Factors Associated with Early Recovery after Intravenous Thrombolytic Therapy in Acute Ischemic Stroke

P‑hydroxybenzyl alcohol ameliorates neuronal cerebral ischemia‑reperfusion injury by activating mitochondrial autophagy through SIRT1

Mitochondrial autophagy serves a key role in clearing damaged mitochondria. P‑hydroxybenzyl alcohol (pHBA) can improve neuronal injury induced by cerebral ischemia‑reperfusion (I/R). However, the mechanism of pHBA improving I/R damage through the mitochondrial pathway remains unclear. A rat model of middle cerebral artery occlusion and reperfusion (MCAO/R) was used in the present study. The rats were treated with sirtuin 1 (SIRT1) inhibitor EX527 and pHBA for 7 days, followed by reperfusion. At 24 h after reperfusion, the infarct size was calculated and the severity of nerve damage was evaluated. Hematoxylin and eosin and Nissl staining revealed cellular changes in the ischemic penumbra. Changes in mitochondrial structure were observed using electron microscopy. Mitochondrial function was evaluated by detecting mitochondrial membrane potential (MMP), mitochondrial permeability transition pore (mPTP) and ATP levels using commercially available kits. In addition, the ischemic penumbra tissues were used for immunofluorescence staining for p62 and LC3 proteins. The expression of SIRT1 and mitochondrial autophagy‑related proteins, PTEN‑induced kinase 1 (PINK1) and Parkin, were detected by western blotting. Finally, apoptosis was analyzed by TUNEL staining and the expression of apoptosis‑related proteins (Bax, Bcl‑2 and Caspase‑3) by western blotting. The results suggested that postoperative pHBA treatment may reduce the size of cerebral infarction and damage to the nervous system, and may improve cell damage in the ischemic penumbra of MCAO/R rats. Compared with rats in the untreated MCAO/R group, the mitochondrial structure of the pHBA‑treated group was improved, the levels of MMP and ATP were increased, and the degree of opening of mPTP was decreased. Simultaneously, immunofluorescence and western blotting results showed that compared with the MCAO/R group, the number of LC3‑ and TUNEL‑positive cells increased, the number of p62‑positive cells decreased, SIRT1 and autophagy protein (PINK1, Parkin and LC3 II/I) expression levels increased and p62 expression decreased in the pHBA group. However, these improvements were blocked by treatment with EX527. In summary, results from the present study suggested that pHBA may improve neuronal injury in the ischemic penumbra of MCAO/R rats through SIRT1‑activated mitochondrial autophagy and mitochondrial‑mediated neuronal apoptosis.

Association of serum biomarkers with early neurologic improvement after intravenous thrombolysis in ischemic stroke

BACKGROUND

Early neurologic improvement (ENI) after intravenous thrombolysis is associated with favorable outcome, but associated serum biomarkers were not fully determined. We aimed to investigate the issue based on a prospective cohort.

METHODS

In INTRECIS study, five centers were designed to consecutively collect blood sample from enrolled patients. The patients with ENI and without ENI were matched by propensity score matching with a ratio of 1:1. Preset 49 biomarkers were measured through microarray analysis. Enrichment of gene ontology and pathway, and protein-protein interaction network were analyzed in the identified biomarkers.

RESULTS

Of 358 patients, 19 patients with ENI were assigned to ENI group, while 19 matched patients without ENI were assigned to Non ENI group. A total of nine biomarkers were found different between two groups, in which serum levels of chemokine (C-C motif) ligand (CCL)-23, chemokine (C-X-C motif) ligand (CXCL)-12, insulin-like growth factor binding protein (IGFBP)-6, interleukin (IL)-5, lymphatic vessel endothelial hyaluronan receptor (LYVE)-1, plasminogen activator inhibitor (PAI)-1, platelet-derived growth factor (PDGF)-AA, suppression of tumorigenicity (ST)-2, and tumor necrosis factor (TNF)-α were higher in the ENI group, compared with those in the Non ENI group.

CONCLUSIONS

We found that serum levels of CCL-23, CXCL-12, IGFBP-6, IL-5, LYVE-1, PAI-1, PDGF-AA, ST-2, and TNF-α at admission were associated with post-thrombolytic ENI in stroke. The role of biomarkers warrants further investigation.

TRIAL REGISTRATION

Clinical Trial Registration: https://www.clinicaltrials.gov; identifier: NCT02854592.

Correlation Between Blood Glucose Variability and Early Therapeutic Effects After Intravenous Thrombolysis With Alteplase and Levels of Serum Inflammatory Factors in Patients With Acute Ischemic Stroke

Objective

To investigate the effects of blood glucose variability on early therapeutic effects after intravenous thrombolysis with alteplase and the levels of serum inflammatory factors in patients with acute ischemic stroke (AIS).

Methods

We enrolled AIS patients who received intravenous thrombolysis within 4.5 h of the onset of symptoms. Clinical data, including the National Institutes of Health Stroke Scale (NIHSS), glycosylated hemoglobin, mean blood glucose, standard deviation of blood glucose, mean amplitude of glycemic excursion, mean variation coefficient of blood glucose, interleukin-6 (IL-6), active matrix metalloproteinase-9 (MMP-9), tumor necrosis factor α (TNF-α), and hypersensitive C-reactive protein (hs-CRP) levels, were compared between a group who showed improvement (the improvement group) and a group who did not show improvement (the non-improvement group). Relevant factors for early neurological improvement after thrombolysis with alteplase were analyzed by using multivariate logistic regression models. A Pearson linear correlation analysis was also performed on blood glucose variation and inflammatory factor levels within the two groups.

Results

A total of 146 patients were included, 63 of which had early symptom improvement (43.15%). The diabetes ratio, atrial fibrillation ratio, baseline NHISS score, random blood glucose at admission, and glycosylated hemoglobin of patients in the improvement group were significantly lower than those in the non-improvement group (P < 0.05 in all cases). The mean blood glucose, standard deviation of blood glucose, mean amplitude of glycemic excursion, and mean blood glucose variation coefficients of patients in the improvement group were significantly lower than those in the non-improvement group (P < 0.05). Serum inflammatory factor levels, including IL-6, MMP-9, TNF-α and hs-CRP, were significantly lower in patients in the improvement group compared to patients in the non-improvement group (P < 0.05). Multivariate logistic regression analysis showed that baseline NIHSS scores (OR = 1.28, 95% CI = 1.05-1.62, P = 0.02), glycosylated hemoglobin scores (OR = 2.57, 95% CI = 1.78-3.98, P = 0.0005), diabetes (OR = 13.10, 95% CI = 1.63~131.45, P = 0.021), the mean amplitude of glycemic excursion (OR = 2.98, 95% CI = 1.92-5.00, P < 0.0001), and the mean variation coefficient of blood glucose (OR = 1.40, 95% CI = 1.26-1.60, P = 0.0078) were significantly correlated with early symptom improvement after thrombolysis. Pearson linear correlation analysis showed that the standard deviation of blood glucose, mean amplitude of glycemic excursion, and the mean variation coefficient of blood glucose were significantly positively correlated with IL-6, MMP-9, TNF-α and hs-CRP levels (P < 0.01).

Conclusions

Blood glucose variability is correlated with early neurological improvement after intravenous thrombolysis with alteplase in AIS patients. With the increase of blood glucose fluctuation range, the inflammatory response is enhanced, which affects the prognosis of patients.

[Efficacy of intravenous thrombolysis for acute severe cerebral infarction and risk factors of poor prognosis: a randomized controlled trial in 152 cases]

OBJECTIVE

To investigate the clinical efficacy and safety of intravenous thrombolysis in patients with acute severe cerebral infarction and analyze the risk factors of poor prognosis after thrombolysis.

METHODS

This randomized controlled trial was conducted among 152 patients with acute severe cerebral infarction, with the onset time all within 4.5 h. The patients were randomized into control group (76 cases) and observation group (76 cases) and received treatment with routine therapy (antiplatelet aggregation, statins, neuroprotection and drugs that stimulate blood flow) and intravenous thrombolytic therapy with alteplase in addition to the routine therapy, respectively. The NIHSS scores were recorded at 24 h, 1 week and 1 month after the treatment. The mRS scores at 3 months and the incidence of symptomatic intracranial hemorrhage at one week after the treatment were compared between the two groups. According to mRS scores at 3 months, the patients in the observation group were divided into good prognosis group (30 patients) and poor prognosis group (46 patients), and the risk factors for poor prognosis were analyzed using univariate and multivariate Logistic regression analysis.

RESULTS

At 24 h, 1 week and 1 month after the treatment, the reduction of NIHSS scores was more significant in the observation group than in the control group (F=24.684, P < 0.001). At 3 months after the treatment, the mRS scores were significantly lower (t=4.396, P < 0.001) and the good prognosis rate was significantly higher (χ2=13.636, P < 0.001) in the observation group than those of the control group. Symptomatic intracranial hemorrhage occurred in 4 cases in the observation group and in 2 cases in the control group within 1 week after the treatment (χ2=0.694, P=0.405). The time from onset to thrombolysis (OR=0.173, P=0.035), prethrombolytic systolic pressure (OR=0.869, P=0.019) and baseline NIHSS score (OR=0.466, P=0.011) were identified as independent risk factors for poor prognosis after intravenous thrombolysis.

CONCLUSION

Intravenous thrombolysis is effective and safe for patients with acute severe cerebral infarction, and the time from onset to thrombolysis, prethrombolytic systolic pressure and baseline NIHSS score are independent risk factors for a poor prognosis after intravenous thrombolysis.

Protective Effects of Chlorogenic Acid on Cerebral Ischemia/Reperfusion Injury Rats by Regulating Oxidative Stress-Related Nrf2 Pathway

INTRODUCTION

Cerebral ischemia-reperfusion (CI/R) injury is caused by blood flow recovery after ischemic stroke. Chlorogenic acid (CGA, 5-O-caffeoylquinic acid) is a major polyphenol component of Coffea canephora, Coffea arabica L. and Mate (Ilex paraguariensis A. StHil.). Previous studies have shown that CGA has a significant neuroprotective effect and can improve global CI/R injury. However, the underlying molecular mechanism of CGA in CI/R injury has not been fully revealed.

MATERIALS

In this study, CI/R rat model was constructed. The rats were randomly divided into nine groups with ten in each group: Control, CGA (500 mg·kg-1), CI/R, CI/R + CGA (20 mg·kg-1), CI/R + CGA (100 mg·kg-1), CI/R + CGA (500 mg·kg-1), ML385 (30 mg·kg-1), CI/R + ML385 (30 mg·kg-1), CI/R + CGA + ML385. Cerebral infarction volume was detected by TTC staining. Brain pathological damage was detected by H&E staining. Apoptosis of cortical cells was detected by TUNEL staining. The expression of related proteins was detected by RT-qPCR and Western blotting.

RESULTS

Step-down test and Y maze test showed that CGA dose-dependently mitigated CI/R-induced brain damage and enhanced learning and spatial memory. Besides, CGA promoted the expression of BDNF and NGF in a dose-dependent manner and alleviated CI/R-induced nerve injury. Moreover, CGA increased the activity of SOD and the level of GSH, as well as decreased production of ROS and LDH and the accumulation of MDA. Notably, CGA attenuated oxidative stress-induced brain injury and apoptosis and inhibited the expression of apoptosis-related proteins (cleaved caspase 3 and caspase 9). Additionally, CGA reversed CI/R induced inactivation of Nrf2 pathway and promoted Nrf2, NQO-1 and HO-1 expression. Nrf2 pathway inhibitor ML385 destroyed this promotion.

DISCUSSION

All the data indicated that CGA had a neuroprotective effect on the CI/R rats by regulating oxidative stress-related Nrf2 pathway.