Early Rehabilitation Exercise after Stroke Improves Neurological Recovery through Enhancing Angiogenesis in Patients and Cerebral Ischemia Rat Model

The activation of AMPK/PGC-1α/GLUT4 signaling pathway through early exercise improves mitochondrial function and mitigates ischemic brain damage

Mitochondria play a crucial role in maintaining cellular energy supply and serve as a source of energy for repairing nerve damage following a stroke. Given that exercise has the potential to enhance energy metabolism, investigating the impact of exercise on mitochondrial function provides a plausible mechanism for stroke treatment. In our study, we established the middle cerebral artery occlusion (MCAO) model in Sprague-Dawley rats and implemented early exercise intervention. Neurological severity scores, beam-walking test score, and weight were used to evaluate neurological function. The volume of cerebral infarction was measured by MRI. Nerve cell apoptosis was detected by TUNEL staining. Mitochondrial morphology and structure were detected by mitochondrial electron microscopy. Mitochondrial function was assessed using membrane potential and ATP measurements. Western blotting was used to detect the protein expression of AMPK/PGC-1α/GLUT4. Through the above experiments, we found that early exercise improved neurological function in rats after MCAO, reduced cerebral infarction volume and neuronal apoptosis, promoted the recovery of mitochondrial morphology and function. We further examined the protein expression of AMPK/PGC-1α/GLUT4 signaling pathway and confirmed that early exercise was able to increase its expression. Therefore, we suggest that early exercise initiated the AMPK/PGC-1α/GLUT4 signaling pathway, restoring mitochondrial function and augmenting energy supply. This, in turn, effectively improved both nerve and body function in rats following ischemic stroke.

Treadmill Exercise Enhances Post-Stroke Functional Recovery in Mice via the CX3CL1/CX3CR1 Signaling Pathway

To validate that treadmill exercise promotes neurofunctional recovery post ischemic stroke and to specifically explore the role of the CX3CL1/CX3CR1 signaling pathway in this treadmill-mediated recovery process. C57BL/6 J mice were used to establish a middle cerebral artery occlusion (MCAO) model. From days 5 to 28 post-stroke, the experimental group did 10-min treadmill sessions twice daily at 12 r/min; the control group remained inactive. On day 6 post-stroke, mice received three intraperitoneal injections of Bromodeoxyuridine (BrdU) or PBS. On days 1, 3, and 5 post-stroke, mice received intracerebroventricular injections of exogenous recombinant CX3CL1, CX3CL1 antagonist, or PBS. The modified neurological severity score (mNSS) and the corner test were used to assess sensorimotor function, and the morris water maze (MWM) test was employed to evaluate cognitive function. Western blot detected CX3CL1 and CX3CR1 protein expression, while immunofluorescence observed these proteins, neurogenesis in the subventricular zone (SVZ), rostral migratory stream (RMS), and dentate gyrus (DG), along with Iba1 and CD68 co-expression. ELISA quantified IL-1β, IL-4, and IL-10 levels. Treadmill exercise significantly improved neurofunctional recovery in MCAO mice, enhanced neurogenesis in the RMS and SVZ, and increased the expression of CX3CL1 and CX3CR1. The CX3CL1/CX3CR1 axis enhanced the impact of treadmill exercise on neurofunctional recovery, promoting neurogenesis in the RMS and SVZ, and reducing inflammation. Additionally, this axis also enhanced neurogenesis and suppressed microglial activation in the DG induced by treadmill exercise. This study demonstrates the CX3CL1/CX3CR1 pathway as critical for treadmill-induced post-stroke recovery, indicating its potential target for exercise mimetics in rehabilitation.

Causal effects of gut microbiota on the prognosis of ischemic stroke: evidence from a bidirectional two-sample Mendelian randomization study

Background

Increasing research has implicated the possible effect of gut microbiota (GM) on the prognosis of ischemic stroke (IS). However, the precise causal relationship between GM and functional outcomes after IS remains unestablished.

Methods

Data on 211 GM taxa from the MiBioGen consortium and data on prognosis of IS from the Genetics of Ischemic Stroke Functional Outcome (GISCOME) network were utilized as summary-level data of exposure and outcome. Four kinds of Mendelian randomization (MR) methods were carried out to ascertain the causal effect of GM on functional outcomes following IS. A reverse MR analysis was performed on the positive taxa identified in the forward MR analysis to determine the direction of causation. In addition, we conducted a comparative MR analysis without adjusting the baseline National Institute of Health Stroke Scale (NIHSS) of post-stroke functional outcomes to enhance confidence of the results obtained in the main analysis.

Results

Four taxa were identified to be related to stroke prognosis in both main and comparative analyses. Specifically, genus Ruminococcaceae UCG005 and the Eubacterium oxidoreducens group showed significantly negative effects on stroke prognosis, while the genus Lachnospiraceae NK4A136 group and Lachnospiraceae UCG004 showed protective effects against stroke prognosis. The reverse MR analysis did not support a causal role of stroke prognosis in GM. No evidence of heterogeneity, horizontal pleiotropy, and outliers was found.

Conclusion

This MR study provided evidence that genetically predicted GM had a causal link with post-stroke outcomes. Specific gut microbiota taxa associated with IS prognosis were identified, which may be helpful to clarify the pathogenesis of ischemic stroke and making treatment strategies.

Micro-ultrasound based characterization of cerebrovasculature following focal ischemic stroke and upon short-term rehabilitation

Notwithstanding recanalization treatments in the acute stage of stroke, many survivors suffer long-term impairments. Physical rehabilitation is the only widely available strategy for chronic-stage recovery, but its optimization is hindered by limited understanding of its effects on brain structure and function. Using micro-ultrasound, behavioral testing, and electrophysiology, we investigated the impact of skilled reaching rehabilitation on cerebral hemodynamics, motor function, and neuronal activity in a rat model of focal ischemic stroke. A 50 MHz micro-ultrasound transducer and intracortical electrophysiology were utilized to characterize neurovascular changes three weeks following focal ischemia elicited by endothelin-1 injection into the sensorimotor cortex. Sprague-Dawley rats were rehabilitated through tray reaching, and their fine skilled reaching was assessed via the Montoya staircase. Focal ischemia led to a sustained deficit in forelimb reaching; and increased tortuosity of the penetrating vessels in the perilesional cortex; with no lateralization of spontaneous neuronal activity. Rehabilitation improved skilled reaching; decreased cortical vascularity; was associated with elevated peri- vs. contralesional hypercapnia-induced flow homogenization and increased perilesional spontaneous cortical neuronal activity. Our study demonstrated neurovascular plasticity accompanying rehabilitation-elicited functional recovery in the subacute stage following stroke, and multiple micro-ultrasound-based markers of cerebrovascular structure and function modified in recovery from ischemia and upon rehabilitation.

Influence of hyperbaric oxygen therapy-specialized care on limb motor function and mental state of cerebral infarction patients with hemiplegia

BACKGROUND

Currently, cerebral infarction (CI) is mainly treated by emergency craniotomy or conservative treatment. However, some studies have questioned the functional recovery of patients after hyperbaric oxygen therapy (HBOT)-specialized care.

OBJECTIVE

This paper mainly explores the influence of HBOT-specialized care on limb motor function (LMF) and mental state of CI patients with hemiplegia.

METHODS

The medical records of 113 CI patients with hemiplegia treated in our hospital from March 2020 to March 2022 were collected. Of these, 53 received routine care nursing (conventional group) and 60 cases were given HBOT-specialized care (research group). Patient general data, scores of Fugl-Meyer Assessment (FMA), National Institutes of Health Stroke Scale (NIHSS), Self-rating Anxiety/Depression Scale (SAS/SDS) and Barthel Index (BI), and nursing efficiency were comparatively analyzed.

RESULTS

The two groups showed comparability in general data. FMA and BI scores were increased in the research group after rehabilitation treatment, higher than the baseline and those of the conventional group, while NIHSS, SAS, and SDS scores were reduced, lower compared with baseline and those of the conventional group. In addition, significantly higher nursing efficiency was determined in the research group.

CONCLUSION

HBOT-specialized care has beneficial effects on LMF, mental state, negative emotions and self-care ability of CI patients with hemiplegia and can enhance nursing efficacy, which deserves clinical popularization.

Recent advances in tissue repair of the blood-brain barrier after stroke

The selective permeability of the blood-brain barrier (BBB) enables the necessary exchange of substances between the brain parenchyma and circulating blood and is important for the normal functioning of the central nervous system. Ischemic stroke inflicts damage upon the BBB, triggering adverse stroke outcomes such as cerebral edema, hemorrhagic transformation, and aggravated neuroinflammation. Therefore, effective repair of the damaged BBB after stroke and neovascularization that allows for the unique selective transfer of substances from the BBB after stroke is necessary and important for the recovery of brain function. This review focuses on four important therapies that have effects of BBB tissue repair after stroke in the last seven years. Most of these new therapies show increased expression of BBB tight-junction proteins, and some show beneficial results in terms of enhanced pericyte coverage at the injured vessels. This review also briefly outlines three effective classes of approaches and their mechanisms for promoting neoangiogenesis following a stroke.

Astragaloside IV promotes angiogenesis by targeting SIRT7/VEGFA signaling pathway to improve brain injury after cerebral infarction in rats

Cerebral infarction (CI) has become one of the leading causes of death and acquired disability worldwide. Astragaloside IV (AST IV), one of the basic components of Astragalus membranaceus, has a protective effect on CI. However, the underlying mechanism has not been conclusively elucidated. Therefore, this study aims to explore the underlying mechanism of AST IV improving brain injury after CI. Middle cerebral artery occlusion (MCAO) and oxygen-glucose deprivation/reoxygenation (OGD/R) were used to simulate cerebral infarction injury in SD rats and HUVECs cells. Neurologic score, Evans blue, TTC and HE staining were used to observe brain injury in rats. Cell viability and migration were measured in vitro. Angiogenesis was detected by immunofluorescence and tube formation assay, and cell cycle was detected by flow cytometry. Western blot was used to find the expression of related proteins. Molecular docking, virtual mutation, site-directed mutagenesis, MST, and lentivirus silencing were used for target validation. The results showed that AST IV alleviated neurological impairment and promoted angiogenesis after CI. Moreover, AST IV greatly increased the transcription levels of SIRT6 and SIRT7, but had no effect on SIRT1-SIRT5, and promoted cell viability, migration, angiogenesis and S phase ratio in OGD/R-induced HUVECs. Furthermore, AST IV up-regulated the protein expressions of CDK4, cyclin D1, VEGFA and VEGF2R. Interestingly, AST IV not only bound to SIRT7, but also increased the expression of SIRT7. Silencing SIRT7 by lentivirus neutralizes the positive effects of AST IV. Taken together, the present study revealed that AST IV may improve brain tissue damage after CI by targeting SIRT7/VEGFA signaling pathway to promote angiogenesis.

The effects of dynamic motion instability system training on motor function and balance after stroke: A randomized trial

BACKGROUND

The balance and postural control of humans is related to the coordination of dynamic perception and movement. Multiple senses, such as vision, vestibular sense, proprioception, and/or a single sensory disorder, would lead to its integration disorder and induce imbalance and abnormal gait.

OBJECTIVE

The present study aimed to determine the effects of dynamic motion instability system training (DMIST) on the balance and motor function of hemiplegic patients after stroke.

METHODS

In this assessor-blinded, randomized controlled trial, the participants allocated to the intervention group (n = 20) received 30 minutes of conventional treatment and 20 minutes of DMIST training. Participants randomized to the control group (n = 20) received the same dose of conventional therapy and 20 minutes of general balance training. Rehabilitation was performed 5 times per week for 8 weeks. The primary outcome was the Fugl-Meyer assessment for the lower extremity (FMA-LE), and the secondary outcomes were the Berg balance scale (BBS) and gait function. Data were collected at baseline and immediately after the intervention.

RESULTS

After 8 weeks (t1), both groups showed significant post-intervention improvements in BBS, FMA-LE, gait speed and stride length (P < 0.05); there were significant positive correlations between the increase in FMA-LE and gait speed and stride length. Compared with the control group, the DMIST group showed significant post-intervention improvements in FMA-LE, gait speed and stride length (P < 0.05). However, no significant differences between the groups were found over time with respect to BBS (P > 0.05). The experiences of patients with DMIST were positive, and no serious adverse events were related to the interventions.

CONCLUSION

Supervised DMIST could be highly effective in treating lower-limb motor function in patients with stroke. Frequent (weekly) and medium-term (8 weeks) dynamic motion instability-guided interventions might be highly effective in enhancing motor function, and subsequently improving gait in stroke patients.

A Systematic Review of Virtual Reality and Robot Therapy as Recent Rehabilitation Technologies Using EEG-Brain-Computer Interface Based on Movement-Related Cortical Potentials

To enhance the treatment of motor function impairment, patients' brain signals for self-control as an external tool may be an extraordinarily hopeful option. For the past 10 years, researchers and clinicians in the brain-computer interface (BCI) field have been using movement-related cortical potential (MRCP) as a control signal in neurorehabilitation applications to induce plasticity by monitoring the intention of action and feedback. Here, we reviewed the research on robot therapy (RT) and virtual reality (VR)-MRCP-based BCI rehabilitation technologies as recent advancements in human healthcare. A list of 18 full-text studies suitable for qualitative review out of 322 articles published between 2000 and 2022 was identified based on inclusion and exclusion criteria. We used PRISMA guidelines for the systematic review, while the PEDro scale was used for quality evaluation. Bibliometric analysis was conducted using the VOSviewer software to identify the relationship and trends of key items. In this review, 4 studies used VR-MRCP, while 14 used RT-MRCP-based BCI neurorehabilitation approaches. The total number of subjects in all identified studies was 107, whereby 4.375 ± 6.3627 were patient subjects and 6.5455 ± 3.0855 were healthy subjects. The type of electrodes, the epoch, classifiers, and the performance information that are being used in the RT- and VR-MRCP-based BCI rehabilitation application are provided in this review. Furthermore, this review also describes the challenges facing this field, solutions, and future directions of these smart human health rehabilitation technologies. By key items relationship and trends analysis, we found that motor control, rehabilitation, and upper limb are important key items in the MRCP-based BCI field. Despite the potential of these rehabilitation technologies, there is a great scarcity of literature related to RT and VR-MRCP-based BCI. However, the information on these rehabilitation methods can be beneficial in developing RT and VR-MRCP-based BCI rehabilitation devices to induce brain plasticity and restore motor impairment. Therefore, this review will provide the basis and references of the MRCP-based BCI used in rehabilitation applications for further clinical and research development.