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Chelluboina B, Vemuganti R. Therapeutic potential of nutraceuticals to protect brain after stroke. Neurochem Int 2020; 142:104908. [PMID: 33220386 DOI: 10.1016/j.neuint.2020.104908] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 11/14/2020] [Accepted: 11/16/2020] [Indexed: 02/07/2023]
Abstract
Stroke leads to significant neuronal death and long-term neurological disability due to synergistic pathogenic mechanisms. Stroke induces a change in eating habits and in many cases, leads to undernutrition that aggravates the post-stroke pathology. Proper nutritional regimen remains a major strategy to control the modifiable risk factors for cardiovascular and cerebrovascular diseases including stroke. Studies indicate that nutraceuticals (isolated and concentrated form of high-potency natural bioactive substances present in dietary nutritional components) can act as prophylactic as well as adjuvant therapeutic agents to prevent stroke risk, to promote ischemic tolerance and to reduce post-stroke consequences. Nutraceuticals are also thought to regulate blood pressure, delay neurodegeneration and improve overall vascular health. Nutraceuticals potentially mediate these effects by their powerful antioxidant and anti-inflammatory properties. This review discusses the studies that have highlighted the translational potential of nutraceuticals as stroke therapies.
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Affiliation(s)
- Bharath Chelluboina
- Department of Neurological Surgery, University of Wisconsin, Madison, WI, USA
| | - Raghu Vemuganti
- Department of Neurological Surgery, University of Wisconsin, Madison, WI, USA; William S. Middleton Veterans Administration Hospital, Madison, WI, USA.
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Palmer BF, Colbert G, Clegg DJ. Potassium Homeostasis, Chronic Kidney Disease, and the Plant-Enriched Diets. ACTA ACUST UNITED AC 2020; 1:65-71. [DOI: 10.34067/kid.0000222019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 11/25/2019] [Indexed: 11/27/2022]
Abstract
There are data demonstrating that ingestion of potassium-rich foods reduces the incidence of stroke, hypertension, nephrolithiasis, and osteoporosis. Dietary-consumption data indicate Westernized diets are high in processed foods, high in sodium content, and low in potassium. In fact, there are data suggesting individuals are not consuming enough potassium in their diet. Although consumption of diets high in plant proteins, fruits, and vegetables—which are excellent sources of potassium—is recognized as healthy and beneficial, individuals with decrements in their kidney function have been advised to avoid these foods. In reviewing the literature that provides the rationale for potassium restriction in patients with reductions in kidney function, it appears there is little direct evidence to support the levels of restriction which are now prescribed. Additionally, there are two new potassium-binding agents which are well tolerated and have been documented to be effective in controlling serum potassium. Therefore, with the new binding agents and the lack of empirical evidence supporting the stringent dietary potassium restrictions, the authors conclude by indicating the pressing need for further research focusing on dietary liberalization of potassium in patients with reductions in kidney function to enhance overall health and well being, to provide them cardiovascular benefits, and to reduce overall risk of mortality through the incorporation of potassium-enriched foods.
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Dominiak A, Wilkaniec A, Wroczyński P, Adamczyk A. Selenium in the Therapy of Neurological Diseases. Where is it Going? Curr Neuropharmacol 2016; 14:282-99. [PMID: 26549649 PMCID: PMC4857624 DOI: 10.2174/1570159x14666151223100011] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 08/20/2015] [Accepted: 09/16/2015] [Indexed: 12/19/2022] Open
Abstract
Selenium (34Se), an antioxidant trace element, is an important regulator of brain function. These beneficial properties that Se possesses are attributed to its ability to be incorporated into selenoproteins as an amino acid. Several selenoproteins are expressed in the brain, in which some of them, e.g. glutathione peroxidases (GPxs), thioredoxin reductases (TrxRs) or selenoprotein P (SelP), are strongly involved in antioxidant defence and in maintaining intercellular reducing conditions. Since increased oxidative stress has been implicated in neurological disorders, including Parkinson’s disease, Alzheimer’s disease, stroke, epilepsy and others, a growing body of evidence suggests that Se depletion followed by decreased activity of Se-dependent enzymes may be important factors connected with those pathologies. Undoubtedly, the remarkable progress that has been made in understanding the biological function of Se in the brain has opened up new potential possibilities for the treatment of neurological diseases by using Se as a potential drug. However, further research in the search for optimal Se donors is necessary in order to achieve an effective and safe therapeutic income.
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Affiliation(s)
| | - Anna Wilkaniec
- Department of Cellular Signaling, Mossakowski Medical Research Centre Polish Academy of Sciences, Pawińskiego 5 St., 02-106 Warsaw, Poland.
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Cappuccio FP, Buchanan LA, Ji C, Siani A, Miller MA. Systematic review and meta-analysis of randomised controlled trials on the effects of potassium supplements on serum potassium and creatinine. BMJ Open 2016; 6:e011716. [PMID: 27566636 PMCID: PMC5013341 DOI: 10.1136/bmjopen-2016-011716] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES High potassium intake could prevent stroke, but supplementation is considered hazardous. We assessed the effect of oral potassium supplementation on serum or plasma potassium levels and renal function. SETTING We updated a systematic review of the effects of potassium supplementation in randomised clinical trials carried out worldwide, published in 2013, extending it to July 2015. We followed the PRISMA guidelines. PARTICIPANTS Any individual taking part in a potassium supplementation randomised clinical trial. Studies included met the following criteria: randomised clinical trials, potassium supplement given and circulating potassium levels reported. INTERVENTION Oral potassium supplementation. PRIMARY OUTCOME MEASURES Serum or plasma potassium and serum or plasma creatinine. RESULTS A total of 20 trials (21 independent groups) were included (1216 participants from 12 different countries). All but 2 were controlled (placebo n=16, control n=2). Of these trials, 15 were crossover, 4 had a parallel group and 1 was sequential. The duration of supplementation varied from 2 to 24 weeks and the amount of potassium given from 22 to 140 mmol/day. In the pooled analysis, potassium supplementation caused a small but significant increase in circulating potassium levels (weighted mean difference (WMD) 0.14 mmol/L, 95% CI 0.09 to 0.19, p<1×10(-5)), not associated with dose or duration of treatment. The average increase in urinary potassium excretion was 45.75 mmol/24 hours, 95% CI 38.81 to 53.69, p<1×10(-5). Potassium supplementation did not cause any change in circulating creatinine levels (WMD 0.30 µmol/L, 95% CI -1.19 to 1.78, p=0.70). CONCLUSIONS In short-term studies of relatively healthy persons, a moderate oral potassium supplement resulted in a small increase in circulating potassium levels and no change in renal function.
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Affiliation(s)
- Francesco P Cappuccio
- Division of Health Sciences (Mental Health & Wellbeing), University of Warwick, WHO Collaborating Centre for Nutrition, Warwick Medical School, Coventry, UK
| | - Laura A Buchanan
- Division of Health Sciences (Mental Health & Wellbeing), University of Warwick, WHO Collaborating Centre for Nutrition, Warwick Medical School, Coventry, UK
| | - Chen Ji
- Division of Health Sciences (Mental Health & Wellbeing), University of Warwick, WHO Collaborating Centre for Nutrition, Warwick Medical School, Coventry, UK
| | - Alfonso Siani
- Institute of Food Sciences, National Research Council, Avellino, Italy
| | - Michelle A Miller
- Division of Health Sciences (Mental Health & Wellbeing), University of Warwick, WHO Collaborating Centre for Nutrition, Warwick Medical School, Coventry, UK
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Palmer BF, Clegg DJ. Achieving the Benefits of a High-Potassium, Paleolithic Diet, Without the Toxicity. Mayo Clin Proc 2016; 91:496-508. [PMID: 26948054 DOI: 10.1016/j.mayocp.2016.01.012] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 01/10/2016] [Accepted: 01/18/2016] [Indexed: 11/29/2022]
Abstract
The average US dietary intake of K(+) is well below the current recommended nutritional requirements. This deficiency is even more striking when comparing our current intake with that of our ancestors, who consumed large amounts of dietary K(+). K(+) deficiency has been implicated in many diseases including cardiovascular disease, kidney stones, and osteoporosis. Importantly, dietary supplementation of K(+) has favorable effects on reducing blood pressure, decreasing the risk of stroke, improving bone health, and reducing the risk of nephrolithiasis. For this comprehensive review, we scanned the literature using PubMed and MEDLINE using the following search terms: potassium intake, renal potassium excretion, and prevention of hyperkalemia. Articles were selected for inclusion if they represented primary data or review articles published between 1980 and 2015 in high-impact journals. The normal kidney has the capacity to tightly regulate K(+) homoeostasis. We discuss new findings with respect to sensing mechanisms by which the kidney maintains K(+) homeostasis in the gastrointestinal tract and distal tubule. There are widely prescribed hypertensive medications that cause hyperkalemia and thus require dietary K(+) restriction. We conclude by discussing newly approved drugs capable of binding K(+) in the gastrointestinal tract and speculate that this new pharmacology might allow diet liberalization in patients at risk for hyperkalemia, affording them the numerous benefits of a K(+)-rich diet.
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Affiliation(s)
- Biff F Palmer
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Deborah J Clegg
- Biomedical Research Department, Diabetes and Obesity Research Institute, Cedars-Sinai Medical Center, Beverly Hills, CA.
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Seth A, Mossavar-Rahmani Y, Kamensky V, Silver B, Lakshminarayan K, Prentice R, Van Horn L, Wassertheil-Smoller S. Potassium intake and risk of stroke in women with hypertension and nonhypertension in the Women's Health Initiative. Stroke 2014; 45:2874-80. [PMID: 25190445 PMCID: PMC4175295 DOI: 10.1161/strokeaha.114.006046] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 07/22/2014] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND PURPOSE Dietary potassium has been associated with lower risk of stroke, but there are little data on dietary potassium effects on different stroke subtypes or in older women with hypertension and nonhypertension. METHODS The study population consisted of 90 137 postmenopausal women aged 50 to 79 at enrollment, free of stroke history at baseline, followed up prospectively for an average of 11 years. Outcome variables were total, ischemic, and hemorrhagic stroke, and all-cause mortality. Incidence was compared across quartiles of dietary potassium intake, and hazard ratios were obtained from Cox proportional hazards models after adjusting for potential confounding variables, and in women with hypertension and nonhypertension separately. RESULTS Mean dietary potassium intake was 2611 mg/d. Highest quartile of potassium intake was associated with lower incidence of ischemic and hemorrhagic stroke and total mortality. Multivariate analyses comparing highest to lowest quartile of potassium intake indicated a hazard ratio of 0.90 (95% confidence interval, 0.85-0.95) for all-cause mortality, 0.88 (95% confidence interval, 0.79-0.98) for all stroke, and 0.84 (95% confidence interval, 0.74-0.96) for ischemic stroke. The effect on ischemic stroke was more apparent in women with nonhypertension among whom there was a 27% lower risk with hazard ratio of 0.73 (95% confidence interval, 0.60-0.88), interaction P<0.10. There was no association with hemorrhagic stroke. CONCLUSIONS High potassium intake is associated with a lower risk of all stroke and ischemic stroke, as well as all-cause mortality in older women, particularly those who are not hypertensive.
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Affiliation(s)
- Arjun Seth
- From the Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (A.S., Y.M.-R., V.K., S.W.-S.); Department of Neurology, Rhode Island Hospital/Warren Alpert Medical School of Brown University, Providence (B.S.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (K.L.); Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA (R.P.); and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (L.V.H.)
| | - Yasmin Mossavar-Rahmani
- From the Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (A.S., Y.M.-R., V.K., S.W.-S.); Department of Neurology, Rhode Island Hospital/Warren Alpert Medical School of Brown University, Providence (B.S.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (K.L.); Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA (R.P.); and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (L.V.H.)
| | - Victor Kamensky
- From the Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (A.S., Y.M.-R., V.K., S.W.-S.); Department of Neurology, Rhode Island Hospital/Warren Alpert Medical School of Brown University, Providence (B.S.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (K.L.); Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA (R.P.); and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (L.V.H.)
| | - Brian Silver
- From the Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (A.S., Y.M.-R., V.K., S.W.-S.); Department of Neurology, Rhode Island Hospital/Warren Alpert Medical School of Brown University, Providence (B.S.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (K.L.); Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA (R.P.); and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (L.V.H.)
| | - Kamakshi Lakshminarayan
- From the Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (A.S., Y.M.-R., V.K., S.W.-S.); Department of Neurology, Rhode Island Hospital/Warren Alpert Medical School of Brown University, Providence (B.S.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (K.L.); Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA (R.P.); and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (L.V.H.)
| | - Ross Prentice
- From the Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (A.S., Y.M.-R., V.K., S.W.-S.); Department of Neurology, Rhode Island Hospital/Warren Alpert Medical School of Brown University, Providence (B.S.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (K.L.); Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA (R.P.); and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (L.V.H.)
| | - Linda Van Horn
- From the Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (A.S., Y.M.-R., V.K., S.W.-S.); Department of Neurology, Rhode Island Hospital/Warren Alpert Medical School of Brown University, Providence (B.S.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (K.L.); Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA (R.P.); and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (L.V.H.)
| | - Sylvia Wassertheil-Smoller
- From the Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (A.S., Y.M.-R., V.K., S.W.-S.); Department of Neurology, Rhode Island Hospital/Warren Alpert Medical School of Brown University, Providence (B.S.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (K.L.); Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA (R.P.); and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (L.V.H.).
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Pires PW, Rogers CT, McClain JL, Garver HS, Fink GD, Dorrance AM. Doxycycline, a matrix metalloprotease inhibitor, reduces vascular remodeling and damage after cerebral ischemia in stroke-prone spontaneously hypertensive rats. Am J Physiol Heart Circ Physiol 2011; 301:H87-97. [PMID: 21551278 DOI: 10.1152/ajpheart.01206.2010] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Matrix metalloproteases (MMPs) are a family of zinc peptidases involved in extracellular matrix turnover. There is evidence that increased MMP activity is involved in remodeling of resistance vessels in chronic hypertension. Thus we hypothesized that inhibition of MMP activity with doxycycline (DOX) would attenuate vascular remodeling. Six-week-old male stroke-prone spontaneously hypertensive rats (SHRSP) were treated with DOX (50 mg·kg(-1)·day(-1) in the drinking water) for 6 wk. Untreated SHRSP were controls. Blood pressure was measured by telemetry during the last week. Middle cerebral artery (MCA) and mesenteric resistance artery (MRA) passive structures were assessed by pressure myography. MMP-2 expression in aortas was measured by Western blot. All results are means ± SE. DOX caused a small increase in mean arterial pressure (SHRSP, 154 ± 1; SHRSP + DOX, 159 ± 3 mmHg; P < 0.001). Active MMP-2 expression was reduced in aorta from SHRSP + DOX (0.21 ± 0.06 vs. 0.49 ± 0.13 arbitrary units; P < 0.05). In the MCA, at 80 mmHg, DOX treatment increased the lumen (273.2 ± 4.7 vs. 238.3 ± 6.3 μm; P < 0.05) and the outer diameter (321 ± 5.3 vs. 290 ± 7.6 μm; P < 0.05) and reduced the wall-to-lumen ratio (0.09 ± 0.002 vs. 0.11 ± 0.003; P < 0.05). Damage after transient cerebral ischemia (transient MCA occlusion) was reduced in SHRSP + DOX (20.7 ± 4 vs. 45.5 ± 5% of hemisphere infarcted; P < 0.05). In the MRA, at 90 mmHg DOX, reduced wall thickness (29 ± 1 vs. 22 ± 1 μm; P < 0.001) and wall-to-lumen ratio (0.08 ± 0.004 vs. 0.11 ± 0.008; P < 0.05) without changing lumen diameter. These results suggest that MMPs are involved in hypertensive vascular remodeling in both the peripheral and cerebral vasculature and that DOX reduced brain damage after cerebral ischemia.
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Affiliation(s)
- Paulo W Pires
- Dept. of Pharmacology and Toxicology, B346 Life Sciences Bldg., Michigan State Univ., East Lansing, MI 48824, USA.
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