Monocyte chemotactic protein-1 as a potential biomarker for early anti-thrombotic therapy after ischemic stroke

Costunolide covalently targets and inhibits CaMKII phosphorylation to reduce ischemia-associated brain damage

BACKGROUND

Chronic cerebral hypoperfusion (CCH) is a leading cause of disability and mortality worldwide. Restoring cerebral blood flow (CBF) through vasodilatation is particularly important in the treatment of CCH. Costunolide (Cos) is a natural sesquiterpenoid compound with vasodilatory effect, but its mechanism is unclear.

PURPOSE

This study aimed to investigate the vasodilatory mechanism of Cos and provide a new therapeutic regimen for treating CCH.

METHODS

The therapeutic effect of Cos on CCH was assessed in a rat model of permanent common carotid artery occlusion. The direct target protein for improving CBF was identified by drug affinity responsive target stability combined with quantitative differential proteomics analysis. The molecular mechanism of Cos acting on its target protein was analyzed by multidisciplinary approaches. The signalling involved was assessed using site-directed pharmacological intervention.

RESULTS

Cos has a significant therapeutic effect on ischemic brain injury by restoring CBF. Multifunctional calcium/calmodulin-dependent protein kinase II (CaMKII) was identified as a direct target of the natural small molecule Cos with a therapeutic effect on CCH. Mechanistic studies revealed that the α,β-unsaturated-γ-lactone ring of Cos covalently binds to the Cys116 residue of CaMKII. It then inhibits the phosphorylation of CaMKII and reduces the calcium concentration in vascular smooth muscle cells, thus playing a role in vasodilation and increasing CBF. Notably, this covalent binding between Cos and CaMKII can exert a long-term vasodilator activity.

CONCLUSION

We reported for the first time that Cos reduced ischemia-associated brain damage by covalently binding to the Cys116 residue of CaMKII, inhibiting CaMKII phosphorylation, and exerting long-term vasodilatory activity. This study not only found a new covalent inhibitor against the phosphorylation of CaMKII but also suggested that pharmacologically targeting CaMKII is a promising therapeutic strategy for CCH.

The Role of CCL2/CCR2 Axis in Cerebral Ischemia-Reperfusion Injury and Treatment: From Animal Experiments to Clinical Trials

C-C motif chemokine ligand 2 (CCL2) is a member of the monocyte chemokine protein family, which binds to its receptor CCR2 to induce monocyte infiltration and mediate inflammation. The CCL2/CCR2 signaling pathway participates in the transduction of neuroinflammatory information between all types of cells in the central nervous system. Animal studies and clinical trials have shown that CCL2/CCR2 mediate the pathological process of ischemic stroke, and a higher CCL2 level in serum is associated with a higher risk of any form of stroke. In the acute phase of cerebral ischemia-reperfusion, the expression of CCL2/CCR2 is increased in the ischemic penumbra, which promotes neuroinflammation and enhances brain injury. In the later phase, it participates in the migration of neuroblasts to the ischemic area and promotes the recovery of neurological function. CCL2/CCR2 gene knockout or activity inhibition can reduce the nerve inflammation and brain injury induced by cerebral ischemia-reperfusion, suggesting that the development of drugs regulating the activity of the CCL2/CCR2 signaling pathway could be used to prevent and treat the cell injury in the acute phase and promote the recovery of neurological function in the chronic phase in ischemic stroke patients.

Monocyte-to-High-Density Lipoprotein Ratio Predicts the Outcome of Acute Ischemic Stroke

Aim: Monocyte-to-high-density lipoprotein ratio (MHR) recently emerged as an inflammatory marker and has been reported to be a novel prognostic indicator of cardiovascular diseases. However, the relationship between MHR and prognosis of acute ischemic stroke (AIS) remains unclear.

Methods: Consecutive AIS patients were prospectively identified from January 2015 to December 2017. Functional outcome was evaluated by the modified Rankin Scale (mRS). Poor outcome was defined as of mRS 3–6. Multivariate logistic regression analysis was conducted to evaluate the relationship between MHR and poor outcome.

Results: A total of 1090 AIS patients within 24 hours of the onset of symptoms were recruited. MHR was higher in poor outcome group compared to that in good outcome group [0.53 (0.37–0.69) vs. 0.48 (0.33–0.60), P = 0.007]. Multivariate logistic regression analysis indicated that higher MHR level was independently associated with the poor outcome at 3 months (OR 2.58, 95% CI, 1.21–5.51, P = 0.015), especially the stroke subtype of large artery atherosclerosis (OR 2.52, 95% CI, 1.03–6.19, P = 0.034). Receiver operating curve (ROC) analysis showed that the area under the ROC curves for MHR was 0.67 and the best predictive cutoff value of MHR was 0.51, with a sensitivity of 62.3% and a specificity of 66.5%.

Conclusions: MHR may be a significant and independent predictor of poor functional outcome in patients with AIS.

Relationship between Cardiac Troponin and Thrombo-Inflammatory Molecules in Prediction of Outcome after Acute Ischemic Stroke

BACKGROUND

In patients with acute ischemic stroke (AIS) without cardiovascular complications, we investigated the association of serum concentration of cardiac troponin (high-sensitivity cardiac troponin T [hs-cTnT]) with thrombo-inflammatory markers.

METHODS

Thirty-five patients with first-ever AIS were prospectively examined. Serum hs-cTnT was measured 6 and 24 hours after stroke, whereas S100B, high-sensitivity C-reactive protein (hsCRP), soluble CD40 ligand, tissue plasminogen activator (tPA), monocyte chemoattractant protein-1 (MCP-1), and P-selectin were measured 6 and 72 hours after stroke. Severity of stroke was assessed by the National Institutes of Health Stroke Scale (NIHSS) on admission, 24 hours later, and at discharge.

RESULTS

Concentration of MCP-1 at 6 hours was higher in the serum of patients with worsened NIHSS by 24 hours (P = .009). Concentration of hs-cTnT at both 6 and 24 hours was higher, if NIHSS worsened by discharge (P = .026 and P = .001). A cutoff value for hs-cTnT measured at T24 greater than or equal to  9.4 predicted worsened NIHSS on discharge with a sensitivity of 81% and a specificity of 74% (area: .808, P = .002). Concentration of hs-cTnT at both 6 and 24 hours was also higher in nonsurvivors compared with survivors (P = .03, respectively), and correlated with (1) tPA levels at 6 hours (P = .001 and P = .002, respectively); (2) MCP-1 concentration at 6 hours (P = .01 and P = .015, respectively); and increased hsCRP levels at 72 hours (P = .01, respectively). Concentration of hs-cTnT at 24 hours was an independent predictor of worsened NIHSS at discharge (odds ratio: 1.58, 95% confidence interval: 1.063-2.370, P = .024).

CONCLUSIONS

Elevated concentration of hs-cTnT measured 24 hours after AIS is an independent predictor of progressing neurologic deficit in patients without apparent myocardial damage, and also correlates with acute elevation of tPA and MCP-1.

Monocytes and monocyte chemoattractant protein 1 (MCP-1) as early predictors of disease outcome in patients with cerebral ischemic stroke

In this study to identify prognostic biomarkers for ischemic stroke (IS) outcome, we monitored monocyte number and monocyte chemoattractant protein (MCP-1) concentration in peripheral blood of 44 patients with IS during the week following IS. According to the severity of IS, patients were allocated to three groups: patients with transient ischemic attack (TIA), patients with National Institute of Health Stroke Scale (NIHSS) score ≤ 12, and patients with NIHSS > 12. In patients with NIHSS > 12 statistically significant increased number of monocytes was observed on day 7. MCP-1 plasma concentration initially increased, decreased at day 3 in patients with NIHSS > 12 and increased and restored on day 7. A negative correlation between the number of monocytes and MCP-1 concentration was observed on day 3 after IS. Higher day-7 MCP-1 level was associated with higher modified Rankin Scale (mRS) value (indicating worse outcome) at 90 days post-IS in patients with NIHSS > 12. Our findings suggest that number of monocytes and plasma MCP-1 level could be clinical prognostic biomarkers as early predictors of disease outcome in patients with IS.

Ischemic stroke biomarkers in blood

Ischemic stroke is a leading cause of adult disability and mortality. With over 15 million strokes occurring every year in the world, methods to better identify patients at risk for stroke are needed, as are methods to improve patient diagnosis and prognosis when stroke occurs. Use of blood-based biomarkers is one method that has been evaluated to predict risk of stroke, diagnose stroke and its causes, predict stroke severity and outcome, and guide prevention therapy. Markers that have been identified include a variety of proteins, nucleic acids and lipids that relate to stroke pathophysiology. The role of blood biomarkers in ischemic stroke is still being defined, and further study is needed to develop blood biomarkers for clinical stroke use. In this review, the authors provide a summary of biomarkers that have been divided by their potential clinical application.