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Li D, Zhou M, Zha F, Long J, Wang Y. Association between N-terminal pro-B-type natriuretic peptide and clinical outcomes in bedridden patients with stroke: a cross-sectional study. BMJ Open 2024; 14:e077083. [PMID: 38286702 PMCID: PMC10826584 DOI: 10.1136/bmjopen-2023-077083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 11/29/2023] [Indexed: 01/31/2024] Open
Abstract
OBJECTIVES Patients with stroke often remain bedridden despite rehabilitation. Serum N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) levels increase after stroke. Our study aimed to investigate the difference in NT-pro-BNP levels between bedridden and non-bedridden patients with stroke and to explore the factors influencing NT-pro-BNP levels in bedridden patients. DESIGN A single-centre, cross-sectional study. SETTING This study was conducted in a hospital, Shenzhen, China. PARTICIPANTS Between January 2019 and December 2022, 465 participants were included in this study. OUTCOME MEASURES The collected data included basic information, laboratory data and echocardiographic parameters. Binary logistic regression analysis and receiver operating characteristic curves were used to identify factors associated with high NT-pro-BNP levels. RESULTS Bedridden patients with stroke had higher levels of NT-pro-BNP, D-dimer, high-sensitivity C reactive protein (hs-CRP) and lower levels of creatinine, high-density lipoprotein cholesterol, albumin and haemoglobin, as well as lower left ventricular ejection fraction, fractional shortening and the ratio between the peak velocities of early and late diastolic filling than non-bedridden patients. In bedridden patients, age ≥75 years, high levels of hs-CRP and creatinine, and low levels of albumin were associated with high NT-pro-BNP levels. In non-bedridden patients, age ≥75 years and high creatinine levels were associated with high NT-pro-BNP levels. In bedridden patients with stroke, the area under the curve (AUC) of hs-CRP was 0.700 (p<0.001, 95% CI 0.638 to 0.762) with a cut-off value of 5.12 mg/L. The AUC of albumin was 0.671 (p<0.001, 95% CI 0.606 to 0.736) with a cut-off value of 37.15 g/L. CONCLUSIONS NT-pro-BNP levels were higher in bedridden patients with stroke than in non-bedridden patients. Decreased albumin and elevated hs-CRP levels were associated with high levels of NT-pro-BNP in bedridden patients. Further studies are needed to explore the risk stratification and potential treatments for elevated NT-pro-BNP in bedridden patients with stroke.
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Affiliation(s)
- Dongxia Li
- Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
| | - Mingchao Zhou
- Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
| | - Fubing Zha
- Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
| | - Jianjun Long
- Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
| | - Yulong Wang
- Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
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Elameer M, Lumley H, Moore SA, Marshall K, Alton A, Smith FE, Gani A, Blamire A, Rodgers H, Price CIM, Mitra D. A prospective study of MRI biomarkers in the brain and lower limb muscles for prediction of lower limb motor recovery following stroke. Front Neurol 2023; 14:1229681. [PMID: 37941576 PMCID: PMC10628497 DOI: 10.3389/fneur.2023.1229681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 09/26/2023] [Indexed: 11/10/2023] Open
Abstract
The aim of this prospective observational longitudinal study was to explore and decipher the predictive value of prospective MRI biomarkers in the brain and lower limb muscles for 3-month lower limb motor recovery following stroke. In the brain, we measured the integrity of the corticospinal tract (fractional anisotropy/"FA"). In the muscles, we measured volume, fatty replacement (fat fraction analysis and proton spectroscopy) and oedema. Measurements were taken at two time points: (1) within 4 weeks of stroke (baseline measurement, clinical and imaging) and (2) 3 months following stroke (follow up measurement, clinical only). Clinical measurements consisted of assessments of functional ability and strength (Fugl-Meyer score, motor NIHSS, Functional Ambulation Category/"FAC", and muscle dynamometry). Twenty-three patients completed imaging and clinical assessments at baseline and follow-up; five patients had partial imaging assessment. The results provided some evidence that damage to the corticospinal tract would result in less motor recovery: recovery of the Fugl-Meyer score and dynamometric ankle plantarflexion, ankle dorsiflexion, and knee extension correlated positively and significantly with fractional anisotropy (0.406-0.457; p = 0.034-p = 0.016). However, fractional anisotropy demonstrated a negative correlation with recovery of the Functional Ambulation Category (-0.359, p = 0.046). For the muscle imaging, significant inverse correlation was observed between vastus lateralis fat fraction vs. NIHSS recovery (-0.401, p = 0.04), and a strong positive correlation was observed between ratio of intra- to extra-myocellular lipid concentrations and the recovery of knee flexion (0.709, p = 0.007). This study supports previous literature indicating a positive correlation between the integrity of the corticospinal tract and motor recovery post-stroke, expanding the limited available literature describing this relationship specifically for the lower limb. However, recovery of functional ambulation behaved differently to other clinical recovery markers by demonstrating an inverse relationship with corticospinal tract integrity. The study also introduces some muscle imaging biomarkers as potentially valuable in the prediction of 3-month lower limb motor recovery following stroke.
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Affiliation(s)
- Mat Elameer
- Department of Neuroradiology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
- Stroke Research Group, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Hannah Lumley
- Stroke Research Group, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Sarah A. Moore
- Stroke Research Group, Newcastle University, Newcastle upon Tyne, United Kingdom
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Katie Marshall
- Department of Medical Physics, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Abi Alton
- Stroke Research Group, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Fiona E. Smith
- Department of Neuroscience, Manchester Metropolitan University, Manchester, United Kingdom
| | - Akif Gani
- Department of Stroke Medicine, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Andrew Blamire
- Newcastle Magnetic Resonance Centre, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Helen Rodgers
- Stroke Research Group, Newcastle University, Newcastle upon Tyne, United Kingdom
| | | | - Dipayan Mitra
- Department of Neuroradiology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
- Stroke Research Group, Newcastle University, Newcastle upon Tyne, United Kingdom
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Feng L, He Y, Dong S, Wang R, Long S, He L. An exploratory descriptive cohort study of 90-day prognosis after acute ischaemic stroke with mechanical thrombectomy. Contemp Nurse 2022; 58:264-275. [PMID: 36052463 DOI: 10.1080/10376178.2022.2107038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIM To evaluate the relationship between nursing assessment findings at discharge and acute ischaemic stroke (AIS) patient prognosis after mechanical thrombectomy (MT). METHODS We analysed the characteristics of 144 AIS patients with MT treatment admitted to a university affiliated teaching hospital in Chengdu, Sichuan Province China, from January 2020 to December 2020. The modified Rankin Scale (mRS) score was used to assess outcomes 90-days after discharge. Exploratory analyses were undertaken using IBM SPSS Statistics (Version 26.0). RESULTS At 90-days, 47.9% (n = 69) had a good prognosis (mRS ≤ 2) including 22.2%(n = 32) fully recovered patients. There were 5 (3.5%) deceased patients and 48.6% (n =70) of patients had a poor prognosis (mRS ≥ 3). In univariate analysis, clinical prognosis correlated with the need for inpatient endotracheal intubation (p = 0.02), nasogastric tube (p<0.001), indwelling urinary catheter (p<0.001), central venous catheter (p = 0.03), health knowledge needs of pressure injury prevention (p = 0.03), National Institute of Health Stroke Scale (NIHSS) score (p<0.001) and Activities of Daily Living (ADL) score (p<0.001) at the time of discharge from hospital. The average hospitalisation time of the 144 patients was 12[IQR, 9-25] days, and the average cost of hospitalisation was $Y$21291.93 (SD 9165.01). CONCLUSION Almost half of the surviving patients had a poor prognosis. In our country, this surgery and rehabilitation impose a significant financial burden that needs to be addressed. However, the longer length of hospital stay and higher costs at discharge may be contributing factors to worse outcomes. The outcomes of comprehensive nursing assessment of the patients, including nursing needs, activities of daily living, and neurological function, can predict their outcome. IMPACT STATEMENT We recommend a comprehensive nursing assessment at discharge that predicts patient outcomes and can be used for subsequent targeted interventions. The prognosis of patients with acute ischaemic stroke after mechanical thrombectomy is poor, and the financial burden needs to be considered.
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Affiliation(s)
- Ling Feng
- West China School of Nursing,Sichuan University/Department of Neurology,West China Hospital,Sichuan University, Chengdu China
| | - Yueyue He
- West China School of Nursing,Sichuan University/Department of Neurology,West China Hospital,Sichuan University, Chengdu China
| | - Shuju Dong
- Department of Neurology, West China Hospital, Sichuan University, Chengdu China
| | - Rui Wang
- West China School of Nursing,Sichuan University/Department of Neurology,West China Hospital,Sichuan University, Chengdu China
| | - Shiyan Long
- West China School of Nursing,Sichuan University/Department of Neurology,West China Hospital,Sichuan University, Chengdu China
| | - Li He
- Department of Neurology, West China Hospital, Sichuan University, Chengdu China
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Huang WY, Li MH, Lee CH, Tuan SH, Sun SF, Liou IH. Efficacy of lateral stair walking training in patients with chronic stroke: A pilot randomized controlled study. Gait Posture 2021; 88:10-15. [PMID: 33946024 DOI: 10.1016/j.gaitpost.2021.04.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 03/21/2021] [Accepted: 04/14/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Patients with chronic stroke have reduced capacity for performing activities of daily living (ADLs) and are at increased risk for falls during walking due to long-term changes to muscle tone and force, as well as movement control. RESEARCH QUESTION To investigate the efficacy of lateral stair walking training on muscle strength of affected lower extremities, balance, ADLs, and gait ability in patients with chronic stroke. METHODS The experimental group received 15 min of lateral stair walking exercise along with 15 min of traditional physiotherapy, whereas the control group received only traditional physiotherapy for 30 min. Both groups received the intervention once a week for 12 weeks. Outcome measurements included muscle strength, postural assessment scale for stroke patients (PASS), Fugal-Meyer assessment for lower extremity (FMA-LE), Barthel index (BI), timed up and go test (TUG), and the gait parameters which were determined by the Reha-Watch system. RESULTS A total of 24 participants completed the study. The experimental group showed significant improvements in hip extensor, flexor, and abductor strength of the affected limb, FMA-LE, BI, TUG, and gait parameters of stride length, velocity, and cadence. Significant differences in affected limb ankle plantar strength (p = 0.024), PASS (p = 0.017), BI (p = 0.039), TUG (p = 0.049), and gait velocity (p < 0.001) were observed between the 2 groups. SIGNIFICANCE Lateral stair walking training alongside physical therapy resulted in significant improvements in hip muscle strength and gait parameters in patients with chronic stroke. Our results support the incorporation of lateral stair walking training into clinical rehabilitation programs. Lateral stair walking training in patients with chronic stroke can be used as an effective treatment to improve gait, balance performance, and ADLs.
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Affiliation(s)
- Wan-Yun Huang
- Department of Physical Medicine and Rehabilitation, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
| | - Min-Hui Li
- Department of Physical Medicine and Rehabilitation, Kaohsiung Veterans General Hospital, Taiwan.
| | - Chao-Hsien Lee
- Department of Health Business Administration, Meiho University, Pingtung, Taiwan.
| | - Sheng-Hui Tuan
- Department of Rehabilitation Medicine, Cishan Hospital, Ministry of Health and Welfare, Kaohsiung, Taiwan.
| | - Shu-Fen Sun
- Department of Physical Medicine and Rehabilitation, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
| | - I-Hsiu Liou
- Department of Physical Medicine and Rehabilitation, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
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5
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Zakharov VV, Vakhnina NV, Gogoleva AG. [The criteria for effectiveness of reperfusion therapy and neuroprotective therapy in ischemic stroke]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:86-92. [PMID: 34037360 DOI: 10.17116/jnevro202112104186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The narrative review discusses the data on efficacy and safety of reperfusion therapy (RT) and neuroprotective therapy in ischemic stroke. The influence of therapy on mortality, residual neurologic deficit and disability is analyzed. It was shown that RT (thrombolysis or mechanical thromboextraction) leads to significant decrease of residual neurologic deficit or disability. The influence of RT on mortality is controversial. There is some evidence that RT can increase early mortality due to hemorrhagic complications. Neuroprotective therapy is much less studied in stroke but is recognized as safe. Neuroprotective therapy (i.e. cerebrolysin) can diminish residual neurologic deficit and disability, while it has no influence on mortality.
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Affiliation(s)
- V V Zakharov
- Sechenov First Moscow State Medical University, Moscow, Russia.,Sklifosovsky Institute of Clinical Medicine, Moscow, Russia
| | - N V Vakhnina
- Sechenov First Moscow State Medical University, Moscow, Russia.,Sklifosovsky Institute of Clinical Medicine, Moscow, Russia
| | - A G Gogoleva
- Sechenov First Moscow State Medical University, Moscow, Russia.,Sklifosovsky Institute of Clinical Medicine, Moscow, Russia
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6
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Shakkour Z, Issa H, Ismail H, Ashekyan O, Habashy KJ, Nasrallah L, Jourdi H, Hamade E, Mondello S, Sabra M, Zibara K, Kobeissy F. Drug Repurposing: Promises of Edaravone Target Drug in Traumatic Brain Injury. Curr Med Chem 2021; 28:2369-2391. [PMID: 32787753 DOI: 10.2174/0929867327666200812221022] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 06/09/2020] [Accepted: 06/11/2020] [Indexed: 11/22/2022]
Abstract
Edaravone is a potent free-radical scavenger that has been in the market for more than 30 years. It was originally developed in Japan to treat strokes and has been used there since 2001. Aside from its anti-oxidative effects, edaravone demonstrated beneficial effects on proinflammatory responses, nitric oxide production, and apoptotic cell death. Interestingly, edaravone has shown neuroprotective effects in several animal models of diseases other than stroke. In particular, edaravone administration was found to be effective in halting amyotrophic lateral sclerosis (ALS) progression during the early stages. Accordingly, after its success in Phase III clinical studies, edaravone has been approved by the FDA as a treatment for ALS patients. Considering its promises in neurological disorders and its safety in patients, edaravone is a drug of interest that can be repurposed for traumatic brain injury (TBI) treatment. Drug repurposing is a novel approach in drug development that identifies drugs for purposes other than their original indication. This review presents the biochemical properties of edaravone along with its effects on several neurological disorders in the hope that it can be adopted for treating TBI patients.
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Affiliation(s)
- Zaynab Shakkour
- American University of Beirut, Faculty of Medicine, Department of Biochemistry and Molecular Genetics, Beirut, Lebanon
| | - Hawraa Issa
- PRASE and Biology Department, Faculty of Sciences - I, Lebanese University, Beirut, Lebanon
| | - Helene Ismail
- American University of Beirut, Faculty of Medicine, Department of Biochemistry and Molecular Genetics, Beirut, Lebanon
| | - Ohanes Ashekyan
- American University of Beirut, Faculty of Medicine, Department of Biochemistry and Molecular Genetics, Beirut, Lebanon
| | - Karl John Habashy
- Faculty of Medicine, American, University of Beirut, Beirut, Lebanon
| | - Leila Nasrallah
- American University of Beirut, Faculty of Medicine, Department of Biochemistry and Molecular Genetics, Beirut, Lebanon
| | - Hussam Jourdi
- Biology & Environmental Sciences Division at University of Balamand, Souk El Gharb, Aley, Lebanon
| | - Eva Hamade
- PRASE and Biology Department, Faculty of Sciences - I, Lebanese University, Beirut, Lebanon
| | - Stefania Mondello
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Mirna Sabra
- Faculty of Medicine, Lebanese University, Neuroscience Research Center (NRC), Beirut, Lebanon
| | - Kazem Zibara
- PRASE and Biology Department, Faculty of Sciences - I, Lebanese University, Beirut, Lebanon
| | - Firas Kobeissy
- American University of Beirut, Faculty of Medicine, Department of Biochemistry and Molecular Genetics, Beirut, Lebanon
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7
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The effect of edaravone on a rat fracture model complicated with ischemia. JOURNAL OF SURGERY AND MEDICINE 2021. [DOI: 10.28982/josam.869495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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8
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New understanding of the pathogenesis and treatment of stroke-related sarcopenia. Biomed Pharmacother 2020; 131:110721. [DOI: 10.1016/j.biopha.2020.110721] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 08/24/2020] [Accepted: 09/02/2020] [Indexed: 12/18/2022] Open
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9
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Mueangson O, Vongvaivanichakul P, Kamdee K, Jansakun C, Chulrik W, Pongpanitanont P, Sathirapanya P, Chunglok W. Malondialdehyde as a Useful Biomarker of Low Hand Grip Strength in Community-Dwelling Stroke Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17217918. [PMID: 33126675 PMCID: PMC7663701 DOI: 10.3390/ijerph17217918] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 10/23/2020] [Accepted: 10/24/2020] [Indexed: 12/12/2022]
Abstract
The assessment of muscle strength by hand grip strength (HGS) is used to evaluate muscle weakness and wasting among stroke patients. This study aimed to investigate the association of oxidative stress/oxidative damage and inflammatory biomarkers with muscle strength and wasting, as evaluated by HGS, among community-dwelling post-stroke patients. The HGS of both paretic and non-paretic limbs was negatively associated with modified Rankin scale (mRS) values. The serum levels of catalase activity and malondialdehyde (MDA), and plasma tumor necrosis factor (TNF)-α levels were significantly increased in post-stroke patients compared with non-stroke controls. Further analysis highlighted that hydrogen peroxide was positively correlated with HGS in the paretic limbs. Interestingly, an elevated MDA level, excluding advanced age and high mRS, increased the risk of low HGS in the non-paretic limbs of stroke patients. This study suggests that there is a detrimental association between MDA and muscle strength and early muscle wasting among post-stroke patients. Hence, MDA is a potentially useful biomarker of muscle weakness and wasting in post-stroke patients living in the community.
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Affiliation(s)
- Onchuma Mueangson
- School of Allied Health Sciences and Research Institute for Health Sciences, Walailak University, Nakhon Si Thammarat 80161, Thailand; (O.M.); (P.V.); (K.K.); (C.J.); (W.C.); (P.P.)
| | - Parinya Vongvaivanichakul
- School of Allied Health Sciences and Research Institute for Health Sciences, Walailak University, Nakhon Si Thammarat 80161, Thailand; (O.M.); (P.V.); (K.K.); (C.J.); (W.C.); (P.P.)
| | - Kornyok Kamdee
- School of Allied Health Sciences and Research Institute for Health Sciences, Walailak University, Nakhon Si Thammarat 80161, Thailand; (O.M.); (P.V.); (K.K.); (C.J.); (W.C.); (P.P.)
| | - Chutima Jansakun
- School of Allied Health Sciences and Research Institute for Health Sciences, Walailak University, Nakhon Si Thammarat 80161, Thailand; (O.M.); (P.V.); (K.K.); (C.J.); (W.C.); (P.P.)
| | - Wanatsanan Chulrik
- School of Allied Health Sciences and Research Institute for Health Sciences, Walailak University, Nakhon Si Thammarat 80161, Thailand; (O.M.); (P.V.); (K.K.); (C.J.); (W.C.); (P.P.)
| | - Pongphan Pongpanitanont
- School of Allied Health Sciences and Research Institute for Health Sciences, Walailak University, Nakhon Si Thammarat 80161, Thailand; (O.M.); (P.V.); (K.K.); (C.J.); (W.C.); (P.P.)
| | - Pornchai Sathirapanya
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkla 90110, Thailand;
| | - Warangkana Chunglok
- School of Allied Health Sciences and Research Institute for Health Sciences, Walailak University, Nakhon Si Thammarat 80161, Thailand; (O.M.); (P.V.); (K.K.); (C.J.); (W.C.); (P.P.)
- Correspondence: ; Tel.: +66-7567-2681
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10
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Yasuda T, Toyoda S, Inoue T, Nakajima T. Muscle Thickness of Anterior Mid-Thigh in Hospitalized Patients: Comparison of Supine and Standing Postures. Arch Rehabil Res Clin Transl 2020; 2:100063. [PMID: 33543089 PMCID: PMC7853370 DOI: 10.1016/j.arrct.2020.100063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objectives To compare the magnitude changes in muscle thickness (MTH) of the anterior mid-thigh between the supine and standing postures. Design Experimental. Setting University hospital laboratory. Participants Inpatients (N=283) between the ages of 29 and 93 years (193 men, 90 women) with cardiovascular disease who volunteered for this study. Interventions Not applicable. Main Outcome Measures MTH of the anterior mid-thigh was measured with a 10 MHz ultrasound probe while the participants stood or lay supine in a relaxed position with their arms extended and by their sides. Results Age and percentage of body fat were greater (P<.01) in women than in men (74.3±12.3 vs 67.7±12.1y and 32.6±10.3% vs 27.4±7.4%, respectively), but standing height, body weight, and body mass index were greater (P<.01) in men than in women (164.9±6.3 vs 149.1±7.5 cm, 65.4±12.7 vs 49.5±11.1 kg, and 23.8±3.9 vs 22.1±4.4 kg/m2, respectively). Correlations were found between the standing posture and supine position in the anterior-mid thigh MTH for both men (r=0.85; P<.01) and women (r=0.82; P<.01). In the anterior-mid thigh for men and women, MTH was greater in the standing posture (3.7±1.0 vs 2.5±0.7 cm) than in supine position (3.1±0.8 vs 2.1±0.7 cm) (both P<.01). Conclusions In this study, MTH of the anterior mid-thigh during prolonged hospitalization was approximately 16% higher in men than in women regardless of posture, and was approximately 32% higher in standing posture than in the supine position regardless of sex.
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Affiliation(s)
- Tomohiro Yasuda
- School of Nursing, Seirei Christopher University, Shizuoka, Japan.,Department of Cardiovascular Medicine, School of Medicine, Dokkyo Medical University, Tochigi, Japan
| | - Shigeru Toyoda
- Department of Cardiovascular Medicine, School of Medicine, Dokkyo Medical University, Tochigi, Japan
| | - Teruo Inoue
- Department of Cardiovascular Medicine, School of Medicine, Dokkyo Medical University, Tochigi, Japan
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11
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Munakomi S. Preventing Muscle Atrophy Following Strokes: A Reappraisal. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1088:593-601. [PMID: 30390272 DOI: 10.1007/978-981-13-1435-3_28] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Muscle atrophy leading to muscle weakness accounts for major cause of disabilities among stroke survivors. It amounts to compromised gait and prevails to viscous cycle of diminished physical capacities and compromised participation in rehabilitative tasks. There is predisposition to recurrent strokes due to added risk of developing metabolic syndrome. Therefore, beyond the shadow of doubt, there is ripple effect of rehabilitation and thereby muscle protection in these subsets of patients. Herein, we highlight upon the newer insights with regard to preventing muscle atrophy following strokes.
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Affiliation(s)
- Sunil Munakomi
- Department of Neurosurgery, Nobel Teaching Hospital, Biratnagar, Nepal.
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12
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Lathuilière A, Mareschal J, Graf CE. How to Prevent Loss of Muscle Mass and Strength among Older People in Neuro-Rehabilitation? Nutrients 2019; 11:E881. [PMID: 31010176 PMCID: PMC6521136 DOI: 10.3390/nu11040881] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 04/17/2019] [Accepted: 04/17/2019] [Indexed: 12/12/2022] Open
Abstract
Stroke is the second leading cause of death worldwide but also of disability. Stroke induces certain alterations of muscle metabolism associated with gross muscle atrophy and a decrease in muscle function, leading to sarcopenia. The vast majority of stroke cases occur in adults over 65 years of age, and the prevalence is expected to massively increase in the coming years in this population. Sarcopenia is associated with higher mortality and functional decline. Therefore, the identification of interventions that prevent muscle alterations after stroke is of great interest. The purpose of this review is to carry out a systematic literature review to identify evidence for nutritional and pharmacological interventions, which may prevent loss of muscle mass in the elderly after stroke. The search was performed on Medline in December 2018. Randomized controlled studies, observational studies and case reports conducted in the last 20 years on post-stroke patients aged 65 or older were included. In total, 684 studies were screened, and eight randomized control trials and two cohort studies were finally included and examined. This review reveals that interventions such as amino acid supplementation or anabolic steroid administration are efficient to prevent muscle mass. Little evidence is reported on nutritional aspects specifically in sarcopenia prevention after stroke. It pinpoints the need for future studies in this particular population.
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Affiliation(s)
- Aurélien Lathuilière
- Department of Rehabilitation and Geriatrics, Geneva University Hospital, 1205 Geneva, Switzerland.
| | - Julie Mareschal
- Clinical Nutrition, Geneva University Hospital, 1205 Geneva, Switzerland.
| | - Christophe E Graf
- Department of Rehabilitation and Geriatrics, Geneva University Hospital, 1205 Geneva, Switzerland.
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13
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Goenka L, Uppugunduri Satyanarayana CR, S SK, George M. Neuroprotective agents in Acute Ischemic Stroke-A Reality Check. Biomed Pharmacother 2018; 109:2539-2547. [PMID: 30551514 DOI: 10.1016/j.biopha.2018.11.041] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 10/22/2018] [Accepted: 11/10/2018] [Indexed: 11/29/2022] Open
Affiliation(s)
- Luxitaa Goenka
- Department of Clinical Pharmacology, SRM Medical College Hospital & Research Centre, Kattankulathur, Chennai, Tamil Nadu, 603203 India
| | - Chakradhara Rao Uppugunduri Satyanarayana
- Platform of Pediatric Onco-Hematology (CANSEARCH Laboratory), Department of Pediatrics, University of Geneva, Bâtiment Tulipe, Avenue De La Roseraie, 641205 Geneva, Switzerland
| | - Suresh Kumar S
- Department of Pharmacology, Ras Al Khaimah Medical and Health Sciences University, Ras Al Khaimah, Ras Al Khaymah, United Arab Emirates
| | - Melvin George
- Department of Clinical Pharmacology, SRM Medical College Hospital & Research Centre, Kattankulathur, Chennai, Tamil Nadu, 603203 India.
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14
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Abstract
Each month, subscribers to The Formulary Monograph Service receive 5 to 6 well-documented monographs on drugs that are newly released or are in late phase 3 trials. The monographs are targeted to Pharmacy & Therapeutics Committees. Subscribers also receive monthly 1-page summary monographs on agents that are useful for agendas and pharmacy/nursing in-services. A comprehensive target drug utilization evaluation/medication use evaluation (DUE/MUE) is also provided each month. With a subscription, the monographs are available online to subscribers. Monographs can be customized to meet the needs of a facility. Through the cooperation of The Formulary, Hospital Pharmacy publishes selected reviews in this column. For more information about The Formulary Monograph Service, contact Wolters Kluwer customer service at 866-397-3433.
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15
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Short Physical Performance Battery for cardiovascular disease inpatients: implications for critical factors and sarcopenia. Sci Rep 2017; 7:17425. [PMID: 29234165 PMCID: PMC5727140 DOI: 10.1038/s41598-017-17814-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 12/01/2017] [Indexed: 12/25/2022] Open
Abstract
We examined the relationship between Short Physical Performance Battery (SPPB) and clinical and laboratory factors and the effect of sarcopenia and sarcopenic obesity (SO) on clinical and laboratory factors for cardiovascular disease (CVD) inpatients. CVD male (n = 318) and female (n = 172) inpatients were recruited. A stepwise multiple-regression analysis was performed to predict total SPPB scores and assess clinical and laboratory factors (physical characteristics, functional and morphological assessments, etc.). Each test outcome were compared among sarcopenia, SO and non-sarcopenic groups. To predict total SPPB scores, the predicted handgrip, Controlling Nutritional Status score, % body fat, anterior mid-thigh muscle thickness, standing height and systolic blood pressure were calculated for males and anterior mid-thigh MTH, BMI, knee extension and fat mass were calculated for females. There were no differences in blood pressure, total SPPB scores and functional assessments between sarcopenia and SO groups for CVD male and female inpatients. In conclusion, the physical performance of CVD inpatients can be predicted by nutritional, functional, clinical and anthropometric variables, regardless the gender and the presence of sarcopenia. Furthermore, the presence of sarcopenia has a negative effect on the clinical and laboratory factors, but there is a difference in impact between sarcopenia and SO regardless the gender.
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16
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Yasuda T, Fukumura K, Nakajima T. Short physical performance battery for middle-aged and older adult cardiovascular disease patients: implication for strength tests and lower extremity morphological evaluation. J Phys Ther Sci 2017; 29:748-753. [PMID: 28533623 PMCID: PMC5430286 DOI: 10.1589/jpts.29.748] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 01/18/2017] [Indexed: 12/22/2022] Open
Abstract
[Purpose] To examine if the SPPB is higher with healthy subjects than outpatients, which
was higher than inpatients and if the SPPB can be validated assessment tool for strength
tests and lower extremity morphological evaluation in cardiovascular disease patients.
[Subjects and Methods] Twenty-four middle aged and older adults with cardiovascular
disease were recruited from inpatient and outpatient facilities and assigned to separate
experimental groups. Twelve age-matched healthy volunteers were assigned to a control
group. SPPB test was used to assess balance and functional motilities. The test outcomes
were compared with level of care (inpatient vs. outpatient), physical characteristics,
strength and lower extremity morphology. [Results] Total SPPB scores, strength tests (knee
extensor muscle strength), and lower extremity morphological evaluation (muscle thickness
of anterior and posterior mid-thigh and posterior lower-leg) were greater in healthy
subjects and outpatients groups compared with inpatients. To predict total Short Physical
Performance Battery scores, the predicted knee extension and anterior mid-thigh muscle
thickness were calculated. [Conclusion] The SPPB is an effective tool as the strength
tests and lower extremity morphological evaluation for middle-aged and older adult
cardiovascular disease patients. Notably, high knee extensor muscle strength and
quadriceps femoris muscle thickness are positively associated with high SPPB scores.
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Affiliation(s)
- Tomohiro Yasuda
- Graduate School of Medicine, University of Tokyo, Japan.,School of Nursing, Seirei Christopher University, Japan.,Faculty of Medicine, Toho University, Japan
| | - Kazuya Fukumura
- Graduate School of Medicine, University of Tokyo, Japan.,Kanto Central Hospital of the Mutual Aid Association of Public School Teachers, Japan
| | - Toshiaki Nakajima
- Graduate School of Medicine, University of Tokyo, Japan.,Heart Center, Dokkyo Medical University Hospital, Japan
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17
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Reeta KH, Singh D, Gupta YK. Edaravone attenuates intracerebroventricular streptozotocin-induced cognitive impairment in rats. Eur J Neurosci 2017; 45:987-997. [DOI: 10.1111/ejn.13543] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 02/10/2017] [Accepted: 02/10/2017] [Indexed: 12/31/2022]
Affiliation(s)
- K. H. Reeta
- Department of Pharmacology; All India Institute of Medical Sciences; Ansari Nagar, New Delhi 110029 India
| | - Devendra Singh
- Department of Pharmacology; All India Institute of Medical Sciences; Ansari Nagar, New Delhi 110029 India
| | - Yogendra K. Gupta
- Department of Pharmacology; All India Institute of Medical Sciences; Ansari Nagar, New Delhi 110029 India
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18
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Ji L, Liu Y, Zhang Y, Chang W, Gong J, Wei S, Li X, Qin L. The antioxidant edaravone prevents cardiac dysfunction by suppressing oxidative stress in type 1 diabetic rats and in high-glucose-induced injured H9c2 cardiomyoblasts. Can J Physiol Pharmacol 2016; 94:996-1006. [PMID: 27376621 DOI: 10.1139/cjpp-2015-0587] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Edaravone, a radical scavenger, has been recognized as a potential protective agent for cardiovascular diseases. However, little is known about the effect of edaravone in cardiac complications associated with diabetes. Here, we have demonstrated that edaravone prevents cardiac dysfunction and apoptosis in the streptozotocin-induced type 1 diabetic rat heart. Mechanistic studies revealed that edaravone treatment improved cardiac function and restored superoxide dismutase levels. In addition, treatment of diabetic animals by edaravone increased protein expressions of sirtuin-1 (SIRT-1), peroxisome proliferator activated receptor γ coactivator α (PGC-1α), nuclear factor like-2 (NRF-2), and B cell lymphoma 2 (Bcl-2), and reduced protein expressions of Bax and Caspase-3 compared to the control group. High glucose incubation resulted in the production of reactive oxygen species (ROS) and cell death. Treatment of high-glucose-incubated H9c2 cells by edaravone reduced ROS production and cell death. In addition, the treatment of high-glucose-incubated H9c2 cells by edaravone increased the activity of antioxidative stress by increasing SIRT-1, PGC-1α, and NRF-2, and this treatment also reduced apoptosis by increasing Bcl-2 expression and reducing Bax and Caspase-3 expressions. Knockdown SIRT-1 with small interferer RNA abolished the effects of edaravone. Overall, our data demonstrated that edaravone may be an effective agent against the development of diabetic cardiomyopathy.
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Affiliation(s)
- Lei Ji
- Department of Cardiology, First Hospital of Jilin University, Changchun 130021, China
- Department of Cardiology, Changchun Central Hospital, Changchun 130051, China
| | - Yingying Liu
- Department of Nephrology, China–Japan Union Hospital of Jilin University, Changchun 130033, China
| | - Ying Zhang
- Department of Neurology, First Hospital of Jilin University, Changchun 130021, China
| | - Wenguang Chang
- Department of Pharmacology, College of Basic Medical Sciences, Jilin University, Changchun 130021, China
| | - Junli Gong
- Department of Cardiology, Changchun Central Hospital, Changchun 130051, China
| | - Shengnan Wei
- Department of Pharmacology, College of Basic Medical Sciences, Jilin University, Changchun 130021, China
| | - Xudong Li
- Department of Cardiology, Changchun Central Hospital, Changchun 130051, China
| | - Ling Qin
- Department of Cardiology, First Hospital of Jilin University, Changchun 130021, China
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19
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Lee I, Hüttemann M, Malek MH. (-)-Epicatechin Attenuates Degradation of Mouse Oxidative Muscle Following Hindlimb Suspension. J Strength Cond Res 2016; 30:1-10. [PMID: 26382133 DOI: 10.1519/jsc.0000000000001205] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The purpose of this study was to conduct a 14-day hindlimb suspension (HS) with and without (-)-epicatechin supplementation to determine whether (-)-epicatechin treatment can attenuate the loss in muscle degradation, angiogenesis, and mitochondrial signaling in oxidative skeletal muscle. Adult mice were randomized into 3 groups: (a) control (C); (b) HS with vehicle (HS-V); and (c) HS with (-)-epicatechin (HS-(-)-Epi). Animals in the HS-(-)-Epi group received (-)-epicatechin (1.0 mg · kg(-1) of body mass) twice daily through oral gavage. For markers related to muscle degradation, the HS-V group had significantly higher protein expression compared with the control and HS-(-)-Epi groups. Moreover, protein expression for myosin heavy chain type I was significantly reduced by approximately 45% in the HS-V group compared with the control and HS-(-)-Epi groups. In addition, capillarity contact and capillary-to-fiber ratio were significantly higher in the HS-(-)-Epi group compared with the HS-V group. Furthermore, protein expression for thrombospondin-1 was significantly higher in HS-V group compared with the control and HS-(-)-Epi groups. Hindlimb suspension also significantly reduced protein expression for mitochondrial signaling compared with the control and HS-(-)-Epi groups. These findings suggest that (-)-epicatechin supplementation attenuates degradation in oxidative muscles after HS.
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Affiliation(s)
- Icksoo Lee
- 1College of Medicine, Dankook University, Cheonan-si, Republic of Korea; 2Center for Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, Michigan; 3Cardiovascular Research Institute, Wayne State University School of Medicine, Detroit, Michigan; and 4Integrative Physiology of Exercise Laboratory, Department of Health Care Sciences, Eugene Applebaum College of Pharmacy & Health Sciences, Wayne State University, Detroit, Michigan
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20
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MIYAJI Y, YOSHIMURA S, SAKAI N, YAMAGAMI H, EGASHIRA Y, SHIRAKAWA M, UCHIDA K, KAGEYAMA H, TOMOGANE Y. Effect of edaravone on favorable outcome in patients with acute cerebral large vessel occlusion: subanalysis of RESCUE-Japan Registry. Neurol Med Chir (Tokyo) 2015; 55:241-7. [PMID: 25739433 PMCID: PMC4533339 DOI: 10.2176/nmc.ra.2014-0219] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Accepted: 11/10/2014] [Indexed: 12/21/2022] Open
Abstract
The data of the nationwide prospective registry of acute cerebral large vessel occlusion (LVO; RESCUE-Japan Registry) were analyzed to know the effect of edaravone, a free radical scavenger, on clinical outcome at 90 days after onset. In this registry, patients with acute cerebral LVO admitted within 24 h after onset were prospectively registered. The effect of various factors including endovascular treatment (EVT), intravenous recombinant tissue plasminogen activator (IV rt-PA), and other medication including edaravone on favorable outcome (modified Rankin scale 0-1) was analyzed. Of the 1,454 registered patients, 1,442 patients (99.2%) had the information of edaravone were analyzed. In total, edaravone group had more patients with favorable outcome compared to non-edaravone group (22.9% vs. 13.8%, p = 0.0006). Edaravone increased favorable outcome in patients treated with IV rt-PA (29.4% vs. 11.1%, p = 0.0107), but not with EVT (21.2% vs. 13.9%, p = 0.309). Logistic regression analysis revealed that higher National Institutes of Health Stroke Scale (NIHSS) score on admission [odds ratio (OR) 0.875, 95% confidence interval (CI) 0.858-0.894] and advanced age (OR 0.963, 95%CI 0.952-0.975) were significantly related to unfavorable outcome. In contrast, IV rt-PA (OR 2.489, 95%CI 1.867-3.319), EVT (OR 1.375, 95%CI 1.013-1.865), and edaravone (OR 1.483, 95%CI 1.027-2.143) were significantly associated with favorable outcome. This analysis indicated that IV rt-PA, EVT, and edaravone were effective to obtain favorable outcome in patients with acute LVO. Combination IV rt-PA with edaravone was more effective.
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Affiliation(s)
- Yuki MIYAJI
- Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Hyogo
| | - Shinichi YOSHIMURA
- Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Hyogo
| | - Nobuyuki SAKAI
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Hyogo
| | - Hiroshi YAMAGAMI
- Department of Stroke and Cerebrovascular Diseases, National Cerebral and Cardiovascular Center, Suita, Osaka
| | - Yusuke EGASHIRA
- Department of Neurosurgery, Graduate School of Medicine, Gifu University, Gifu, Gifu
| | - Manabu SHIRAKAWA
- Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Hyogo
| | - Kazutaka UCHIDA
- Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Hyogo
| | - Hirohito KAGEYAMA
- Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Hyogo
| | - Yusuke TOMOGANE
- Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Hyogo
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21
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Higashi Y, Hoshijima M, Yawata T, Nobumoto A, Tsuda M, Shimizu T, Saito M, Ueba T. Suppression of oxidative stress and 5-lipoxygenase activation by edaravone improves depressive-like behavior after concussion. J Neurotrauma 2014; 31:1689-99. [PMID: 24849726 DOI: 10.1089/neu.2014.3331] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Brain concussions are a serious public concern and are associated with neuropsychiatric disorders, such as depression. Patients with concussion who suffer from depression often experience distress. Nevertheless, few pre-clinical studies have examined concussion-induced depression, and there is little information regarding its pharmacological management. Edaravone, a free radical scavenger, can exert neuroprotective effects in several animal models of neurological disorders. However, the effectiveness of edaravone in animal models of concussion-induced depression remains unclear. In this study, we examined whether edaravone could prevent concussion-induced depression. Mice were subjected to a weight-drop injury and intravenously administered edaravone (3.0 mg/kg) or vehicle immediately after impact. Serial magnetic resonance imaging showed no abnormalities of the cerebrum on diffusion T1- and T2-weighted images. We found that edaravone suppressed concussion-induced depressive-like behavior in the forced swim test, which was accompanied by inhibition of increased hippocampal and cortical oxidative stress (OS) and suppression of 5-lipoxygenase (5-LOX) translocation to the nuclear envelope in hippocampal astrocytes. Hippocampal OS in concussed mice was also prevented by the nicotinamide adenine dinucleotide phosphate oxidase inhibitor, apocynin, and administration of BWB70C, a 5-LOX inhibitor, immediately and 24 h after injury prevented depressive-like behaviors in concussed mice. Further, antidepressant effects of edaravone were observed in mice receiving 1.0 or 3.0 mg/kg of edaravone immediately after impact, but not at a lower dose of 0.1 mg/kg. This antidepressant effect persisted up to 1 h after impact, whereas edaravone treatment at 3 h after impact had no effect on concussion-induced depressive-like behavior. These results suggest that edaravone protects against concussion-induced depression, and this protection is mediated by suppression of OS and 5-LOX translocation.
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Affiliation(s)
- Youichirou Higashi
- 1 Department of Neurosurgery, Kochi Medical School, Kochi University , Kochi, Japan
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22
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Kikuchi K, Tancharoen S, Takeshige N, Yoshitomi M, Morioka M, Murai Y, Tanaka E. The efficacy of edaravone (radicut), a free radical scavenger, for cardiovascular disease. Int J Mol Sci 2013; 14:13909-30. [PMID: 23880849 PMCID: PMC3742225 DOI: 10.3390/ijms140713909] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Revised: 06/19/2013] [Accepted: 06/21/2013] [Indexed: 02/07/2023] Open
Abstract
Edaravone was originally developed as a potent free radical scavenger, and has been widely used to treat acute ischemic stroke in Japan since 2001. Free radicals play an important role in the pathogenesis of a variety of diseases, such as cardiovascular diseases and stroke. Therefore, free radicals may be targets for therapeutic intervention in these diseases. Edaravone shows protective effects on ischemic insults and inflammation in the heart, vessel, and brain in experimental studies. As well as scavenging free radicals, edaravone has anti-apoptotic, anti-necrotic, and anti-cytokine effects in cardiovascular diseases and stroke. Edaravone has preventive effects on myocardial injury following ischemia and reperfusion in patients with acute myocardial infarction. Edaravone may represent a new therapeutic intervention for endothelial dysfunction in the setting of atherosclerosis, heart failure, diabetes, or hypertension, because these diseases result from oxidative stress and/or cytokine-induced apoptosis. This review evaluates the potential of edaravone for treatment of cardiovascular disease, and covers clinical and experimental studies conducted between 1984 and 2013. We propose that edaravone, which scavenges free radicals, may offer a novel option for treatment of cardiovascular diseases. However, additional clinical studies are necessary to verify the efficacy of edaravone.
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Affiliation(s)
- Kiyoshi Kikuchi
- Department of Pharmacology, Faculty of Dentistry, Mahidol University, 6 Yothe Road, Rajthevee, Bangkok 10400, Thailand; E-Mails: (K.K.); (S.T.)
- Division of Brain Science, Department of Physiology, Kurume University School of Medicine, 67 Asahi-machi, Kurume 830-0011, Japan; E-Mail:
- Department of Neurosurgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume 830-0011, Japan; E-Mails: (N.T.); (M.Y.); (M.M.)
| | - Salunya Tancharoen
- Department of Pharmacology, Faculty of Dentistry, Mahidol University, 6 Yothe Road, Rajthevee, Bangkok 10400, Thailand; E-Mails: (K.K.); (S.T.)
| | - Nobuyuki Takeshige
- Department of Neurosurgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume 830-0011, Japan; E-Mails: (N.T.); (M.Y.); (M.M.)
| | - Munetake Yoshitomi
- Department of Neurosurgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume 830-0011, Japan; E-Mails: (N.T.); (M.Y.); (M.M.)
| | - Motohiro Morioka
- Department of Neurosurgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume 830-0011, Japan; E-Mails: (N.T.); (M.Y.); (M.M.)
| | - Yoshinaka Murai
- Division of Brain Science, Department of Physiology, Kurume University School of Medicine, 67 Asahi-machi, Kurume 830-0011, Japan; E-Mail:
| | - Eiichiro Tanaka
- Division of Brain Science, Department of Physiology, Kurume University School of Medicine, 67 Asahi-machi, Kurume 830-0011, Japan; E-Mail:
- Author to whom correspondence should be addressed. E-Mail: ; Tel.: +81-942-31-7542; Fax: +81-942-31-7695
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Ohta M, Higashi Y, Yawata T, Kitahara M, Nobumoto A, Ishida E, Tsuda M, Fujimoto Y, Shimizu K. Attenuation of axonal injury and oxidative stress by edaravone protects against cognitive impairments after traumatic brain injury. Brain Res 2012; 1490:184-92. [PMID: 22982593 DOI: 10.1016/j.brainres.2012.09.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Revised: 08/30/2012] [Accepted: 09/07/2012] [Indexed: 12/21/2022]
Abstract
Traumatic axonal injury (TAI), a feature of traumatic brain injury (TBI), progressively evolves over hours through impaired axonal transport and is thought to be a major contributor to cognitive dysfunction. In spite of various studies suggesting that pharmacologic or physiologic interventions might reduce TAI, clinical neuroprotective treatments are still unavailable. Edaravone, a free radical scavenger, has been shown to exert neuroprotective effects in animal models of several brain disorders. In this study, to evaluate whether edaravone suppresses TAI following TBI, mice were subjected to weight drop injury and had either edaravone (3.0mg/kg) or saline administered intravenously immediately after impact. Axonal injury and oxidative stress were assessed using immunohistochemistry with antibodies against amyloid precursor protein, a marker of impaired axonal transport, and with 8-hydroxy-2'-deoxyguanosine, a marker of oxidative DNA damage. Edaravone significantly suppressed axonal injury and oxidative stress in the cortex, corpus callosum, and hippocampus 24h after injury. The neuroprotective effects of edaravone were observed in mice receiving 1.0, 3.0, or 10mg/kg of edaravone immediately after impact, but not after 0.3mg/kg of edaravone. With treatment 1h after impact, axonal injury was also significantly suppressed and this therapeutic effect persisted up to 6h after impact. Furthermore, behavioral tests performed 9 days after injury showed memory deficits in saline-treated traumatized mice, which were not evident in the edaravone-treated group. These results suggest that edaravone protects against memory deficits following TBI and that this protection is mediated by suppression of TAI and oxidative stress.
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Affiliation(s)
- Manabu Ohta
- Department of Neurosurgery, Kochi Medical School, Kohasu, Okoh-cho, Nankoku, Kochi 783-8505, Japan.
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Kikuchi K, Miura N, Kawahara KI, Murai Y, Morioka M, Lapchak PA, Tanaka E. Edaravone (Radicut), a free radical scavenger, is a potentially useful addition to thrombolytic therapy in patients with acute ischemic stroke. Biomed Rep 2012; 1:7-12. [PMID: 24648884 DOI: 10.3892/br.2012.7] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Accepted: 08/08/2012] [Indexed: 01/30/2023] Open
Abstract
Acute ischemic stroke (AIS) is a major cause of morbidity and mortality in the aging population worldwide. Alteplase, a recombinant tissue plasminogen activator, is the only Food and Drug Administration-approved thrombolytic agent for the treatment of AIS. Only 2-5% of patients with stroke receive thrombolytic treatment, mainly due to delay in reaching the hospital. Edaravone is a free radical scavenger marketed in Japan to treat patients with AIS, who present within 24 h of the onset of symptoms. When used in combination with alteplase, edaravone may have three useful effects: enhancement of early recanalization, inhibition of alteplase-induced hemorrhagic transformation and extension of the therapeutic time window for alteplase. This is the first review of the literature evaluating the clinical efficacy of edaravone, aiming to clarify whether edaravone should be further evaluated for clinical use worldwide. This review covers both clinical and experimental studies conducted between 1994 and 2012. Edaravone is a potentially useful neurovascular protective agent, used in combination with thrombolytic agents to treat >15 million patients devastated by stroke worldwide annually. Additional clinical studies are necessary to verify the efficacy of edaravone when used in combination with a thrombolytic agent.
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Affiliation(s)
- Kiyoshi Kikuchi
- Department of Neurology, Cedars-Sinai Medical Center, Davis Research Building, Los Angeles, CA 90048, USA
| | - Naoki Miura
- Veterinary Teaching Hospital and Laboratory of Veterinary Diagnostic Imaging, Faculty of Agriculture, Kagoshima University, Kagoshima 890-0065
| | - Ko-Ichi Kawahara
- Laboratory of Functional Foods, Department of Biomedical Engineering, Osaka Institute of Technology, Osaka 535-8585; ; Department of Systems Biology in Thromboregulation, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima 890-8520, Japan
| | | | - Motohiro Morioka
- Neurosurgery, Kurume University School of Medicine, Fukuoka 830-0011
| | - Paul A Lapchak
- Department of Neurology, Cedars-Sinai Medical Center, Davis Research Building, Los Angeles, CA 90048, USA
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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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26
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Abe K. [Therapeutic time window for ischemic stroke]. Rinsho Shinkeigaku 2011; 51:1182-1184. [PMID: 22277527 DOI: 10.5692/clinicalneurol.51.1182] [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: 05/31/2023]
Abstract
Neuroprotection is essential for therapy in acute stage of stroke. Both neurotrophic factors (NTFs) and free radical scavenger can be such neuroprotective reagents with inhibiting death signals and potentiating survival signals under cerebral ischemia. Edaravone, a free radical scavenger, is the first clinical drug for neuroprotection in the world which has been used from 2001 in most ischemic stroke patients in Japan. Edaravone scavenges hydroxyl radicals both in hydrophilic and hydrophobic conditions, and is especially useful in thrombolytic therapy with tissue plasminogen activator (tPA). Combination therapy of Edaravone with tPA greatly increased survival of stroke animals, reduced infarct size, and inhibited molecular markers of oxidative damage in lipid, protein and DNA. Use of Edaravone greatly reduced hemorrhagic transformation accompanied by tPA treatment, and may also extend therapeutic time window with tPA therapy for more than 3 hr in human stroke patients.
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Affiliation(s)
- Koji Abe
- Department of Neurology, Graduate School of Medicine and Dentistry, Okayama University
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27
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Wang GH, Jiang ZL, Li YC, Li X, Shi H, Gao YQ, Vosler PS, Chen J. Free-radical scavenger edaravone treatment confers neuroprotection against traumatic brain injury in rats. J Neurotrauma 2011; 28:2123-34. [PMID: 21732763 DOI: 10.1089/neu.2011.1939] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Traumatic brain injury (TBI) is one of the leading causes of neurological disability in young adults. Edaravone, a novel synthetic small-molecule free-radical scavenger, has been shown to have a neuroprotective effect in both animal models of cerebral ischemia and stroke patients; however, the underlying mechanism is poorly understood. In this report, we investigated the potential mechanisms of edaravone treatment in a rat model of TBI. TBI was induced in the right cerebral cortex of male adult rats using Feeney's weight-drop method. Edaravone (0.75, 1.5, or 3 mg/kg) or vehicle (normal saline) was intravenously administered at 2 and 12 h after TBI. Edaravone treatment significantly decreased hippocampal CA3 neuron loss, reduced oxidative stress, and decreased neuronal programmed cell death compared to vehicle treatment. The protective effects of edaravone treatment were also related to the pathology of TBI on non-neuronal cells, as edaravone decreased astrocyte and glial activation. Lastly, edaravone treatment significantly reduced the presence of inflammatory cytokines, cerebral edema, blood-brain barrier (BBB) permeability, and, importantly, neurological deficits following TBI. Our results suggest that edaravone exerts a neuroprotective effect in the rat model of TBI. The likely mechanism is via inhibiting oxidative stress, leading to a decreased inflammatory response and glial activation, and thereby reducing neuronal death and improving neurological function.
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Affiliation(s)
- Guo-Hua Wang
- Department of Neuropharmacology, Institute of Nautical Medicine, Nantong University, Nantong, Jiangsu, China
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Aoki M, Warita H, Mizuno H, Suzuki N, Yuki S, Itoyama Y. Feasibility study for functional test battery of SOD transgenic rat (H46R) and evaluation of edaravone, a free radical scavenger. Brain Res 2011; 1382:321-5. [DOI: 10.1016/j.brainres.2011.01.058] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2010] [Revised: 01/17/2011] [Accepted: 01/19/2011] [Indexed: 10/18/2022]
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