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Xu XM, Zhang H, Meng RL. Cranial midline shift is a predictor of the clinical prognosis of acute cerebral infarction patients undergoing emergency endovascular treatment. Sci Rep 2023; 13:21037. [PMID: 38030746 PMCID: PMC10687008 DOI: 10.1038/s41598-023-48401-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 11/26/2023] [Indexed: 12/01/2023] Open
Abstract
Endovascular treatment is widely used in acute cerebral infarction (ACI), but patient prognosis varies greatly. We aimed to investigate the predictive value of midline shift (MLS) threshold for the clinical prognosis of patients with ACI who undergo emergency endovascular treatment. We prospectively enrolled patients with ACI who received endovascular treatment within 24 h of onset. Cranial images were collected within 24 h after endovascular treatment. We assessed MLS at the level of the midbrain, pineal calcification, septum pellucida, and falx cerebri and noted the maximum MLS (MLS[max]) among these locations. Functional outcomes were assessed at 90 days using the modified Rankin Scale. Receiver operating characteristic curves and optimal cutoff points were used to analyze the predictive value of MLS. We enrolled 82 patients, including 46 with poor outcomes. Although the MLS values at all levels were significantly different between the poor and favorable outcome groups (p < 0.01), the MLS(max) tended to be a better marker for 90-day poor outcome. To predict poor outcome, the optimal cutoff values for MLS(max) within 24 and 48 h after intervention were 0.45 and 2.35 mm, respectively. MLS(max) has predictive value for patient prognosis.
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Affiliation(s)
- Xiao-Min Xu
- Department of Neurology, The Affiliated Hospital of Southwest Medical University, Taiping Street, Jiangyang District, Luzhou, 646000, Sichuan, China.
- Laboratory of Neurological Diseases and Brain Function, Luzhou, Sichuan, China.
| | - Hao Zhang
- Department of Neurology, The Affiliated Hospital of Southwest Medical University, Taiping Street, Jiangyang District, Luzhou, 646000, Sichuan, China
- Laboratory of Neurological Diseases and Brain Function, Luzhou, Sichuan, China
| | - Ren-Liang Meng
- Department of Neurology, The Affiliated Hospital of Southwest Medical University, Taiping Street, Jiangyang District, Luzhou, 646000, Sichuan, China
- Laboratory of Neurological Diseases and Brain Function, Luzhou, Sichuan, China
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Hu D, Mo X, Luo J, Wang F, Huang C, Xie H, Jin L. 17-DMAG ameliorates neuroinflammation and BBB disruption via SOX5 mediated PI3K/Akt pathway after intracerebral hemorrhage in rats. Int Immunopharmacol 2023; 123:110698. [PMID: 37517381 DOI: 10.1016/j.intimp.2023.110698] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 07/13/2023] [Accepted: 07/20/2023] [Indexed: 08/01/2023]
Abstract
Intracerebral hemorrhage (ICH) can result in secondary brain injury due to inflammation and breakdown of the blood-brain barrier (BBB), which are closely associated with patient prognosis. The potential of the heat shock protein 90 (Hsp90) inhibitor 17-DMAG in promoting neuroprotection has been observed in certain vascular diseases. However, the precise role of 17-DMAG treatment in ICH is not yet fully understood. In this study, we found that treatment with 17-DMAG (5 mg/kg) effectively reduced hematoma expansion and resulted in improved neurological outcomes. Meanwhile, the injection of 17-DMAG had a positive effect on reducing BBB disruption in rats with ICH. This effect was achieved by increasing the levels of BBB tight junction proteins (TJPs) such as zo-1, claudin-5, and occludin. As a result, the leakage of EB extravasation, brain edema and IgG in the peri-hematoma tissue were reduced. Furthermore, the injection of 17-DMAG decreased the infiltration of neutrophils into the brain tissues surrounding the hematoma in ICH rats and also reduced the production of proinflammatory cytokines IL-6 and TNF-α. Next, we used integrative mass spectrometry (MS) and molecular docking analysis to confirm that sex determining region Y-box protein 5 (SOX5) is a potential direct target of 17-DMAG in ICH. SOX5 encodes a positive regulator of the PI3K/Akt axis, and treatment with 17-DMAG resulted in a noticeable increase in SOX5 accumulation. To further investigate the role of SOX5, we employed virus-regulated SOX5 silencing and found that suppressing SOX5 blocked the ability of 17-DMAG to suppress neutrophil trafficking. Additionally, silencing SOX5 blocked the protective effects of 17-DMAG on the BBB by inhibiting PI3K, p-Akt, and BBB TJPs levels, which led to an increase in EB and IgG leakage in the peri-hematoma tissue after ICH. Similarly, when SOX5 was knocked down, the protective effects of 17-DMAG were lost. Overall, the results of our study indicate that the injection of 17-DMAG has the potential to mitigate neuroinflammation and prevent the disruption of the BBB caused by ICH, resulting in improved neurological outcomes in rats. These positive effects are attributed to the regulation of SOX5 and activation of the PI3K/Akt pathway. These findings highlight the possibility of targeting SOX5 and the PI3K/Akt pathway as a novel therapeutic approach for ICH.
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Affiliation(s)
- Di Hu
- Department of Neurology and Stroke Centre, the First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Xiaocong Mo
- Department of Oncology, the First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, China
| | - Jihang Luo
- Department of Oncology, the First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, China
| | - Fang Wang
- Department of Neurology and Stroke Centre, the First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Cheng Huang
- Department of Neurology and Stroke Centre, the First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Hesong Xie
- Department of Neurology and Stroke Centre, the First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Ling Jin
- Department of Oncology, the First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, China.
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Yang L, Su X, Lu F, Zong R, Ding S, Liu J, Wilson G, Li L, Yang Y, Wang W, Wang X, Chen J, Ma X. Serum and brain metabolomic study reveals the protective effects of Bai-Mi-Decoction on rats with ischemic stroke. Front Pharmacol 2022; 13:1005301. [PMID: 36506507 PMCID: PMC9729534 DOI: 10.3389/fphar.2022.1005301] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 11/07/2022] [Indexed: 11/25/2022] Open
Abstract
Bai-Mi-Decoction (BMD), which is composed of Eugenia caryophyllata, Myristica fragrans, Moschus berezovskii, and Crocus sativu, is a characteristic TCM multi-herb formula for brain disease. However, the mechanism of protective effects of BMD on ischemic stroke (IS) still has not been clarified. Our study is designed to elucidate the protective effects and underlying mechanisms of BMD on IS by employing pharmacodynamic and serum and brain metabolomic methods. In this experiment, 90 adult male Sprague-Dawley rats were randomly divided into the sham operation group (SHAM, vehicle), middle cerebral artery occlusion-reperfusion injury model group (MCAO/R, vehicle), positive control group (NMDP, 36 mg/kg/day nimodipine), and low (BMDL, 0.805 g/kg/day), moderate (BMDM, 1.61 g/kg/day), and high (BMDH, 3.22 g/kg/day) dosage of BMD prophylactic administration groups. The drugs were dissolved in 0.5% CMC-Na and orally administered to rats with equal volumes (100 g/ml body weight) once a day for 14 consecutive days. Neurological deficit score, cerebral infarct volume, change in body weight, and serum NO, SOD, MDA, GSH, and GSSG levels were determined. Pathological abnormalities using hematoxylin and eosin staining and the expression of VEGF, caspase-3, and NF-κB were analyzed. Furthermore, serum and brain metabolic profiles were explored to reveal the underlying mechanism using UHPLC-QTOF-MS/MS technology. BMD exhibited significant neuroprotective effects on MCAO/R rats. As compared to the MCAO/R model group, it could reduce the neurological deficit score and cerebral infarct volume, increase body weight, enhance GSH, SOD, and GSSG activities, and decrease NO and MDA contents of MCAO/R rats. Meanwhile, BMD could ameliorate pathological abnormalities of MCAO/R rats through reducing neuronal loss, vacuolated spaces, shrunken neurons, and destructed neuron structure, as well as regulating the expression of VEGF, caspase-3, and NF-κB. UHPLC-QTOF-MS/MS-based serum and brain metabolomics analysis found a total of 53 differential metabolites between MCAO/R and SHAM groups, of which 30 were significantly regulated by BMD intervention, and further metabolic pathway analysis implied that the protective effects were mainly associated with amino acid and glycerophospholipid metabolisms. Our pharmacodynamic and metabolomic results revealed the neuroprotective effects of BMD on MCAO/R rats, and the underlying mechanisms were probably related to amino acid and glycerophospholipid metabolisms.
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Affiliation(s)
- Lingling Yang
- Department of Pharmaceutical Analysis, Key Laboratory of Hui Ethnic Medicine Modernization, Ministry of Education, School of Pharmacy, Ningxia Medical University, Yinchuan, China
| | - Xiaojuan Su
- Department of Pharmaceutical Analysis, Key Laboratory of Hui Ethnic Medicine Modernization, Ministry of Education, School of Pharmacy, Ningxia Medical University, Yinchuan, China
| | - Fangfang Lu
- Department of Pharmaceutical Analysis, Key Laboratory of Hui Ethnic Medicine Modernization, Ministry of Education, School of Pharmacy, Ningxia Medical University, Yinchuan, China
| | - Rong Zong
- Department of Pharmaceutical Analysis, Key Laboratory of Hui Ethnic Medicine Modernization, Ministry of Education, School of Pharmacy, Ningxia Medical University, Yinchuan, China
| | - Shuqin Ding
- Department of Pharmaceutical Analysis, Key Laboratory of Hui Ethnic Medicine Modernization, Ministry of Education, School of Pharmacy, Ningxia Medical University, Yinchuan, China
| | - Jing Liu
- Department of Pharmaceutical Analysis, Key Laboratory of Hui Ethnic Medicine Modernization, Ministry of Education, School of Pharmacy, Ningxia Medical University, Yinchuan, China
| | - Gidion Wilson
- Department of Pharmaceutical Analysis, Key Laboratory of Hui Ethnic Medicine Modernization, Ministry of Education, School of Pharmacy, Ningxia Medical University, Yinchuan, China
| | - Liuyan Li
- Department of Pharmaceutical Analysis, Key Laboratory of Hui Ethnic Medicine Modernization, Ministry of Education, School of Pharmacy, Ningxia Medical University, Yinchuan, China
| | - Youyue Yang
- Department of Pharmaceutical Analysis, Key Laboratory of Hui Ethnic Medicine Modernization, Ministry of Education, School of Pharmacy, Ningxia Medical University, Yinchuan, China
| | - Weibiao Wang
- Department of Pharmaceutical Analysis, Key Laboratory of Hui Ethnic Medicine Modernization, Ministry of Education, School of Pharmacy, Ningxia Medical University, Yinchuan, China
| | - Xiaoying Wang
- Department of Pharmaceutical Analysis, Key Laboratory of Hui Ethnic Medicine Modernization, Ministry of Education, School of Pharmacy, Ningxia Medical University, Yinchuan, China
| | - Jianyu Chen
- Fujian University of Traditional Chinese Medicine, Fuzhou, China,*Correspondence: Jianyu Chen, ; Xueqin Ma,
| | - Xueqin Ma
- Department of Pharmaceutical Analysis, Key Laboratory of Hui Ethnic Medicine Modernization, Ministry of Education, School of Pharmacy, Ningxia Medical University, Yinchuan, China,*Correspondence: Jianyu Chen, ; Xueqin Ma,
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4
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Cui Y, Wang XH, Zhao Y, Chen SY, Sheng BY, Wang LH, Chen HS. Change of Serum Biomarkers to Post-Thrombolytic Symptomatic Intracranial Hemorrhage in Stroke. Front Neurol 2022; 13:889746. [PMID: 35720096 PMCID: PMC9202348 DOI: 10.3389/fneur.2022.889746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 04/21/2022] [Indexed: 11/18/2022] Open
Abstract
Background Symptomatic intracranial hemorrhage (sICH) is a terrible complication after intravenous alteplase in stroke, and numerous biomarkers have been investigated. However, the change of biomarkers to sICH has not been well determined. Aim To investigate the association between the change of biomarkers and sICH. Methods This is a prospective cohort study, and patients with sICH within 24 h after thrombolysis were enrolled, while patients without sICH were matched by propensity score matching with a ratio of 1:1. The blood samples were collected before and 24 h after intravenous thrombolysis (IVT), and preset 49 serum biomarkers were measured by microarray analysis. Protein function enrichment analyses were performed to detect the association between the change of biomarkers and sICH. Results Of consecutive 358 patients, 7 patients with sICH in 24 h were assigned to the sICH group, while 7 matched patients without any ICH were assigned to the non-sICH group. A total of 9 biomarkers were found to significantly change before vs. after thrombolysis between groups, including increased biomarkers, such as brain-derived neurotrophic factor, C-C motif chemokine ligand (CCL)-24, interleukin (IL)-6, IL-10, IL-18, and vascular endothelial growth factor, and decreased biomarkers, such as CCL-11, intercellular adhesion molecule-1, and IL-7. Conclusions This is the first study to identify changes in serum biomarkers in patients with sICH after IVT, and found that 6 neuroinflammatory and 3 neuroprotective biomarkers may be associated with brain injury following post-thrombolytic sICH. Clinical Trial Registration https://www.clinicaltrials.gov, identifier: NCT02854592.
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Affiliation(s)
- Yu Cui
- Department of Neurology, General Hospital of Northern Theatre Command, Shenyang, China
| | - Xin-Hong Wang
- Department of Neurology, General Hospital of Northern Theatre Command, Shenyang, China
| | - Yong Zhao
- Department of Neurology, Haicheng Hospital of Traditional Chinese Medicine, Haicheng, China
| | - Shao-Yuan Chen
- Department of Neurology, Chinese People's Liberation Army 321 Hospital, Baicheng, China
| | - Bao-Ying Sheng
- Department of Neurology, Jiamusi University First Affiliated Hospital, Jiamusi, China
| | - Li-Hua Wang
- Department of Neurology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Hui-Sheng Chen
- Department of Neurology, General Hospital of Northern Theatre Command, Shenyang, China
- *Correspondence: Hui-Sheng Chen
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5
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Yang L, Qian J, Yang B, He Q, Wang J, Weng Q. Challenges and Improvements of Novel Therapies for Ischemic Stroke. Front Pharmacol 2021; 12:721156. [PMID: 34658860 PMCID: PMC8514732 DOI: 10.3389/fphar.2021.721156] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 08/10/2021] [Indexed: 01/01/2023] Open
Abstract
Stroke is the third most common disease all over the world, which is regarded as a hotspot in medical research because of its high mortality and morbidity. Stroke, especially ischemic stroke, causes severe neural cell death, and no effective therapy is currently available for neuroregeneration after stroke. Although many therapies have been shown to be effective in preclinical studies of ischemic stroke, almost none of them passed clinical trials, and the reasons for most failures have not been well identified. In this review, we focus on several novel methods, such as traditional Chinese medicine, stem cell therapy, and exosomes that have not been used for ischemic stroke till recent decades. We summarize the proposed basic mechanisms underlying these therapies and related clinical results, discussing advantages and current limitations for each therapy emphatically. Based on the limitations such as side effects, narrow therapeutic window, and less accumulation at the injury region, structure transformation and drug combination are subsequently applied, providing a deep understanding to develop effective treatment strategies for ischemic stroke in the near future.
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Affiliation(s)
- Lijun Yang
- Center for Drug Safety Evaluation and Research, Zhejiang Province Key Laboratory of Anti-Cancer Drug Research, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
| | - Jing Qian
- Center for Drug Safety Evaluation and Research, Zhejiang Province Key Laboratory of Anti-Cancer Drug Research, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China.,Zhejiang Center for Drug and Cosmetic Evaluation, Hangzhou, China
| | - Bo Yang
- Center for Drug Safety Evaluation and Research, Zhejiang Province Key Laboratory of Anti-Cancer Drug Research, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
| | - Qiaojun He
- Center for Drug Safety Evaluation and Research, Zhejiang Province Key Laboratory of Anti-Cancer Drug Research, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China.,Department of Cardiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jiajia Wang
- Center for Drug Safety Evaluation and Research, Zhejiang Province Key Laboratory of Anti-Cancer Drug Research, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
| | - Qinjie Weng
- Center for Drug Safety Evaluation and Research, Zhejiang Province Key Laboratory of Anti-Cancer Drug Research, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China.,Department of Cardiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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6
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Spronk E, Sykes G, Falcione S, Munsterman D, Joy T, Kamtchum-Tatuene J, Jickling GC. Hemorrhagic Transformation in Ischemic Stroke and the Role of Inflammation. Front Neurol 2021; 12:661955. [PMID: 34054705 PMCID: PMC8160112 DOI: 10.3389/fneur.2021.661955] [Citation(s) in RCA: 72] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 03/29/2021] [Indexed: 01/01/2023] Open
Abstract
Hemorrhagic transformation (HT) is a common complication in patients with acute ischemic stroke. It occurs when peripheral blood extravasates across a disrupted blood brain barrier (BBB) into the brain following ischemic stroke. Preventing HT is important as it worsens stroke outcome and increases mortality. Factors associated with increased risk of HT include stroke severity, reperfusion therapy (thrombolysis and thrombectomy), hypertension, hyperglycemia, and age. Inflammation and the immune system are important contributors to BBB disruption and HT and are associated with many of the risk factors for HT. In this review, we present the relationship of inflammation and immune activation to HT in the context of reperfusion therapy, hypertension, hyperglycemia, and age. Differences in inflammatory pathways relating to HT are discussed. The role of inflammation to stratify the risk of HT and therapies targeting the immune system to reduce the risk of HT are presented.
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Affiliation(s)
- Elena Spronk
- Division of Neurology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Gina Sykes
- Division of Neurology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Sarina Falcione
- Division of Neurology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Danielle Munsterman
- Division of Neurology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Twinkle Joy
- Division of Neurology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Joseph Kamtchum-Tatuene
- Neuroscience and Mental Health Institute, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Glen C Jickling
- Division of Neurology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
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7
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Kong L, Ma Y, Wang Z, Liu N, Ma G, Liu C, Shi R, Du G. Inhibition of hypoxia inducible factor 1 by YC-1 attenuates tissue plasminogen activator induced hemorrhagic transformation by suppressing HMGB1/TLR4/NF-κB mediated neutrophil infiltration in thromboembolic stroke rats. Int Immunopharmacol 2021; 94:107507. [PMID: 33657523 DOI: 10.1016/j.intimp.2021.107507] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 01/27/2021] [Accepted: 02/11/2021] [Indexed: 12/13/2022]
Abstract
Hemorrhagic transformation (HT) is a frequent complication of ischemic stroke after thrombolytic therapy and seriously affects the prognosis of stroke. Due to the limited therapeutic window and hemorrhagic complications, tissue plasminogen activator (t-PA) is underutilized in acute ischemic stroke. Currently, there are no clinically effective drugs to decrease the incidence of t-PA-induced HT. Hypoxia-inducible factor 1 (HIF-1) is an important transcription factor that maintains oxygen homeostasis and mediates neuroinflammation under hypoxia. However, the effect of HIF-1 on t-PA-induced HT is not clear. The aim of this study was to investigate the role of HIF-1 in t-PA-induced HT by applying YC-1, an inhibitor of HIF-1. In the present study, we found that HIF-1 expression was significantly increased in ischemic brain tissue after delayed t-PA treatment and was mainly localized in neurons and endothelial cells. Inhibition of HIF-1 by YC-1 improved infarct volume and neurological deficits. YC-1 inhibited matrix metalloproteinase protein expression, increased tight junction protein expression, and ameliorated BBB disruption and the occurrence of HT. Furthermore, YC-1 suppressed the release of inflammatory factors, neutrophil infiltration and the activation of the HMGB1/TLR4/NF-κB signaling pathway. These results demonstrated that inhibition of HIF-1 could protect BBB integrity by suppressing HMGB1/TLR4/NF-κB-mediated neutrophil infiltration, thereby reducing the risk of t-PA-induced HT. Thus, HIF-1 may be a potential therapeutic target for t-PA-induced HT.
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Affiliation(s)
- Linglei Kong
- Beijing Key Laboratory of Drug Targets Identification and Drug Screening, Centre for Pharmaceutical Screening, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100050, China
| | - Yinzhong Ma
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Zhiyuan Wang
- State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Key Laboratory of Neuropsychopharmacology, Beijing Institute of Pharmacology and Toxicology, Beijing 100850, China
| | - Nannan Liu
- Guangdong Pharmaceutical University, Guangzhou 510006, China
| | - Guodong Ma
- Beijing Key Laboratory of Drug Targets Identification and Drug Screening, Centre for Pharmaceutical Screening, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100050, China
| | - Chengdi Liu
- Beijing Key Laboratory of Drug Targets Identification and Drug Screening, Centre for Pharmaceutical Screening, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100050, China
| | - Ruili Shi
- Department of Physiology, Baotou Medical College, Baotou 014060, China.
| | - Guanhua Du
- Beijing Key Laboratory of Drug Targets Identification and Drug Screening, Centre for Pharmaceutical Screening, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100050, China.
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8
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Bi Y, Shen J, Chen SC, Chen JX, Xia YP. Prognostic value of neutrophil to lymphocyte ratio in acute ischemic stroke after reperfusion therapy. Sci Rep 2021; 11:6177. [PMID: 33731740 PMCID: PMC7971057 DOI: 10.1038/s41598-021-85373-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 02/24/2021] [Indexed: 12/12/2022] Open
Abstract
The purpose of this study was to investigate whether baseline neutrophil to lymphocyte ratio (NLR) was an independent predictor for early symptomatic intracranial hemorrhage (sICH), poor functional outcome and mortality at 3 months after reperfusion therapy in acute ischemic stroke (AIS) patients. Using PubMed and EMBASE, we searched for literature published before January 19th, 2019. Two reviewers independently confirmed each study’s eligibility, assessed risk of bias, and extracted data. One reviewer combined studies using random effects meta-analysis. 9 studies with 3651 patients were pooled in the meta-analysis. Overall, baseline NLR levels were greater in patients with poor outcome. The standardized mean difference (SMD) in the NLR levels between patients with poor functional outcome (mRS > 2) and good functional outcome (mRS ≤ 2) was 0.54 units (95% credible interval [CI] [0.38, 0.70]). Heterogeneity test showed that there were significant differences between individual studies (p = 0.02; I2 = 72.8%). The NLR levels were associated with sICH in four included studies (n = 2003, SMD = 0.78, 95% [CI] [0.18, 1.38], I2 = 73.9%). Higher NLR levels were positively correlated with 3-month mortality (n = 1389, ES = 1.71, 95% CI [1.01,2.42], p < 0.01, I2 = 0%) when data were used as categorical variables. Our meta-analysis suggests that increased NLR levels are positively associated with greater risk of sICH, 3-month poor functional outcome and 3-month mortality in AIS patients undergoing reperfusion treatments. Although there are some deficits in this study, it may be feasible to predict the prognosis of reperfusion therapy in AIS patients with NLR levels.
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Affiliation(s)
- Ying Bi
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Jing Shen
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Sheng-Cai Chen
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Ji-Xiang Chen
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
| | - Yuan-Peng Xia
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
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9
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Shi K, Zou M, Jia DM, Shi S, Yang X, Liu Q, Dong JF, Sheth KN, Wang X, Shi FD. tPA Mobilizes Immune Cells That Exacerbate Hemorrhagic Transformation in Stroke. Circ Res 2021; 128:62-75. [PMID: 33070717 DOI: 10.1161/circresaha.120.317596] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
RATIONALE Hemorrhagic complications represent a major limitation of intravenous thrombolysis using tPA (tissue-type plasminogen activator) in patients with ischemic stroke. The expression of tPA receptors on immune cells raises the question of what effects tPA exerts on these cells and whether these effects contribute to thrombolysis-related hemorrhagic transformation. OBJECTIVE We aim to determine the impact of tPA on immune cells and investigate the association between observed immune alteration with hemorrhagic transformation in ischemic stroke patients and in a rat model of embolic stroke. METHODS AND RESULTS Paired blood samples were collected before and 1 hour after tPA infusion from 71 patients with ischemic stroke. Control blood samples were collected from 27 ischemic stroke patients without tPA treatment. A rat embolic middle cerebral artery occlusion model was adopted to investigate the underlying mechanisms of hemorrhagic transformation. We report that tPA induces a swift surge of circulating neutrophils and T cells with profoundly altered molecular features in ischemic stroke patients and a rat model of focal embolic stroke. tPA exacerbates endothelial injury, increases adhesion and migration of neutrophils and T cells, which are associated with brain hemorrhage in rats subjected to embolic stroke. Genetic ablation of annexin A2 in neutrophils and T cells diminishes the effect of tPA on these cells. Decoupling the interaction between mobilized neutrophils/T cells and the neurovascular unit, achieved via a S1PR (sphingosine-1-phosphate receptor) 1 modulator RP101075 and a CCL2 (C-C motif chemokine ligand 2) synthesis inhibitor bindarit, which block lymphocyte egress and myeloid cell recruitment, respectively, attenuates hemorrhagic transformation and improves neurological function after tPA thrombolysis. CONCLUSIONS Our findings suggest that immune invasion of the neurovascular unit represents a previously unrecognized mechanism underlying tPA-mediated brain hemorrhage, which can be overcome by precise immune modulation during thrombolytic therapy.
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Affiliation(s)
- Kaibin Shi
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, China (K.S., M.Z., D.-M.J., X.Y., Q.L., F.-D.S.)
- China National Clinical Research Center for Neurological Diseases, Jing-Jin Center for Neuroinflammation, Beijing Tiantan Hospital, Capital Medical University, China (K.S., F.-D.S.)
| | - Ming Zou
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, China (K.S., M.Z., D.-M.J., X.Y., Q.L., F.-D.S.)
| | - Dong-Mei Jia
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, China (K.S., M.Z., D.-M.J., X.Y., Q.L., F.-D.S.)
| | - Samuel Shi
- Neuroscience Graduate Program, Arizona State University, Tempe (S.S.)
| | - Xiaoxia Yang
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, China (K.S., M.Z., D.-M.J., X.Y., Q.L., F.-D.S.)
| | - Qiang Liu
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, China (K.S., M.Z., D.-M.J., X.Y., Q.L., F.-D.S.)
| | - Jing-Fei Dong
- Division of Hematology, Department of Medicine, BloodWorks Northwest Research Institute, School of Medicine, University of Washington, Seattle (J.-f.D.)
| | - Kevin N Sheth
- Department of Neurology, Yale University School of Medicine, New Haven, CT (K.N.S.)
| | - Xiaoying Wang
- Department of Neurosurgery, Clinical Neuroscience Research Center, Tulane University School of Medicine, New Orleans, LA (X.W.)
| | - Fu-Dong Shi
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, China (K.S., M.Z., D.-M.J., X.Y., Q.L., F.-D.S.)
- China National Clinical Research Center for Neurological Diseases, Jing-Jin Center for Neuroinflammation, Beijing Tiantan Hospital, Capital Medical University, China (K.S., F.-D.S.)
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10
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Ma G, Pan Z, Kong L, Du G. Neuroinflammation in hemorrhagic transformation after tissue plasminogen activator thrombolysis: Potential mechanisms, targets, therapeutic drugs and biomarkers. Int Immunopharmacol 2020; 90:107216. [PMID: 33296780 DOI: 10.1016/j.intimp.2020.107216] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/18/2020] [Accepted: 11/16/2020] [Indexed: 12/11/2022]
Abstract
Hemorrhagic transformation (HT) is a common and serious complication following ischemic stroke, especially after tissue plasminogen activator (t-PA) thrombolysis, which is associated with increased mortality and disability. Due to the unknown mechanisms and targets of HT, there are no effective therapeutic drugs to decrease the incidence of HT. In recent years, many studies have found that neuroinflammation is closely related to the occurrence and development of HT after t-PA thrombolysis, including glial cell activation in the brain, peripheral inflammatory cell infiltration and the release of inflammatory factors, involving inflammation-related targets such as NF-κB, MAPK, HMGB1, TLR4 and NLRP3. Some drugs with anti-inflammatory activity have been shown to protect the BBB and reduce the risk of HT in preclinical experiments and clinical trials, including minocycline, fingolimod, tacrolimus, statins and some natural products. In addition, the changes in MMP-9, VAP-1, NLR, sICAM-1 and other inflammatory factors are closely related to the occurrence of HT, which may be potential biomarkers for the diagnosis and prognosis of HT. In this review, we summarize the potential inflammation-related mechanisms, targets, therapeutic drugs, and biomarkers associated with HT after t-PA thrombolysis and discuss the relationship between neuroinflammation and HT, which provides a reference for research on the mechanisms, prevention and treatment drugs, diagnosis and prognosis of HT.
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Affiliation(s)
- Guodong Ma
- Beijing Key Laboratory of Drug Targets Identification and Drug Screening, Centre for Pharmaceutical Screening, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100050, China
| | - Zirong Pan
- Beijing Key Laboratory of Drug Targets Identification and Drug Screening, Centre for Pharmaceutical Screening, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100050, China
| | - Linglei Kong
- Beijing Key Laboratory of Drug Targets Identification and Drug Screening, Centre for Pharmaceutical Screening, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100050, China.
| | - Guanhua Du
- Beijing Key Laboratory of Drug Targets Identification and Drug Screening, Centre for Pharmaceutical Screening, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100050, China.
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11
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Maestrini I, Tagzirt M, Gautier S, Dupont A, Mendyk AM, Susen S, Tailleux A, Vallez E, Staels B, Cordonnier C, Leys D, Bordet R. Analysis of the association of MPO and MMP-9 with stroke severity and outcome: Cohort study. Neurology 2020; 95:e97-e108. [PMID: 32111692 DOI: 10.1212/wnl.0000000000009179] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 12/10/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE In acute cerebral ischemia, circulating neutrophil count and neutrophil-to-lymphocyte ratio (NLR) are positively associated with stroke severity and worse outcomes. Mediators of this effect are unknown. We aimed to investigate (1) the relationship between plasma matrix metalloproteinase-9 (MMP-9) and myeloperoxidase (MPO) concentrations with stroke severity and outcome and (2) MMP-9 and MPO release after ex vivo stimulation of neutrophils by recombinant tissue plasminogen activator (rtPA). METHODS We analyzed data collected in 255 patients with supratentorial cerebral infarcts recruited within 48 hours of symptoms onset irrespective of rtPA treatment. The endpoints were excellent outcome (modified Rankin Scale score 0-1), symptomatic intracerebral hemorrhage (European Cooperative Acute Stroke Study-II definition), and death at 3 months. The role of rtPA treatment on peripheral neutrophil degranulation was investigated in 18 patients within 4.5 hours and after 72 hours. RESULTS Neutrophil counts, NLR, and MPO plasma concentrations, but not MMP-9, were positively correlated with stroke severity. Higher neutrophil counts and NLR were independently associated with worse outcomes and higher mortality rates at month 3. Higher MPO plasma concentrations, but not MMP-9, were associated with worse outcome. Neutrophil-derived MMP-9, after ex vivo rtPA stimulation, but not MPO, were higher after 72 hours in patients treated by IV rtPA but not associated with hemorrhagic transformation. CONCLUSIONS Neutrophil counts, NLR, and MPO plasma concentrations are associated with worse outcome in patients with acute cerebral ischemia, in contrast to MMP-9. Further investigations are needed to deepen our knowledge on MPO's role in the deleterious effect of neutrophils because it could represent a potential therapeutic target.
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Affiliation(s)
- Ilaria Maestrini
- From the Departments of Neurology (I.M., A.-M.M., C.C., D.L.) and Medical Pharmacology (S.G., R.B.), Degenerative and Vascular Cognitive Disorders, University Hospital CHU Lille, Inserm U1171, University of Lille, France; Department of Human Neurosciences (I.M.), "Sapienza" University of Rome, Italy; and European Genomic Institute for Diabetes (M.T., A.D., S.S., A.T., E.V., B.S.), University Hospital CHU Lille, Inserm U1011, Institut Pasteur of Lille, University of Lille, France
| | - Madjid Tagzirt
- From the Departments of Neurology (I.M., A.-M.M., C.C., D.L.) and Medical Pharmacology (S.G., R.B.), Degenerative and Vascular Cognitive Disorders, University Hospital CHU Lille, Inserm U1171, University of Lille, France; Department of Human Neurosciences (I.M.), "Sapienza" University of Rome, Italy; and European Genomic Institute for Diabetes (M.T., A.D., S.S., A.T., E.V., B.S.), University Hospital CHU Lille, Inserm U1011, Institut Pasteur of Lille, University of Lille, France
| | - Sophie Gautier
- From the Departments of Neurology (I.M., A.-M.M., C.C., D.L.) and Medical Pharmacology (S.G., R.B.), Degenerative and Vascular Cognitive Disorders, University Hospital CHU Lille, Inserm U1171, University of Lille, France; Department of Human Neurosciences (I.M.), "Sapienza" University of Rome, Italy; and European Genomic Institute for Diabetes (M.T., A.D., S.S., A.T., E.V., B.S.), University Hospital CHU Lille, Inserm U1011, Institut Pasteur of Lille, University of Lille, France
| | - Annabelle Dupont
- From the Departments of Neurology (I.M., A.-M.M., C.C., D.L.) and Medical Pharmacology (S.G., R.B.), Degenerative and Vascular Cognitive Disorders, University Hospital CHU Lille, Inserm U1171, University of Lille, France; Department of Human Neurosciences (I.M.), "Sapienza" University of Rome, Italy; and European Genomic Institute for Diabetes (M.T., A.D., S.S., A.T., E.V., B.S.), University Hospital CHU Lille, Inserm U1011, Institut Pasteur of Lille, University of Lille, France
| | - Anne-Marie Mendyk
- From the Departments of Neurology (I.M., A.-M.M., C.C., D.L.) and Medical Pharmacology (S.G., R.B.), Degenerative and Vascular Cognitive Disorders, University Hospital CHU Lille, Inserm U1171, University of Lille, France; Department of Human Neurosciences (I.M.), "Sapienza" University of Rome, Italy; and European Genomic Institute for Diabetes (M.T., A.D., S.S., A.T., E.V., B.S.), University Hospital CHU Lille, Inserm U1011, Institut Pasteur of Lille, University of Lille, France
| | - Sophie Susen
- From the Departments of Neurology (I.M., A.-M.M., C.C., D.L.) and Medical Pharmacology (S.G., R.B.), Degenerative and Vascular Cognitive Disorders, University Hospital CHU Lille, Inserm U1171, University of Lille, France; Department of Human Neurosciences (I.M.), "Sapienza" University of Rome, Italy; and European Genomic Institute for Diabetes (M.T., A.D., S.S., A.T., E.V., B.S.), University Hospital CHU Lille, Inserm U1011, Institut Pasteur of Lille, University of Lille, France
| | - Anne Tailleux
- From the Departments of Neurology (I.M., A.-M.M., C.C., D.L.) and Medical Pharmacology (S.G., R.B.), Degenerative and Vascular Cognitive Disorders, University Hospital CHU Lille, Inserm U1171, University of Lille, France; Department of Human Neurosciences (I.M.), "Sapienza" University of Rome, Italy; and European Genomic Institute for Diabetes (M.T., A.D., S.S., A.T., E.V., B.S.), University Hospital CHU Lille, Inserm U1011, Institut Pasteur of Lille, University of Lille, France
| | - Emmanuelle Vallez
- From the Departments of Neurology (I.M., A.-M.M., C.C., D.L.) and Medical Pharmacology (S.G., R.B.), Degenerative and Vascular Cognitive Disorders, University Hospital CHU Lille, Inserm U1171, University of Lille, France; Department of Human Neurosciences (I.M.), "Sapienza" University of Rome, Italy; and European Genomic Institute for Diabetes (M.T., A.D., S.S., A.T., E.V., B.S.), University Hospital CHU Lille, Inserm U1011, Institut Pasteur of Lille, University of Lille, France
| | - Bart Staels
- From the Departments of Neurology (I.M., A.-M.M., C.C., D.L.) and Medical Pharmacology (S.G., R.B.), Degenerative and Vascular Cognitive Disorders, University Hospital CHU Lille, Inserm U1171, University of Lille, France; Department of Human Neurosciences (I.M.), "Sapienza" University of Rome, Italy; and European Genomic Institute for Diabetes (M.T., A.D., S.S., A.T., E.V., B.S.), University Hospital CHU Lille, Inserm U1011, Institut Pasteur of Lille, University of Lille, France
| | - Charlotte Cordonnier
- From the Departments of Neurology (I.M., A.-M.M., C.C., D.L.) and Medical Pharmacology (S.G., R.B.), Degenerative and Vascular Cognitive Disorders, University Hospital CHU Lille, Inserm U1171, University of Lille, France; Department of Human Neurosciences (I.M.), "Sapienza" University of Rome, Italy; and European Genomic Institute for Diabetes (M.T., A.D., S.S., A.T., E.V., B.S.), University Hospital CHU Lille, Inserm U1011, Institut Pasteur of Lille, University of Lille, France
| | - Didier Leys
- From the Departments of Neurology (I.M., A.-M.M., C.C., D.L.) and Medical Pharmacology (S.G., R.B.), Degenerative and Vascular Cognitive Disorders, University Hospital CHU Lille, Inserm U1171, University of Lille, France; Department of Human Neurosciences (I.M.), "Sapienza" University of Rome, Italy; and European Genomic Institute for Diabetes (M.T., A.D., S.S., A.T., E.V., B.S.), University Hospital CHU Lille, Inserm U1011, Institut Pasteur of Lille, University of Lille, France
| | - Regis Bordet
- From the Departments of Neurology (I.M., A.-M.M., C.C., D.L.) and Medical Pharmacology (S.G., R.B.), Degenerative and Vascular Cognitive Disorders, University Hospital CHU Lille, Inserm U1171, University of Lille, France; Department of Human Neurosciences (I.M.), "Sapienza" University of Rome, Italy; and European Genomic Institute for Diabetes (M.T., A.D., S.S., A.T., E.V., B.S.), University Hospital CHU Lille, Inserm U1011, Institut Pasteur of Lille, University of Lille, France.
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