures such as the Modified Rankin Scale (mRS) and domain-specific measures (e.g. motor, sensory, language or cognitive function). This study related motor phenotypes to the mRS, specifically aiming to (1) determine whether mRS levels distinguish motor impairment and function phenotypes, and (2) compare mRS outcomes to meaningful changes in impairment and function from acute to subacute recovery after stroke. METHODS Patients with upper extremity weakness after ischemic stroke were assessed with a battery of impairment and functional measures within the first week and at 90-days post-stroke. Impairment and functional outcomes were examined in relation to 90-day mRS scores. Clinically meaningful changes in motor impairment, activities of daily living, and mobility were examined in relation to 90-day mRS. RESULTS In this cohort of n = 73 stroke patients, impairment and functional outcomes were associated with 90-day mRS scores but showed substantial variability within individual mRS levels: within mRS level 2, upper extremity impairment ranged from near hemiplegia (with an upper extremity Fugl-Meyer 8) to no deficits (upper extremity Fugl-Meyer 66). Overall, there were few differences in impairment and functional outcomes between adjacent mRS levels. While some outcome measures were significantly different between mRS levels 3 and 4 (Nine-Hole Peg, Leg Motor, Gait Velocity, Timed Up and Go, National Institutes of Health Stroke Scale, and Barthel Index), none of the outcome measures differed between mRS levels 1 and 2. Fugl-Meyer and Grip Strength were not different between any adjacent mRS levels. A substantial number of patients experienced clinically meaningful changes in impairment and function in the first 90 days post-stroke but did not achieve good mRS outcome (mRS ≤ 2). CONCLUSIONS The mRS broadly relates to domain-specific outcomes after stroke confirming its established value in stroke trials, but it does not precisely distinguish differences in impairment and function nor does it sufficiently capture meaningful clinical changes across impairment, ADL status, and mobility. These findings underscore the potential utility of incorporating detailed phenotypic measures alongside the mRS in future stroke trials.
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Affiliation(s)
- Kimberly S Erler
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.,School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA, USA.,Department of Occupational Therapy, Massachusetts General Hospital, Boston, MA, USA
| | - Rui Wu
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Julie A DiCarlo
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Marina F Petrilli
- School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA, USA
| | - Perman Gochyyev
- School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA, USA
| | - Leigh R Hochberg
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.,Division of Neurocritical Care, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.,Stroke Service, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.,VA RR&D Center for Neurorestoration and Neurotechnology, VA Medical Center, Providence, RI, USA.,School of Engineering and Carney Institute for Brain Science, Brown University, Providence, RI, USA
| | - Steven A Kautz
- Department of Health Sciences and Research, Medical University of South Carolina, Charleston, SC, USA.,Ralph H Johnson VA Medical Center, Charleston, SC, USA
| | - Lee H Schwamm
- Stroke Service, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Steven C Cramer
- Department of Neurology University of California, Los Angeles, CA, USA.,California Rehabilitation Institute, Los Angeles, CA, USA
| | - Seth P Finklestein
- Stroke Service, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - David J Lin
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.,School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA, USA.,Division of Neurocritical Care, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.,Stroke Service, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.,VA RR&D Center for Neurorestoration and Neurotechnology, VA Medical Center, Providence, RI, USA
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12
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Michiels L, Mertens N, Thijs L, Radwan A, Sunaert S, Vandenbulcke M, Verheyden G, Koole M, Van Laere K, Lemmens R. Changes in synaptic density in the subacute phase after ischemic stroke: A 11C-UCB-J PET/MR study. J Cereb Blood Flow Metab 2022; 42:303-314. [PMID: 34550834 PMCID: PMC9122519 DOI: 10.1177/0271678x211047759] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Functional alterations after ischemic stroke have been described with Magnetic Resonance Imaging (MRI) and perfusion Positron Emission Tomography (PET), but no data on in vivo synaptic changes exist. Recently, imaging of synaptic density became available by targeting synaptic vesicle protein 2 A, a protein ubiquitously expressed in all presynaptic nerve terminals. We hypothesized that in subacute ischemic stroke loss of synaptic density can be evaluated with 11C-UCB-J PET in the ischemic tissue and that alterations in synaptic density can be present in brain regions beyond the ischemic core. We recruited ischemic stroke patients to undergo 11C-UCB-J PET/MR imaging 21 ± 8 days after stroke onset to investigate regional 11C-UCB-J SUVR (standardized uptake value ratio). There was a decrease (but residual signal) of 11C-UCB-J SUVR within the lesion of 16 stroke patients compared to 40 healthy controls (ratiolesion/controls = 0.67 ± 0.28, p = 0.00023). Moreover, 11C-UCB-J SUVR was lower in the non-lesioned tissue of the affected hemisphere compared to the unaffected hemisphere (ΔSUVR = -0.17, p = 0.0035). The contralesional cerebellar hemisphere showed a lower 11C-UCB-J SUVR compared to the ipsilesional cerebellar hemisphere (ΔSUVR = -0.14, p = 0.0048). In 8 out of 16 patients, the asymmetry index suggested crossed cerebellar diaschisis. Future research is required to longitudinally study these changes in synaptic density and their association with outcome.
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Affiliation(s)
- Laura Michiels
- Department of Neurosciences, KU Leuven, Leuven, Belgium.,VIB, Center for Brain & Disease Research, Laboratory of Neurobiology, Leuven, Belgium.,Department of Neurology, University Hospitals Leuven, Leuven, Belgium
| | - Nathalie Mertens
- Nuclear Medicine and Molecular Imaging, 26657KU Leuven, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Liselot Thijs
- Department of Rehabilitation Sciences, 26657KU Leuven, KU Leuven, Leuven, Belgium
| | - Ahmed Radwan
- Translational MRI, 26657KU Leuven, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Stefan Sunaert
- Translational MRI, 26657KU Leuven, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium.,Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Mathieu Vandenbulcke
- VIB, Center for Brain & Disease Research, Laboratory of Neurobiology, Leuven, Belgium.,Department of Geriatric Psychiatry, University Psychiatric Centre, KU Leuven, Leuven, Belgium
| | - Geert Verheyden
- Department of Rehabilitation Sciences, 26657KU Leuven, KU Leuven, Leuven, Belgium
| | - Michel Koole
- Nuclear Medicine and Molecular Imaging, 26657KU Leuven, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Koen Van Laere
- Nuclear Medicine and Molecular Imaging, 26657KU Leuven, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium.,Division of Nuclear Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Robin Lemmens
- Department of Neurosciences, KU Leuven, Leuven, Belgium.,VIB, Center for Brain & Disease Research, Laboratory of Neurobiology, Leuven, Belgium.,Department of Neurology, University Hospitals Leuven, Leuven, Belgium
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13
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Laaksonen K, Ward NS. Biomarkers of plasticity for stroke recovery. HANDBOOK OF CLINICAL NEUROLOGY 2022; 184:287-298. [PMID: 35034742 DOI: 10.1016/b978-0-12-819410-2.00033-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Stroke is the commonest cause of physical disability in the world. Our understanding of the biologic mechanisms involved in recovery and repair has advanced to the point that therapeutic opportunities to promote recovery through manipulation of post-stroke plasticity have never been greater. This work has almost exclusively been carried out in rodent models of stroke with little translation into human studies. The challenge ahead is to develop a mechanistic understanding of recovery from stroke in humans. Advances in neuroimaging techniques can now provide the appropriate intermediate level of description to bridge the gap between a molecular and cellular account of recovery and a behavioral one. Clinical trials can then be designed in a stratified manner taking into account when an intervention should be delivered and who is most likely to benefit. This approach is most likely to lead to the step-change in how restorative therapeutic strategies are delivered in human stroke patients.
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Affiliation(s)
- Kristina Laaksonen
- Department of Neurology, Helsinki University Hospital, and Clinical Neurosciences, Neurology, University of Helsinki, Helsinki, Finland
| | - Nick S Ward
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, United Kingdom; Department of Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom.
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14
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Wei H, Zhen L, Wang S, Zhang Y, Wang K, Jia P, Zhang Y, Wu Z, Yang Q, Hou W, Lv J, Zhang P. De novo Lipogenesis in Astrocytes Promotes the Repair of Blood-Brain Barrier after Transient Cerebral Ischemia Through Interleukin-33. Neuroscience 2022; 481:85-98. [PMID: 34822949 DOI: 10.1016/j.neuroscience.2021.11.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 11/07/2021] [Accepted: 11/15/2021] [Indexed: 12/22/2022]
Abstract
Astrocytes experience significant metabolic shifts in the "sensitive period" of neurological function recovery following cerebral ischemia. However, the changes in astrocyte lipid metabolism and their implications for neurological recovery remain unknown. In the present study, we employed a mouse middle cerebral artery occlusion model to investigate the changes in de novo lipogenesis and interleukin-33 (IL-33) production in astrocytes and elucidate their role in blood-brain barrier (BBB) repair in the subacute phase of cerebral ischemia. Neurological behavior evaluation was used to assess functional changes in mice. Pharmacological inhibition and astrocyte-specific downregulation of fatty acid synthase (FASN) were used to evaluate the role of de novo lipogenesis in brain injury. Intracerebroventricular administration of recombinant IL-33 was performed to study the contribution of IL-33 to BBB disruption. Extravasation of Evans blue dye, dextran and IgG were used to assess BBB integrity. Western blotting of tight junction proteins ZO-1, Occludin, and Claudin-5 were performed at defined time points to evaluate changes in BBB. It was found that de novo lipogenesis was activated, and IL-33 production increased in astrocytes at the subacute stage of cerebral ischemia injury. Inhibition of lipogenesis in astrocytes decreased IL-33 production in the peri-infarct area, deteriorated BBB damage and interfered with neurological recovery. In addition, supplementation of IL-33 alleviated BBB destruction and improved neurological recovery worsened by lipogenesis inhibition. These findings indicate that astrocyte lipogenesis increases the production of IL-33 in the peri-infarct area, which promotes BBB repair in the subacute phase of cerebral ischemia injury and improves long-term functional recovery.
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Affiliation(s)
- Haidong Wei
- Department of Anesthesiology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710004, China
| | - Luming Zhen
- Department of Anesthesiology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710004, China
| | - Shiquan Wang
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi 710032, China
| | - Yuanyuan Zhang
- Department of Anesthesiology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710004, China
| | - Kui Wang
- Department of Anesthesiology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710004, China
| | - Pengyu Jia
- Department of Anesthesiology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710004, China
| | - Yan Zhang
- Department of Anesthesiology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710004, China
| | - Zhixin Wu
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi 710032, China
| | - Qianzi Yang
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi 710032, China
| | - Wugang Hou
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi 710032, China
| | - Jianrui Lv
- Department of Anesthesiology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710004, China
| | - Pengbo Zhang
- Department of Anesthesiology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710004, China.
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15
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Roby-Brami A, Jarrassé N, Parry R. Impairment and Compensation in Dexterous Upper-Limb Function After Stroke. From the Direct Consequences of Pyramidal Tract Lesions to Behavioral Involvement of Both Upper-Limbs in Daily Activities. Front Hum Neurosci 2021; 15:662006. [PMID: 34234659 PMCID: PMC8255798 DOI: 10.3389/fnhum.2021.662006] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 05/27/2021] [Indexed: 01/02/2023] Open
Abstract
Impairments in dexterous upper limb function are a significant cause of disability following stroke. While the physiological basis of movement deficits consequent to a lesion in the pyramidal tract is well demonstrated, specific mechanisms contributing to optimal recovery are less apparent. Various upper limb interventions (motor learning methods, neurostimulation techniques, robotics, virtual reality, and serious games) are associated with improvements in motor performance, but many patients continue to experience significant limitations with object handling in everyday activities. Exactly how we go about consolidating adaptive motor behaviors through the rehabilitation process thus remains a considerable challenge. An important part of this problem is the ability to successfully distinguish the extent to which a given gesture is determined by the neuromotor impairment and that which is determined by a compensatory mechanism. This question is particularly complicated in tasks involving manual dexterity where prehensile movements are contingent upon the task (individual digit movement, grasping, and manipulation…) and its objective (placing, two step actions…), as well as personal factors (motivation, acquired skills, and life habits…) and contextual cues related to the environment (presence of tools or assistive devices…). Presently, there remains a lack of integrative studies which differentiate processes related to structural changes associated with the neurological lesion and those related to behavioral change in response to situational constraints. In this text, we shall question the link between impairments, motor strategies and individual performance in object handling tasks. This scoping review will be based on clinical studies, and discussed in relation to more general findings about hand and upper limb function (manipulation of objects, tool use in daily life activity). We shall discuss how further quantitative studies on human manipulation in ecological contexts may provide greater insight into compensatory motor behavior in patients with a neurological impairment of dexterous upper-limb function.
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Affiliation(s)
- Agnès Roby-Brami
- ISIR Institute of Intelligent Systems and Robotics, AGATHE Team, CNRS UMR 7222, INSERM U 1150, Sorbonne University, Paris, France
| | - Nathanaël Jarrassé
- ISIR Institute of Intelligent Systems and Robotics, AGATHE Team, CNRS UMR 7222, INSERM U 1150, Sorbonne University, Paris, France
| | - Ross Parry
- ISIR Institute of Intelligent Systems and Robotics, AGATHE Team, CNRS UMR 7222, INSERM U 1150, Sorbonne University, Paris, France.,LINP2-AAPS Laboratoire Interdisciplinaire en Neurosciences, Physiologie et Psychologie: Activité Physique, Santé et Apprentissages, UPL, Paris Nanterre University, Nanterre, France
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