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Wang W, Lu D, Shi Y, Wang Y. Exploring the Neuroprotective Effects of Lithium in Ischemic Stroke: A literature review. Int J Med Sci 2024; 21:284-298. [PMID: 38169754 PMCID: PMC10758146 DOI: 10.7150/ijms.88195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 11/17/2023] [Indexed: 01/05/2024] Open
Abstract
Ischemic stroke ranks among the foremost clinical causes of mortality and disability, instigating neuronal degeneration, fatalities, and various sequelae. While standard treatments, such as intravenous thrombolysis and endovascular thrombectomy, prove effective, they come with limitations. Hence, there is a compelling need to develop neuroprotective agents capable of improving the functional outcomes of the nervous system. Numerous preclinical studies have demonstrated that lithium can act in multiple molecular pathways, including glycogen synthase kinase 3(GSK-3), the Wnt signaling pathway, the mitogen-activated protein kinase (MAPK)/ extracellular signal-regulated kinase (ERK) signaling pathway, brain-derived neurotrophic factor (BDNF), mammalian target of rapamycin (mTOR), and glutamate receptors. Through these pathways, lithium has been shown to affect inflammation, autophagy, apoptosis, ferroptosis, excitotoxicity, and other pathological processes, thereby improving central nervous system (CNS) damage caused by ischemic stroke. Despite these promising preclinical findings, the number of clinical trials exploring lithium's efficacy remains limited. Additional trials are imperative to thoroughly ascertain the effectiveness and safety of lithium in clinical settings. This review delineates the mechanisms underpinning lithium's neuroprotective capabilities in the context of ischemic stroke. It elucidates the intricate interplay between these mechanisms and sheds light on the involvement of mitochondrial dysfunction and inflammatory markers in the pathophysiology of ischemic stroke. Furthermore, the review offers directions for future research, thereby advancing the understanding of the potential therapeutic utility of lithium and establishing a theoretical foundation for its clinical application.
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Affiliation(s)
- Weihua Wang
- Department of Emergency, Affiliated Hospital of Weifang Medical University, Weifang, Shandong 261031, P.R. China
| | - Dunlin Lu
- Department of Emergency, Affiliated Hospital of Weifang Medical University, Weifang, Shandong 261031, P.R. China
| | - Youkui Shi
- Department of Emergency, Affiliated Hospital of Weifang Medical University, Weifang, Shandong 261031, P.R. China
| | - Yanqiang Wang
- Department of Neurology Ⅱ, Affiliated Hospital of Weifang Medical University, Weifang, Shandong 261031, P.R. China
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Liu Y, Liu L, Zhi Z, Chen R, Wang Q, Wang M, Wang Y, Zhao L. Higher serum lipocalin 2 is associated with post-stroke depression at discharge. BMC Neurol 2023; 23:294. [PMID: 37543589 PMCID: PMC10403916 DOI: 10.1186/s12883-023-03319-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 07/05/2023] [Indexed: 08/07/2023] Open
Abstract
BACKGROUND AND AIMS Post-stroke depression (PSD), as one of the common complications after stroke, seriously affects the physical and mental health and functional prognosis of patients. Previous studies have shown that the increase of inflammatory mediators is associated with the occurrence of PSD. Lipocalin 2 (LCN2), as an acute phase protein, is involved in the development of acute ischemic stroke (AIS), and its expression is up-regulated in patients with depression, suggesting that there is a potential correlation between serum LCN2 and depression. The aim of this study was to explore the relationship between serum LCN2 at admission and PSD at discharge. METHODS A total of 358 AIS patients were retrospectively included. All patients had fasting venous blood taken within 24 h of admission to detect serum LCN2. The patients were evaluated by 17-item Hamilton Depression Scale (HAMD) before discharge. Patients with HAMD score > 7 were diagnosed with PSD. The correlation between serum LCN2 and PSD was tested using binary logistic regression analysis. RESULTS In our study, 92 (25.7%) patients were diagnosed with PSD at discharge. According to the serum LCN2 value, the patients were divided into three layers (Tertile1 ≤ 105.24ng/ml; Tertile2: 105.24-140.12ng/ml; Tertile3 ≥ 140.12ng/ml), with T1 layer (the lowest levels) as a reference, after adjusting for multiple potential confounding factors, T3 layer (the highest levels) was independently associated with the occurrence of PSD (odds ratio [OR] = 2.639, 95% confidence interval [CI]: 1.317-5.287, P = 0.006). Similar results were found when the serum LCN2 was analyzed as a continuous variable. The optimal cut-off value of serum LCN2 at admission to predict PSD at discharge was 117.60ng/ml, at this threshold, the sensitivity was 77.2%, and the specificity was 53.4%. CONCLUSIONS High serum LCN2 levels at admission are an independent risk factor for PSD in patients with AIS at discharge.
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Affiliation(s)
- Yufeng Liu
- Department of Neurology, Affiliated Huai'an Hospital of Xuzhou Medical University, No.62, South Huaihai Road, Huai'an 223002, Huai'an, 223002, Jiangsu, China
| | - Lu Liu
- Department of Neurology, Affiliated Huai'an Hospital of Xuzhou Medical University, No.62, South Huaihai Road, Huai'an 223002, Huai'an, 223002, Jiangsu, China
| | - Zhongwen Zhi
- Department of Neurology, Affiliated Huai'an Hospital of Xuzhou Medical University, No.62, South Huaihai Road, Huai'an 223002, Huai'an, 223002, Jiangsu, China
| | - Rui Chen
- Department of Neurology, Affiliated Huai'an Hospital of Xuzhou Medical University, No.62, South Huaihai Road, Huai'an 223002, Huai'an, 223002, Jiangsu, China
| | - Qing Wang
- Department of Neurology, Affiliated Huai'an Hospital of Xuzhou Medical University, No.62, South Huaihai Road, Huai'an 223002, Huai'an, 223002, Jiangsu, China
| | - Mengchao Wang
- Department of Neurology, Affiliated Huai'an Hospital of Xuzhou Medical University, No.62, South Huaihai Road, Huai'an 223002, Huai'an, 223002, Jiangsu, China
| | - Yuqian Wang
- Department of Neurology, Affiliated Huai'an Hospital of Xuzhou Medical University, No.62, South Huaihai Road, Huai'an 223002, Huai'an, 223002, Jiangsu, China.
| | - Liandong Zhao
- Department of Neurology, Affiliated Huai'an Hospital of Xuzhou Medical University, No.62, South Huaihai Road, Huai'an 223002, Huai'an, 223002, Jiangsu, China.
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