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Zheng H, Wu H, Wang D, Wang S, Ji D, Liu X, Gao G, Su X, Zhang Y, Ling Y. Research progress of prodrugs for the treatment of cerebral ischemia. Eur J Med Chem 2024; 272:116457. [PMID: 38704941 DOI: 10.1016/j.ejmech.2024.116457] [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: 03/21/2024] [Revised: 04/20/2024] [Accepted: 04/25/2024] [Indexed: 05/07/2024]
Abstract
It is well-known that pharmacotherapy plays a pivotal role in the treatment and prevention of cerebral ischemia. Nevertheless, existing drugs, including numerous natural products, encounter various challenges when applied in cerebral ischemia treatment. These challenges comprise poor brain absorption due to low blood-brain barrier (BBB) permeability, limited water solubility, inadequate bioavailability, poor stability, and rapid metabolism. To address these issues, researchers have turned to prodrug strategies, aiming to mitigate or eliminate the adverse properties of parent drug molecules. In vivo metabolism or enzymatic reactions convert prodrugs into active parent drugs, thereby augmenting BBB permeability, improving bioavailability and stability, and reducing toxicity to normal tissues, ultimately aiming to enhance treatment efficacy and safety. This comprehensive review delves into multiple effective prodrug strategies, providing a detailed description of representative prodrugs developed over the past two decades. It underscores the potential of prodrug approaches to improve the therapeutic outcomes of currently available drugs for cerebral ischemia. The publication of this review serves to enrich current research progress on prodrug strategies for the treatment and prevention of cerebral ischemia. Furthermore, it seeks to offer valuable insights for pharmaceutical chemists in this field, offer guidance for the development of drugs for cerebral ischemia, and provide patients with safer and more effective drug treatment options.
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Affiliation(s)
- Hongwei Zheng
- School of Pharmacy, Nantong Key Laboratory of Small Molecular Drug Innovation, Jiangsu Province Key Laboratory for Inflammation and Molecular Drug Target, Nantong University, 226001, Nantong, Jiangsu, PR China
| | - Hongmei Wu
- School of Pharmacy, Nantong Key Laboratory of Small Molecular Drug Innovation, Jiangsu Province Key Laboratory for Inflammation and Molecular Drug Target, Nantong University, 226001, Nantong, Jiangsu, PR China; Department of Neurosurgery, Affiliated Hospital of Nantong University, 226001, Nantong, Jiangsu, PR China
| | - Dezhi Wang
- School of Pharmacy, Nantong Key Laboratory of Small Molecular Drug Innovation, Jiangsu Province Key Laboratory for Inflammation and Molecular Drug Target, Nantong University, 226001, Nantong, Jiangsu, PR China; Department of Neurosurgery, Affiliated Hospital of Nantong University, 226001, Nantong, Jiangsu, PR China
| | - Sijia Wang
- School of Pharmacy, Nantong Key Laboratory of Small Molecular Drug Innovation, Jiangsu Province Key Laboratory for Inflammation and Molecular Drug Target, Nantong University, 226001, Nantong, Jiangsu, PR China; Department of Neurosurgery, Affiliated Hospital of Nantong University, 226001, Nantong, Jiangsu, PR China
| | - Dongliang Ji
- School of Pharmacy, Nantong Key Laboratory of Small Molecular Drug Innovation, Jiangsu Province Key Laboratory for Inflammation and Molecular Drug Target, Nantong University, 226001, Nantong, Jiangsu, PR China; Department of Neurosurgery, Affiliated Hospital of Nantong University, 226001, Nantong, Jiangsu, PR China
| | - Xiao Liu
- School of Pharmacy, Nantong Key Laboratory of Small Molecular Drug Innovation, Jiangsu Province Key Laboratory for Inflammation and Molecular Drug Target, Nantong University, 226001, Nantong, Jiangsu, PR China
| | - Ge Gao
- School of Pharmacy, Nantong Key Laboratory of Small Molecular Drug Innovation, Jiangsu Province Key Laboratory for Inflammation and Molecular Drug Target, Nantong University, 226001, Nantong, Jiangsu, PR China
| | - Xing Su
- Department of Neurosurgery, Affiliated Hospital of Nantong University, 226001, Nantong, Jiangsu, PR China.
| | - Yanan Zhang
- School of Pharmacy, Nantong Key Laboratory of Small Molecular Drug Innovation, Jiangsu Province Key Laboratory for Inflammation and Molecular Drug Target, Nantong University, 226001, Nantong, Jiangsu, PR China.
| | - Yong Ling
- School of Pharmacy, Nantong Key Laboratory of Small Molecular Drug Innovation, Jiangsu Province Key Laboratory for Inflammation and Molecular Drug Target, Nantong University, 226001, Nantong, Jiangsu, PR China.
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Zhao L, Li J, Kälviäinen R, Jolkkonen J, Zhao C. Impact of drug treatment and drug interactions in post-stroke epilepsy. Pharmacol Ther 2021; 233:108030. [PMID: 34742778 DOI: 10.1016/j.pharmthera.2021.108030] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 11/01/2021] [Accepted: 11/01/2021] [Indexed: 12/21/2022]
Abstract
Stroke is a huge burden on our society and this is expected to grow in the future due to the aging population and the associated co-morbidities. The improvement of acute stroke care has increased the survival rate of stroke patients, and many patients are left with permanent disability, which makes stroke the main cause of adult disability. Unfortunately, many patients face other severe complications such as post-stroke seizures and epilepsy. Acute seizures (ASS) occur within 1 week after the stroke while later occurring unprovoked seizures are diagnosed as post-stroke epilepsy (PSE). Both are associated with a poor prognosis of a functional recovery. The underlying neurobiological mechanisms are complex and poorly understood. There are no universal guidelines on the management of PSE. There is increasing evidence for several risk factors for ASS/PSE, however, the impacts of recanalization, drugs used for secondary prevention of stroke, treatment of stroke co-morbidities and antiseizure medication are currently poorly understood. This review focuses on the common medications that stroke patients are prescribed and potential drug interactions possibly complicating the management of ASS/PSE.
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Affiliation(s)
- Lanqing Zhao
- Department of Sleep Medicine Center, The Shengjing Affiliated Hospital, China Medical University, Shenyang, Liaoning, PR China
| | - Jinwei Li
- Department of Stroke Center, The First Affiliated Hospital, China Medical University, Shenyang, Liaoning, PR China
| | - Reetta Kälviäinen
- Kuopio Epilepsy Center, Neurocenter, Kuopio University Hospital, Full Member of ERN EpiCARE, Kuopio, Finland; Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Jukka Jolkkonen
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland.
| | - Chuansheng Zhao
- Department of Neurology, The First Affiliated Hospital, China Medical University, Shenyang, Liaoning, PR China.
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Fang J, Tuo M, Ouyang K, Xu Y. Statin on post-stroke epilepsy: A systematic review and meta-analysis. J Clin Neurosci 2020; 83:83-87. [PMID: 33339690 DOI: 10.1016/j.jocn.2020.11.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 10/22/2020] [Accepted: 11/23/2020] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Recent research has shown that statins can reduce the incidence of epilepsy after stroke, especially ischemic stroke, but the results are inconsistent. In view of current stroke guidelines do not recommend the use of anti-epileptic drugs (AED) for the prevention of epilepsy after stroke, statins may be a good choice. The purpose of this study was to conduct a systematic review and meta-analysis to determine the effect of statins on the prevention of epilepsy after stroke. METHODS Correlative cohort studies were identified through search of PubMed, Cochrane Library and Embase databases. The main outcomes included post-stroke epilepsy (PSE) and early-onset seizure (ES). Subgroup analyses and Sensitivity analysis were performed to evaluate the influences of the predefined study characteristics on the outcome. RESULTS Seven studies were included (n = 40831). Statin use was associated with a lower risk of PSE (including 6 articles) (odds ratio [OR] 0.60, 95% confidence interval [CI] [0.42, 0.84], p = 0.003), and there is a remarkable effect in ES (including 6 articles) (OR 0.36, 95% CI [0.25, 0.54], p < 0.00001). CONCLUSION Appropriate use of statins after stroke can reduce the risk of PSE, especially ES.
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Affiliation(s)
- Jiabin Fang
- Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan 430071, Hubei, PR China
| | - Minghui Tuo
- Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan 430071, Hubei, PR China
| | - Keni Ouyang
- Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan 430071, Hubei, PR China
| | - Yan Xu
- Department of Neurology, Zhongnan Hospital of Wuhan University, No. 169 East Lake Road, Wuchang District, Wuhan 430071, Hubei, PR China
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Abstract
OBJECTIVE Statins are a class of drugs that competitively bind to the active site of HMG-CoA reductase enzyme, thereby inhibiting the initial steps in cholesterol synthesis. Originally approved for use in lowering serum cholesterol, a risk factor for developing atherosclerosis and coronary heart disease, statins have subsequently been noted to have myriad extrahepatic effects, including potential effects on cognition, diabetes, breast cancer, bone, and muscle. This narrative review assesses the current state of the science regarding the risks and benefits of statin therapy in women to identify areas where additional research is needed. METHODS Basic and clinical studies were identified by searching PubMed with particular attention to inclusion of female animals, women, randomized controlled trials, and sex-specific analyses. RESULTS Statin therapy is generally recommended to reduce the risk of cardiovascular disease. None of the current clinical guidelines, however, offer sex-specific recommendations for women due to lack of understanding of sex differences and underlying mechanisms of disease processes. In addition, conclusions regarding efficacy of treatments do not consider lipid solubility for the drug, dosing, duration of treatment, interactions with estrogen, or comorbidities. Pleiotropic effects of statins are often derived from secondary analysis of studies with cardiovascular events as primary outcomes. CONCLUSIONS Many of the trials that have established the efficacy and safety of statins were conducted predominantly or entirely in men, with results extrapolated to women. Additional research is needed to guide clinical recommendations specific to women. : Video Summary:http://links.lww.com/MENO/A462.
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Affiliation(s)
- Stephanie S. Faubion
- Center for Women’s Health, Mayo Clinic, Rochester, MN
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN
| | - Ekta Kapoor
- Center for Women’s Health, Mayo Clinic, Rochester, MN
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN
| | - Ann M. Moyer
- Department of Pathology and Laboratory Medicine, Mayo Clinic, Rochester, MN
| | - Howard N. Hodis
- Atherosclerosis Research Unit, Departments of Medicine and Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Virginia M. Miller
- Departments of Surgery and Physiology & Biomedical Engineering, Women’s Health Research Center, Mayo Clinic, Rochester, MN
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Paseban M, Mohebbati R, Niazmand S, Sathyapalan T, Sahebkar A. Comparison of the Neuroprotective Effects of Aspirin, Atorvastatin, Captopril and Metformin in Diabetes Mellitus. Biomolecules 2019; 9:biom9040118. [PMID: 30934759 PMCID: PMC6523359 DOI: 10.3390/biom9040118] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 03/13/2019] [Accepted: 03/21/2019] [Indexed: 12/23/2022] Open
Abstract
Objective: The aim of this study was to investigate the effect of combined intake of a high dose of aspirin, atorvastatin, captopril and metformin on oxidative stress in the brain cortex and hippocampus of streptozotocin (STZ)-induced diabetic rats. Material and methods: Rats were randomly divided into the following 11 groups: control and diabetic (D), as well as 9 groups that were treated with metformin (M, 300 mg/kg) or aspirin (ASA, 120 mg/kg) alone or in different combinations with captopril (C, 50 mg/kg) and/or atorvastatin (AT, 40 mg/kg) as follows: (D + M), (D + ASA), (D + M + ASA), (D + M + C), (D + M + AT), (D + M + C + ASA), (D + M + C + AT), (D + M + AT + ASA) and (D + M + C + AT + ASA). The rats in treatment groups received drugs by gavage daily for six weeks. Serum lipid profile and levels of oxidative markers in the brain cortex and hippocampus tissues were evaluated. Results: The levels of malondialdehyde in the brain cortex and hippocampus in all the treated groups decreased significantly (p < 0.05). There was a significant increase in the total thiol concentration as well as catalase activity in treated rats in (M + AT), (M + C + ASA), (M + C + AT), (M + AT + ASA) and (M + C + AT + ASA) groups in cortex and hippocampus in comparison with the diabetic rats (p < 0.05). Also, the superoxide dismutase activity in all treated rats with medications was significantly increased compared to the diabetic rats (p < 0.05–0.01). Conclusion: Our findings showed that the combined use of high-dose aspirin, metformin, captopril and atorvastatin potentiated their antioxidant effects on the brain, and hence could potentially improve cognitive function with their neuroprotective effects on hippocampus.
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Affiliation(s)
- Maryam Paseban
- Department of Physiology, School of Medicine, Mashhad University of Medical Sciences, Mashhad 9177948564, Iran.
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad 9177948564, Iran.
| | - Reza Mohebbati
- Department of Physiology, School of Medicine, Mashhad University of Medical Sciences, Mashhad 9177948564, Iran.
| | - Saeed Niazmand
- Department of Physiology, School of Medicine, Mashhad University of Medical Sciences, Mashhad 9177948564, Iran.
- Neurogenic Inflammation Research Center, Mashhad University of Medical Sciences, Mashhad 9177948564, Iran.
| | - Thozhukat Sathyapalan
- Department of Academic Diabetes, Endocrinology and Metabolism, Hull York Medical School, University of Hull, Hull, HU3 2RW, UK.
| | - Amirhossein Sahebkar
- Neurogenic Inflammation Research Center, Mashhad University of Medical Sciences, Mashhad 9177948564, Iran.
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of MedicalSciences; Mashhad 9177948564, Iran.
- School of Pharmacy, Mashhad University of Medical Sciences; Mashhad 9177948564, Iran.
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Lin FJ, Lin HW, Ho YF. Effect of Statin Intensity on the Risk of Epilepsy After Ischaemic Stroke: Real-World Evidence from Population-Based Health Claims. CNS Drugs 2018; 32:367-376. [PMID: 29619760 DOI: 10.1007/s40263-018-0501-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Statins possess neuroprotective effects. However, real-world evidence supporting their utility in post-stroke epilepsy (PSE) prevention is limited. OBJECTIVE The association between statin use, including timing of prescribing (pre-stroke vs post-stroke), type (lipophilicity, intensity of therapy) and dose intensity, and risk of developing PSE were investigated by studying Taiwanese health claims (2003-2013). METHODS Patients with new-onset ischaemic stroke were identified. The main outcome was a diagnosis of epilepsy after ischaemic stroke. According to pre-stroke statin use, groups of current users, former users, and non-users were compared using ANOVA. An extended Cox regression model was utilized to estimate the hazard ratio (HR) of PSE, with post-stroke statin use and certain comedications as time-dependent variables. Serial sensitivity analyses were performed to ensure study robustness. RESULTS Of the 20,858 ischaemic stroke patients, 954 (4.6%) developed PSE. Post-stroke statin use (adjusted HR (aHR) 0.55; 95% confidence interval 0.46-0.67, p < 0.001), but not pre-stroke statin use was associated with a significantly reduced risk of developing PSE. A dose-response correlation was also observed between PSE risk reduction and quartiles of the statin cumulative defined daily dose (cDDD) (aHR 0.84, 0.67, 0.53, and 0.50 for the lowest, second, third, and highest quartiles of cDDD, respectively). Risk predictors and protectors against PSE were also characterized. CONCLUSION The post-stroke use of statins after ischaemic stroke was associated with PSE risk reduction in a cDDD-dependent manner. Further clinical studies on the potential applications of statins for PSE prophylaxis, particularly among at-risk patients, are warranted.
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Affiliation(s)
- Fang-Ju Lin
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, No. 33, Lin-Sen S. Rd., Taipei, 10050, Taiwan.,School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan
| | - Hung-Wei Lin
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, No. 33, Lin-Sen S. Rd., Taipei, 10050, Taiwan
| | - Yunn-Fang Ho
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, No. 33, Lin-Sen S. Rd., Taipei, 10050, Taiwan. .,School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan. .,Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan.
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Bringeland GH, Nacu A, Waje‐Andreassen U, Thomassen L, Naess H. U-curve relation between cholesterol and prior ischemic stroke. Brain Behav 2016; 6:e00574. [PMID: 27843706 PMCID: PMC5102651 DOI: 10.1002/brb3.574] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 07/21/2016] [Accepted: 07/30/2016] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVES Previous prospective studies on ischemic stroke patients have shown conflicting results concerning the association between cholesterol level and patient outcome. We aimed to investigate the relation between cholesterol level and prior ischemic stroke. We hypothesized that acute ischemic stroke patients with increased cholesterol on admission more frequently had experienced prior ischemic stroke. METHODS All consecutive patients with acute ischemic stroke (the index stroke) admitted to the Stroke Unit, Department of Neurology, Haukeland University Hospital between February 2006 and October 2013 were prospectively registered in The Bergen NORSTROKE Registry. On admission, cholesterol, low-density lipoprotein, and high-density lipoprotein levels were measured and prior ischemic stroke, risk factors, and medication were registered. Patients with prior versus no prior ischemic stroke were compared regarding risk factors, cholesterol levels, and use of statins on admission for the index stroke. Only patients with available cholesterol values measured on admission were included in the analyses. RESULTS Of the 2,514 included patients admitted with acute ischemic stroke, 429 (17%) patients had prior ischemic stroke. We found a U-curve relationship between the relative frequency of prior ischemic stroke and cholesterol level. Lower frequency of prior ischemic stroke was associated with high cholesterol level on admission up to 5.5 mmol/L. For cholesterol levels higher than this, the opposite was true. These associations included all patients and statin-naive patients. For patients using statin there was a declining relative frequency of prior ischemic stroke from low to high cholesterol levels. CONCLUSION Our hypothesis was falsified. The association between lower cholesterol levels and higher frequency of prior ischemic stroke in patients with cholesterol <5.5 mmol/L cannot be solely an effect of aggressive statin treatment in patients with prior ischemic stroke, as the association pertained also to patients who did not use statin.
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Affiliation(s)
| | - Aliona Nacu
- Department of NeurologyHaukeland University HospitalBergenNorway
- Institute of Clinical MedicineUniversity of BergenBergenNorway
| | - Ulrike Waje‐Andreassen
- Department of NeurologyHaukeland University HospitalBergenNorway
- Institute of Biological and Medical PsychologyUniversity of BergenBergenNorway
| | - Lars Thomassen
- Department of NeurologyHaukeland University HospitalBergenNorway
- Institute of Clinical MedicineUniversity of BergenBergenNorway
| | - Halvor Naess
- Department of NeurologyHaukeland University HospitalBergenNorway
- Institute of Clinical MedicineUniversity of BergenBergenNorway
- Centre for Age‐Related MedicineStavanger University HospitalStavangerNorway
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Lanzillo R, Quarantelli M, Pozzilli C, Trojano M, Amato MP, Marrosu MG, Francia A, Florio C, Orefice G, Tedeschi G, Bellantonio P, Annunziata P, Grimaldi LM, Comerci M, Brunetti A, Bonavita V, Alfano B, Marini S, Brescia Morra V. No evidence for an effect on brain atrophy rate of atorvastatin add-on to interferon β1b therapy in relapsing-remitting multiple sclerosis (the ARIANNA study). Mult Scler 2015; 22:1163-73. [PMID: 26466947 DOI: 10.1177/1352458515611222] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 09/17/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND A previous phase 2 trial has suggested that statins might delay brain atrophy in secondary progressive multiple sclerosis. OBJECTIVES The objective of this study was to evaluate the effect of atorvastatin add-on therapy on cerebral atrophy in relapsing-remitting multiple sclerosis. METHODS This randomised, placebo-controlled study compared atorvastatin 40 mg or placebo add-on therapy to interferon β1b for 24 months. Brain magnetic resonance imaging, multiple sclerosis functional composite score, Rao neuropsychological battery and expanded disability status scale were evaluated over 24 months. RESULTS A total of 154 patients were randomly assigned, 75 in the atorvastatin and 79 in the placebo arms, with a comparable drop-out rate (overall 23.4%). Brain atrophy over 2 years was not different in the two arms (-0.38% and -0.32% for the atorvastatin and placebo groups, respectively). Relapse rate, expanded disability status scale, multiple sclerosis functional composite score or cognitive changes were not different in the two arms. Patients withdrawing from the study had a higher number of relapses in the previous 2 years (P=0.04) and a greater probability of relapsing within 12 months. CONCLUSIONS Our results suggest that the combination of atorvastatin and interferon β1b is not justified in early relapsing-remitting multiple sclerosis and adds to the body of evidence indicating an absence of significant radiological and clinical benefit of statins in relapsing-remitting multiple sclerosis.
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Affiliation(s)
- Roberta Lanzillo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, Italy
| | - Mario Quarantelli
- National Research Council (CNR) Biostructure and Bioimaging Institute (IBB), Naples Multiple Sclerosis Centre, Italy
| | - Carlo Pozzilli
- Department of Neurology and Psychiatry, Sapienza University, Italy
| | - Maria Trojano
- Department of Neurosciences and Organs of Senses, University of Bari, Italy
| | | | - Maria G Marrosu
- Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Italy
| | - Ada Francia
- Department of Neurology and Psychiatry, Sapienza University, Italy
| | - Ciro Florio
- Multiple Sclerosis Regional Center, Azienda Ospedaliera "Antonio Cardarelli", Italy
| | - Giuseppe Orefice
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, Italy
| | - Gioacchino Tedeschi
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, Second University of Naples, Italy
| | | | - Pasquale Annunziata
- Department of Neurological, Neurosurgical and Behavioural Sciences, University of Siena, Italy
| | - Luigi M Grimaldi
- Neurology Unit, Fondazione Istituto San Raffaele "G. Giglio", Italy
| | - Marco Comerci
- National Research Council (CNR) Biostructure and Bioimaging Institute (IBB), Naples Multiple Sclerosis Centre, Italy
| | - Arturo Brunetti
- Department of Biomedical Advanced Sciences, Federico II University, Italy
| | | | - Bruno Alfano
- National Research Council (CNR) Biostructure and Bioimaging Institute (IBB), Naples Multiple Sclerosis Centre, Italy
| | | | - Vincenzo Brescia Morra
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, Italy
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Moonis M, Fisher M. HMG CoA reductase inhibitors (statins): use in stroke prevention and outcome after stroke. Expert Rev Neurother 2014; 4:241-7. [PMID: 15853565 DOI: 10.1586/14737175.4.2.241] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The use of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) has been demonstrated to reduce the risk of primary and secondary ischemic stroke in patients with ischemic heart disease (relative risk reduction is 20-30%), confirmed by several prospective randomized placebo-controlled trials. At least one large prospective trial has also shown a similar benefit in patients without underlying ischemic heart disease. This is in contrast to an open-labeled trial conducted in the USA, which failed to demonstrate a significant benefit of statins in reducing stroke risk in hypertensive hyperlipidemic patients. It is less clear if treatment with statins before or after the onset of ischemic stroke also reduces its severity (improves outcome). Experimental animal studies where mice were pretreated with statins, demonstrated a reduced infarct size compared with untreated animals. Treatment with statins after stroke onset has also been demonstrated to enhance recovery without influencing infarct size (by increased angiogenesis, synaptogenesis and blood flow). A few clinical retrospective studies have demonstrated similar results. Prospective blinded placebo-controlled trials to test these findings are still lacking. This review discusses the various prospective trials in stroke prevention and available data on the effects of statins in improving outcome of established ischemic stroke. Alternate mechanisms of statins besides their lipid-lowering effect and relevance in reducing stroke risk and improving outcome are discussed. Finally, based on the present information, an evidence-based perspective about current and future use of statins in the short- and long-term management of ischemic stroke is presented.
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Affiliation(s)
- Majaz Moonis
- University of Massachusetts Medical School, Worcester, MA 01655, USA.
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Lee CY, Jaw T, Tseng HC, Chen IC, Liou HH. Lovastatin modulates glycogen synthase kinase-3β pathway and inhibits mossy fiber sprouting after pilocarpine-induced status epilepticus. PLoS One 2012; 7:e38789. [PMID: 22761705 PMCID: PMC3383707 DOI: 10.1371/journal.pone.0038789] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Accepted: 05/10/2012] [Indexed: 11/18/2022] Open
Abstract
This study was undertaken to assay the effect of lovastatin on the glycogen synthase kinase-3 beta (GSK-3β) and collapsin responsive mediator protein-2 (CRMP-2) signaling pathway and mossy fiber sprouting (MFS) in epileptic rats. MFS in the dentate gyrus (DG) is an important feature of temporal lobe epilepsy (TLE) and is highly related to the severity and the frequency of spontaneous recurrent seizures. However, the molecular mechanism of MFS is mostly unknown. GSK-3β and CRMP-2 are the genes responsible for axonal growth and neuronal polarity in the hippocampus, therefore this pathway is a potential target to investigate MFS. Pilocarpine-induced status epilepticus animal model was taken as our researching material. Western blot, histological and electrophysiological techniques were used as the studying tools. The results showed that the expression level of GSK-3β and CRMP-2 were elevated after seizure induction, and the administration of lovastatin reversed this effect and significantly reduced the extent of MFS in both DG and CA3 region in the hippocampus. The alteration of expression level of GSK-3β and CRMP-2 after seizure induction proposes that GSK-3β and CRMP-2 are crucial for MFS and epiletogenesis. The fact that lovastatin reversed the expression level of GSK-3β and CRMP-2 indicated that GSK-3β and CRMP-2 are possible to be a novel mechanism of lovatstain to suppress MFS and revealed a new therapeutic target and researching direction for studying the mechanism of MFS and epileptogenesis.
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Affiliation(s)
- Chun-Yao Lee
- Department of Pharmacology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Thomas Jaw
- Department of Pharmacology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Huan-Chin Tseng
- Department of Pharmacology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - I-Chun Chen
- Department of Pharmacology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Horng-Huei Liou
- Department of Pharmacology, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
- * E-mail:
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Clinical neuroprotective drugs for treatment and prevention of stroke. Int J Mol Sci 2012; 13:7739-7761. [PMID: 22837724 PMCID: PMC3397556 DOI: 10.3390/ijms13067739] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Revised: 06/15/2012] [Accepted: 06/19/2012] [Indexed: 01/12/2023] Open
Abstract
Stroke is an enormous public health problem with an imperative need for more effective therapies. In therapies for ischemic stroke, tissue plasminogen activators, antiplatelet agents and anticoagulants are used mainly for their antithrombotic effects. However, free radical scavengers, minocycline and growth factors have shown neuroprotective effects in the treatment of stroke, while antihypertensive drugs, lipid-lowering drugs and hypoglycemic drugs have shown beneficial effects for the prevention of stroke. In the present review, we evaluate the treatment and prevention of stroke in light of clinical studies and discuss new anti-stroke effects other than the main effects of drugs, focusing on optimal pharmacotherapy.
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Wang Q, Yan J, Chen X, Li J, Yang Y, Weng J, Deng C, Yenari MA. Statins: multiple neuroprotective mechanisms in neurodegenerative diseases. Exp Neurol 2010; 230:27-34. [PMID: 20406638 DOI: 10.1016/j.expneurol.2010.04.006] [Citation(s) in RCA: 104] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2010] [Accepted: 04/12/2010] [Indexed: 01/16/2023]
Abstract
Statins have been widely used for the treatment of a variety of conditions beyond their original role in lowering cholesterol. Since statins have relatively few side effects, they have been recognized as useful medicine to ameliorate neurodegenerative disorders. Current studies on the applications of statins have demonstrated their neuroprotective and clinical significance among neurodegenerative diseases like cerebral ischemic stroke, vascular dementia, Alzheimer's disease, and Parkinson's disease, though the neuroprotective mechanisms are not completely understood. This review will discuss recent development in the use of statins in slowing down the progression of these neurodegenerative diseases. It will summarize the potential mechanisms for statin-mediated neuroprotective effects in neurodegenerative diseases. In detail, this review discuss the roles of statins in lowering cholesterol, reducing reactive oxygen species, impairing β-amyloid production and serum apolipoprotein E levels, enhancing the levels of endothelial nitric oxide synthase and cerebral blood flow, and modulating cognitive related receptors and matrix metalloproteases. Finally, different alterations of various receptors in brain regions following statin treatment and their correlations with cognitive dysfunction in Parkinson's disease will also be reviewed, as well as the potential for therapy in ameliorating the progression of Parkinson's disease. This article is part of a Special Issue entitled "Interaction between repair, disease, & inflammation."
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Affiliation(s)
- Qing Wang
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, Guangdong 510630, PR China.
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Eroglu H, Nemutlu E, Turkoglu OF, Nacar O, Bodur E, Sargon MF, Beskonakli E, Oner L. A Quadruped Study on Chitosan Microspheres Containing Atorvastatin Calcium: Preparation, Characterization, Quantification and in-Vivo Application. Chem Pharm Bull (Tokyo) 2010; 58:1161-7. [DOI: 10.1248/cpb.58.1161] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Hakan Eroglu
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Hacettepe University
| | - Emirhan Nemutlu
- Department of Analytical Chemistry, Faculty of Pharmacy, Hacettepe University
| | | | - Osman Nacar
- Department of Neurosurgery, Ankara Numune Research & Education Hospital
| | - Ebru Bodur
- Department of Biochemistry, Faculty of Medicine, Hacettepe University
| | | | - Etem Beskonakli
- Department of Neurosurgery, Ankara Ataturk Research & Education Hospital
| | - Levent Oner
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Hacettepe University
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Berger C, Xia F, Maurer MH, Schwab S. Neuroprotection by pravastatin in acute ischemic stroke in rats. ACTA ACUST UNITED AC 2007; 58:48-56. [PMID: 18035423 DOI: 10.1016/j.brainresrev.2007.10.010] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2007] [Revised: 10/24/2007] [Accepted: 10/26/2007] [Indexed: 11/18/2022]
Abstract
Pleiotropic mechanisms beyond their cholesterol lowering effect of 3-hydroxy 3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors or statins such as pravastatin are known. We used a temporary middle cerebral artery occlusion (tMCAO) model in 114 Wistar rats to assess i) whether repeated injections of various doses of pravastatin (0.1, 0.5, 1 and 2 mg/kg) at 30 min, 6 h, 1, 2, 3, and 4 days after stroke onset are neuroprotective, ii) whether attenuation of striatal glutamate and interleukin-6 (IL-6) release is part of the neuroprotective mechanism, and iii) how local cerebral blood flow (CBF) is influenced by pravastatin both in the acute and late stage of ischemia. Animals were sacrificed 5 days after MCAO, infarct size was analyzed with 2,3,5-triphenyltetrazolium chloride (TTC) staining. As compared to saline (139+/-14 mm3, n=11), higher doses of pravastatin beyond 0.1 mg/kg significantly reduced infarct size with the greatest effect obtained with 1 mg/kg (60+/-14 mm3, n=11, P=0.0004). Using cerebral microdialyis in this dose group, we demonstrated that striatal glutamate increase in the ischemic hemisphere was attenuated by pravastatin compared to placebo. Likewise, IL-6 release was diminished at 2 h, but not at 6 h after tMCAO. Improvement of local CBF by pravastatin was observed at day 5, but not at 5 h after tMCAO, thus representing a more long term effect of pravastatin. In conclusion, a relatively high dose of pravastatin administered repetitively after stroke onset improved neurological outcome through various cholesterol-independent mechanisms.
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Comparison of biochemical effects of statins and fish oil in brain: the battle of the titans. ACTA ACUST UNITED AC 2007; 56:443-71. [PMID: 17959252 DOI: 10.1016/j.brainresrev.2007.09.004] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2007] [Revised: 09/16/2007] [Accepted: 09/17/2007] [Indexed: 11/20/2022]
Abstract
Neural membranes are composed of glycerophospholipids, sphingolipids, cholesterol and proteins. The distribution of these lipids within the neural membrane is not random but organized. Neural membranes contain lipid rafts or microdomains that are enriched in sphingolipids and cholesterol. These rafts act as platforms for the generation of glycerophospholipid-, sphingolipid-, and cholesterol-derived second messengers, lipid mediators that are necessary for normal cellular function. Glycerophospholipid-derived lipid mediators include eicosanoids, docosanoids, lipoxins, and platelet-activating factor. Sphingolipid-derived lipid mediators include ceramides, ceramide 1-phosphates, and sphingosine 1-phosphate. Cholesterol-derived lipid mediators include 24-hydroxycholesterol, 25-hydroxycholesterol, and 7-ketocholesterol. Abnormal signal transduction processes and enhanced production of lipid mediators cause oxidative stress and inflammation. These processes are closely associated with the pathogenesis of acute neural trauma (stroke, spinal cord injury, and head injury) and neurodegenerative diseases such as Alzheimer disease. Statins, the HMG-CoA reductase inhibitors, are effective lipid lowering agents that significantly reduce risk for cardiovascular and cerebrovascular diseases. Beneficial effects of statins in neurological diseases are due to their anti-excitotoxic, antioxidant, and anti-inflammatory properties. Fish oil omega-3 fatty acids, eicosapentaenoic acid and docosahexaenoic acid, have similar anti-excitotoxic, antioxidant and anti-inflammatory effects in brain tissue. Thus the lipid mediators, resolvins, protectins, and neuroprotectins, derived from eicosapentaenoic acid and docosahexaenoic acid retard neuroinflammation, oxidative stress, and apoptotic cell death in brain tissue. Like statins, ingredients of fish oil inhibit generation of beta-amyloid and provide protection from oxidative stress and inflammatory processes. Collective evidence suggests that antioxidant, anti-inflammatory, and anti-apoptotic properties of statins and fish oil contribute to the clinical efficacy of treating neurological disorders with statins and fish oil. We speculate that there is an overlap between neurochemical events associated with neural cell injury in stroke and neurodegenerative diseases. This commentary compares the neurochemical effects of statins with those of fish oil.
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Johnson-Anuna LN, Eckert GP, Franke C, Igbavboa U, Müller WE, Wood WG. Simvastatin protects neurons from cytotoxicity by up-regulating Bcl-2 mRNA and protein. J Neurochem 2007; 101:77-86. [PMID: 17241114 DOI: 10.1111/j.1471-4159.2006.04375.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Statins are most commonly prescribed to reduce hypercholesterolemia; however, recent studies have shown that statins have additional benefits, including neuroprotection. Until now, the mechanism underlying statin-induced neuroprotection has been poorly understood. Recent in vivo studies from our lab reported the novel finding that simvastatin increased expression levels of a gene encoding for a major cell survival protein, bcl-2 [Johnson-Anuna et al., J. Pharmacol. Exp. Ther.312 (2005) 786]. The purpose of the present experiments was to determine if simvastatin could protect neurons from excitotoxicity by altering Bcl-2 levels. Neurons were pre-treated with simvastatin and challenged with a compound known to reduce Bcl-2 levels and induce cell death. Simvastatin pre-treatment resulted in a significant reduction in cytotoxicity (lactate dehydrogenase release and caspase 3 activation) following challenge compared with unchallenged neurons. In addition, chronic simvastatin treatment significantly increased Bcl-2 mRNA and protein levels while challenge resulted in a significant reduction in Bcl-2 protein abundance. G3139, an antisense oligonucleotide directed against Bcl-2, abolished the protective effects of simvastatin and eliminated simvastatin-induced up-regulation of Bcl-2 protein. These findings suggest that neuroprotection by simvastatin is dependent on the drug's previously unexplored and important effect of up-regulating Bcl-2.
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Affiliation(s)
- Leslie N Johnson-Anuna
- Department of Pharmacology, University of Minnesota School of Medicine, Geriatric Research, Education and Clinical Center, VA Medical Center, Minneapolis, Minnesota 55417, USA
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Pannu R, Christie DK, Barbosa E, Singh I, Singh AK. Post-trauma Lipitor treatment prevents endothelial dysfunction, facilitates neuroprotection, and promotes locomotor recovery following spinal cord injury. J Neurochem 2006; 101:182-200. [PMID: 17217414 DOI: 10.1111/j.1471-4159.2006.04354.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
We have previously reported neuroprotection in spinal cord injury (SCI) by Lipitor [atorvastatin (AT)]-pre-treatment. Though informative, pre-treatment studies find only limited clinical application as trauma occurrence is unpredictable. Therefore, this study investigates the efficacy of AT treatment post-SCI. In a rat model of contusion-SCI resulting in complete hindlimb paralysis, AT treatment (5 mg/kg; gavage) was begun 2, 4, or 6 h post-SCI followed by a once daily dose thereafter for 6 weeks. While the placebo vehicle (VHC)-SCI rats showed substantial functional deficit, AT-SCI animals exhibited significant functional recovery. AT diminished injury-induced blood-spinal cord barrier (BSCB) dysfunction with significantly reduced infiltration and tumor necrosis factor-alpha/interleukin-1beta/inducible nitric oxide synthase expression at site of injury. BSCB protection in AT-SCI was attributable to attenuated matrix metalloproteinase-9 (MMP9) expression - a central player in BSCB disruption. Furthermore, endothelial MMP9 expression was found to be RhoA/ROCK pathway-mediated and regulated by AT through an isoprenoid-dependent mechanism. Attenuation of these early inflammatory events reduced secondary damage. Significant reduction in axonal degeneration, myelin degradation, gliosis, and neuronal apoptosis with resultant enhancement in tissue sparing was observed in AT-SCI compared with VHC-SCI. In summary, this novel report presenting the efficacy of post-injury AT treatment might be of critical therapeutic value as effective treatments are currently unavailable for SCI.
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Affiliation(s)
- Ravinder Pannu
- Department of Pediatrics, Centre for Developmental Neurological Disorders: Charles P. Darby Children's Research Institute, Charleston, South Carolina 29425, USA
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Abstract
Considerable evidence now indicates that Alzheimer's disease (AD) is a vascular disorder with neurodegenerative consequences. As a result, AD and vascular dementia (VaD) can each be described as a 'vasocognopathy'. The term better describes the origin of the disease (vaso: vessel/blood flow), its primary effect on a system (-cogno: relating to cognition) and its clinical course (-pathy: disorder). Evidence that AD is a vasocognopathy is partly supported by the following multidisciplinary findings: (1) epidemiologic studies linking AD and vascular risk factors to cerebral hypoperfusion; (2) evidence that AD and vascular dementia (VaD) share practically all reported risk factors; (3) evidence that pharmacotherapy which increases or improves cerebral perfusion lowers AD symptoms; (4) evidence of preclinical detection of AD candidates using regional cerebral perfusion and glucose uptake studies; (5) evidence of overlapping clinical symptoms in AD and VaD; (6) evidence of parallel cerebrovascular and neurodegenerative pathologic markers (including plaques and tangles) in AD and VaD; (7) evidence that cerebral infarction increases AD incidence by 50%; (8) evidence that chronic brain hypoperfusion can trigger hypometabolic, cognitive and neurodegenerative changes typical of AD; (9) evidence that most autopsied AD brains contain cerebrovascular pathology; (10) evidence that mild cognitive impairment (a transition stage for AD) converts to AD or VaD in 48% and 56% of cases, respectively, within several years. The collective evidence presented here poses a powerful argument for the re-classification of AD as a vascular disorder. Re-classification would allow a new strategy that could result in the tactical development and application of genuinely effective treatments, provide earlier diagnosis and reduce AD prevalence by focusing on the root of the problem.
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Affiliation(s)
- Jack C de la Torre
- Institute of Pathology, Case Western Reserve University, Cleveland, OH, USA.
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Greisenegger S, Müllner M, Tentschert S, Lang W, Lalouschek W. Effect of pretreatment with statins on the severity of acute ischemic cerebrovascular events. J Neurol Sci 2004; 221:5-10. [PMID: 15178206 DOI: 10.1016/j.jns.2004.01.015] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2003] [Revised: 11/21/2003] [Accepted: 01/16/2004] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Treatment with statins reduces the risk of ischemic stroke among patients at increased risk for vascular disease. Recent experimental data suggest neuroprotective properties of statins in acute cerebral ischemia. We investigated whether a premedication with statins is associated with a better outcome in patients with acute ischemic cerebrovascular events. METHODS Within a cross-sectional study, nested in a cohort we identified 1691 patients with a recent ischemic stroke or transient ischemic attack. Clinical severity of the vascular event was evaluated by the modified Rankin Scale (mRS) after 1 week. By means of multivariate logistic regression modeling, we determined the influence of prior statin use on stroke severity with adjustment for potential confounding factors. RESULTS Severe stroke, defined as a modified Rankin Scale of 5 or 6 (n=231; 14%), was less frequent in patients receiving statin treatment before the event (6% vs. 14%, OR=0.37; 95% CI 0.19 to 0.74; p=0.004). This association remained significant after adjustment for confounding factors. We found a significant interaction between the presence of diabetes and the effect of pretreatment with statins on stroke outcome. Of the patients with diabetes, none of those on statin treatment but 16% of those without a statin had a bad outcome. After exclusion of the group of diabetic patients with prior statin medication, the protective effect was reduced and not statistically significant anymore. CONCLUSIONS Pretreatment with statins seems to be associated with reduced clinical severity in patients with acute ischemic cerebrovascular events, particularly in patients with diabetes.
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Affiliation(s)
- S Greisenegger
- Clinical Department for Clinical Neurology, University Clinic of Neurology, Vienna, Austria
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Obradović D, Gligić B, Obradović S, Popović S, Maksić J, Vukotić N. [Statins and cerebral ischemia]. VOJNOSANIT PREGL 2003; 60:461-70. [PMID: 12958806 DOI: 10.2298/vsp0304461o] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
<zakljucak> CVB su vodeci uzrok invalidnosti u svetu, drugi uzrok mortaliteta u nerazvijenim zemljama (na trecem mestu u razvijenim zemljama), a jedna trecina bolesnika umire unutar prvih 6 meseci od razbolevanja (95, 96). Ovo su zvanicni podaci Svetske zdravstvene organizacije, a statistika je otisla korak dalje i pokazala da u SAD svake 53. sekunde jedan covek oboli od CVB (97). Mozda bi pricu o statinima i IBM trebalo zavrsiti ovim izrazito nepovoljnim epidemioloskim podacima vezanim za CVB, koji naglasavaju znacaj iznalazenja adekvatne terapije koja bi smanjila rizik obolevanja (98), kao i ogromne troskove vezane za lecenje i posledicnu invalidnost. Aspirin dovodi do redukcije vaskularnog mortaliteta i morbiditeta vezanog za CVB od 13% klopidogrel do 22% (99), a statini nezavisno od upotrebe drugih lekova ukljucujuci i aspirin, do 30%. Imajuci u vidu sve ove izrazito dobre rezultate lecenja statinima, uz dozu rezervisanosti vezanu za eventualne udaljene efekte ove terapije, nema sumnje da se radi o lekovima koji ce uticati na promenu celokupnog pristupa lecenju bolesnika sa rizikom od IBM.
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Etminan M, Gill S, Samii A. The role of lipid-lowering drugs in cognitive function: a meta-analysis of observational studies. Pharmacotherapy 2003; 23:726-30. [PMID: 12820814 DOI: 10.1592/phco.23.6.726.32184] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
STUDY OBJECTIVE To quantify the risk of cognitive impairment with use of lipid-lowering drugs. DESIGN AND DATA SOURCES Literature search through MEDLINE and EMBASE databases; data from seven observational studies were analyzed. MEASUREMENTS AND MAIN RESULTS We quantified the risk of cognitive impairment first with the use of any lipid-lowering drug, and then specifically with the statins, using the random effects model. We tested for heterogeneity using the Q statistic as well as quantitatively using the Ri statistic. All seven studies provided data for statin users, and five provided data only on use of lipid-lowering drugs. Compared with patients not receiving lipid-lowering drugs, the relative risk of cognitive impairment with any lipid-lowering drug was 0.62 but was not statistically significant (95% confidence interval [CI] 0.28-1.38), and the relative risk with statins was 0.43 and was statistically significant (95% CI 0.31-0.62). CONCLUSION Lipid-lowering drugs--in particular, the statins--seem to lower the odds of developing cognitive impairment. Randomized, controlled trials are needed to address the efficacy of these agents specifically in different types of dementia.
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Affiliation(s)
- Mahyar Etminan
- Pharmacoepidemiology Unit, Royal Victoria Hospital, McGill University, Montreal, Quebec, Canada
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Scalia R, Stalker TJ. Microcirculation as a target for the anti-inflammatory properties of statins. Microcirculation 2002; 9:431-42. [PMID: 12483541 DOI: 10.1038/sj.mn.7800168] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2002] [Accepted: 08/26/2002] [Indexed: 01/31/2023]
Abstract
Statins are inhibitors of the 3-hydroxy-3-methylglutaryl coenzyme A reductase, a ubiquitous enzyme critical for the biosynthesis of cholesterol. Because of their cholesterol-lowering properties, statins are extensively used in medical practice, and large clinical trials have shown that statins effectively reduce cardiovascular related morbidity and mortality. In the past 5 years, an important, new concept suggesting that the cardioprotective effects of statins are not necessarily related to cholesterol-lowering actions has emerged. Indeed, in vivo findings have clearly shown that statins exert anti-inflammatory and immunomodulatory effects and that they modulate vascular remodeling under normocholesterolemic conditions. These pleiotropic properties of statins affect important molecules in vascular biology and help preserve endothelial function in acute and chronic inflammatory states of the cardiovascular system, including coronary and cerebral artery diseases, diabetes, and atherosclerosis. Emerging evidence indicates that the microcirculation is a crucial target for the pleiotropic actions of statins because of its important role in regulating blood flow, leukocyte-endothelium interactions, and vascular remodeling. Accordingly, this review focuses on the role that the microcirculation plays in the vascular protective action of statins.
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Affiliation(s)
- Rosario Scalia
- Department of Physiology, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA
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Deutsch J, Rapoport SI, Rosenberger TA. Coenzyme A and short-chain acyl-CoA species in control and ischemic rat brain. Neurochem Res 2002; 27:1577-82. [PMID: 12515307 DOI: 10.1023/a:1021614422668] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
A rapid and reliable method was developed to quantify brain concentrations of coenzyme A (CoA) and short-chain acyl-CoAs having chain length < or = 4 carbon atoms. The method employs tissue extraction and isolation using an oligonucleotide purification cartridge and quantifies concentrations by peak area analysis following high-performance liquid chromatography (HPLC). In adult anesthetized rats subjected to 4-s high-energy microwave irradiation to stop brain metabolism, the brain concentrations of CoA, 3-hydroxy-3-methylglutaryl-CoA (HMG-CoA), acetyl-CoA, and butyryl-CoA equaled 68.7 +/- 18.5, 2.7 +/- 1.5, 7.6 +/- 2.3, and 30.6 +/- 15.9 nmol x g(-1), respectively. After 5 min of complete ischemia, the brain concentrations of CoA and HMG-CoA increased 2- and 12-fold compared to controls, whereas acetyl-CoA and butyryl-CoA concentrations did not change. Markedly elevated levels of CoA and HMG-CoA following cerebral ischemia may reflect disturbed energy metabolism and altered formation of cholesterol and isoprenoids.
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Affiliation(s)
- Joseph Deutsch
- Department of Medicinal Chemistry, David R. Bloom Center for Pharmacy, The Hebrew University School of Pharmacy, Jerusalem, Israel
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