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Kraglund KL, Mortensen JK, Damsbo AG, Modrau B, Simonsen SA, Iversen HK, Madsen M, Grove EL, Johnsen SP, Andersen G. Neuroregeneration and Vascular Protection by Citalopram in Acute Ischemic Stroke (TALOS). Stroke 2019; 49:2568-2576. [PMID: 30355209 DOI: 10.1161/strokeaha.117.020067] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background and Purpose- Recent studies indicate a possible beneficial effect on neuroregeneration and vascular protection of selective serotonin reuptake inhibitors after stroke. We conducted a national multicentre study to explore these effects. Methods- The TALOS study (The Efficacy of Citalopram Treatment in Acute Stroke) is a Danish placebo-controlled, randomized, double-blind study of citalopram started within 7 days after symptom onset to detect improvement in functional outcomes and cardiovascular protection in nondepressed, first-ever ischemic stroke. Study medication was given as add-on to standard medical care and treatment duration and follow-up was 6 months. There were 2 coprimary outcomes: changes in functional disability from 1 to 6 months on the modified Rankin Scale, and a composite vascular end point of transient ischemic attack/stroke, myocardial infarction, or vascular mortality during the first 6 months. Results- We enrolled 642 patients randomized to either citalopram (n=319) or placebo (n=323). Median National Institutes of Health Stroke Scale was 5.3 (range, 0-27) versus 4.8 (range, 0-28) at admission. Improvement in functional recovery from 1 to 6 months occurred in 160 (50%) patients on citalopram and 136 (42%) on placebo (odds ratio, 1.27; 95% CI, 0.92-1.74; P=0.057). When dropouts before 31 days were excluded (n=90), the analysis population showed an odds ratio of 1.37 (95% CI, 0.97-1.91; P=0.07). During a median follow-up of 150 days, 23 (7%) patients in the citalopram group and 26 (8%) patients in the placebo group had a primary, vascular end point (hazard ratio, 0.89; 95% CI, 0.50-1.60; P=0.24). A total of 28 patients (4%) died (16 versus 12; P=0.42) during the study. Conclusions- Early citalopram treatment did not improve functional recovery in nondepressed ischemic stroke patients within the first 6 months, although a borderline statistical significant effect was observed in the analysis population. The risk of cardiovascular events was similar between treatment groups, and citalopram treatment was well tolerated. Clinical Trial Registration- URL: https://www.clinicaltrials.gov . Unique identifier: NCT01937182. URL: https://www.clinicaltrialsregister.eu/ . EudraCT number: 2013-002253-30.
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Affiliation(s)
- Kristian Lundsgaard Kraglund
- From the Department of Neurology, Acute Stroke Unit, Aarhus University Hospital, Denmark (K.L.K., J.K.M., A.G.D., G.A.).,Department of Clinical Epidemiology, Aarhus University Hospital, Denmark (M.M., S.P.J.).,Department of Cardiology, Aarhus University Hospital, Denmark (E.L.G.).,Department of Neurology, Acute Stroke Unit, Aalborg University Hospital, Denmark (B.M.).,Department of Neurology, Acute Stroke Unit, Rigshospitalet, University of Copenhagen, Denmark (S.A.S., H.K.I.).,Faculty of Health, Institute of Clinical Medicine, Aarhus University, Denmark (E.L.G., S.P.J., G.A.)
| | - Janne Kaergaard Mortensen
- From the Department of Neurology, Acute Stroke Unit, Aarhus University Hospital, Denmark (K.L.K., J.K.M., A.G.D., G.A.).,Department of Clinical Epidemiology, Aarhus University Hospital, Denmark (M.M., S.P.J.).,Department of Cardiology, Aarhus University Hospital, Denmark (E.L.G.).,Department of Neurology, Acute Stroke Unit, Aalborg University Hospital, Denmark (B.M.).,Department of Neurology, Acute Stroke Unit, Rigshospitalet, University of Copenhagen, Denmark (S.A.S., H.K.I.).,Faculty of Health, Institute of Clinical Medicine, Aarhus University, Denmark (E.L.G., S.P.J., G.A.)
| | - Andreas Gammelgaard Damsbo
- From the Department of Neurology, Acute Stroke Unit, Aarhus University Hospital, Denmark (K.L.K., J.K.M., A.G.D., G.A.).,Department of Clinical Epidemiology, Aarhus University Hospital, Denmark (M.M., S.P.J.).,Department of Cardiology, Aarhus University Hospital, Denmark (E.L.G.).,Department of Neurology, Acute Stroke Unit, Aalborg University Hospital, Denmark (B.M.).,Department of Neurology, Acute Stroke Unit, Rigshospitalet, University of Copenhagen, Denmark (S.A.S., H.K.I.).,Faculty of Health, Institute of Clinical Medicine, Aarhus University, Denmark (E.L.G., S.P.J., G.A.)
| | - Boris Modrau
- From the Department of Neurology, Acute Stroke Unit, Aarhus University Hospital, Denmark (K.L.K., J.K.M., A.G.D., G.A.).,Department of Clinical Epidemiology, Aarhus University Hospital, Denmark (M.M., S.P.J.).,Department of Cardiology, Aarhus University Hospital, Denmark (E.L.G.).,Department of Neurology, Acute Stroke Unit, Aalborg University Hospital, Denmark (B.M.).,Department of Neurology, Acute Stroke Unit, Rigshospitalet, University of Copenhagen, Denmark (S.A.S., H.K.I.).,Faculty of Health, Institute of Clinical Medicine, Aarhus University, Denmark (E.L.G., S.P.J., G.A.)
| | - Sofie Amalie Simonsen
- From the Department of Neurology, Acute Stroke Unit, Aarhus University Hospital, Denmark (K.L.K., J.K.M., A.G.D., G.A.).,Department of Clinical Epidemiology, Aarhus University Hospital, Denmark (M.M., S.P.J.).,Department of Cardiology, Aarhus University Hospital, Denmark (E.L.G.).,Department of Neurology, Acute Stroke Unit, Aalborg University Hospital, Denmark (B.M.).,Department of Neurology, Acute Stroke Unit, Rigshospitalet, University of Copenhagen, Denmark (S.A.S., H.K.I.).,Faculty of Health, Institute of Clinical Medicine, Aarhus University, Denmark (E.L.G., S.P.J., G.A.)
| | - Helle Klingenberg Iversen
- From the Department of Neurology, Acute Stroke Unit, Aarhus University Hospital, Denmark (K.L.K., J.K.M., A.G.D., G.A.).,Department of Clinical Epidemiology, Aarhus University Hospital, Denmark (M.M., S.P.J.).,Department of Cardiology, Aarhus University Hospital, Denmark (E.L.G.).,Department of Neurology, Acute Stroke Unit, Aalborg University Hospital, Denmark (B.M.).,Department of Neurology, Acute Stroke Unit, Rigshospitalet, University of Copenhagen, Denmark (S.A.S., H.K.I.).,Faculty of Health, Institute of Clinical Medicine, Aarhus University, Denmark (E.L.G., S.P.J., G.A.)
| | - Morten Madsen
- From the Department of Neurology, Acute Stroke Unit, Aarhus University Hospital, Denmark (K.L.K., J.K.M., A.G.D., G.A.).,Department of Clinical Epidemiology, Aarhus University Hospital, Denmark (M.M., S.P.J.).,Department of Cardiology, Aarhus University Hospital, Denmark (E.L.G.).,Department of Neurology, Acute Stroke Unit, Aalborg University Hospital, Denmark (B.M.).,Department of Neurology, Acute Stroke Unit, Rigshospitalet, University of Copenhagen, Denmark (S.A.S., H.K.I.).,Faculty of Health, Institute of Clinical Medicine, Aarhus University, Denmark (E.L.G., S.P.J., G.A.)
| | - Erik Lerkevang Grove
- From the Department of Neurology, Acute Stroke Unit, Aarhus University Hospital, Denmark (K.L.K., J.K.M., A.G.D., G.A.).,Department of Clinical Epidemiology, Aarhus University Hospital, Denmark (M.M., S.P.J.).,Department of Cardiology, Aarhus University Hospital, Denmark (E.L.G.).,Department of Neurology, Acute Stroke Unit, Aalborg University Hospital, Denmark (B.M.).,Department of Neurology, Acute Stroke Unit, Rigshospitalet, University of Copenhagen, Denmark (S.A.S., H.K.I.).,Faculty of Health, Institute of Clinical Medicine, Aarhus University, Denmark (E.L.G., S.P.J., G.A.)
| | - Søren Paaske Johnsen
- From the Department of Neurology, Acute Stroke Unit, Aarhus University Hospital, Denmark (K.L.K., J.K.M., A.G.D., G.A.).,Department of Clinical Epidemiology, Aarhus University Hospital, Denmark (M.M., S.P.J.).,Department of Cardiology, Aarhus University Hospital, Denmark (E.L.G.).,Department of Neurology, Acute Stroke Unit, Aalborg University Hospital, Denmark (B.M.).,Department of Neurology, Acute Stroke Unit, Rigshospitalet, University of Copenhagen, Denmark (S.A.S., H.K.I.).,Faculty of Health, Institute of Clinical Medicine, Aarhus University, Denmark (E.L.G., S.P.J., G.A.)
| | - Grethe Andersen
- From the Department of Neurology, Acute Stroke Unit, Aarhus University Hospital, Denmark (K.L.K., J.K.M., A.G.D., G.A.).,Department of Clinical Epidemiology, Aarhus University Hospital, Denmark (M.M., S.P.J.).,Department of Cardiology, Aarhus University Hospital, Denmark (E.L.G.).,Department of Neurology, Acute Stroke Unit, Aalborg University Hospital, Denmark (B.M.).,Department of Neurology, Acute Stroke Unit, Rigshospitalet, University of Copenhagen, Denmark (S.A.S., H.K.I.).,Faculty of Health, Institute of Clinical Medicine, Aarhus University, Denmark (E.L.G., S.P.J., G.A.)
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Ormonde do Carmo MBO, Mendes-Ribeiro AC, Matsuura C, Pinto VL, Mury WV, Pinto NO, Moss MB, Ferraz MR, Brunini TMC. Major depression induces oxidative stress and platelet hyperaggregability. J Psychiatr Res 2015; 61:19-24. [PMID: 25560770 DOI: 10.1016/j.jpsychires.2014.12.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 10/14/2014] [Accepted: 12/11/2014] [Indexed: 12/11/2022]
Abstract
We have previously demonstrated an impairment of intraplatelet L-arginine-nitric oxide-cGMP pathway in major depression (MD) associated to platelet dysfunction. Here, we evaluated arginase pathway and phosphodiesterase 5 (PDE5) expression in platelets, systemic and intraplatelet oxidative status in untreated MD patients, and their effects on platelet aggregation. Blood samples were collected from 22 treatment naive MD patients (31 ± 2 yr) and 27 healthy subjects (33 ± 2 yr). MD patients presented with an activation of platelet arginase II, which competes with L-arginine for the production of nitric oxide (NO). An increase in protein carbonylation, overexpression of NADPH oxidase and PDE5, an enzyme that inactivates cGMP, was observed in platelets from MD patients compared to controls. In this context, platelet hyperaggregability was found in MD patients. On the other hand, antioxidant enzymes catalase, glutathione peroxidase and superoxide dismutase activities in serum and in platelets did not differ between groups. The increased activation of intraplatelet arginase and platelet aggregability, in addition to an overexpression of PDE5 and oxidative stress may contribute to alterations in L-arginine-NO-cGMP pathway and in platelet function, and consequently to the increased thrombotic risk in MD.
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Affiliation(s)
| | - Antônio Cláudio Mendes-Ribeiro
- Department of Pharmacology and Psychobiology, University of the State of Rio de Janeiro, Rio de Janeiro, Brazil; Department of Physiological Sciences, Federal University of the State of Rio de Janeiro, Brazil
| | - Cristiane Matsuura
- Department of Pharmacology and Psychobiology, University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Vivian L Pinto
- Department of Pharmacology and Psychobiology, University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Wanda V Mury
- Department of Pharmacology and Psychobiology, University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Nathalia O Pinto
- Department of Pharmacology and Psychobiology, University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Monique B Moss
- Department of Pharmacology and Psychobiology, University of the State of Rio de Janeiro, Rio de Janeiro, Brazil; Department of Physiological Sciences, Federal University of the State of Rio de Janeiro, Brazil
| | - Marcos Rochedo Ferraz
- Department of Pharmacology and Psychobiology, University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Tatiana M C Brunini
- Department of Pharmacology and Psychobiology, University of the State of Rio de Janeiro, Rio de Janeiro, Brazil.
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Rutten B, Tersteeg C, Vrijenhoek JEP, van Holten TC, Elsenberg EHAM, Mak-Nienhuis EM, de Borst GJ, Jukema JW, Pijls NHJ, Waltenberger J, van Zonneveld AJ, Moll FL, McClellan E, Stubbs A, Pasterkamp G, Hoefer I, de Groot PG, Roest M. Increased platelet reactivity is associated with circulating platelet-monocyte complexes and macrophages in human atherosclerotic plaques. PLoS One 2014; 9:e105019. [PMID: 25122139 PMCID: PMC4133361 DOI: 10.1371/journal.pone.0105019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 06/29/2014] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE Platelet reactivity, platelet binding to monocytes and monocyte infiltration play a detrimental role in atherosclerotic plaque progression. We investigated whether platelet reactivity was associated with levels of circulating platelet-monocyte complexes (PMCs) and macrophages in human atherosclerotic carotid plaques. METHODS Platelet reactivity was determined by measuring platelet P-selectin expression after platelet stimulation with increasing concentrations of adenosine diphosphate (ADP), in two independent cohorts: the Circulating Cells cohort (n = 244) and the Athero-Express cohort (n = 91). Levels of PMCs were assessed by flow cytometry in blood samples of patients who were scheduled for percutaneous coronary intervention (Circulating Cells cohort). Monocyte infiltration was semi-quantitatively determined by histological examination of atherosclerotic carotid plaques collected during carotid endarterectomy (Athero-Express cohort). RESULTS We found increased platelet reactivity in patients with high PMCs as compared to patients with low PMCs (median (interquartile range): 4153 (1585-11267) area under the curve (AUC) vs. 9633 (3580-21565) AUC, P<0.001). Also, we observed increased platelet reactivity in patients with high macrophage levels in atherosclerotic plaques as compared to patients with low macrophage levels in atherosclerotic plaques (mean ± SD; 8969 ± 3485 AUC vs. 7020 ± 3442 AUC, P = 0.02). All associations remained significant after adjustment for age, sex and use of drugs against platelet activation. CONCLUSION Platelet reactivity towards ADP is associated with levels of PMCs and macrophages in human atherosclerotic carotid plaques.
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Affiliation(s)
- Bert Rutten
- Laboratory of Clinical Chemistry and Hematology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Claudia Tersteeg
- Laboratory of Clinical Chemistry and Hematology, University Medical Center Utrecht, Utrecht, the Netherlands
- Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Joyce E. P. Vrijenhoek
- Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
- Interuniversity Cardiology Institute of the Netherlands, Utrecht, the Netherlands
| | - Thijs C. van Holten
- Laboratory of Clinical Chemistry and Hematology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Ellen H. A. M. Elsenberg
- Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Elske M. Mak-Nienhuis
- Laboratory of Clinical Chemistry and Hematology, University Medical Center Utrecht, Utrecht, the Netherlands
- Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Gert Jan de Borst
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - J. Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Nico H. J. Pijls
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands
| | - Johannes Waltenberger
- Department for Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Anton Jan van Zonneveld
- Department of Nephrology and Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Frans L. Moll
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Elizabeth McClellan
- Department of Bioinformatics, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Andrew Stubbs
- Department of Bioinformatics, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Gerard Pasterkamp
- Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Imo Hoefer
- Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Philip G. de Groot
- Laboratory of Clinical Chemistry and Hematology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Mark Roest
- Laboratory of Clinical Chemistry and Hematology, University Medical Center Utrecht, Utrecht, the Netherlands
- * E-mail:
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