Effects of dl-3-n-butylphthalide on serum lipoprotein-associated phospholipase A2 and hypersensitive C-reactive protein levels in acute cerebral infarction

Effect of Jin three needles combined with Tong Qiao and blood activation Tang on neurological function, coagulation function and serum level in stroke patients

To investigate the efficacy and safety of Jin three needles combined with Tong Qiao Wu Blood-streaming Tang in patients with acute ischemic stroke (AIS), this retrospective study analyzed the data of patients with AIS between January 2017 and December 2022. The National Institutes of Health Stroke Scale (NIHSS) scores, blood neuron-specific enolase, S100β protein (S100β), fibrinogen (FIB), cerebral infarct volume, D-dimer (D-D), prothrombin time (PT), activated partial thromboplastin time, hypersensitive c-reactive protein (hs-CRP), serum tumor necrosis factor-α (TNF-α), and homocysteine (Hcy) were compared between the 2 groups. The treatment effect was significantly better in the observation group than in the comparison group (P < .05). The NIHSS score, neuron-specific enolase, S100β, and cerebral infarct volume were significantly lower in both groups after treatment than before treatment (P < .05). FIB and D-D levels were significantly lower and APTT and PT levels were significantly higher in both groups after treatment than before treatment (P < .05). TNF-α, hs-CRP, and Hcy were significantly lower in both groups after treatment than before treatment, and TNF-α, hs-CRP and Hcy were significantly lower in the observation group than in the comparison group (P < .05). No statistically significant difference in the incidence of adverse reactions occurred between the 2 groups (P > .05). Combining Jin three needles can improve the therapeutic effect in patients with AIS, promote the recovery of neurological function, improve coagulation function, and reduce the inflammatory response with good safety.

Efficacy of Butylphthalide in Combination with Edaravone in the Treatment of Acute Ischemic Stroke and the Effect on Serum Inflammatory Factors

Objective

To investigate the efficacy of butylphthalide combined with edaravone in the treatment of acute ischemic stroke and the effect on serum inflammatory factors.

Methods

One hundred and sixty patients with acute ischemic stroke who attended the neurovascular intervention department of our hospital from May 2020 to June 2022 were enrolled as study subjects for prospective analysis and were equally divided into a control group and an experimental group using the random number table method, with 80 cases in each group. The control group was treated with edaravone injection, while the experimental group was treated with butylphthalide combined with edaravone. The disease was recorded to compare the efficacy, erythrocyte sedimentation rate, homocysteine, serum inflammatory factors including tumor necrosis factor-α, C-reactive protein and interleukin-6 levels, and the incidence of adverse reactions between the two groups.

Results

The total effective rate of treatment in the experimental group was 90.0% (72/80), while that of the control group was 62.5% (50/80), the total effective rate of the experimental group was significantly higher than that of the control group, and the difference was statistically significant (P < 0.05). After treatment, the erythrocyte sedimentation rate, homocysteine level, and serum TNF-α, CRP, and IL-6 levels of patients in the experimental group improved compared with those before treatment, and the degree of improvement was better than that of the control group, and the difference was statistically significant (P < 0.05). After 3 months of treatment, a comparison of the incidence of adverse reactions in the two groups showed no statistically significant difference between the two groups (P > 0.05).

Conclusion

The treatment of acute ischemic stroke with butylphthalide combined with edaravone has positive significance in improving blood circulation regulation and serum inflammatory factor levels and is reliable and worthy of clinical promotion.

Biopharmaceutical, preclinical pharmacokinetic and pharmaco-dynamic investigations of an orally administered novel 3-nbutylphthalide prodrug for ischemic stroke treatment

Ischemic stroke (IS) has been contributing in leading causes of disability and death worldwide and the cases are still increasing. In China, naturally sourced compound 3-n-butylphthalide (NBP) is widely applied in clinical practice for IS treatment with established evidences of efficacy and safety. However, NBP is an oily liquid at room temperature and has no active brain targeting ability, quite limiting its broader application in clinical practice. Via intravenous injection (i.v.) a prodrug compound (DB1) we previously developed deriving from NBP had dramatically enhanced the pharmacological effects, where however, this i.v. route still discount future patient compliance. As druggability of DB1 in oral administration has yet to be elaborated, the current study intended to systemically investigate its biopharmaceutical properties, so as to further consider clinical applicability of DB1 oral preparations. Additionally, pharmacokinetics and pharmacodynamics of DB1 via oral administered route were also studied, illustrating broad potential of further DB1 medicine development. After the derivation, aqueous solubility of DB1 improved 3∼400 folds compared with NBP in various pH media, and n-octanol/water partition coefficient kept in the range of 0∼2. In situ single-pass intestinal perfusion on rats showed effective permeability coefficient of DB1 over 10^-2 cm/s. In contrast to NBP, oral administration of DB1 could display significant enhanced bioavailability in rats and achieve increased accumulation in brain tissues. As expected, DB1 effectively alleviated oxidative stress damage and reduced infarct volume on ischemia/reperfusion (I/R) modeled rats, resulting in reduced mortality. Additionally, this new prodrug did not add any safety concerns based on NBP. Therefore, biopharmaceutical results and preclinical pharmacodynamic evidences support the conclusion that an oral administration of DB1 may have a good potential for clinical IS treatment.

Protocol of End-PSCI trial: a multicenter, randomized controlled trial to evaluate the effects of DL-3-n-butylphthalide on delayed-onset post stroke cognitive impairment

Background

Delayed-onset post stroke cognitive impairment (PSCI) results from secondary neurodegeneration induced by stroke. Whereas targeted prevention or treatment strategies are still missing due to lack of evidences. This trial aims to evaluate the preventive effects of DL-3-n-butylphthalide (NBP) on delayed-onset PSCI.

Methods

Effects of NBP on Delayed-onset Post Stroke Cognitive Impairment (End-PSCI) is a prospective, parallel-group, open-label, multicenter, randomized controlled trial with blinded outcome assessment. Hospital patients with acute cerebral infarction (within 2 weeks of onset) will be randomized into either standard medical therapy group or standard medical therapy combined NBP treatment group (NBP 200 mg, three times per day for 24 weeks). The primary outcome is the difference of incidence of delayed-onset PSCI between two groups. The secondary outcomes include difference of white matter degeneration, cognitive scores and prevalence of early-onset PSCI between two groups.

Discussion

End-PSCI trial will provide evidences for NBP preventing delayed-onset PSCI. The secondary outcomes will also provide valuable insights into the pathogenesis of delayed-onset PSCI and mechanism of NBP’s actions.

Trial registration

Trialsearch.who.int, ChiCTR2000032555, 2020/5/2, prospectively registered.

Efficacy and safety of 3-n-butylphthalide combined with endovascular treatment in acute ischemic stroke due to large vessel occlusion

BACKGROUND

The drug 3-n-butylphthalide (NBP) was developed and approved in China, where it has been used to treat ischemic cerebrovascular diseases. It is also considered to have a neuroprotective effect. This study aimed to evaluate whether NBP combined with endovascular treatment (EVT) can improve the clinical outcome and safety in patients with acute ischemic stroke (AIS) due to large vessel occlusion (LVO).

METHODS

Data from three studies of patients treated with EVT for AIS due to LVO were combined in this study. Patients of LVO undergoing EVT were dichotomized into NBP and non-NBP subgroups. The primary efficacy outcome was the shift of the modified Rankin Scale (mRS) score at 90 days. The secondary efficacy outcome included favorable functional outcomes, functional independence, and excellent outcome (defined as an mRS score of 3 or less) at 90 days. Safety outcomes included mortality within 90 days and symptomatic intracranial hemorrhage (sICH) within 48 h.

RESULTS

A total of 1820 patients undergoing EVT were included in this study; 628 (37.5%) patients received NBP treatment, whereas 1138 (62.5%) did not. After adjusting for multiple factors, NBP was associated with the improvement of functional outcomes at 90 days (adjusted common odds ratio [OR]: 1.503; 95% confidence interval (CI): 1.254-1.801; p < 0.001). NBP was associated with a higher rate of 90-day favorable outcomes (adjusted OR: 1.589; 95% CI: 1.251-2.020; p < 0.001) and a lower rate of 90-day mortality (adjusted OR: 0.486 [95% CI: 0.372-0.635]; p < 0.001). sICH occurred in 74 of 682 (10.9%) patients in the NBP group and 155 of 1126 (13.8%) patients in the non-NBP group; no statistical difference was detected (adjusted OR: 0.787 [95% CI: 0.567-1.092]; p = 0.152).

CONCLUSION

Among patients with AIS due to LVO, NBP combined with EVT is associated with better functional outcomes and reduced mortality risk without increasing the risk of sICH.

Clinical Effect of Butylphthalide Combined with Rt-PA Intravenous Thrombolysis in the Treatment of Acute Cerebral Infarction

Objective

To assess the clinical effect of butylphthalide combined with rt-PA intravenous thrombolysis in the treatment of acute cerebral infarction (ACI).

Methods

Totally, 312 acute cerebral infarction patients were included in this research. Those in the group for experiment received butylphthalide (25 mg QD) combined with rt-PA intravenous thrombolysis (0.9 mg/kg QD), while the control group received rt-PA intravenous (P < 0.05). Moreover, NIHSS (NIH Stroke Scale/Score) and Barthel index scores in the two groups improved, NIHSS score had ameliorated, and Barthel index score was higher than that in the reference group (P < 0.05).

Conclusion

The combination of butylphthalide and recombination plasminogen activator alteplase (rt-PA) intravenous thrombolysis has a significant clinical effect in the treatment of acute cerebral infarction. It can alleviate the inflammatory symptoms, accelerate the recovery of neurological function, and improve the ability of daily living.

Neuroprotective mechanism of crocin via PI3K/Akt/mTOR signaling pathway after cerebral infarction: an in vitro study

OBJECTIVES

To explore the potential neuroprotective mechanism of crocin after cerebral infarction.

METHODS

The murine hippocampal neuronal cell line HT-22, was used as the study model, with a control group, OGD-group, low-dose crocin group, middle-dose crocin group, and high-dose crocin group. Except for the control-group, cells in the other groups were treated with OGD for 6 h, in which 1 μg/mL, 2 μg/mL and 5 μg/mL of crocin were added in low-dose group, medium-dose group and high-dose group, respectively. Subsequently, the OGD cells were cultured for another 6 h. CCK-8 assay was carried out to detect the cell viability of each group, flow cytometry was used to detect cell apoptosis, immunofluorescence was conducted to detect the expression of reactive oxygen species, and Western Blot was performed to detect the protein expression of p-PI3K, p-Akt, p-mTOR, LC-3 I, LC-3 II, and Beclin-1.

RESULTS

After hypoxia-reoxygenation treatment, the viability of HT22 cells was remarkably decreased, the apoptosis rate and expression of ROS were significantly increased, the protein expression of p-PI3K, p-Akt and p-mTOR were reduced, while the expression of LC-3 II/I and Beclin-1 were increased. After crocin treatment, the activity of hypoxic reoxygenated cells increased, the apoptosis rate decreased, the expression of reactive oxygen species dropped, the protein expression of p-PI3K, p-Akt and p-mTOR increased, and the expression of LC-3 II/I and Beclin-1 decreased.

CONCLUSION

At the cellular level, crocin can inhibit autophagy by activating the PI3K/Akt/mTOR pathway, and reduce the level of oxidative stress, thus playing a neuroprotective role.

Effect of Edaravone Combined with Anticoagulant Therapy on the Serum hs-CRP, IL-6, and TNF-α Levels and Activity of Daily Living in Patients with Acute Cerebral Infarction

Objective

To explore the effect of edaravone combined with anticoagulant therapy on the serum hs-CRP, IL-6, and TNF-α levels and the activity of daily living (ADL) in patients with acute cerebral infarction (ACI).

Methods

The clinical data of 84 ACI patients treated in our hospital from August 2020 to August 2021 were retrospectively analyzed, and they were divided into the routine group (n = 42) and the combined group (n = 42) according to the order of admission. Both groups were treated with routine clinical treatment, and the combined group was additionally treated with edaravone combined with anticoagulant therapy. Serum samples were collected from both groups after treatment. ELISA was used to detect the serum inflammatory factor levels, and the modified Barthel index score was used to evaluate the ADL of patients.

Results

Compared with the routine group, the combined group achieved obviously lower levels of PMA, CD62p, and serum inflammatory factors after treatment (P < 0.001), higher modified Barthel score after treatment (P < 0.001), lower plasma viscosity, platelet aggregation rate, and plasma fibrinogen level after treatment (P < 0.001), and higher clinical overall efficacy (P < 0.05).

Conclusion

Edaravone combined with anticoagulant therapy is a reliable method to enhance ADL and reduce the inflammatory response of ACI patients. This strategy greatly reduces the platelet-activating factor levels of patients and improves the comprehensive clinical efficacy, and its further research will help to establish a better solution for these patients.

Association Between High-Sensitivity C-Reactive Protein and Prognosis of Patients with Acute Cerebral Infarction

PURPOSE

To investigate the association of serum high-sensitivity C-reactive protein (hs-CRP) with the severity of neurological deficits and prognosis in patients with acute cerebral infarction (ACI).

PATIENTS AND METHODS

In this retrospective analysis, 119 patients with ACI were recruited from January to December 2020. The serum hs-CRP level was measured by a latex-enhanced immunoturbidimetric assay. The severity of neurological deficits and prognosis of ACI patients were assessed using the National Institutes of Health Stroke Scale (NIHSS) and the modified Rankin Scale (mRS). Multivariate logistic analysis was performed and receiver operating characteristic (ROC) curves were plotted to evaluate the value of hs-CRP in predicting the prognosis of ACI.

RESULTS

The patients with a more favorable prognosis (mRS score 0-2) had a lower median serum hs-CRP level than those with a worse prognosis (mRS score 3-6) (3.32 IQR: 1.51, 8.04 to 17.93 IQR:16.02, 19.01; P<0.001). After adjusting for potential confounders, multivariable linear regression showed that serum hs-CRP level was independently associated with NIHSS score (Beta = 0.952, P<0.001) and mRS score (Beta=0.878, P<0.001). Multivariate logistic analysis revealed that high hs-CRP level was an independent predictor of the poor prognosis in patients with ACI (adjusted¹ OR = 1.995; 95% CI = 1.499-2.655; adjusted² OR = 2.75; 95% CI = 1.015-7.457). ROC curve analysis indicated that the area under the curve for hs-CRP to predict poor prognosis was 0.986. The cutoff value, sensitivity, and specificity were 11.835 mg/L, 95%, and 92.5%, respectively. In terms of ischemic stroke subtypes, the serum hs-CRP level was higher in large-artery atherosclerosis (LAA) patients than in those with small-artery occlusion (SAO) and cardioembolism (CE). In addition, the patients with LAA had higher scores of NIHSS and mRS than those with SAO and CE.

CONCLUSION

Serum hs-CRP level is an independent predictor of prognosis, and an efficient index to discriminate patients with ACI, especially for those with LAA.

Butylphthalide Combined With Conventional Treatment Attenuates MMP-9 Levels and Increases VEGF Levels in Patients With Stroke: A Prospective Cohort Study

Background and Purpose: Butylphtalide increases the vascular endothelial growth factor (VEGF) and decreases matrix metalloproteinase (MMP)-9 in animal models of stroke and might be of use in the management of stroke. To explore whether butylphthalide combined with conventional treatment can change the levels of MMP-9 and VEGF and the National Institutes of Health Stroke Scale (NIHSS) scores of patients with stroke.

Methods: This was a prospective cohort study involving inpatients admitted to the Jiangxi Provincial People's Hospital (January–June 2019) due to acute cerebral infarction. The patients received conventional treatments with or without butylphthalide. The changes in the NIHSS scores were compared between groups. Plasma MMP-9 and VEGF were measured by enzyme-linked immunosorbent assay.

Results: A total of 24 patients were included in the conventional treatment group and 46 in the butylphthalide group. The butylphthalide group showed lower MMP-9 (130 ± 59 vs. 188 ± 65, p = 0.001) and higher VEGF (441 ± 121 vs. 378 ± 70, p = 0.034) levels on day 6 compared with the conventional treatment group. The changes in MMP-9 and VEGF were significant, starting on day 3 in the butylphthalide group but on day 6 in the conventional treatment group. There were no differences between the two groups in the NIHSS scores at admission and at discharge (p > 0.05). The overall response rate was higher in the butylphthalide group compared with the conventional treatment group (63.0 vs. 37.5%, p = 0.042).

Conclusion: Butylphthalide combined with conventional treatment can decrease MMP-9 levels and increase VEGF levels. The patients showed the reduced NIHSS scores, possibly suggesting some improvement in prognosis after stroke. Still, the conclusions need to be confirmed in a larger sample and in different etiological subtypes of stroke.

Fuzzy C-Means Clustering Algorithm-Based Magnetic Resonance Imaging Image Segmentation for Analyzing the Effect of Edaravone on the Vascular Endothelial Function in Patients with Acute Cerebral Infarction

This paper aimed to discuss the denoising ability of magnetic resonance imaging (MRI) images based on fuzzy C-means clustering (FCM) algorithm and the influence of Butylphthalide combined with Edaravone treatment on nerve function and vascular endothelial function in patients with acute cerebral infarction (ACI). Based on FCM algorithm, Markov Random Field (MRF) model algorithm was introduced to obtain a novel algorithm (NFCM), which was compared with FCM and MRF algorithm in terms of misclassification rate (MCR) and difference of Kappa index (KI). 90 patients with ACI diagnosed in hospital from December 2018 to December 2019 were selected as subjects, who were divided into combined treatment group (conventional treatment + Edaravone + Butylphthalide) and Edaravone group (conventional treatment + Edaravone) randomly, each consisting of 45 cases. The National Institutes of Health Stroke Scale (NIHSS) score and endothelial function index level such as plasma nitric oxide (NO), human endothelin-1 (ET-1), and vascular endothelial cell growth factor (VEGF) were compared before and after treatment between the two groups. The results showed that the MCR of NFCM was evidently inferior to FCM and MRF, and the KI was notably higher relative to the other two algorithms. After treatment, the NIHSS score of the combined treatment group was (9.09 ± 1.86) points and that of Edaravone group was (14.97 ± 3.44) points, with evident difference between the two groups (P < 0.05). After treatment, the NO of the combined treatment was (54.63 ± 4.85), and that of Edaravone group was (41.54 ± 5.27), which was considerably different (P < 0.01), and the VEGF and ET-1 of combined treatment group were greatly inferior to Edaravone group (P < 0.01). It was revealed that the novel algorithm based on FCM can obtain more favorable quality and segmentation accuracy of MRI images. Moreover, Butylphthalide combined with Edaravone treatment can effectively improve nerve function, vascular endothelial function, and short-term prognosis in ACI, which was safe and worthy of clinical adoption.

From Seeds of Apium graveolens Linn. to a Cerebral Ischemia Medicine: The Long Journey of 3-n-Butylphthalide

3-n-Butylphthalide (NBP) as well as its derivatives and analogues (NBPs), in racemic or enantiomerically pure forms, possess potent and diverse pharmacological properties and have shown a great potential therapeutic interest for many human conditions, especially for cerebral ischemia. This Perspective outlines the synthesis and therapeutic applications of NBPs.

Effects of dl-3-n-butylphthalide on serum lipoprotein-associated phospholipase A2 and hypersensitive C-reactive protein levels in acute cerebral infarction

OBJECTIVE

This study aims to explore the curative effect of dl-3-n-butylphthalide (NBP) on patients with acute cerebral infarction (ACI) and its effects on serum lipoprotein-associated phospholipase A2 (Lp-PLA2) and hypersensitive C-reactive protein (hs-CRP) levels.

METHODS

A total of 136 ACI patients treated in our hospital, who met the criteria, were selected and randomly divided into two groups: control group (n = 60, including 28 males and 32 females) and treatment group (n = 76, including 32 males and 44 females). Patients in the control group were treated with routine drug therapy, while patients in the treatment group were treated with NBP on this basis. A dose of 100 ml was administered by intravenous injection for 2 times/day, for 14 days. The curative effect was evaluated using the National Institute of Health Stroke Scale (NIHSS) and Barthel index (BI) self-care ability. The levels of the two factors in serum were measured using enzyme-linked immunosorbent assay, and the changes in levels of these two factors in serum at different time points before and after treatment were compared between the two groups.

RESULTS

(a) Lp-PLA2 and hs-CRP levels in the treatment group after treatment were significantly lower than those before treatment and those in the control group after treatment (p < .05). (b) The NIHSS and BI scores in the treatment group were significantly lower after treatment than before treatment and those in the control group after treatment (p < .05).

CONCLUSION

Dl-3-n-butylphthalide can improve the expression of Lp-PLA2 and hs-CRP in serum in ACI patients. Furthermore, NBP has significant efficacy in inhibiting inflammation and improving neurological symptoms.