Inflammatory Responses After Ischemic Stroke

Changes in border-associated macrophages after stroke: Single-cell sequencing analysis

JOURNAL/nrgr/04.03/01300535-202601000-00038/figure1/v/2025-06-09T151831Z/r/image-tiff Border-associated macrophages are located at the interface between the brain and the periphery, including the perivascular spaces, choroid plexus, and meninges. Until recently, the functions of border-associated macrophages have been poorly understood and largely overlooked. However, a recent study reported that border-associated macrophages participate in stroke-induced inflammation, although many details and the underlying mechanisms remain unclear. In this study, we performed a comprehensive single-cell analysis of mouse border-associated macrophages using sequencing data obtained from the Gene Expression Omnibus (GEO) database (GSE174574 and GSE225948). Differentially expressed genes were identified, and enrichment analysis was performed to identify the transcription profile of border-associated macrophages. CellChat analysis was conducted to determine the cell communication network of border-associated macrophages. Transcription factors were predicted using the 'pySCENIC' tool. We found that, in response to hypoxia, border-associated macrophages underwent dynamic transcriptional changes and participated in the regulation of inflammatory-related pathways. Notably, the tumor necrosis factor pathway was activated by border-associated macrophages following ischemic stroke. The pySCENIC analysis indicated that the activity of signal transducer and activator of transcription 3 (Stat3) was obviously upregulated in stroke, suggesting that Stat3 inhibition may be a promising strategy for treating border-associated macrophages-induced neuroinflammation. Finally, we constructed an animal model to investigate the effects of border-associated macrophages depletion following a stroke. Treatment with liposomes containing clodronate significantly reduced infarct volume in the animals and improved neurological scores compared with untreated animals. Taken together, our results demonstrate comprehensive changes in border-associated macrophages following a stroke, providing a theoretical basis for targeting border-associated macrophages-induced neuroinflammation in stroke treatment.

Targeting capabilities of engineered extracellular vesicles for the treatment of neurological diseases

Recent advances in research on extracellular vesicles have significantly enhanced their potential as therapeutic agents for neurological diseases. Owing to their therapeutic properties and ability to cross the blood-brain barrier, extracellular vesicles are recognized as promising drug delivery vehicles for various neurological conditions, including ischemic stroke, traumatic brain injury, neurodegenerative diseases, glioma, and psychosis. However, the clinical application of natural extracellular vesicles is hindered by their limited targeting ability and short clearance from the body. To address these limitations, multiple engineering strategies have been developed to enhance the targeting capabilities of extracellular vesicles, thereby enabling the delivery of therapeutic contents to specific tissues or cells. Therefore, this review aims to highlight the latest advancements in natural and targeting-engineered extracellular vesicles, exploring their applications in treating traumatic brain injury, ischemic stroke, Parkinson's disease, Alzheimer's disease, amyotrophic lateral sclerosis, glioma, and psychosis. Additionally, we summarized recent clinical trials involving extracellular vesicles and discussed the challenges and future prospects of using targeting-engineered extracellular vesicles for drug delivery in treating neurological diseases. This review offers new insights for developing highly targeted therapies in this field.

Methyl isoeugenol suppresses NLRP3 inflammasome-mediated pyroptosis via activation of Nrf2/NQO1/HO-1 signaling in cerebral ischemia-reperfusion injury

Microglial neuroinflammation is considered to be a vital injury factor aggravating ischemia-reperfusion (I/R) injury on the progression of cerebral ischemic stroke. Mounting evidences have verified the effect of pyroptosis mediated by NLRP3 inflammasome on modulating microglial phenotype, and maintaining the microglial M1/M2 phenotype balance could be a novel target to ameliorate cerebral I/R injury. Herein, we focused on the anti-neuroinflammatory effect of methyl isoeugenol, a bioactive compound isolated from Acorus tatarinowii Schott, on nuclear factor erythroid 2-related factor 2 (Nrf2)-mediated NLRP3 inflammasome in vivo or in vitro. The results showed that methyl isoeugenol reduced cerebral infarct volume, modulated microglia M1/M2 phenotypes, and protected against NLRP3 inflammasome-primed pyroptosis. Mechanistically, methyl isoeugenol increased the nuclear translocation of Nrf2 and decreased that of NF-κB, and consequently, upregulated cellular antioxidants (HO-1 and NQO1), with the increased expression of antioxidant enzymes SOD and the decreased expression of lipid peroxidation MDA. These findings suggest that Nrf2 may serve as a vital target for the protective effect of methyl isoeugenol, making methyl isoeugenol as a promising anti-neuroinflammatory agent for NLRP3 inflammasome mediated microglial neuroinflammation in I/R injury.

Oleoylethanolamide exerts neuroprotection following ischemic stroke through microglial PPARα signal

Ischemic stroke remains a major cause of morbidity and mortality worldwide, often leading to long-term neurological deficits. The pathophysiology of ischemic stroke involves complex processes, including neuroinflammation, oxidative stress, and blood-brain barrier disruption. Our previous studies have demonstrated the potential of oleoylethanolamide (OEA) as therapeutic drug for ischemic stroke. However, the precise mechanisms underlying the effects of OEA remain poorly understood. Here, we investigated the potential molecular mechanism of OEA in neuroprotection against ischemic stroke in a mice model of middle cerebral artery occlusion (MCAO) and oxygen-glucose deprivation/reperfusion (OGD/R)-induced BV2 and bEnd.3 cells. We found that the ablation of microglia by the PLX3397 dramatically diminishes the therapeutic effects of OEA in ischemic stroke. Additionally, OEA significantly reduced the infiltration of macrophages/monocytes, polymorphonuclear neutrophils, T cells, and B cells in the ischemic brain hemisphere. Meanwhile, OEA remarkably protected the integrity of the blood-brain barrier through increasing the ZO-1 and Occludin expression in vivo and in vitro. Furthermore, the microglia conditional knockout PPARα mice (cKO mice) displayed greater infarct volumes following OEA treatment in comparison to PPARαflox/flox mice (control mice), highlighting the critical role of microglial PPARα signal in the therapeutic effects of OEA. Therefore, we found that OEA exerts its therapeutic effects against ischemic stroke through microglia PPARα signal. Our findings provide new evidence for the therapeutic potential of OEA in ischemic stroke, further indicating that OEA may become a novel candidate for ischemic stroke therapy.

Impaired membrane lipids in ischemic stroke: a key player in inflammation and thrombosis

BACKGROUND

Membrane lipids play a crucial role in brain function and cell signalling, and they serve as key biological substrates in inflammatory responses, thrombosis, and energy metabolism. Multiple clinical and molecular evidences suggest that membrane lipids are probably involved in the pathogenesis of ischemic stroke (IS). However, current knowledge about the membrane lipid landscape and its involvement in IS pathophysiology is limited.

METHODS

We performed untargeted lipidomic analysis on erythrocyte membranes from 56 IS patients and 55 healthy controls. Integrated with gene expression and weighted gene co-expression network analysis, we identified dysregulated lipid signalling pathways and their contributions to IS pathophysiology.

RESULTS

A total of 1392 erythrocyte membrane lipids were detected and quantified. Our results revealed significant impairment of membrane lipid homeostasis in IS patients, characterized by a marked reduction in glycerophospholipids (GPLs) and lysophospholipids (LPLs). Further analysis indicated that the impaired lipids were primarily concentrated in three disturbed signalling pathways, including the phospholipase A2-mediated GPL-LPL pathway, the phospholipase C-mediated inositol 1,4,5-trisphosphate/diglyceride pathway, and the sphingosine-1-phosphate (S1P)-S1P receptors pathway. Gene expression results indicated that these pathways were inhibited during the subacute phase of IS. Furthermore, these lipid signalling pathways form a highly interconnected network that collaboratively contributes to inflammation and thrombosis in IS, thereby influencing the progression and prognosis of the disease.

CONCLUSION

Our findings reveal impaired erythrocyte membrane lipid homeostasis in IS, which implicates inflammatory processes and thrombosis in IS. This research offers new insights into the role of membrane lipids in IS pathogenesis, potentially informing future monitoring and therapeutic strategies.

Evaluation of novel glucose-related blood biomarkers for predicting in-hospital mortality in patients with acute ischemic stroke

Acute Ischemic Stroke (AIS) is a major cause of death and disability worldwide. AIS patients with hyperglycemia demonstrate a potential risk to enhance severity and mortality rates. Glycemic markers, including blood glucose, hemoglobin A1c, and stress hyperglycemia ratio (SHR), have currently been reported to predict unfavorable outcomes in these patients. However, the ability of novel glucose-related blood biomarkers, such as the glucose to albumin ratio (GAR), glucose to estimated average glucose ratio (GAGR), and glucose to potassium ratio (GPR), to predict severe AIS patients and in-hospital mortality in Thailand remains unclear. This study aimed to investigate the utility of novel glucose related-blood biomarkers in predicting severity and in-hospital mortality among AIS patients. We conducted a retrospective single-center analysis of data from patients admitted to the Stroke Unit at Saraburi Hospital between January 1 and December 31, 2023. A total of 351 AIS patients were examined, with 191 (54.4%) presenting severe cases, and 31 (8.8%) died in the hospital. We demonstrated that the GAR was superior to SHR, GAGR, and GPR in predicting severity, showing an area under the curve (AUC) of 0.672 (95% CI: 0.614-0.731), yielding a sensitivity of 72.8% and a specificity of 56.6%. However, the SHR showed a highest AUC of 0.832 (95% CI: 0.734-0.930) in predicting in-hospital mortality, with sensitivity and specificity of 87.1% and 64.7%, respectively. Furthermore, AIS patients with GAR ≥ 30.0 and SHR ≥ 18.0 had a 12.761 and 12.365-fold increased risk of death (p < 0.001), respectively. Our study indicates that, besides SHR, GAR may serve as a predictive and cost-effective biomarker for predicting severe cases and in-hospital mortality of AIS, facilitating early triage even with limited resources.

Cinnamaldehyde enhances the intervention effect of puerarin on stroke from the perspectives of pharmacokinetics and pharmacodynamics

The low oral bioavailability of puerarin (Pue) affects its therapeutic effect. The aim of this study is to enhance the absorption of Pue and improve therapeutic efficacy by adding cinnamaldehyde (CA). The pharmacokinetics of Pue in rats were studied using oral administration: CA + Pue, and single Pue. The Caco-2 cell model was used to investigate the effect of CA on the absorption and transport of Pue. The absorption sensitivity of TSG to P-gp inhibitors verapamil (Ver), Ko143, and MK-571 in vivo were simultaneously evaluated, and assessed the effects of ATP binding cassette (ABC) transporter inhibitors (such as P-gp inhibitors verapamil, MK-571, and BCRP inhibitor Ko143) on predicting targeted transport of active ingredients to explore the relationship between Pue transport and inhibition of these efflux proteins. A rat model of middle cerebral artery occlusion (MCAO) was established to explore the therapeutic effect of single Pue and Pue with CA on ischemic stroke (IS). The results showed that compared with Pue suspension, CA increased the absorption of Pue in rats, with Cmax and AUC(0-t) being 4.84 times and 11.54 times higher, respectively. Both P-gp and MRP play a role in the transport mechanism of Pue. Compared with single Pue, the transmembrane transport from Basolateral (BL) to Apical (AP) side of Pue was significantly reduced when Pue was applied in combination with CA. In addition, the efflux ratio (ER) value also significantly decreased. This discovery suggests that CA may reduce the secretion of Pue, thereby enhancing its absorption and transport by inhibiting exocytosis mediated by efflux transporters, similar to the effect of Ver. On the other hand, in the MCAO rat model, Pue + CA reduced the extent of cerebral infarction, alleviated pathological damage, significantly reduced the level of inflammatory mediators, and increased the release of anti-inflammatory factors, suggesting that CA can synergize with Pue to exert a better therapeutic effect on IS. Therefore, the combination of Pue and CA for the treatment of IS has profound scientific significance and rationality from the points of disposition and pharmacodynamics in vivo.

Chinese herb pairs for cardiovascular and cerebrovascular diseases: Compatibility effects, pharmacological potential, clinical efficacy, and molecular mechanisms

ETHNOPHARMACOLOGICAL RELEVANCE

Cerebrovascular and cardiovascular diseases are pathophysiologically interconnected. In the past, researchers have mainly focused on developing one herbal medicine treatment. Single herb often fails to address the multifactorial pathology of these diseases. The pathogenesis and progression of the disease are complex, making the therapeutic effect of a single herb potentially limiting. Traditional Chinese medicine emphasizes herb pairs, which enhance therapeutic efficacy through synergistic interactions.

AIM OF THE REVIEW

This review focused on the mechanisms and potential clinical applications of Chinese herb pairs such as Astragali Radix-Carthami Flos, Salviae Miltiorrhizae Radix-Puerariae Lobatae Radix, Salviae Miltiorrhizae Radix-Chuanxiong Rhizoma, Salviae Miltiorrhizae Radix-Notoginseng Radix, Salviae Miltiorrhizae Radix-Carthami Flos, Astragali Radix-Angelicae Sinensis Radix, Notoginseng Radix-Carthami Flos, and Astragali Radix-Salviae Miltiorrhizae Radix, as well as provided a scientific basis for clinical applications of Chinese herb pairs.

MATERIALS AND METHODS

A systematic search and collection of studies on Chinese herb pairs in cardiovascular and cerebrovascular diseases was carried out using electronic databases such as PubMed, CNKI, Wan Fang Database, Baidu Scholar, and Web of Science. The keywords searched included Chinese herb pairs, cardiovascular disease, cerebrovascular disease, Astragali Radix, Salviae Miltiorrhizae Radix, Angelicae Sinensis Radix, Carthami Flos, Notoginseng Radix, and so on.

RESULTS

Studies revealed that the Chinese herb pairs had more beneficial effects than single herb and demonstrated a variety of roles in cardiovascular and cerebrovascular diseases. Preclinical studies indicated that Chinese herb pairs are more effective than single herb in treating cardiovascular and cerebrovascular diseases by modulating disease-related pathways and molecular targets. Further research is needed to fully explore their potential. The review also outlined the potential clinical applications of these Chinese herb pairs, highlighting their safety and efficacy.

CONCLUSIONS

Chinese herb pairs showed good promise as an alternative therapy for cardiovascular and cerebrovascular diseases due to their multi-component and multi-target characteristics. Consequently, further research was necessary to fully explore the potential of Chinese herb pairs in treating cardiovascular and cerebrovascular diseases, based on the current data.

Elucidating stroke etiology through lipidomics of thrombi and plasma in acute ischemic stroke patients undergoing endovascular thrombectomy

Acute ischemic stroke (AIS) requires detailed etiology information to guide optimal management. Given the pivotal role of lipids in AIS, we conducted a comprehensive lipidomics analysis of paired thrombi and plasma from AIS patients, correlating the findings with stroke etiology. Patients were recruited across four etiologies: cardioembolism (CE), large artery atherosclerosis (LAA), active cancer (Cancer), and undetermined. Plasma and thrombi were collected before and during endovascular thrombectomy and analyzed using in-house targeted lipidomics. Among 51 patients (37 CE, 7 LAA, 4 Cancer, and 3 undetermined), we identified 37 and 70 lipid species significantly different between thrombi in CE and LAA, and CE and Cancer, respectively (FDR-corrected P < 0.05). No significant differences were observed in plasma. Notably, 21 diacylglycerols and 11 polyunsaturated triacylglycerols were depleted (2.5 to 12 folds) in LAA compared to CE, while 10 ceramides and 57 glycerophospholipids were elevated in Cancer. With 80% validation accuracy, 29 and 59 lipids distinguished LAA and Cancer from CE, respectively. A neural network model using these lipids effectively classified undetermined patients. This study emphasizes the significance of thrombus lipids in distinguishing between LAA, CE, and Cancer etiologies in AIS, enhancing our understanding of stroke pathophysiology and informing future clinical managements.

Endothelial Cell Integrin α6 Regulates Vascular Remodeling Through the PI3K/Akt-eNOS-VEGFA Axis After Stroke

The angiogenic response is essential for the repair of ischemic brain tissue. Integrin α6 (Itga6) expression has been shown to increase under hypoxic conditions and is expressed exclusively in vascular structures; however, its role in post-ischemic angiogenesis remains poorly understood. In this study, we demonstrate that mice with endothelial cell-specific knockout of Itga6 exhibit reduced neovascularization, reduced pericyte coverage on microvessels, and accelerated breakdown of microvascular integrity in the peri-infarct area. In vitro, endothelial cells with ITGA6 knockdown display reduced proliferation, migration, and tube-formation. Mechanistically, we demonstrated that ITGA6 regulates post-stroke angiogenesis through the PI3K/Akt-eNOS-VEGFA axis. Importantly, the specific overexpression of Itga6 in endothelial cells significantly enhanced neovascularization and enhanced the integrity of microvessels, leading to improved functional recovery. Our results suggest that endothelial cell Itga6 plays a crucial role in key steps of post-stroke angiogenesis, and may represent a promising therapeutic target for promoting recovery after stroke.

MiR-367-3p Alleviates Oxidative Stress Injury in the Ischemia/Reperfusion Injury Cell Model by Targeting Nicotinamide Adenine Dinucleotide Phosphate Oxidase 4-mediated Keap1/Nrf2/ARE Pathway

ABSTRACT

Ischemic stroke is a debilitating central nervous disease linked to oxidative stress. Although miR-367-3p has been reported to be related to ischemic stroke, the direct evidence concerning oxidative stress remains elusive. Our study aimed to elucidate the mechanisms associated with oxidative stress in ischemic stroke. Initially, we discovered that miR-367-3p was notably downregulated in SH-SY5Y cells induced by oxygen-glucose deprivation/reoxygenation (OGD/R). Employing the in vitro ischemia/reperfusion injury model, we further demonstrated that overexpression of miR-367-3p alleviated OGD/R-induced apoptosis, inflammation, and oxidative stress, accompanied by the activation of the Keap1/Nrf2/ARE pathway. Mechanistically, nicotinamide adenine dinucleotide phosphate oxidase 4 (NOX4) was confirmed to be the target of miR-367-3p by dual-luciferase reporter assay. Moreover, the knockdown of NOX4 mimicked, while overexpression reversed the effects of miR-367-3p overexpression on OGD/R-induced oxidative stress injury and the impaired Keap1/Nrf2/ARE pathway. In conclusion, our findings indicate that miR-367-3p mitigates OGD/R-induced oxidative stress injury by activating the Keap1/Nrf2/ARE pathway through targeting NOX4.

Comparison of background characteristics and neuropathology findings between medico-legal autopsy cases with traumatic axonal injury, vascular axonal injury, or absence of axonal injury in β-amyloid precursor protein stain

In forensic neuropathology, the β-amyloid precursor protein (β-APP) immunostain is used to diagnose axonal injury (AI). The two most common aetiologies are traumatic (TAI) and ischaemic (vascular; VAI). We aimed to identify background characteristics and neuropathology findings that are suggestive of TAI, VAI, or no AI in neuropathologically examined medico-legal autopsy cases. The dataset comprised 166 cases from Finland over the period 2016-2023. The diagnosis of AI was based on β-APP stain (TAI, VAI, or no AI). Data on background characteristics and neuropathology findings were collected from cause-of-death investigation documents. Prevalence ratios were calculated for each variable to enable comparisons between the AI categories. The sample were 71.7% males; median age was 41 years (range 0-96). There were 26 cases with TAI, 44 with VAI, and 96 with no AI. The variables that showed statistical significance and had at least two-fold prevalence among TAI cases compared to VAI cases were: a documented recent injury; and presence of any extracranial/cranial/intracranial injury (including subdural haemorrhage [SDH], subarachnoid haemorrhage [SAH], intracerebral/ventricular haemorrhage [ICVH], or contusion) in autopsy or neuropathology. Correspondingly, variables indicating TAI over no AI were: a documented recent injury; postinjury survival ≥ 24 h; and presence of any extracranial/cranial/intracranial injury (including SDH, SAH, ICVH, contusion), herniation, or infarction in autopsy or neuropathology. Postinjury survival < 30 min was identified as an indicator of no AI over TAI. Finally, variables indicating VAI over no AI were: postinjury survival ≥ 24 h; lack of external injury to the head; and presence of SDH, brain oedema, herniation, or infarction in autopsy or neuropathology. In conclusion, we report several differences in characteristics and findings between cases diagnosed with TAI, VAI, and no AI. Our findings may help estimate the likelihood and potential aetiology of AI based on background characteristics and other neuropathology findings.

Therapeutic Efficacy of Tirofiban Combined With Thrombus Aspiration and Stent Thrombectomy in the Treatment of Large Vessel Occlusion Ischemic Stroke

OBJECTIVE

This research aimed to ascertain the effects of tirofiban combined with thrombus aspiration and stent thrombectomy on large vessel occlusion ischemic stroke (LVO-IS).

METHODS

Sixty patients with acute ischemic stroke (AIS) caused by LVO were randomized into the control group and the intervention group (n=30). Patients in the control group received thrombus aspiration combined with stent thrombectomy, while those in the intervention group were treated with tirofiban combined with thrombus aspiration and stent thrombectomy. General data, perioperative-related indicators, cerebral blood flow perfusion, coagulation function indicators, and neurological function indicators were collected, and the prognosis was observed after 3-month treatment.

RESULTS

A comparison of symptomatic cerebral hemorrhage rate and hospital mortality rate between the 2 groups displayed no significant difference ( P >0.05). The rate of revascularization in the intervention group (90.00%) was higher versus the control group (66.67%). After treatment, the mean blood flow and cerebral blood volume of the intervention group were higher and the time to peak cerebral blood flow was less versus the control group. The prothrombin time, activated partial thromboplastin time, and prothrombinogen time of the intervention group were higher, and fibrinogen was lower versus the control group. A lower National Institutes of Health Stroke Scale score was observed in the intervention group versus the control group.

CONCLUSIONS

Tirofiban combined with thrombus aspiration and stent thrombectomy has good efficacy in LVO-IS patients.

Identification immune-related hub genes in diagnosing atherosclerosis with ischemic stroke through comprehensive bioinformatics analysis and machine learning

Background

Atheroma plaques are major etiological factors in the pathogenesis of ischemic stroke (IS). Emerging evidence highlights the critical involvement of the immune microenvironment and dysregulated inflammatory responses throughout IS progression. Consequently, therapeutic strategies targeting specific immune-related markers or signaling pathways within this microenvironment hold significant promise for IS management.

Methods

We integrated Weighted Gene Co-expression Network Analysis (WGCNA), CIBERSORT, and machine learning (LASSO/Random Forest) to identify disease-associated modules and hub genes. Immune infiltration analysis evaluated hub gene-immune cell correlations, while protein-protein interaction (PPI) and ROC curve analyses assessed diagnostic performance.

Results

Comprehensive bioinformatics analysis identified three hub genes-OAS2, TMEM106A, and ABCB1-with high prognostic value for ischemic stroke. Immune infiltration profiling revealed significant correlations between these genes and distinct immune cell populations, underscoring their roles in modulating the immune microenvironment. The diagnostic performance of the gene panel was robust, achieving an area under the curve (AUC) was calculated as 0.9404 (p < 0.0001; 95% CI: 0.887-0.9939) for atherosclerotic plaques, demonstrating superior accuracy compared to conventional biomarkers.

Conclusion

By integrating machine learning with multi-omics bioinformatics, we established a novel three-gene signature (OAS2, TMEM106A, ABCB1) for precise diagnosis of atherosclerosis and ischemic stroke. These genes exhibit dual diagnostic utility and may influence disease progression through immune cell modulation. Our findings provide a foundation for developing targeted therapies and biomarker-driven clinical tools.

Association of alkaline-phosphatase/albumin ratio with all-cause mortality in critically ill patients with ischemic stroke: a retrospective study

Background

Recent studies have shown that alkaline phosphatase to albumin ratio (APAR) is a prognostic biomarker for coronary heart disease and cancer. However, the effect of APAR on the prognosis of ischemic stroke (IS) remains unclear. We aimed to assess the association of APAR with all-cause mortality in critically ill patients with IS.

Methods

Critically ill patients with IS were identified from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) Version 3.0 database, and classified into quartiles based on APAR index levels. Clinical outcomes included all-cause mortality at 28-days, 90-days and 365-days after admission. Cox proportional hazards regression analysis and restricted cubic spline method were used to clarify the relationship between APAR index and clinical outcomes in critically ill patients with IS.

Results

A total of 1,690 critically ill patients with IS were selected from the MIMIC-IV database. Multivariate Cox proportional hazard analysis showed that increased APAR index was significantly associated with all-cause mortality. After adjusting for potential confounding factors, patients with higher APAR (Q4: 1.524-2.794) had significantly increased all-cause mortality at 28-days, 90-days, and 365-days after admission (HR 2.05, 95%CI 1.47-2.86, p = 0; HR 2.09, 95%CI 1.53-2.85, p = 0; HR 2.11, 95%CI 1.55-2.87, p = 0). APAR had a linear relationship with 28-days and 365-days mortality (P for non-linearity: 0.098 and 0.051), but a nonlinear relationship with 90-days mortality (P for non-linearity: 0.042). Subgroup analyses further revealed that higher APAR was also associated with increased long-term mortality in IS patients without hypertension, DM, cardiovascular disease, liver disease or CKD. In addition, we did not observe any interaction between subgroup variables and APAR.

Conclusion

A higher APAR index was significantly associated with increased all-cause mortality at 28-days, 90-days and 365-days after admission for critically ill patients with IS. The APAR index may help identify patients with IS at high risk of all-cause death.

Identification and validation of the inflammatory response-related LncRNAs as diagnostic biomarkers for acute ischemic stroke

Ischemic stroke is one of the leading causes of deaths and disability, which is linked to inflammation. In this study, we aimed to identify inflammation-related lncRNAs as diagnostic biomarkers of acute ischemic stroke (AIS). A competing endogenous RNAs (ceRNA) network was established through whole transcriptome analysis. Gene expression datasets from the GEO database were analyzed to identify differentially expressed genes (DEGs), miRNAs and lncRNAs. Inflammation-related DEGs were determined through the intersection of the DEGs of the inflammation-related gene set from Genecards. Multiple databases like lncBase and Targetscan were analyzed to establish a ceRNA network. Several hub genes and sub-networks were obtained from a protein to protein (PPI) network. In addition, the candidate lncRNAs derived from the subnetwork were validated using mice MCAO model and clinical samples. Finally, a network comprising 20 lncRNAs, 26 miRNAs, and 43 inflammatory genes was analyzed, leading to the identification of MALAT1, SNHG8, and GAS5 as potential diagnostic biomarkers. Knockdown of MALAT1 and GAS5 resulted in decreased neurological severity score and inflammation response in mice MCAO model, indicating that these genes were significant diagnostic biomarkers for distinguishing AIS from healthy controls. These findings show that circulating MALAT1 and GAS5 have the potential to serve as clinical diagnostic biomarkers of AIS associated with inflammation.

Preserving Blood-Brain Barrier Integrity in Ischemic Stroke: a Review on MSCs-sEVs Content and Potential Molecular Targets

Ischemic stroke (IS) is a life-threatening condition that constitutes the second leading cause of death globally. Despite its high impact on public health, there is a shortage of treatments due to the complexity of the cellular and molecular mechanisms implicated. One main limiting factor for successful IS therapeutic intervention is stroke-induced blood-brain barrier (BBB) damage, particularly over tight junction proteins (TJs). BBB disruption is a well-established feature of IS, accelerating ischemic tissue damage and worsening prognosis. In recent years, mesenchymal stem cells (MSCs) and their small extracellular vesicles (MSCs-sEVs) have emerged as promising therapeutic interventions for several neurological disorders, including IS. However, its effects on BBB repair after IS are not completely understood. In this review, we will discuss novel experimental evidence of MSCs-sEVs effects in BBB protection and highlight the relevance of molecules reported in MSCs-sEVs, their potential cellular and molecular targets, and putative mechanisms implicated in BBB repair, providing a promising research avenue that may translate into effective therapeutic strategies for IS.

EdU tracking of leukocyte recruitment in mouse models of ischemic stroke and sterile lung inflammation

The discovery of copper(I)-catalyzed azide-alkyne cycloaddition (click chemistry) has significantly advanced the detection of proliferating cells by utilizing 5-ethynyl-2'-deoxyuridine (EdU). EdU, a thymidine analogue, is incorporated into DNA during replication and detected by the direct reaction with an azide-conjugated fluorophore. Traditionally, dividing cells are labeled using 5-bromodeoxyuridine (BrdU), another nucleotide analogue. However, BrdU detection is a harsh method that requires substantial sample processing, unlike EdU detection. EdU is classically used to identify proliferating cells; however, we report a streamlined methodology that uses EdU to label and track leukocyte recruitment that is compatible with flow cytometry and microscopy and preserves transgenic fluorophores. EdU labeling was performed in two different models of sterile inflammation: ischemic stroke and hydrochloric acid aspiration. EdU injection was timed to differentially label circulating monocytes, neutrophils and T cells. Tissue analysis showed EdU-positive monocytes and T cells were enriched in both inflammatory models. This suggests that recently divided monocytes and T cells are preferentially recruited to these vascular beds during inflammation and highlights the utility of this labeling approach to track leukocyte subtypes longitudinally during inflammation.

Complexity of Damage-Associated Molecular Pattern Molecule Expression Profile in Porcine Brain Affected by Ischemic Stroke

Studies using large animal models are essential for better understanding the molecular processes underlying neurological diseases, including ischemic stroke, and serve as a robust foundation for evaluating potential therapies. To better understand the complex role of damage-associated molecular pattern molecules (DAMPs) after ischemia, we aimed to determine their expression in the porcine brain affected by ischemic stroke at four time points: 6 h, 24 h, 3 days and 7 days post-stroke. Within the first 24 h after the stroke, we observed the increased expression of several key factors, including calcium-binding proteins, peroxiredoxins, heat shock proteins and interleukins (1α and 1β, IL10, IL17α). Moreover, by day 7, multiple DAMPs were up-regulated, coinciding with an enhanced expression of vascular endothelial growth factor A (VEGFA) in the affected hemisphere. The effects of ischemic stroke were also evident systemically, as indicated by the altered serum levels of both pro- and anti-inflammatory interleukins, reflecting dynamic inflammatory response. To conclude, our findings provide new insights about the time-dependent DAMP activity in a large animal model of ischemic stroke, highlighting the simultaneous occurrence of an ongoing inflammatory response and the possible initiation of vascular remodeling as early as one week after stroke onset.

LncRNA-mRNA co-expression network in the mechanism of butylphthalide treatment for ischemic stroke

BACKGROUND

Butylphthalide has shown significant potential in the treatment of ischemic stroke, but its precise mechanisms of action remain unclear. Long non-coding RNAs (lncRNAs) and messenger RNAs (mRNAs) play crucial roles in the pathogenesis of ischemic stroke and may serve as potential therapeutic targets. This study investigated the effects of butylphthalide treatment on the lncRNA-mRNA co-expression network in ischemic stroke patients.

METHODS

Peripheral blood samples were collected from ischemic stroke patients treated with butylphthalide and from control subjects. mRNA and lncRNA expression profiles were obtained using microarray scanning, and differentially expressed lncRNAs (DElncRNAs) were validated by qRT-PCR. Target genes interacting with DElncRNAs were predicted using the miRTargetLink database. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses were performed on both DElncRNAs and differentially expressed mRNAs (DEmRNAs). A protein-protein interaction (PPI) network was constructed for proteins encoded by DEmRNAs. Co-expression analysis, based on Pearson correlation coefficients, identified the top five mRNAs and lncRNAs with high connectivity. Finally, molecular docking was performed to investigate the binding interaction between butylphthalide and key mRNAs.

RESULTS

A total of 86 differentially expressed mRNAs (69 upregulated, 17 downregulated) and 35 DElncRNAs (all upregulated) were identified. DEmRNAs were primarily associated with pathways related to cell receptors, signal transduction, cell proliferation, migration, and glucose metabolism, while DElncRNAs were involved in processes such as embryonic development, neuronal connectivity, and energy metabolism. Co-expression analysis identified key mRNA nodes (SETD9, ZNF718, AOC2, MPND, ODF1) and lncRNA nodes (IDH2-DT, CLEC12A-AS1, CARD8-AS1, LINC01275, ZNF436-AS1). Molecular docking analysis suggested that MT-CO1, SETD9, and ZNF718 could be potential targets of butylphthalide.

CONCLUSION

Butylphthalide may exert its therapeutic effects by regulating the LncRNA-mRNA co-expression network, influencing energy metabolism and neuronal development. This provides new insights into its mechanism of action and potential therapeutic targets.

Edaravone Alleviates BV-2 Microglia-Mediated Neuroinflammation Through the PI3K/AKT/ NF-κB Pathway

Ischemic stroke (IS) poses a significant threat to human health. Research has demonstrated that microglia (MG)-mediated neuroinflammatory responses play a crucial role in the pathogenesis of IS. Consequently, inhibiting MG activation and reducing the inflammatory response may be key strategies for the clinical treatment of stroke and neurodegenerative diseases. Edaravone (EDA), a potent anti-inflammatory and antioxidant, is currently used in the clinical treatment of IS; however, its anti-inflammatory mechanisms remain inadequately understood. To address this, network pharmacology (NP) analysis is employed to identify the phosphatidylinositol 3-kinase/protein kinase B (PI3K/Akt) signaling pathway as a potential mediator of the inflammatory response triggered by activated microglia following EDA treatment. In vitro oxygen-glucose deprivation (OGD) is used to induce BV-2 MG activation, and an in vivo middle cerebral artery occlusion (MCAO) mouse model is established. Western blot and immunofluorescence staining are used to detect changes in the phosphorylation levels of pathway-related proteins and the expression of inflammatory factors. Additionally, the PI3K pathway inhibitor LY294002 and a PI3K overexpression plasmid are introduced to further analyze the expression changes of these markers. The results suggest that EDA may alleviate the inflammatory response mediated by activated MG through the PI3K/Akt signaling pathway.

Exploration of the shared gene signatures and molecular mechanisms between cardioembolic stroke and ischemic stroke

Introduction

This study aimed to investigate the shared molecular mechanisms underlying cardioembolic stroke (CS) and ischemic stroke (IS) using integrated bioinformatics analysis.

Methods

Microarray datasets for the CS (GSE58294, blood samples from CS and controls) and IS (GSE16561, blood from IS and controls; GSE22255, peripheral blood mononuclear cells from IS and matched controls) were acquired from the Gene Expression Omnibus database. Differential expression analysis and weighted gene co-expression network analysis were utilized to identify shared genes between the two diseases. Protein-protein interaction (PPI) network and topology analyses were conducted to identify the core shared genes. Three machine learning algorithms were employed to detect biomarkers from the core shared genes, and the diagnostic value of the hub genes was evaluated by establishing a predictive nomogram. Immune infiltration was evaluated using single-sample gene set enrichment analysis (ssGSEA), and pathways were analyzed with gene set enrichment analysis.

Results

There were 125 shared up-regulated genes and 2 shared down-regulated between CS and IS, which were mainly involved in immune inflammatory response-related biological functions. The Maximum Clique Centrality algorithm identified 25 core shared genes in the PPI network constructed using the shared genes. ABCA1, CLEC4E, and IRS2 were identified as biomarkers for both CS and IS and performed well in predicting the onset risk of CS and IS. All three biomarkers were highly expressed in both CS and IS compared to their corresponding controls. These biomarkers significantly correlated with neutrophil infiltration and autophagy activation in both CS and IS. Particularly, all three biomarkers were associated with the activation of neutrophil extracellular trap formation, but only in the IS.

Conclusion

ABCA1, CLEC4E, and IRS2 were identified as potential key biomarkers and therapeutic targets for CS and IS. Autophagy and neutrophil infiltration may represent the common mechanisms linking these two diseases.

The association between the systemic immune-inflammation index and in-hospital mortality among acute ischemic stroke with atrial fibrillation patients undergoing intravenous thrombolysis

Objective

This study aimed to explore the relationship between the systemic immune-inflammatory index (SII) and the probability of in-hospital mortality among acute ischemic stroke (AIS) with atrial fibrillation (AF) patients undergoing intravenous thrombolysis.

Methods

This single-center, retrospective observational study included individuals among AIS with AF who received intravenous thrombolysis. The SII is determined by taking the product of the platelet and neutrophil counts, followed by dividing this result by the lymphocyte count. In-hospital mortality was defined as a Modified Rankin Scale (mRS) score of 6 point. The investigation applied logistic regression models, along with subgroup, sensitivity, and receiver operating characteristic (ROC) curve analyses assessments, to explore the relationship between the SII and in-hospital mortality.

Results

541 patients were included in this study, 50 (9.24%) of whom died during their hospital stay. Multifactorial logistic regression analyses using fully adjusted models, demonstrated that the SII is independently associated with the risk of in-hospital death. Patients with elevated SII levels experienced a significantly increased risk of in-hospital mortality, which was found to be 2.557 (95% CI: 1.154-5.665, P = 0.021) times greater compared to those with lower SII levels. Through multivariate logistic regression analyses, a notable correlation between the SII and the probability of death during hospitalization was observed across various subgroups, including individuals aged ≤75 and >75years, women, patients with persistent AF, those receiving thrombolytic therapy, diabetic and nondiabetic patients, individuals with BMI ≥24 kg/m2, and those with an admission National Institutes of Health Stroke Scale score ≤20 (P < 0.05). Two sensitivity analyses confirmed the robustness of this association from multiple perspectives (P < 0.05). ROC analysis demonstrated that the SII, the baseline model, and their combined model all showed strong predictive power for in-hospital mortality. Notably, the combined model outperformed the SII alone (P < 0.05). In addition, the predictive value of SII for in-hospital death was significantly higher than that of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR).

Conclusion

A significant association has been observed between the risk of in-hospital death among AIS with AF individual undergoing intravenous thrombolysis and the SII.

Comprehensive analysis of autophagy status and its relationship with immunity and inflammation in ischemic stroke through integrated transcriptomic and single-cell sequencing

Ischemic stroke (IS) significantly impacts patients' health and quality of life, with the roles of autophagy and autophagy-related genes in IS still not fully understood. In this study, IS datasets were retrieved from the GEO database. Autophagy-related genes(ARGs) were identified and screened for differential expression. A prediction model was constructed using machine learning algorithm. WGCNA was employed to analyze differential regulation modules among different clusters of stroke patients. The analysis results were validated using single-cell sequencing data. Finally, autophagy hub genes were validated in an external cohort and an IS mouse model. We observed suppressed autophagy states in IS patients. A diagnostic model with good clinical efficacy for stroke diagnosis was constructed based on the selected key genes (AUC = 0.87). Consensus clustering identified two IS subtypes with distinct gene expression patterns and immune cell infiltration. scRNA-seq data analysis confirmed downregulation of pexophagy in IS. CellChat analysis identified key signaling pathways and intercellular interactions related to pexophagy. Validation in an external cohort and IS mouse model confirmed differential gene expression, supporting the involvement of pexophagy in IS pathogenesis. The identified key genes, molecular subtypes, and cellular interactions provide a foundation for further research into targeted therapies and precision medicine approaches for IS patients.

The fuzzy MAD stroke conjecture, using Fuzzy C Means to classify multimodal apparent diffusion for ischemic stroke lesion stratification

BACKGROUND

In conjunction with an epidemiologically determined treatment window, current radiological acute ischemic stroke practice discerns two lesion (stage) types: core (dead tissue, identified by diffusion-weighted imaging (DWI)) and penumbra (tissue region receiving just enough blood flow to be potentially salvageable, identified by the perfusion diffusion mismatch). However, advancements in preclinical and clinical studies have indicated that this approach may be too rigid, warranting a more fine-grained patient-tailored approach. This study aimed to demonstrate the ability to noninvasively provide insights into the current in vivo stroke lesion cascade.

METHODS

To elucidate a finer-grained depiction of the acute focal ischemic stroke cascade in vivo, we retrospectively applied our multimodal apparent diffusion (MAD) method to multi-b-value DWI, up to a b-value of 10,000 s/mm2 in 34 patients with acute focal ischemic stroke. Fuzzy C Means was used to cluster the MAD parameters.

RESULTS

We discerned 18 clusters consistent with normal appearing tissue (NAT) types and 14 potential ischemic lesion (stage) types, providing insights into the variability and aggressiveness of lesion progression and current anomalous stroke-related imaging features. Of the 529 ischemic stroke lesion instances previously identified by two radiologists, 493 (92 %) were autonomously identified; 460 (87 %) were identified as efficaciously or better than the radiologists.

CONCLUSIONS

The data analyzed included a small number of clinical patients without follow-up or contemporaneous histology; therefor, the findings and theorizing should be treated as conjecture. Nevertheless, each identified NAT and lesion type is consistent with the known underpinnings of physiological tissues and pathological ischemic stroke lesion (stage) types. Several findings should be considered in current clinical imaging: WM fluid accumulation, BBB compromise conundrum, b1000 identified core may not be dead tissue, and a practical reason for DWI (pseudo) normalization.

A novel histone deacetylase inhibitor protects the blood-brain barrier by regulating NF-κB and Nrf2 signaling pathways in OGD/R injury

Ischemic stroke, a severe cerebrovascular disease, is particularly prevalent among the elderly. Rsearch has indicated that histone deacetylases (HDACs) are pivotal in the pathogenesis of ischemic stroke. We introduce a novel HDACs inhibitor, HDI-1, as a potential therapeutic strategy for this condition. Our study reveals that HDI-1 expedites the restoration of tight junction proteins, Occludin and Claudin-5, in the oxygen-glucose deprivation/reoxygenation (OGD/R) model using human cerebral microvascular endothelial cells (hCMEC/D3). Moreover, HDI-1 mitigates the impairment of cellular monolayer membrane permeability following injury. This effect may stem from HDI-1's ability to selectively suppress the enzymatic activity of HDAC2. By inhibiting the activation of the NF-κB pathway triggered by OGD/R injury, HDI-1 reduces the secretion of pro-inflammatory cytokines IL-1β, IL-6, and TNF-α, thereby diminishing the inflammatory response in hCMEC/D3 cells. Meanwhile, HDI-1 exhibits antioxidant properties by enhancing the Nrf2/HO-1 signaling pathway. Collectively, our findings propose HDI-1 as a promising candidate for ischemic stroke treatment.

Neutrophil-like cell membrane-coated metal-organic frameworks for siRNA delivery targeting NOX4 to alleviate oxidative stress in acute ischemic injury

Although reperfusion is the most effective treatment for acute ischemic stroke, it often results in serious secondary ischemia/reperfusion (I/R) injury due to oxidative stress. This oxidative stress primarily results from the overproduction of reactive oxygen species (ROS) during reperfusion which, in turn, is largely induced by high expression of NADPH oxidase 4 (NOX4). Inhibiting NOX4 gene expression has therefore been proposed as a direct approach to reduce ROS production and promote angiogenesis. Recognizing both the potential of siRNA-based therapies for selective gene silencing and the critical role of neutrophil-endothelial interactions during I/R injury, here we present a unique therapeutic approach where neutrophil-like cell membrane coated porous metal-organic framework nanoparticles are loaded with siNOX4 (M-MOF-siNOX4) and designed to target damaged brain microvascular tissue. These then mitigate oxidative stress by suppressing NOX4 expression. Using an in vitro oxygen-glucose deprivation/re-oxygenation model, we demonstrate that M-MOF-siNOX4 nanoparticles specifically bind to activated endothelial cells, effectively reducing NOX4 expression, decreasing both ROS production and cell apoptosis, and restoring cell viability. Use of an in vivo mouse model of middle cerebral artery occlusion further confirmed M-MOF-siNOX4 nanoparticles to substantially alleviate brain damage and protect neurological function following ischemic stroke. Taken together, our study presents an innovative and effective siRNA-based strategy for reducing oxidative stress in ischemic stroke therapy. STATEMENT OF SIGNIFICANCE: Ischemia/reperfusion (I/R) injury, a major complication of acute ischemic stroke, is primarily driven by oxidative stress due to the excessive production of reactive oxygen species (ROS). Current treatments targeting oxidative stress and cell death often lack specificity, leading to off-target effects. This study introduces an innovative nanoparticle-based therapy using neutrophil-like cell membrane-coated metal-organic frameworks (MOFs) to deliver siNOX4, an siRNA targeting NOX4, a key ROS-producing enzyme. This approach enhances targeted delivery, reduces ROS production and cell death, and significantly improves neurological recovery in stroke models. By overcoming the limitations of existing therapies, this strategy holds strong potential for revolutionizing ischemic stroke treatment and addressing other disorders related to oxidative stress.

Rationale and Study Design to Assess the Efficacy and Safety of Minocycline in Patients with Moderate to Severe Acute Ischaemic Stroke (EMPHASIS)

BACKGROUND

Inflammation and blood-brain barrier disruption may contribute to the pathogenesis of ischaemic stroke. Minocycline was shown to exert anti-inflammatory effects by attenuating microglial activation and protecting blood-brain barrier in preclinical studies. Previous small-scale clinical studies have suggested that minocycline may have a potential beneficial effect on prognosis in acute ischaemic stroke. However, the efficacy and safety of minocycline in patients with acute ischaemic stroke need to be further confirmed.

STUDY AIMS

We designed the study, Efficacy and Safety of Minocycline in Patients with Moderate to Severe Acute Ischaemic Stroke (EMPHASIS), to evaluate the effect of minocycline in improving the functional outcome and the drug safety in patients with acute ischaemic stroke.

METHODS

The EMPHASIS study is a multicentre, randomised, double-blind, placebo-controlled trial aiming to recruit patients with acute ischaemic stroke. Patients who had ischaemic stroke within 72 hours of onset, a National Institutes of Health Stroke Scale score between 4 and 25 and Ia≤1 (moderate-to-severe) will be randomly allocated to either minocycline or placebo groups in a 1:1 ratio. Patients will receive minocycline (or placebo) with a loading dose of 200 mg, and subsequent 100 mg every 12 hours for 4 days. All patients will receive routine guideline-based treatment. The primary efficacy outcome is an excellent functional outcome assessed by the proportion of modified Rankin Scale score of 0-1 at 90±7 days. The main safety outcomes include the number of symptomatic intracranial haemorrhage at 24±2 hours and 6±1 days.

DISCUSSION

The EMPHASIS trial is the first phase III trial to investigate whether minocycline is effective and safe in improving functional outcome at 90 days in patients with moderate-to-severe acute ischaemic stroke. The data generated may provide valuable evidence of a potential anti-inflammation treatment for ischaemic stroke.

Identification of novel inflammatory response-related biomarkers in patients with ischemic stroke based on WGCNA and machine learning

BACKGROUND

Ischemic stroke (IS) is one of the most common causes of disability in adults worldwide. This study aimed to identify key genes related to the inflammatory response to provide insights into the mechanisms and management of IS.

METHODS

Transcriptomic data for IS were downloaded from the Gene Expression Omnibus (GEO) database. Weighted gene co-expression network analysis (WGCNA) and differential expression analysis were used to identify inflammation-related genes (IRGs) associated with IS. Hub IRGs were screened using Lasso, SVM-RFE, and random forest algorithms, and a nomogram diagnostic model was constructed. The diagnostic performance of the model was assessed using receiver operating characteristic (ROC) curves and calibration plots. Additionally, immune cell infiltration and potential small molecule drugs targeting IRGs were analyzed. The expression of IRG was verified by qRT-PCR in healthy controls and IS patients.

RESULTS

Nine differentially expressed IRGs were identified in IS, including NMUR1, AHR, CD68, OSM, CDKN1A, RGS1, BTG2, ATP2C1, and TLR3. Machine learning algorithms selected three hub IRGs (AHR, OSM, and NMUR1). A diagnostic model based on these three genes showed excellent diagnostic performance for IS, with an area under the curve (AUC) greater than 0.9 in both the training and validation sets. Immune infiltration analysis revealed higher levels of neutrophils and activated CD4 + T cells, and lower levels of CD8 + T cells, activated NK cells, and naive B cells in IS patients. The hub IRGs exhibited significant correlations with immune cell infiltration. Furthermore, small molecule drugs targeting hub IRGs were identified, including chrysin, piperine, genistein, and resveratrol, which have potential therapeutic effects for IS. qRT-PCR evaluation demonstrated that the levels of blood biomarkers (AHR, OSM, and NMUR1) in IS patients could serve as distinguishing indicators between IS patients and healthy controls (P < 0.05).

CONCLUSION

This study confirmed the significant impact of IRGs on the progression of IS and provided new diagnostic and therapeutic targets for personalized treatment of IS.

Macrophage membrane coated functionalized nanoparticles for targeted drug delivery and neural function repair in cerebral ischemia-reperfusion injury

Vascular dementia (VD) is the second leading cause of cognitive impairment after Alzheimer's disease, posing a heavy burden to families and society. The majority of causes of VD are vascular diseases such as stroke, with ischemic stroke accounting for a large proportion. After ischemia-reperfusion, factors such as mitochondrial damage and increased xanthine oxidase lead to excessive production of reactive oxygen species (ROS) at the ischemic site, further exacerbating brain injury. Therefore, developing effective ROS scavengers is crucial. Polydopamine has become one of the widely used surface functionalized materials in recent years, due to its excellent biocompatibility and antioxidant properties. This paper proposed a macrophage membrane disguised polydopamine (PDA) nanoplatform for loading the neuroprotective drug puerarin (PUE). The as made PUE@PDA@CMs (PPCs) nanoplatforms can significantly and effectively clear ROS, alleviate oxidative microenvironment, and protect neurons from oxidative stress damage. The macrophage membranes modification enables PPCs to respond to lymphocyte recruitment at the site of cerebral ischemia-reperfusion injury, thereby targeting and aggregating to the injury site. In a mouse model of vascular dementia, PPCs treatment significantly reduced neuronal apoptosis and provided significant cognitive and memory function recovery, providing new strategies and prospects for the treatment of central nervous system diseases.

Molecular heterogeneity in human stroke - What can we learn from the peripheral blood transcriptome?

Stroke is a multifaceted disease with genetic and environmental components like diet and lifestyle. The central nervous and immune systems display complex interactions, with the peripheral immune response participating in brain injury and repair mechanisms following stroke. The bidirectional communication between the injured brain and peripheral blood presents an opportunity to investigate the molecular changes in the latter. There is substantial heterogeneity in stroke pathogenesis, pathophysiology, comorbidities, and response to treatment and outcome. This is captured and underscored by heterogeneity in the peripheral blood transcriptome. The current review highlights the role of the human peripheral blood transcriptome architecture for molecular phenotyping of different stroke etiologies and comorbidities, and for identifying underlying molecular correlates with clinically important variables and outcomes. Specific transcriptome features can potentially provide targets for clinical translation and for prioritizing genes and pathways for evaluation in experimental models. We also propose an approach to study the patient-specific transcriptional architecture and uncover the combinatorial heterogeneity in altered pathways in stroke patients that can also guide the search for treatment and prevention targets. Deciphering the molecular heterogeneity of stroke in a tissue that can be easily accessed and monitored, such as peripheral blood, may improve clinical trial success.

Novel Hypochlorous Acid-Activated Near-Infrared Probe Monitors the Dynamic Changes of Myeloperoxidase Activity in Ischemic Brain

Myeloperoxidase (MPO) contributes to the progression of ischemic damage. To fully understand MPO biology, highly sensitive and specific probes that can trace the activity of endogenous MPO fluxes are indispensable. Here, we developed two hypochlorous acid (HClO)-activated near-infrared probes to image MPO activity in a noninvasive manner. The probe MPO-NIR-II could track MPO-induced HClO in real time and in situ upon various stimuli with high sensitivity and specificity. Furthermore, MPO-NIR-II could monitor the MPO activity by in vivo fluorescence imaging and confocal laser scanning microscopy in mice with ischemic stroke. Moreover, a high-content screening system for MPO inhibitors was established by combining MPO-NIR-II with MPO-overexpressed cells and mouse brain slices with ischemic stroke, and the candidate compound AZD5904 was found to effectively attenuate ischemic brain injury. Overall, this work provides a versatile fluorescence tool that holds great promise for visualizing endogenous MPO fluxes of brain ischemia.

Salidroside Derivative SHPL-49 Exerts Anti-Neuroinflammatory Effects by Modulating Excessive Autophagy in Microglia

The neuroinflammation triggered by cellular demise plays a pivotal role in ameliorating the injury associated with ischemic stroke, which represents a significant global burden of mortality and disability. The compound SHPL-49, a derivative of rhodioloside, was discovered by our research team and has previously demonstrated neuroprotective effects in rats with ischemic stroke. This study aimed to elucidate the underlying mechanisms of SHPL-49's protective effects. Preliminary investigations revealed that SHPL-49 effectively alleviates PMCAO-induced neuroinflammation. Further studies indicated that SHPL-49 downregulates the expression of the lysosomal protein LAMP-2 and reduces lysosomal activity, impeding the fusion of lysosomes and autophagosomes, thus inhibiting excessive autophagy and increasing the expression levels of the autophagy proteins LC3-II and P62. Furthermore, SHPL-49 effectively reverses the NF-κB nuclear translocation induced by the autophagy inducer rapamycin, significantly lowering the expression levels of the inflammatory factors IL-6, IL-1β, and iNOS. In a co-culture system of BV2 and PC12 cells, SHPL-49 enhanced PC12 cell viability by inhibiting excessive autophagy in BV2 cells and reducing the ratio of apoptotic proteins Bax and BCL-2. The overall findings suggest that SHPL-49 exerts its neuroprotective effects through the inhibition of excessive autophagy and the suppression of the NF-κB signaling pathway in microglia, thereby attenuating neuroinflammation.

The predictive role of composite inflammatory ratio parameters in the conscious awareness recovery after severe acute ischemic stroke: a retrospective cohort study

BACKGROUND

Inflammatory mechanisms play a significant role in ischemic stroke. Peripheral neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), which are indicators capable of reflecting the magnitude of the inflammatory response, have been research hotspots. However, few research findings evaluate the prediction significance of these biomarkers in the recovery of conscious awareness following severe acute ischemic stroke.

METHODS

This was a retrospective cohort study of 142 patients with consciousness disorders after acute ischemic stroke (GCS score ≤ 8) treated from January 2022 to May 2024. The cases were divided into three groups according to the GCS score at discharge as died/ vegetative state (GCS ≤ 3),moderate/ severe coma(GCS = 4-11) and mild coma/ normal (GCS:12-15). Demographic and clinical assessment data were reviewed and abstracted. NLR, PLR, SII and SIRI were calculated based on the peripheral blood tests at admission. The study investigated the correlation between changes in GCS scores from admission to discharge (calculated as the GCS score at discharge minus the baseline GCS score, where a negative value indicates worsening and a positive value indicates improvement) and the levels of NLR, PLR, SII, and SIRI.

RESULTS

The level of NLR, PLR, SII and SIRI in died/ vegetative state group were significantly higher than those in moderate/ severe coma group (p = 0.0429, p = 0.0215, p = 0.0288, p = 0.026, respectively) and mild coma/ normal group (p = 0.0085, p = 0.0079, p = 0.0019, p = 0.0017, respectively). The area under the curve (AUC) values of NLR, PLR, SII, and SIRI to prognosis were 0.670, 0.661, 0.677, and 0.609, respectively. Spearman correlation analysis indicated NLR, PLR and SII were negatively correlated with GCS scores increase during hospitalization (r =- 0.317, p<0.0001 for NLR, r = -0.285, p = 0.001 for PLR, r = -0.3331, p < 0.0001 for SII, r= -0.199,p = 0.018 for SIRI).However, ordinal logistic regression analyses failed to indicate that NLR, PLR, SII and SIRI were independent predictors of poor consciousness response for severe acute ischemic stroke coma patients after adjusting for other confounders.

CONCLUSION

Patients with poorer consciousness outcomes exhibited a tendency towards elevated NLR, PLR, SII, and SIRI levels which were inversely correlated with GCS scores increase during hospitalization. However, the four indexes did not exhibit sufficient promise to be the valuable predictors for the prognosis of recovery from consciousness following severe acute ischemic stroke.

TEPP-46 inhibits glycolysis to promote M2 polarization of microglia after ischemic stroke

Following an ischemic stroke, neuroinflammation is triggered and is often typified by microglial activation. According to recent research, increased glycolysis metabolism frequently occurs when microglia become activated in an inflammatory response. In this study, we found that the PKM2 expression of microglia was gradually increased during the activation of microglia in ischemic stroke. TEPP-46, the activator of PKM2, enhanced the M2 polarization and promoted phagocytosis of microglia both in vivo and in vitro. Meanwhile, TEPP-46 administration ameliorated neuroinflammation and neuronal injuries and reduced the infarct volume of tMCAO mice. Mechanistically, we demonstrated that TEPP-46 suppressed the nuclear translocation of PKM2 and the interaction of PKM2 and HIF-1α, and inhibited glycolysis of microglia. According to our research, PKM2 modulation in microglia may be a viable therapeutic approach to lessen neuroinflammation following ischemic stroke, and TEPP-46 may be able to polarize microglia from an M1 to an M2 phenotype after ischemia/reperfusion damage.

Association between oxidative balance score and all-cause mortality in stroke survivors

Stroke is the second leading cause of death globally. Oxidative stress plays a critical role in the development of stroke. The Oxidative Balance Score (OBS) is a tool used to assess the combined impact of diet and lifestyle on the body's antioxidant capacity. The study included stroke survivors from the National Health and Nutrition Examination Survey (1999-2018), with a total of 1,781 participants and a median follow-up duration of 6.5 years, during which 786 participants (39.59%) died. The relationship between OBS and all-cause mortality was assessed using the Cox proportional hazards model. The results indicated that individuals in higher OBS quartiles had lower mortality rates. Specifically, patients in the fourth quartile had a 41% reduced risk of all-cause mortality compared to those in the first quartile (HR = 0.59, 95% CI = 0.42-0.84, p = 0.003). Restricted cubic spline analysis revealed a linear inverse relationship between OBS and all-cause mortality. Subgroup analysis further demonstrated that the inverse association persisted across various population subgroups. Overall, our study suggests that higher levels of OBS can reduce the risk of all-cause mortality in stroke survivors and provides new evidence for their diet and lifestyle.

The Aging Immune System: A Critical Attack on Ischemic Stroke

Ischemic stroke caused by cerebrovascular embolism is an age-related disease with high rates of disability and mortality. Although the mechanisms of immune and inflammatory development after stroke have been of great interest, most studies have neglected the critical and unavoidable factor of age. As the global aging trend intensifies, the number of stroke patients is constantly increasing, emphasizing the urgency of finding effective measures to address the needs of elderly stroke patients. The concept of "immunosenescence" appears to explain the worse stroke outcomes in older individuals. Immune remodeling due to aging involves dynamic changes at all levels of the immune system, and the overall consequences of central (brain-resident) and peripheral (non-brain-resident) immune cells in stroke vary according to the age of the individual. Lastly, the review outlines recent strategies aimed at immunosenescence to improve stroke prognosis.

Electroacupuncture Promotes the Generation of Intestinal Treg Cells After Ischemic Stroke by Foxp3 Acetylation Regulation

Electroacupuncture (EA) has been shown to ameliorate brain injury and protect against intestinal injury after ischemic stroke. These protective effects are closely associated with the enhancement of regulatory T (Treg) cell numbers and function in the intestine, as well as the inhibition of intestinal γδ T cell production and their migration to the brain. This study aimed to elucidate the potential mechanism by which EA regulates intestinal Treg cell differentiation after stroke. Sprague-Dawley rats were divided into three groups: the sham group, the middle cerebral artery occlusion (MCAO) group, and the MCAO plus EA (MEA) group. The MCAO model was generated by occluding the middle cerebral artery. EA was applied to Baihui (GV20) acupoint once daily. Samples were collected 3 days after reperfusion. Our results showed that EA reduced the inflammatory response in the brain and intestine after ischemic stroke. EA treatment increased the percentage of Treg cells in the small intestine of rats. EA increased the levels of SCFAs, while also inhibiting histone deacetylase activity (HDAC). Additionally, acetylated Foxp3 protein in the small intestine was increased after EA treatment. These results suggest that EA at GV20 alleviates brain and intestinal inflammatory injury in stroke rats, potentially through the enhancement of SCFA-mediated Foxp3 acetylation in Treg cells.

Annexin A1: The dawn of ischemic stroke (Review)

Ischemic stroke is a prevalent clinical condition that poses a significant global challenge. Developing innovative strategies to address this issue is crucial. Annexin A1 (ANXA1), a key member of the annexin superfamily, performs various functions, such as inhibiting inflammatory factor release, promoting phagocytosis, and blocking leukocyte migration. Evidence indicates that ANXA1 plays a pivotal role in the pathogenesis of ischemic stroke. The present article reviews involvement of ANXA1 in anti‑atherosclerosis, inflammatory processes, blood‑brain barrier protection, platelet aggregation and anti‑apoptotic mechanisms. The potential applications of ANXA1 in treating ischemic stroke are also explored.

ADAR1 Promotes NUPR1 A-to-I RNA Editing to Exacerbate Ischemic Brain Injury by Microglia Mediated Neuroinflammation

Microglial cells occupy a crucial position as potential therapeutic targets in the context of ischemic stroke (IS). Nonetheless, the intrinsic mechanisms that govern microglial activation in the aftermath of IS remain incompletely elucidated. ADAR1 p150 plays a significant role in immune regulation and stress responses; however, the specific pathways through which it modulates microglial activation and the subsequent mechanisms that unfold following IS have yet to be clearly delineated. The distal middle cerebral artery occlusion (dMCAO) mouse model was utilized to induce IS. The evaluation of infarct volume was conducted through TTC staining, while neurological function was assessed using the modified Neurological Severity Score (mNSS). To evaluate the expression of ADAR1 and apoptosis-related proteins, immunofluorescence and Western blot techniques were employed. BV2 cells were subjected to oxygen-glucose deprivation followed by reperfusion (OGD/R). Additionally, a co-culture system of BV2 cells and neurons was established, and subsequent assessments of neuronal viability and apoptosis were performed using CCK-8 assays and LDH release assays. ADAR1 p150 expression was significantly upregulated in the brains of ischemic mice, particularly within microglial cells. The overexpression of ADAR1 p150 was found to promote microglial activation and enhance pro-inflammatory responses, whereas the knockdown of ADAR1 p150 yielded the opposite effect. Additionally, the knockdown of ADAR1 p150 in microglia resulted in a marked reduction in neuronal apoptosis within the co-culture system. Rescue experiments indicated that the knockdown of NUPR1 partially reinstated the inflammatory response previously induced by ADAR1 p150 knockdown. Notably, ADAR1 p150 knockdown also inhibited A-to-I RNA editing while simultaneously upregulating NUPR1. Furthermore, the reduction of ADAR1 expression was associated with decreased infarct volume, improved neurological outcomes, and a significant attenuation of neuroinflammation in dMCAO mice. ADAR1 p150 enhances the microglial inflammatory response and neuronal apoptosis in IS by facilitating A to I RNA editing of NUPR1.

Role of Peripheral Blood Regulatory T Cells and IL-2 in the Collateral Circulation of Acute Ischemic Stroke

Background

Inflammation is recognized as a pivotal factor in the pathophysiology of acute ischemic stroke (AIS) and has the potential to influence the collateral circulation of patients. The objective of this investigation was to explore the link between peripheral regulatory T cells (Tregs), interleukin-2 (IL-2), and the status of collateral circulation.

Methods

Between September 2023 and May 2024, the study incorporated 117 AIS patients from the neurology department, with 60 identified as having good collateral status (GCS) and 57 with poor collateral status (PCS). Additionally, a control group of 46 healthy individuals was included. Collateral circulation in AIS patients was assessed via computed tomography angiography. The levels of peripheral blood Tregs were quantified through flow cytometry, while IL-2 was measured by ELISA.

Results

In this investigation, patients diagnosed with PCS demonstrated reduced Tregs (5.77 ± 1.55%) and IL-2 levels (7.37 ± 2.61 pg/mL) compared to individuals with GCS (7.09 ± 1.32%, 9.95 ± 3.58 pg/mL) and healthy controls (7.17 ± 1.40%,10.33 ± 4.01 pg/mL). Logistic regression analysis identified significant associations between Tregs and IL-2 levels and collateral circulation status (p<0.05), with diminished levels of both being independent predictors of PCS when compared to GCS. A nomogram was developed to forecast risk factors for collateral circulation, further highlighting the potential of plasma Tregs and IL-2 levels as biomarkers in predicting collateral circulation among AIS patients. The diagnostic performance of Tregs and IL-2 was assessed utilizing receiver operating characteristic (ROC) analysis. The area under the ROC curve (AUC) for Tregs in differentiating GCS from PCS patients was ascertained to be 0.741 (95% confidence interval [CI]: 0.652-0.830), while for IL-2, it was 0.710 (95% CI: 0.618-0.803). Moreover, the combined measurement of Tregs and IL-2 resulted in an AUC of 0.779 (95% CI: 0.695-0.863).

Conclusion

Plasma levels of peripheral blood Tregs and IL-2 may function as promising biomarkers for the prediction of collateral circulation status, suggesting potential new therapeutic approaches aimed at enhancing cerebral collateral circulation, and providing new therapeutic targets for acute ischemic stroke.

Investigating the possible mechanism of Cornus officinalis in the therapy of ischemic stroke by UHPLC-Q-TOF-MS, network pharmacology, molecular docking, and experimental verification

ETHNOPHARMACOLOGICAL RELEVANCE

Cornus officinalis is a conventional Chinese medicine for tonifying liver and kidney in ancient China. The active ingredients from Cornus officinalis can delay the progression of cerebral aneurysms, alleviate experimental autoimmune encephalomyelitis, and show a good intervention effect on brain diseases. Loganin, the active ingredient of Cornus officinalis, has a neuroprotective effect on cerebral ischemia-reperfusion injury in mice. It is yet unknown, nevertheless, how Cornus officinalis works to treat ischemic stroke.

AIM OF THE STUDY

Based on ultra-high performance liquid chromatography-quadrupole/time-of-flight mass spectrometry (UHPLC-Q-TOF-MS), network pharmacology and molecular docking, Cornus officinalis's mechanism of intervention in ischemic stroke is explored and verified by experiments.

MATERIALS AND METHODS

To examine the chemical components of Cornus officinalis, UHPLC-Q-TOF-MS was used. The network pharmacology was used to construct the "active ingredient-core target-main pathway" network of Cornus officinalis. Then, the link between the main active components and the key protein targets, as determined by network pharmacology, was verified through the application of molecular docking. The middle cerebral artery occlusion/reperfusion (MCAO/R) rat model used in this study was created using the suture technique. The pharmacological effects of Cornus officinalis were explored by neurological function score, behavior, TTC staining, ultrasound and flow cytometry. Western blot and qPCR were used to confirm the core target.

RESULTS

The outcomes of the investigation demonstrated that Cornus officinalis had a potent anti-ischemic stroke effect. UHPLC-Q-TOF-MS method was used to determine 24 chemical constituents in Cornus officinalis, of which 22 components had a close relationship with protein targets relevant to ischemic stroke. The 27 protein targets screened by "active ingredient-core target-main pathway" may be the possible targets of Cornus officinalis in the therapy of ischemic stroke. Most of the 27 protein targets had to do with the inflammatory response, apoptosis and energy metabolism. KEGG enrichment analysis showed that AGE/RAGE ranked high and was closely related to inflammatory response. Molecular docking predicted that the top 10 components in the network diagram had good binding with inflammatory factors IL6, IL-1β and TNF-α protein targets. Western blot research outcomes stated that Cornus officinalis could firmly impede the production of AGE, RAGE, and P-NFκB P65. Cornus officinalis had the potential to prevent ischemic stroke by drastically inhibiting the production of TNF-α, IL-1β, and IL-6, according to the results of qPCR study.

CONCLUSION

This study found that Cornus officinalis can improve the brain injury, motor ability and blood flow velocity of MCAO/R rats and suppress the inflammatory reaction through the AGE/RAGE/NFκB pathway to exert the therapeutic effect on ischemic stroke.

Intranasal delivery of hMSC-derived supernatant for treatment of ischemic stroke by inhibiting the pro-inflammatory polarization of neutrophils

BACKGROUND

Stem cells utilized for ischemic stroke treatment often display unstable homing capabilities and diminished activity in vivo, limiting their neuroprotective efficacy. Furthermore, the optimal delivery route for stem cells remains undetermined. While the cytokines secreted by stem cells show promise in modulating post-stroke inflammation, the direct application of these supernatants in ischemic stroke treatment and the underlying mechanisms are still unclear.

METHODS

Secretory supernatants (hMSC-L) and cell lysate products (hMSC-M) from primary human umbilical cord mesenchymal stem cells-cultured medium were administered intranasally to mice with cerebral ischemia. The neuroprotective effects of hMSC-L and hMSC-M were assessed with TTC staining, behavioral tests and pathological staining. Flow cytometry and qPCR evaluated the expression of immune cells and cytokines in the CNS and peripheral immune organs. In vitro, flow cytometry and ELISA measured the effects of hMSC-L and hMSC-M on N2 polarization and inflammatory cytokines expression in primary murine neutrophils. Western blot analysis determined the impact of hMSC-L and hMSC-M on the PPAR-γ/STAT6/SOCS1 pathway, which is crucial for N2 neutrophil polarization.

RESULTS

TTC staining, behavioral experiments, and pathological assessments reveal intranasal delivery of hMSC-L and hMSC-M significantly reduces the infarct volume of mice with cerebral ischemia, improves neurological function scores, and promotes motor function recovery. Higher concentrations of hMSC-M contributed a more pronounced effect on neuropathological improvements in ischemic mice. Intranasal delivery of hMSC-L and hMSC-M significantly reduces neutrophil infiltration in the brain post-stroke and increases the proportion of anti-inflammatory N2-subtype neutrophils, boosting the expression levels of IL-10 and TGF-β. In vitro experiments demonstrate that hMSC-L and hMSC-M promote nuclear translocation of PPAR-γ in neutrophils stimulated with PMA, activating the downstream STAT6/SOCS1 signaling pathway to encourage N2-subtype neutrophil polarization.

CONCLUSIONS

Intranasal delivery of hMSC-L and hMSC-M effectively ameliorates cerebral ischemic injury in mice, comparable to traditional administration routes like intravenous delivery. Treatment with hMSC-L and hMSC-M enhances the PPAR-γ/STAT6/SOCS1 pathway and improves the neuroinflammatory response post-stroke by increasing N2 neutrophil infiltration. These results provide a theoretical basis for a deeper understanding of the mechanisms of stem cell therapy and for exploring suitable delivery pathways of stem cell treatment.

Diosmin alleviates NLRP3 inflammasome-dependent cellular pyroptosis after stroke through RSK2/CREB pathway

In the context of our previous analyses on the main active ingredients of Jieyudan, a classic formula targeting aphasia in stroke, we further delve into the function and mechanisms of its active ingredient, Diosmin (DM), which may exert neuroprotective effects, in ischemic stroke. Herein, bioinformatics analysis revealed targets of DM and their intersection with differentially expressed genes in ischemic stroke. Middle cerebral artery occlusion (MCAO) rats and oxygen-glucose deprivation (OGD) cells were used to construct in vivo and in vitro models of ischemic stroke. The effects of DM on MCAO rats were assessed by Zea-Longa score, Morris water maze, TTC staining, Nissl staining, immunohistochemistry, and Western blot. At the cellular level, cell counting kit-8 assay and Western blot were carried out to verify the mechanism of DM in ischemic stroke. In vivo, DM decreased neurological deficit score, cerebral infarct volume and neuronal damage, and improved cognitive function in MCAO rats. In vitro, DM increased the viability of OGD-treated cells. In addition, DM down-regulated the expressions of NLR family pyrin domain containing 3 (NLRP3) and pyroptosis-associated proteins, while up-regulating ribosomal protein S6 kinase A3 (RSK2) level and activating cyclic-AMP response element-binding protein (CREB) signaling. Conversely, RSK2 inhibitor LJH685 reduced the viability and promoted pyroptosis-associated protein levels, which also partially reversed the effects of DM in vitro. Collectively, DM plays a therapeutic role in ischemic stroke by inhibiting NLRP3 inflammasome-mediated cellular pyroptosis via the RSK2/CREB pathway.

Circulating miR-574-5p shows diagnostic and prognostic significance and regulates oxygen-glucose deprivation (OGD)-induced inflammatory activation of microglia by targeting ATP2B2

BACKGROUND

Early screening is critical for the prevention of ischemic stroke. miR-574-5p was considered a promising biomarker for ischemic stroke but lacks direct confirmation. This study evaluated miR-574-5p in discriminating ischemic stroke and predicting the severity and prognosis of patients, aiming to provide novel insights into the clinical prevention of ischemic stroke.

METHODS

The clinical significance of miR-574-5p was evaluated in 103 ischemic stroke patients with 87 healthy individuals as control. The potential of serum miR-574-5p in the diagnosis and prognosis of ischemic stroke was assessed by ROC and logistic regression analyses. In vitro, oxygen-glucose deprivation (OGD)-induced microglia was established. The regulation of inflammation, oxidative stress, and proliferation of microglia by miR-574-5p were assessed by cell transfection. The downstream targets of miR-574-5p were predicted from public databases, and the targeting relationship was evaluated by luciferase reporter assay.

RESULTS

Reducing serum miR-574-5p was observed in ischemic stroke patients relative to healthy individuals, which discriminated ischemic stroke patients. Serum miR-574-5p was negatively correlated with the NIHSS score of ischemic stroke patients and was identified as a risk factor for patients' adverse prognosis. In OGD-induced microglia, overexpressing miR-574-5p could alleviate OGD-induced inflammation and oxidative stress and promote cell growth. Among predicted targets, ATP2B2 was upregulated in ischemic stroke and showed a negative correlation with miR-574-5p. miR-574-5p negatively regulated ATP2B2 in OGD-induced microglia, and the overexpression of ATP2B2 reversed the protective effect of miR-574-5p.

CONCLUSION

miR-574-5p acted as a biomarker for ischemic stroke and mediated neuroinflammation via targeting ATP2B2.

Association of systemic immune-inflammation index (SII) with risk of psoriasis: a cross-sectional analysis of National Health and Nutrition Examination Survey 2011-2014

BACKGROUND

The systemic immune-inflammation index (SII) is an emerging marker of inflammation, and the onset of psoriasis is associated with inflammation. The aim of our study was to investigate the potential impact of SII on the incidence rate of adult psoriasis.

METHODS

We conducted a cross-sectional study based on the National Health and Nutrition Examination Survey (NHANES) 2011-2014 data sets. Multiple logistic regression analyses with appropriate covariates adjustment were the major methods in this study. Subgroup analyses were conducted by age, gender, race, smoking status, alcohol consumption, history of heart attack, stroke, coronary heart disease and diabetes. Interactions among these variables were also detected. We further utilized smooth curve fitting to explore potential nonlinear associations between SII and psoriasis across different subgroups. The receiver operating characteristic curve analysis was used to assess the diagnostic value of SII for psoriasis in the general population and diabetic individuals. Multiple imputation was adopted as sensitivity analysis to address potential bias due to missing data.

RESULTS

9314 participants (≥ 20 years) were included. A significant positive association was observed between SII and psoriasis (OR = 1.56; P = 0.0069). Subgroup analysis revealed significant positive association in males (OR = 1.52; P = 0.0288), females (OR = 1.61; P = 0.0322), Non-Hispanic Whites (OR = 1.55; P = 0.0190), people aged 40-59 years (OR = 1.98; P = 0.0386), diabetics (OR = 3.40; P = 0.0088), and overweight participants (OR = 1.80; P = 0.0034). SII had a higher predictive value for psoriasis in diabetic patients (AUC = 0.62; 95% CI [0.55, 0.70]). In stroke patients, SII was negatively correlated with the occurrence of psoriasis, and interaction test suggested the effect of SII on psoriasis was significantly modified by stroke (P = 0.0003). Nonlinear relationships between SII and psoriasis were observed in participants aged 20 to 39, former smokers, current drinkers, individuals with or without heart attack, those without coronary heart disease, and overweight participants.

CONCLUSIONS

SII was positively associated with psoriasis. Testing for SII levels may help to identify the onset of psoriasis early.

LncRNA Tug1 Regulates Post-Stroke Microglial Pyroptosis via PINK1/Parkin-Mediated Mitophagy

Microglia, the central nervous system's primary immune cells, play a key role in the progression of cerebral ischemic stroke, particularly through their involvement in pyroptosis. The long non-coding RNA taurine up-regulated gene 1 (Tug1) is elevated during ischemic stroke and is critical in driving post-stroke neuroinflammation. However, the underlying molecular mechanisms remain unclear. This study explores the biological role of Tug1 and its potential mechanisms in regulating pyroptosis in microglia. We utilized an in vivo photothrombosis (PT) mice model and an in vitro oxygen-glucose deprivation and reperfusion (OGD/R) BV2 cell model to explore the mechanisms underlying ischemic stroke. Initially, we assessed the expression levels of Tug1 in the OGD/R model in vitro and the PT model in vivo. Subsequently, we investigated the impact of Tug1 on microglial pyroptosis by knocking down Tug1, silencing the PTEN-induced putative kinase 1 (Pink1) expression, and employing the mitophagy inhibitor mdivi-1. Tug1 exacerbated microglial pyroptosis by inhibiting mitophagy in both in vivo and in vitro models. The increase in mitophagy observed following Tug1 knockdown was reversed by either silencing Pink1 expression or using the mitophagy inhibitor mdivi-1. This reversal resulted in exacerbated pyroptosis and worsened neurological damage. Further mechanistic studies revealed that Tug1 knockdown significantly reduced microglial pyroptosis and alleviated neuronal damage by enhancing PINK1/Parkin-mediated mitophagy. For the first time, this study reveals that Tug1 promotes hypoxia-induced microglial pyroptosis by inhibiting PINK1/Parkin-mediated mitophagy, potentially providing a promising therapeutic target for ischemic inflammatory injury.

Suppressing the Inflammatory Prostaglandin Signaling after Thrombotic Stroke Ameliorates Ischemic Brain Injury and Facilitates Poststroke Recovery

Acute cerebral ischemia is a leading cause of death and disability, particularly among old adults. The narrow therapeutic window and risk of hemorrhagic transformation largely limit patient eligibility for the current treatment. The neuroinflammatory signaling pathway involving the prostaglandin E2 (PGE2) receptor subtype EP2 has now been clarified to contribute to the secondary neurotoxicity following ischemic stroke. We previously demonstrated the feasibility of pharmacologically targeting EP2 for ischemic stroke using an EP2 antagonist in a mouse model of transient middle cerebral artery occlusion. Herein, we evaluated the effects of a second-generation EP2 antagonist with improved potency and selectivity in a mouse model of thrombotic stroke, the most common type of stroke. We found that the EP2 antagonist, when administered hours after an ischemic stroke induced within motor and somatosensory cortices by photoactivation of a light-sensitive dye Rose Bengal, reduced cortical infarction in a dose-dependent manner. EP2 inhibition also improved the poststroke body weight recovery and reduced neurological impairments in locomotor and cognitive functions, revealed by a panel of behavioral tests. These broad benefits support the feasibility of targeting the PGE2/EP2 axis-mediated neuroinflammatory pathway as a novel strategy to alleviate the ischemic brain injury caused by thrombotic occlusion and accelerate poststroke recovery.

RVG-peptide-camouflaged iron-coordinated engineered polydopamine nanoenzyme with ROS scavenging and inhibiting inflammatory response for ischemic stroke therapy

Stroke is one of the most common causes of death and disability. In addition, most neuroprotective agents fail to rescue neurons from cerebral ischemic insults due to their poor ability to penetrate the blood-brain barrier (BBB). Here, the tailored engineered nanoenzyme has been successfully synthesized by coordination-driven co-assembly of dopamine (DA) and iron ion (Fe3+), which is subsequently camouflaged by neuron-specific rabies viral glycoprotein (RVG) peptide to scavenge reactive oxygen species (ROS) and inhibit inflammatory response in damaged neuron for the efficient therapy of ischemic stroke. The resulting nanoenzyme with good biocompatibility, core-shell structure, and suitable diameter can nondestructively cross the BBB and then internalize into the damaged neuron through the camouflaging and homologous targeted strategy of neuron-specific RVG peptide. After intravenous injection into transient middle cerebral artery occlusion (tMCAO) mouse models, nanoenzyme exerted a significant neuroprotective effect, resulting in a 50 % reduction in neurological scores and an approximate 33 % decrease in cerebral infarction volume. Interestingly, such nanoenzyme can eliminate free radicals, reduce neuroinflammation, enhance BBB integrity, improve mitochondrial function, and inhibit neuronal ferroptosis. Taken together, this well-designed nanoenzyme with its excellent biocompatibility and well-understood mechanisms holds promise a robust therapy for ischemic stroke.

STING Activation in Macrophages and Microglia Drives Poststroke Inflammation: Implications for Neuroinflammatory Mechanisms and Therapeutic Interventions

BACKGROUND

Monocyte-derived macrophages and microglia initially adopt an anti-inflammatory phenotype following stroke but later transition to a pro-inflammatory state. The mechanisms underlying this phenotypic shift remain unclear. This study investigates the activation dynamics of molecular signaling pathways in macrophages and microglia after stroke.

METHODS

We utilized publicly available single-cell RNA sequencing datasets to examine the activation dynamics of molecular signaling pathways alongside the pro-inflammatory phenotype of macrophages and microglia. Male C57BL/6 mice underwent transient middle cerebral artery occlusion (tMCAO), with the STING inhibitor H151 administered to tMCAO mice. Neurobehavioral performance was assessed using rotarod, foot fault, novel object recognition, and water maze tests at 5-, 7-, 10-, and 14-days post-stroke. Primary microglia and bone marrow-derived macrophages were cultured for in vitro experiments.

RESULTS

Single-cell sequencing data indicated that the activation of STING and subsequent type I interferon signaling drove the phenotypic shift of microglia and macrophages toward a pro-inflammatory state in the stroke lesion. Immunostaining demonstrated that the emergence of pro-inflammatory microglia and macrophages aligned with the activation time course of STING and type I interferon signaling. Continuous phagocytosis by macrophages and microglia led to STING activation, which triggered type I interferon signaling and promoted the phenotypic shift. Inhibition of STING signaling prevented this transition, reduced neuroinflammation, and conferred protection against ischemic stroke.

CONCLUSION

These findings elucidated the critical role of STING-mediated type I interferon signaling in driving post-stroke neuroinflammation and underscored the potential of STING inhibition as a therapeutic strategy for alleviating neuroinflammatory responses following stroke.