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Baena-Caldas GP, Li J, Pedraza L, Ghosh S, Kalmes A, Barone FC, Moreno H, Hernández AI. Neuroprotective effect of the RNS60 in a mouse model of transient focal cerebral ischemia. PLoS One 2024; 19:e0295504. [PMID: 38166102 PMCID: PMC10760892 DOI: 10.1371/journal.pone.0295504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 11/22/2023] [Indexed: 01/04/2024] Open
Abstract
BACKGROUND Stroke is a major cause of death, disability, and public health problems. Its intervention is limited to early treatment with thrombolytics and/or endovascular clot removal with mechanical thrombectomy without any available subacute or chronic neuroprotective treatments. RNS60 has reduced neuroinflammation and increased neuronal survival in several animal models of neurodegeneration and trauma. The aim here was to evaluate whether RNS60 protects the brain and cognitive function in a mouse stroke model. METHODS Male C57BL/6J mice were subjected to sham or ischemic stroke surgery using 60-minute transient middle cerebral artery occlusion (tMCAo). In each group, mice received blinded daily administrations of RNS60 or control fluids (PNS60 or normal saline [NS]), beginning 2 hours after surgery over 13 days. Multiple neurobehavioral tests were conducted (Neurological Severity Score [mNSS], Novel Object Recognition [NOR], Active Place Avoidance [APA], and the Conflict Variant of APA [APAc]). On day 14, cortical microvascular perfusion (MVP) was measured, then brains were removed and infarct volume, immunofluorescence of amyloid beta (Aβ), neuronal density, microglial activation, and white matter damage/myelination were measured. SPSS was used for analysis (e.g., ANOVA for parametric data; Kruskal Wallis for non-parametric data; with post-hoc analysis). RESULTS Thirteen days of treatment with RNS60 reduced brain infarction, amyloid pathology, neuronal death, microglial activation, white matter damage, and increased MVP. RNS60 reduced brain pathology and resulted in behavioral improvements in stroke compared to sham surgery mice (increased memory-learning in NOR and APA, improved cognitive flexibility in APAc). CONCLUSION RNS60-treated mice exhibit significant protection of brain tissue and improved neurobehavioral functioning after tMCAo-stroke. Additional work is required to determine mechanisms, time-window of dosing, and multiple dosing volumes durations to support clinical stroke research.
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Affiliation(s)
- Gloria Patricia Baena-Caldas
- Departments of Neurology and Physiology & Pharmacology, SUNY Downstate Health Sciences University, Brooklyn, NY, United States of America
- Department of Pathology, SUNY Downstate Health Sciences University, Brooklyn, NY, United States of America
- Health Sciences Division, Department of Morphology, School of Biomedical Sciences, Universidad del Valle, Cali, Colombia
| | - Jie Li
- Departments of Neurology and Physiology & Pharmacology, SUNY Downstate Health Sciences University, Brooklyn, NY, United States of America
| | - Lina Pedraza
- Departments of Neurology and Physiology & Pharmacology, SUNY Downstate Health Sciences University, Brooklyn, NY, United States of America
| | - Supurna Ghosh
- Revalesio Corporation, Tacoma, WA, United States of America
| | - Andreas Kalmes
- Revalesio Corporation, Tacoma, WA, United States of America
| | - Frank C. Barone
- Departments of Neurology and Physiology & Pharmacology, SUNY Downstate Health Sciences University, Brooklyn, NY, United States of America
- The Robert F. Furchgott Center for Neural and Behavioral Science, Downstate Medical Center, State University of New York, Brooklyn, NY, United States of America
| | - Herman Moreno
- Departments of Neurology and Physiology & Pharmacology, SUNY Downstate Health Sciences University, Brooklyn, NY, United States of America
- The Robert F. Furchgott Center for Neural and Behavioral Science, Downstate Medical Center, State University of New York, Brooklyn, NY, United States of America
| | - A. Iván Hernández
- Department of Pathology, SUNY Downstate Health Sciences University, Brooklyn, NY, United States of America
- The Robert F. Furchgott Center for Neural and Behavioral Science, Downstate Medical Center, State University of New York, Brooklyn, NY, United States of America
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Pardo K, Naftali J, Barnea R, Findler M, Perlow A, Brauner R, Auriel E, Raphaeli G. Effect of time delay in inter-hospital transfer on outcomes of endovascular treatment of acute ischemic stroke. Front Neurol 2023; 14:1303061. [PMID: 38187154 PMCID: PMC10766796 DOI: 10.3389/fneur.2023.1303061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 12/05/2023] [Indexed: 01/09/2024] Open
Abstract
Background Endovascular treatment (EVT) with mechanical thrombectomy is the standard of care for large vessel occlusion (LVO) in acute ischemic stroke (AIS). The most common approach today is to perform EVT in a comprehensive stroke center (CSC) and transfer relevant patients for EVT from a primary stroke center (PSC). Rapid and efficient treatment of LVO is a key factor in achieving a good clinical outcome. Methods We present our retrospective cohort of patients who underwent EVT between 2018 and 2021, including direct admissions and patients transferred from PSC. Primary endpoints were time intervals (door-to-puncture, onset-to-puncture, door-to-door) and favorable outcome (mRS ≤ 2) at 90 days. Secondary outcomes were successful recanalization, mortality rate, and symptomatic intracranial hemorrhage (sICH). Additional analysis was performed for transferred patients not treated with EVT; endpoints were time intervals, favorable outcomes, and reason for exclusion of EVT. Results Among a total of 405 patients, 272 were admitted directly to our EVT center and 133 were transferred; there was no significant difference between groups in the occluded vascular territory, baseline NIHSS, wake-up strokes, or thrombolysis rate. Directly admitted patients had a shorter door-to-puncture time than transferred patients (190 min vs. 293 min, p < 0.001). The median door-to-door shift time was 204 min. We found no significant difference in functional independence, successful recanalization rates, or sICH rates. The most common reason to exclude transferred patients from EVT was clinical or angiographic improvement (55.6% of patients). Conclusion Our results show that transferring patients to the EVT center does not affect clinical outcomes, despite the expected delay in EVT. Reassessment of patients upon arrival at the CSC is crucial, and patient selection should be done based on both time and tissue window.
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Affiliation(s)
- Keshet Pardo
- Department of Neurology, Rabin Medical Center – Beilinson Hospital, Petah Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Jonathan Naftali
- Department of Neurology, Rabin Medical Center – Beilinson Hospital, Petah Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Rani Barnea
- Department of Neurology, Rabin Medical Center – Beilinson Hospital, Petah Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Michael Findler
- Department of Neurology, Rabin Medical Center – Beilinson Hospital, Petah Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Alain Perlow
- Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel
- Department of Radiology, Rabin Medical Center – Beilinson Hospital, Petah Tikva, Israel
| | - Ran Brauner
- Department of Neurology, Rabin Medical Center – Beilinson Hospital, Petah Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Eitan Auriel
- Department of Neurology, Rabin Medical Center – Beilinson Hospital, Petah Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Guy Raphaeli
- Department of Neurology, Rabin Medical Center – Beilinson Hospital, Petah Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel
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Ernst J, Storch KF, Tran AT, Gabriel MM, Leotescu A, Boeck AL, Huber MK, Abu-Fares O, Bronzlik P, Götz F, Worthmann H, Schuppner R, Grosse GM, Weissenborn K. Advancement of door-to-needle times in acute stroke treatment after repetitive process analysis: never give up! Ther Adv Neurol Disord 2022; 15:17562864221122491. [PMID: 36147621 PMCID: PMC9486271 DOI: 10.1177/17562864221122491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 08/05/2022] [Indexed: 11/21/2022] Open
Abstract
Background: In acute ischemic stroke, timely treatment is of utmost relevance.
Identification of delaying factors and knowledge about challenges concerning
hospital structures are crucial for continuous improvement of process times
in stroke care. Objective: In this study, we report on our experience in optimizing the door-to-needle
time (DNT) at our tertiary care center by continuous quality
improvement. Methods: Five hundred forty patients with acute ischemic stroke receiving intravenous
thrombolysis (IVT) at Hannover Medical School were consecutively analyzed in
two phases. In study phase I, including 292 patients, process times and
delaying factors were collected prospectively from May 2015 until September
2017. In study phase II, process times of 248 patients were obtained from
January 2019 until February 2021. In each study phase, a new clinical
standard operation procedure (SOP) was implemented, considering previously
identified delaying factors. Pre- and post-SOP treatment times and delaying
factors were analyzed to evaluate the new protocols. Results: In study phase I, SOP I reduced the median DNT by 15 min. The probability to
receive treatment within 30 min after admission increased by factor 5.35
[95% confidence interval (CI): 2.46–11.66]. Further development of the SOP
with implementation of a mobile thrombolysis kit led to a further decrease
of DNT by 5 min in median in study phase II. The median DNT was 29
(25th–75th percentiles: 18–44) min, and the probability to undergo IVT
within 15 min after admission increased by factor 4.2 (95% CI: 1.63–10.83)
compared with study phase I. Conclusion: Continuous process analysis and subsequent development of targeted workflow
adjustments led to a substantial improvement of DNT. These results
illustrate that with appropriate vigilance, there is constantly an
opportunity for improvement in stroke care.
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Affiliation(s)
- Johanna Ernst
- Department of Neurology, Hannover Medical School, Carl-Neuberg Strasse 1, Hannover 30625, Lower Saxony, Germany
| | - Kai F Storch
- Department of Neurology, Hannover Medical School, Hannover, Germany.,Department of Anesthesiology, Hannover Medical School, Hannover, Germany
| | - Anh Thu Tran
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Maria M Gabriel
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Andrei Leotescu
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Anna-Lena Boeck
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Meret K Huber
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Omar Abu-Fares
- Department of Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Paul Bronzlik
- Department of Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Friedrich Götz
- Department of Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Hans Worthmann
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Ramona Schuppner
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Gerrit M Grosse
- Department of Neurology, Hannover Medical School, Hannover, Germany
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