Collateral lessons from recent acute ischemic stroke trials

Abstract

Numerous acute ischemic stroke trials have recently published detailed results, providing an opportunity to consider the role of collaterals in stroke pathophysiology and their influential effect on patient outcomes. Safety and Efficacy of NeuroFlo Technology in Ischemic Stroke (SENTIS), the largest randomized controlled trial of device therapy to date, tested the potential augmentation of collateral perfusion. SYNTHESIS Expansion, Mechanical Retrieval and Recanalization of Stroke Clots Using Embolectomy (MR RESCUE), and Interventional Management of Stroke (IMS) III chronicled the saga of endovascular therapy trialed against medical treatment for acute ischemic stroke. These recent randomized studies, however, largely neglect current device technology available for endovascular therapy as advanced by the TREVO2 and SOLITAIRE?^TM FR With the Intention For Thrombectomy (SWIFT) studies. Such exhaustive efforts in recent trials have failed to introduce a new treatment for stroke that unequivocally improves patient outcomes. Collateral perfusion is widely recognized to vary across individuals in any population and exerts a dramatic effect on baseline variables including the time course of ischemic injury, stroke severity, imaging findings, and therapeutic opportunities. Similarly, collaterals have been recognized to influence recanalization, reperfusion, hemorrhagic transformation, and subsequent neurological outcomes after stroke. Collateral lessons may be gleaned from these trials, to expand consideration of overall study results and perhaps most importantly, alter ongoing and new trials in development. Detailed analyses of available information on collaterals from these trials demonstrate that collaterals may be more influential than the choice of treatment modality or intervention.     

The Potential Role of Monocyte Chemoattractant Protein-1 for Major Depressive Disorder

The immune hypothesis of major depressive disorder (MDD) fits well with the supposed interaction between genetic and environmental factors in disorders with a complicated etiopathogenesis. It has been suggested that infectious diseases are associated with MDD in that cytokines may play a critical role as a key modulator in the transition between infection and the development of MDD. It has been also suggested that antidepressants have immunomodulatory effects on some cytokines and cytokine receptors, although the exact mechanism has not yet been fully elucidated. Among cytokines, monocyte chemoattractant protein-1 (MCP-1) is especially well known and has attracted considerable interest owing to its immunomodulatory functions. MCP-1 is expressed in highly regionalized neuronal areas in the brain, leading to kind of modulation of neuronal activity and neuroendocrine functions commonly seen in patients with MDD. Additionally, it is involved in the control of other cytokines that have been consistently proposed as associated with the development of MDD. It also has a possible role in the neurodegenerative process of a number of central nervous system (CNS) diseases. Hence, this paper draws from the perspective of immunology to offer several suggestions about the role of MPC-1 in the development of MDD.     

冷诱导RNA结合蛋白在脑缺血中的作用

背景 冷诱导RNA结合蛋白(cold-inducible RNA binding protein,CIRP)是一种低温诱导的,在脑组织广泛表达的冷休克蛋白.新近研究表明CIRP在缺血诱发的脑损伤中发挥重要的作用. 目的 对CIRP在脑缺血中的作用及相关研究进展进行综述. 内容 概述了CIRP的结构特征及其在脑部的表达情况,阐述了其在脑缺血中的作用. 趋向 CIRP的具体作用机制尚不明确,但对其机制的研究为治疗脑缺血提供了新的方向.     

缺血后适应对树鼩脑缺血信号转导及转录激活因子3过磷酸化的调控作用

目的观察信号转导及转录激活因子3(STAT3)磷酸化在树鼩脑缺血后适应(PC)神经保护中的作用,并探讨其可能机制。方法将50只健康成年树鼩随机分为对照组、脑缺血4 h组、脑缺血24 h组、后适应4 h组和后适应24 h组(每组n=5),其中10只动物做HE染色(n=5)及电子显微镜观察(n=5)。本实验通过光化学反应建立树鼩血栓性脑缺血模型;于缺血后4 h夹闭患侧颈总动脉3次(每次5 min)实施缺血PC。采用TTC染色观察树鼩脑梗死面积的变化,通过HE和电子显微镜观察脑皮质和海马组织学改变及其超微结构变化,应用Western blotting检测皮层总STAT3(t-STAT3)及磷酸化STAT3(p-STAT3)蛋白表达变化。结果脑缺血后皮层血管内皮细胞肿胀,皮层及海马神经元损伤,线粒体肿胀、嵴溶解,以缺血24 h损伤最为明显,脑梗死面积达到(24.78±2.06)%。而皮层p-STAT3蛋白表达随缺血时间延长呈增高趋势,缺血4 h p-STAT3蛋白表达明显增高(0.24±0.1,P<0.01),缺血24 h p-STAT3蛋白表达则持续增高(0.32±0.1,P<0.01)。缺血PC处理后皮层血管内皮细胞水肿好转,皮层及海马神经元损伤减轻,脑梗死面积减小为(17.67±1.90)%(P<0.01)。与缺血组相比,缺血PC 4 h p-STAT3蛋白表达进一步升高(0.41±0.09,P<0.01),缺血PC 24 h p-STAT3蛋白表达增高更加显著(0.70±0.11,P<0.01)。结论树鼩脑缺血可导致STAT3磷酸化代偿性增强,缺血PC的脑保护作用可能与其促进STAT3过磷酸化有关。     

外泌体在缺血性脑卒中的研究进展

正1外泌体概述外泌体是直径在30~100 nm的胞外囊泡,通过细胞被释放到细胞外液中~([1])。它们存在于生物体液中,诸如血液和脑脊液。外泌体携带有DNA、RNA、蛋白质和脂质等。由于外泌体的微泡结构为其内在的小分子提供了一个安全稳定的环境,同时这些信号小分子利用循环系统在胞间信号交换发挥重要作用,这让外泌体表现出一个成熟、稳定的信号传输系统~([2])。研究发现,外泌体中的m RNA和micro RNA     

Neuroprotective Effect of Compound Anisodine in a Mouse Model with Chronic Ocular Hypertension

Background:

Compound anisodine (CA) is a compound preparation made from hydrobromide anisodine and procaine hydrochloride. The former is an M-choline receptor blocker with the function of regulating the vegetative nervous system, improving microcirculation, and so on. The latter is an antioxidant with the activities of neuroprotection. This study aimed to investigate the potential neuroprotection of CA, which affects the degeneration of the retinal ganglion cells (RGCs) in an animal model with chronic ocular hypertension.

Methods:

Female C57BL/6J mice (n = 24) were divided randomly into four groups: Normal control group without any treatment (Group A, n = 6); CA control group with feeding the CA solution (Group B, n = 6); microbeads (MBs) control group with injecting MB into the anterior chamber (Group C, n = 6); CA study group with MB injection and with feeding the CA solution (Group D, n = 6). Intraocular pressure (IOP) was measured every 3 days after MB injection. At the 21^st day, neurons were retrograde-labeled by Fluoro-Gold (FG). Animals were sacrificed on the 27^th day. Retinal flat mounts were stained immunohistologically by β-III-tubulin. FG-retrograde-labeled RGCs, β-III-tubulin-positive RGCs, and β-III-tubulin-positive nerve fibers were quantified.

Results:

Mice of Groups C and D expressed the incidence of consistent IOP elevation, which is above the IOP level of Group A with the normal one. There is no significant difference in IOP between Groups A and B (P > 0.05). On the 27^th day, there were distinct loss in stained RGCs and nerve fibers from Groups C and D compared with Group A (all P < 0.001). The quantity was significantly higher in Group D as compared to Group C (all P < 0.001) but lower than Group A (all P < 0.001). There was no significant difference in the quantity of RGCs and nerve fibers between Groups A and B (all P > 0.05).

Conclusions:

These findings suggest that CA plays an importantly neuroprotective role on RGCs in a mouse model with chronic ocular hypertension.     

Estrogen-IGF-1 interactions in neuroprotection: Ischemic stroke as a case study

The steroid hormone 17b-estradiol and the peptide hormone insulin-like growth factor (IGF)-1 independently exert neuroprotective actions in neurologic diseases such as stroke. Only a few studies have directly addressed the interaction between the two hormone systems, however, there is a large literature that indicates potentially greater interactions between the 17b-estradiol and IGF-1 systems. The present review focuses on key issues related to this interaction including IGF-1 and sex differences and common activation of second messenger systems. Using ischemic stroke as a case study, this review also focuses on independent and cooperative actions of estrogen and IGF-1 on neuroprotection, blood brain barrier integrity, angiogenesis, inflammation and post-stroke epilepsy. Finally, the review also focuses on the astrocyte, a key mediator of post stroke repair, as a local source of 17b-estradiol and IGF-1. This review thus highlights areas where significant new research is needed to clarify the interactions between these two neuroprotectants.     

Corticosteroid responses following hypoxic preconditioning provide neuroprotection against subsequent hypoxic-ischemic brain injury in the newborn rats

Limited research has evaluated the corticosteroids (CS) response in hypoxic preconditioning (PC) induced neuroprotection against subsequent hypoxic-ischemic (HI) brain injury in newborns. To measure, CS response to hypoxic PC, at postnatal day 6 (P6), rat pups were randomly divided into sham, NoPC (exposure to 21% O₂) and PC (exposure to 8% O₂ for 3 h) groups. In a separate experiment, at P6, rat pups were randomly divided into three groups (sham, NoPC + HI, PC + HI). Rat pups in NoPC + HI and PC + HI groups, respectively had normoxic or hypoxic exposure for 3 h at P6 and then had the right carotid artery permanently ligated followed by 140 min of hypoxia at P7 (HI). Plasma CS levels were measured at 0.5, 1, 3, 6 and 12 h after hypoxic PC and hypoxic PC followed by HI. To investigate whether CS response to hypoxic PC provides neuroprotection against HI, at P6, rat pups were randomly divided into five groups. Fifteen minutes prior to PC or normoxic exposure, rat pups in DMSO + PC + HI and DMSO + NoPC + HI groups received DMSO while in RU486 + PC + HI and RU486 + NoPC + HI groups received RU486 (glucocorticoid receptor blocker, 60 mg/kg) s.c., respectively. Afterwards, rat pups were exposed to normoxia (DMSO + NoPC + HI, RU486 + NoPC + HI) or hypoxia (DMSO + PC + HI, RU486 + PC + HI) for 3 h and then HI 24 h later (P7). Rat pups at the corresponding age without any exposure to PC or HI or RU486/DMSO were used as sham. We found that hypoxic PC caused CS surge as well as augmented CS surge and preserved the glucocorticoid feedback regulation after HI. Hypoxic PC reduced HI induced early and delayed brain damage. RU486 partially but significantly inhibited hypoxic PC induced neuroprotection.     

Evaluation of neuroprotection by melatonin against adverse effects of prenatal exposure to a nonsteroidal anti-inflammatory drug during peripheral nerve development

The potential ability of melatonin to protect against impairment of the fetal peripheral nerve system due to maternal consumption of diclofenac sodium (DS) was investigated. Eighty-four pregnant rats were divided into seven groups: control (CONT), saline administered (PS), DS administered (DS), DS with low-dose melatonin administered (DS + MLT10), DS with high-dose melatonin administered (DS + MLT50), low-dose melatonin administered (MLT10), and high-dose melatonin administered (MLT50). After the pregnancy, six male newborn rats from each group were sacrificed at 4 and 20 weeks of age. Their right sciatic nerves were harvested, and nerve fibers were evaluated using stereological techniques. Mean numbers of myelinated axons, axon cross-section areas and the mean thickness of the myelin sheet were estimated. Four-week-old prenatally DS-exposed rats had significantly fewer axons, a smaller myelinated axonal area, and a thinner myelin sheath compared to CONT group (p < 0.05). Although melatonin at both doses significantly increased axon numbers, only a high dose of melatonin increased the diameter of those axons (p < 0.05). At 20-weeks of age, myelinated axon number in the DS group was not only significantly lower than all other groups (p < 0.05) but also the cross-sectional area of these axons was smaller than all other groups (p < 0.05). There were no differences between the groups regarding the mean thickness of the myelin sheet. The current study indicates that prenatal exposure to DS decreases the number and the diameter of sciatic nerve axons and that melatonin prophylaxis can prevent these effects.     

Actions and interactions of estradiol and glucocorticoids in cognition and the brain: Implications for aging women

Menopause involves dramatic declines in estradiol production and levels. Importantly, estradiol and the class of stress hormones known as glucocorticoids exert countervailing effects throughout the body, with estradiol exerting positive effects on the brain and cognition, glucocorticoids exerting negative effects on the brain and cognition, and estradiol able to mitigate negative effects of glucocorticoids. Although the effects of these hormones in isolation have been extensively studied, the effects of estradiol on the stress response and the neuroprotection offered against glucocorticoid exposure in humans are less well known. Here we review evidence suggesting that estradiol-related protection against glucocorticoids mitigates stress-induced interference with cognitive processes. Animal and human research indicates that estradiol-related mitigation of glucocorticoid damage and interference is one benefit of estradiol supplementation during peri-menopause or soon after menopause. The evidence for estradiol-related protection against glucocorticoids suggests that maintaining estradiol levels in post-menopausal women could protect them from stress-induced declines in neural and cognitive integrity.