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Cui P, Hou H, Song B, Xia Z, Xu Y. Vitamin D and ischemic stroke - Association, mechanisms, and therapeutics. Ageing Res Rev 2024; 96:102244. [PMID: 38395199 DOI: 10.1016/j.arr.2024.102244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 02/07/2024] [Accepted: 02/19/2024] [Indexed: 02/25/2024]
Abstract
Confronting the rising tide of ischemic stroke and its associated mortality and morbidity with ageing, prevention and acute management of ischemic stroke is of paramount importance. Mounting observational studies have established a non-linear association of vitamin D status with cardiovascular diseases, including ischemic stroke. Paradoxically, current clinical trials fail to demonstrate the cardiovascular benefits of vitamin D supplementation. We aim to update recent clinical and experimental findings on the role of vitamin D in the disease course of ischemic stroke, from its onset, progression, recovery, to recurrence, and the established and alternative possible pathophysiological mechanisms. This review justifies the necessities to address stroke etiological subtypes and focus on vitamin D-deficient subjects for investigating the potential of vitamin D supplementation as a preventive and therapeutic approach for ischemic stroke. Well-powered clinical trials are warranted to determine the efficacy, safety, timing, target individuals, optimal dosages, and target 25OHD concentrations of vitamin D supplementation in the prevention and treatment of ischemic stroke.
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Affiliation(s)
- Pan Cui
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China; NHC Key Laboratory of Prevention and Treatment of Cerebrovascular Diseases, Zhengzhou, Henan, China; Clinical Systems Biology Laboratories, Translation Medicine Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, Henan, China
| | - Haiman Hou
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Bo Song
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China; NHC Key Laboratory of Prevention and Treatment of Cerebrovascular Diseases, Zhengzhou, Henan, China
| | - Zongping Xia
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China; NHC Key Laboratory of Prevention and Treatment of Cerebrovascular Diseases, Zhengzhou, Henan, China; Clinical Systems Biology Laboratories, Translation Medicine Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, Henan, China.
| | - Yuming Xu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China; NHC Key Laboratory of Prevention and Treatment of Cerebrovascular Diseases, Zhengzhou, Henan, China; Henan Key Laboratory of Cerebrovascular Diseases, Zhengzhou University, Zhengzhou, Henan, China.
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Liu S, Lv Y, Zhang Y, Suo H, Wang F, Gao S. Global trends and burden of stroke attributable to particulate matter pollution from 1990 to 2019. Ecotoxicol Environ Saf 2024; 274:116205. [PMID: 38503105 DOI: 10.1016/j.ecoenv.2024.116205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 03/08/2024] [Accepted: 03/09/2024] [Indexed: 03/21/2024]
Abstract
OBJECTIVE To investigate the association between particulate matter and the incidence, disability, and mortality of stroke, we reported the burden of stroke attributable to particulate matter (PM2.5) pollution, including ambient particulate matter pollution (APMP) and household air pollution from solid fuels (HAP), from 1990 to 2019. METHODS We retrieved the detailed data on the burden of stroke attributable to PM2.5 from the Global Burden of Disease (GBD) 2019. The number of disability-adjusted life-years (DALYs) and deaths, age-standardized death rates (ASMR), and age-standardized disability-adjusted life-years rates (ASDR) attributable to PM2.5 were estimated by age, sex, geographical location, socio-demographic index (SDI), and stroke subtypes (ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage). The estimated annual percentage change (EAPC) was calculated to assess the trends in ASDR and ASMR during the period 1990-2019. RESULTS Regarding stroke subtypes, the proportion of ischemic stroke burden is increasing, while intracerebral hemorrhage carries the heaviest burden. Both APMP and HAP contributed the most to stroke-related deaths and DALYs of stroke among the elderly populations and males. The highest ASDR and ASMR of stroke attributable to APMP were in the middle SDI regions, especially in East Asia. For HAP, the highest ASDR and ASMR were in the low SDI regions, mainly in Oceania. From 1990-2019, in terms of the EAPC results, APMP caused an increased burden of stroke, whereas the impact of HAP significantly fell. The most pronounced increase in ASDR and ASMR for strokes attributed to APMP were in the low-middle SDI and low SDI regions, particularly among the 25-35 age group. CONCLUSIONS Stroke attributed to PM2.5 is a global health problem, and the patterns and trends were heterogeneous across APMP and HAP. Targeted interventions should be formulated for APMP and HAP.
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Affiliation(s)
- Siqi Liu
- Department of Toxicology, School of Public Health, Harbin Medical University, Heilongjiang Province, China
| | - Yanming Lv
- Department of Toxicology, School of Public Health, Harbin Medical University, Heilongjiang Province, China
| | - Ya Zhang
- Department of Toxicology, School of Public Health, Harbin Medical University, Heilongjiang Province, China
| | - Huimin Suo
- Department of Toxicology, School of Public Health, Harbin Medical University, Heilongjiang Province, China
| | - Fan Wang
- Department of Epidemiology, School of Public Health, Harbin Medical University, Heilongjiang Province, China
| | - Shuying Gao
- Department of Toxicology, School of Public Health, Harbin Medical University, Heilongjiang Province, China.
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Benkő S, Dénes Á. Microglial Inflammatory Mechanisms in Stroke: The Jury Is Still Out. Neuroscience 2024:S0306-4522(24)00057-5. [PMID: 38364965 DOI: 10.1016/j.neuroscience.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 02/09/2024] [Accepted: 02/12/2024] [Indexed: 02/18/2024]
Abstract
Microglia represent the main immune cell population in the CNS with unique homeostatic roles and contribution to broad neurological conditions. Stroke is associated with marked changes in microglial phenotypes and induction of inflammatory responses, which emerge as key modulators of brain injury, neurological outcome and regeneration. However, due to the limited availability of functional studies with selective targeting of microglia and microglia-related inflammatory pathways in stroke, the vast majority of observations remain correlative and controversial. Because extensive review articles discussing the role of inflammatory mechanisms in different forms of acute brain injury are available, here we focus on some specific pathways that appear to be important for stroke pathophysiology with assumed contribution by microglia. While the growing toolkit for microglia manipulation increasingly allows targeting inflammatory pathways in a cell-specific manner, reconsideration of some effects devoted to microglia may also be required. This may particularly concern the interpretation of inflammatory mechanisms that emerge in response to stroke as a form of sterile injury and change markedly in chronic inflammation and common stroke comorbidities.
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Affiliation(s)
- Szilvia Benkő
- Laboratory of Inflammation-Physiology, Department of Physiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.
| | - Ádám Dénes
- "Momentum" Laboratory of Neuroimmunology, Institute of Experimental Medicine, Budapest H-1083, Hungary.
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Kousholt BS, Præstegaard KF, Stone JC, Thomsen AF, Johansen TT, Ritskes-Hoitinga M, Wegener G. Reporting quality in preclinical animal experimental research in 2009 and 2018: A nationwide systematic investigation. PLoS One 2022; 17:e0275962. [PMID: 36327216 DOI: 10.1371/journal.pone.0275962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 09/27/2022] [Indexed: 11/05/2022] Open
Abstract
Lack of translation and irreproducibility challenge preclinical animal research. Insufficient reporting methodologies to safeguard study quality is part of the reason. This nationwide study investigates the reporting prevalence of these methodologies and scrutinizes the reported information’s level of detail. Publications were from two time periods to convey any reporting progress and had at least one author affiliated to a Danish University. We retrieved all relevant animal experimental studies using a predefined research protocol and a systematic search. A random sampling of 250 studies from 2009 and 2018 led to 500 publications in total. Reporting of measures known to impact study results estimates were assessed. Part I discloses a simplified two-level scoring “yes/no” to identify the presence of reporting. Part II demonstrates an additional three-level scoring to analyze the reported information’s level of detail. Overall reporting prevalence is low, although minor improvements are noted. Reporting of randomization increased from 24.0% in 2009 to 40.8% in 2018, blinded experiment conduct from 2.4% to 4.4%, blinded outcome assessment from 23.6% to 38.0%, and sample size calculation from 3.2% to 14.0%. Poor reporting of details is striking with reporting of the random allocation method to groups being only 1.2% in 2009 and 6.0% in 2018. Reporting of sample size calculation method was 2.4% in 2009 and 7.6% in 2018. Only conflict-of-interest statements reporting increased from 37.6% in 2009 to 90.4%. Measures safeguarding study quality are poorly reported in publications affiliated with Danish research institutions. Only a modest improvement was noted during the period 2009–2018, and the lack of details urgently prompts institutional strategies to accelerate this. We suggest thorough teaching in designing, conducting and reporting animal studies. Education in systematic review methodology should be implemented in this training and will increase motivation and behavior working towards quality improvements in science.
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Yang Z, Wang G, Luo N, Tsang CK, Huang L. Consensus clustering of gene expression profiles in peripheral blood of acute ischemic stroke patients. Front Neurol 2022; 13:937501. [PMID: 35989931 PMCID: PMC9388856 DOI: 10.3389/fneur.2022.937501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 07/11/2022] [Indexed: 11/13/2022] Open
Abstract
Acute ischemic stroke (AIS) is a primary cause of mortality and morbidity worldwide. Currently, no clinically approved immune intervention is available for AIS treatment, partly due to the lack of relevant patient classification based on the peripheral immunity status of patients with AIS. In this study, we adopted the consensus clustering approach to classify patients with AIS into molecular subgroups based on the transcriptomic profiles of peripheral blood, and we identified three distinct AIS molecular subgroups and 8 modules in each subgroup by the weighted gene co-expression network analysis. Remarkably, the pre-ranked gene set enrichment analysis revealed that the co-expression modules with subgroup I-specific signature genes significantly overlapped with the differentially expressed genes in AIS patients with hemorrhagic transformation (HT). With respect to subgroup II, exclusively male patients with decreased proteasome activity were identified. Intriguingly, the majority of subgroup III was composed of female patients who showed a comparatively lower level of AIS-induced immunosuppression (AIIS). In addition, we discovered a non-linear relationship between female age and subgroup-specific gene expression, suggesting a gender- and age-dependent alteration of peripheral immunity. Taken together, our novel AIS classification approach could facilitate immunomodulatory therapies, including the administration of gender-specific therapeutics, and attenuation of the risk of HT and AIIS after ischemic stroke.
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Affiliation(s)
- Zhiyong Yang
- Clinical Neuroscience Institute, The First Affiliated Hospital of Jinan University, Guangzhou, China.,Department of Neurology, The First Clinical Medical School of Jinan University, Guangzhou, China
| | - Guanghui Wang
- Clinical Neuroscience Institute, The First Affiliated Hospital of Jinan University, Guangzhou, China.,Department of Neurology, The First Clinical Medical School of Jinan University, Guangzhou, China
| | - Nan Luo
- Clinical Neuroscience Institute, The First Affiliated Hospital of Jinan University, Guangzhou, China.,Department of Neurology, The First Clinical Medical School of Jinan University, Guangzhou, China
| | - Chi Kwan Tsang
- Clinical Neuroscience Institute, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Li'an Huang
- Clinical Neuroscience Institute, The First Affiliated Hospital of Jinan University, Guangzhou, China.,Department of Neurology, The First Clinical Medical School of Jinan University, Guangzhou, China
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Maksimova MY, Ivanov AV, Nikiforova KA, Virus ED, Suanova ET, Ochtova FR, Piradov MA, Kubatiev AA. Plasma low molecular weight aminothiols in ischemic stroke patients with type 2 diabetes mellitus. BRSMU 2021. [DOI: 10.24075/brsmu.2021.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
It was found that ischemic stroke (IS) results in decreased levels of a number of reduced forms of low molecular weight aminothiols (LMWTs). The study was aimed to assess the impact of type 2 diabetes mellitus (Т2D) on the total content, reduced forms and redox status of LMWTs in patients with IS. A total of 175 patients with IS in the internal carotid artery basin (the average age was 62 (55–69)) years) were assessed, who were admitted to the Center within the first 10–24 h since the onset of neurological disorder. The index group included 68 patients with IS and T2D (males made up 41.2%). The comparison group consisted of 107 patients with IS and stress hyperglycemia (males made up 57%), and the control group included 31 non-diabetic patients with chronic cerebrovascular disease (CCVD) (males made up 54.8%). The admission plasma levels of LMWTs were assessed by liquid chromatography in all patients. It was found, that IS in patients with T2D was associated with the rapid decrease in total cysteine (tCys), total glutathione (tGSH), total homocysteine (tHcy), reduced glutathione (rGSH), and glutathione redox status (GSH RS), along with the increase in cysteine redox status (Cys RS) and homocysteine redox status (Hcy RS). In contrast to patients with stress hyperglycemia developing during the acute period of IS, patients with T2D had lower tCys, tGSH, and tHcy levels. Thus, GSH RS of 4.06% or lower in the first 24 hours after the IS in patients with T2D was a predictor of poor functional outcome (mRS score was 3 or more 3 weeks after IS).
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Affiliation(s)
| | - AV Ivanov
- Research Institute of General Pathology and Pathophysiology, Moscow, Russia
| | - KA Nikiforova
- Research Institute of General Pathology and Pathophysiology, Moscow, Russia
| | - ED Virus
- Research Institute of General Pathology and Pathophysiology, Moscow, Russia
| | - ET Suanova
- Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - FR Ochtova
- Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - MA Piradov
- Research Center of Neurology, Moscow, Russia
| | - AA Kubatiev
- Research Institute of General Pathology and Pathophysiology, Moscow, Russia
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Wang Y, Feng F, Zheng P, Wang L, Wang Y, Lv Y, Shen L, Li K, Feng T, Chen Y, Liu Z, Yao Y. Dysregulated lncRNA and mRNA may promote the progression of ischemic stroke via immune and inflammatory pathways: results from RNA sequencing and bioinformatics analysis. Genes Genomics 2021; 44:97-108. [PMID: 34699043 PMCID: PMC8546200 DOI: 10.1007/s13258-021-01173-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 09/27/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Long non-coding RNAs (lncRNAs) are widely involved in gene transcription regulation and which act as epigenetic modifiers in many diseases. OBJECTIVE To determine whether lncRNAs are involved in ischemic stroke (IS), we analyzed the expression profile of lncRNAs and mRNAs in IS. METHODS RNA sequencing was performed on the blood of three pairs of IS patients and healthy controls. Differential expression analysis was used to identify differentially expressed lncRNAs (DElncRNAs) and mRNAs (DEmRNAs). Based on the co-expression relationships between lncRNA and mRNA, a series of bioinformatics analysis including GO and KEGG enrichment analysis and PPI analysis, were conducted to predict the function of lncRNA. RESULTS RNA sequencing produced a total of 5 DElncRNAs and 144 DEmRNAs. Influenza A pathway and Herpes simplex infection pathway were the most significant pathways. EP300 and NFKB1 were the most important target proteins, and Human leucocyte antigen (HLA) family were the key genes in IS. CONCLUSIONS Analysis of this study revealed that dysregulated lncRNAs in IS may lead to IS by affecting the immune and inflammation system.
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Affiliation(s)
- Yingshuang Wang
- Key Laboratory of Organ Regeneration and Transplantation of Ministry of Education, Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, 130021, China
| | - Feifei Feng
- Jilin Province of Jilin Combine Traditional Chinese and Western Medicine Hospital, Jilin, 132000, China
| | - Pingping Zheng
- Futian District Center for Disease Prevention and Control, Shenzhen, 518040, China
| | - Lijuan Wang
- Department of Neurology, The Neuroscience Center, The First Hospital of Jilin University, Jilin University, Changchun, 130021, China
| | - Yanjun Wang
- Nursing Department, The Second Hospital of Jilin University, Changchun, 130021, Jilin, China
| | - Yaogai Lv
- Key Laboratory of Organ Regeneration and Transplantation of Ministry of Education, Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, 130021, China
| | - Li Shen
- Key Laboratory of Organ Regeneration and Transplantation of Ministry of Education, Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, 130021, China
| | - Kexin Li
- Key Laboratory of Organ Regeneration and Transplantation of Ministry of Education, Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, 130021, China
| | - Tianyu Feng
- Key Laboratory of Organ Regeneration and Transplantation of Ministry of Education, Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, 130021, China
| | - Yang Chen
- Key Laboratory of Organ Regeneration and Transplantation of Ministry of Education, Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, 130021, China
| | - Zhigang Liu
- Department of Pain Management, The Second Hospital of Jilin University, No.218, Ziqiang Street, Nanguan District, Changchun, 130041, Jilin, China.
| | - Yan Yao
- Key Laboratory of Organ Regeneration and Transplantation of Ministry of Education, Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, 130021, China.
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Coveney S, McCabe JJ, Murphy S, Belton O, Gray C, Cassidy T, Dolan E, de Gaetano M, Harbison J, Horgan G, Marnane M, Merwick A, Noone I, Williams DJ, Kelly PJ. Dose-Dependent Association of Inflammatory Cytokines with Carotid Atherosclerosis in Transient Ischaemic Attack: Implications for Clinical Trials. Cerebrovasc Dis 2021; 51:178-187. [PMID: 34496366 DOI: 10.1159/000517739] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 06/08/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The 5-year recurrence risk after ischaemic stroke and transient ischaemic attack (TIA) is 25-30%. Although inflammation may be a target for prevention trials, the contribution of plaque inflammation to acute cerebrovascular events remains unclear. We investigated the association of acute inflammatory cytokines and high-sensitivity C-reactive protein (CRP) with recently symptomatic carotid atherosclerosis in a prospective cohort study. METHODS Blood and Imaging markers of TIA BIO-TIA) is a multicentre prospective study of imaging and inflammatory markers in patients with TIA. Exclusion criteria were infection and other co-morbid illnesses associated with inflammation. CRP and serum cytokines (interleukin [IL]-6, IL-1β, IL-8, IL-10, IL-12, interferon-γ [IFN-γ] and tumour necrosis factor-α [TNF-α]) were measured. All patients had carotid imaging. RESULTS Two hundred and thirty-eight TIA cases and 64 controls (TIA mimics) were included. Forty-nine (20.6%) cases had symptomatic internal carotid artery stenosis. Pro-inflammatory cytokine levels increased in a dose-dependent manner across controls, TIA without carotid stenosis (CS), and TIA with CS (IL-1β, ptrend = 0.03; IL-6, ptrend < 0.0001; IL-8, ptrend = 0.01; interferon (IFN)-γ, ptrend = 0.005; TNF-α, ptrend = 0.003). Results were unchanged when DWI-positive cases were excluded. On multivariable linear regression, only age (p = 0.01) and CS (p = 0.04) independently predicted log-IL-6. On multivariable Cox regression, CRP was the only independent predictor of 90-day stroke recurrence (adjusted hazard ratio per 1-unit increase 1.03 [95% CI: 1.01-1.05], p = 0.003). CONCLUSION Symptomatic carotid atherosclerosis was associated with elevated cytokines in TIA patients after controlling for other sources of inflammation. High-sensitivity CRP was associated with recurrent ischaemic stroke at 90 days. These findings implicate acute plaque inflammation in the pathogenesis of cerebral thromboembolism and support a rationale for randomized trials of anti-inflammatory therapy for stroke patients, who were excluded from coronary trials.
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Affiliation(s)
- Sarah Coveney
- Stroke Service, Mater University Hospital and University College Dublin, Dublin, Ireland.,Health Research Board Stroke Clinical Trials Network, Dublin, Ireland
| | - John J McCabe
- Stroke Service, Mater University Hospital and University College Dublin, Dublin, Ireland.,Health Research Board Stroke Clinical Trials Network, Dublin, Ireland
| | - Sean Murphy
- Stroke Service, Mater University Hospital and University College Dublin, Dublin, Ireland.,Health Research Board Stroke Clinical Trials Network, Dublin, Ireland
| | - Orina Belton
- University College Dublin, Conway Institute, Dublin, Ireland
| | - Cleona Gray
- Vascular Imaging Department, Mater University Hospital, Dublin, Ireland
| | - Tim Cassidy
- Health Research Board Stroke Clinical Trials Network, Dublin, Ireland.,Medicine for the Older Person, St Vincent's University Hospital, Dublin, Ireland
| | - Eamon Dolan
- Health Research Board Stroke Clinical Trials Network, Dublin, Ireland.,Medicine for the Older Person, Connolly Hospital Blanchardstown, Dublin, Ireland
| | | | - Joe Harbison
- Health Research Board Stroke Clinical Trials Network, Dublin, Ireland.,Stroke Service, St James' Hospital and Trinity College Dublin, Dublin, Ireland
| | - Gillian Horgan
- Stroke Service, Mater University Hospital and University College Dublin, Dublin, Ireland.,Health Research Board Stroke Clinical Trials Network, Dublin, Ireland
| | - Michael Marnane
- Stroke Service, Mater University Hospital and University College Dublin, Dublin, Ireland.,Health Research Board Stroke Clinical Trials Network, Dublin, Ireland
| | - Aine Merwick
- Health Research Board Stroke Clinical Trials Network, Dublin, Ireland.,Cork University Hospital, Cork, Ireland
| | - Imelda Noone
- Health Research Board Stroke Clinical Trials Network, Dublin, Ireland.,Medicine for the Older Person, St Vincent's University Hospital, Dublin, Ireland
| | - David J Williams
- Health Research Board Stroke Clinical Trials Network, Dublin, Ireland.,Department of Stroke and Geriatric Medicine, RCSI University of Medicine and Health Sciences and Beaumont Hospital, Dublin, Ireland
| | - Peter J Kelly
- Stroke Service, Mater University Hospital and University College Dublin, Dublin, Ireland.,Health Research Board Stroke Clinical Trials Network, Dublin, Ireland
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Cai H, Cai T, Zheng H, Liu L, Zhou L, Pang X, Zhan Q, Wang Y, Yang C, Guo Z, Pan H, Wang Q. The Neuroprotective Effects of Danggui-Shaoyao San on Vascular Cognitive Impairment: Involvement of the Role of the Low-Density Lipoprotein Receptor-Related Protein. Rejuvenation Res 2020; 23:420-433. [PMID: 32242481 DOI: 10.1089/rej.2019.2182] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Affiliation(s)
- Haobin Cai
- Department of Neurology & Psychology, Shenzhen Traditional Chinese Medicine Hospital, Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Tiantian Cai
- Institute of Clinical Pharmacology, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Haotao Zheng
- Department of Neurology & Psychology, Shenzhen Traditional Chinese Medicine Hospital, Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Lijin Liu
- Department of Neurology & Psychology, Shenzhen Traditional Chinese Medicine Hospital, Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Liuchang Zhou
- Department of Neurology & Psychology, Shenzhen Traditional Chinese Medicine Hospital, Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Xile Pang
- Department of Neurology & Psychology, Shenzhen Traditional Chinese Medicine Hospital, Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Qinkai Zhan
- Institute of Clinical Pharmacology, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yijie Wang
- Institute of Clinical Pharmacology, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Cong Yang
- Institute of Clinical Pharmacology, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zhouke Guo
- Department of Neurology & Psychology, Shenzhen Traditional Chinese Medicine Hospital, Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Huafeng Pan
- Institute of Clinical Pharmacology, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Qi Wang
- Institute of Clinical Pharmacology, Guangzhou University of Chinese Medicine, Guangzhou, China
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10
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Takase KI. Cardiogenic cerebral infarction in the parietal lobe predicts the development of post-stroke epilepsy. Seizure 2020; 80:196-200. [PMID: 32623354 DOI: 10.1016/j.seizure.2020.06.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 06/06/2020] [Accepted: 06/08/2020] [Indexed: 11/19/2022] Open
Abstract
PURPOSE Post-stroke epilepsy (PSE) is a major late complication of cardioembolic cerebral infarction. However, few studies have examined the epileptogenicity and characteristics of first-occurrence cardioembolic cerebral infarctions. METHODS This retrospective study included 93 consecutive patients with old cardioembolic cerebral infarctions who were classified into two groups based on their epileptic history: patients presenting with PSE or stroke without seizure (SWS). Each patient was diagnosed with an epileptic seizure subtype and treated with appropriate anti-epileptic therapy after admission. We evaluated clinical characteristics, laboratory results, and intracranial infarct areas. The sizes of these areas were measured using MRI diffusion-weighted image (DWI) of each patient after their first stroke. The volume was calculated by multiplying the total slice area with the slice thickness. RESULTS PSE was diagnosed in 43 (46.2 %) of 93 patients. The mean (± SD) time from infarction onset to the first seizure in the PSE group was 22.5 ± 31.6 months. The PSE group exhibited significantly more atrial fibrillation (p = 0.022) and higher glucose levels (p < 0.001) compared with the SWS group. The most common PSE seizure type was focal to bilateral tonic-clonic seizure (61.0 %). Although DWI did not reveal any significant differences in the volume of infarctions between the two groups, the involvement of the parietal lobe in infarction of the PSE group (69.8 %) upon first admission was significantly higher (p = 0.006) than that of the SWS group (40.0 %). Multiple logistic regression analysis revealed that parietal lobe involvement in infarction (OR 4.95; 95 % CI 1.25-19.60; p = 0.023) was a significant independent predictor of PSE. CONCLUSION The involvement of the parietal lobe in infarction was a significant independent predictor of PSE. Dysfunction of the parietal lobe might play a critical role in the epileptogenesis of PSE.
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Affiliation(s)
- Kei-Ichiro Takase
- Department of Neurology, Iizuka Hospital, 3-83 Yoshio-machi, Iizuka, 820-8505, Fukuoka, Japan.
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11
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Peterson TC, Lechtenberg KJ, Piening BD, Lucas TA, Wei E, Chaib H, Dowdell AK, Snyder M, Buckwalter MS. Obesity Drives Delayed Infarct Expansion, Inflammation, and Distinct Gene Networks in a Mouse Stroke Model. Transl Stroke Res 2021; 12:331-46. [PMID: 32588199 DOI: 10.1007/s12975-020-00826-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 05/11/2020] [Accepted: 06/03/2020] [Indexed: 01/11/2023]
Abstract
Obesity is associated with chronic peripheral inflammation, is a risk factor for stroke, and causes increased infarct sizes. To characterize how obesity increases infarct size, we fed a high-fat diet to wild-type C57BL/6J mice for either 6 weeks or 15 weeks and then induced distal middle cerebral artery strokes. We found that infarct expansion happened late after stroke. There were no differences in cortical neuroinflammation (astrogliosis, microgliosis, or pro-inflammatory cytokines) either prior to or 10 h after stroke, and also no differences in stroke size at 10 h. However, by 3 days after stroke, animals fed a high-fat diet had a dramatic increase in microgliosis and astrogliosis that was associated with larger strokes and worsened functional recovery. RNA sequencing revealed a dramatic increase in inflammatory genes in the high-fat diet-fed animals 3 days after stroke that were not present prior to stroke. Genetic pathways unique to diet-induced obesity were primarily related to adaptive immunity, extracellular matrix components, cell migration, and vasculogenesis. The late appearance of neuroinflammation and infarct expansion indicates that there may be a therapeutic window between 10 and 36 h after stroke where inflammation and obesity-specific transcriptional programs could be targeted to improve outcomes in people with obesity and stroke.
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12
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Smith CJ, Heal C, Vail A, Jeans AR, Westendorp WF, Nederkoorn PJ, van de Beek D, Kalra L, Montaner J, Woodhead M, Meisel A. Antibiotic Class and Outcome in Post-stroke Infections: An Individual Participant Data Pooled Analysis of VISTA-Acute. Front Neurol 2019; 10:504. [PMID: 31156537 PMCID: PMC6527959 DOI: 10.3389/fneur.2019.00504] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 04/26/2019] [Indexed: 12/21/2022] Open
Abstract
Introduction: Antibiotics used to treat post-stroke infections have differing antimicrobial and anti-inflammatory effects. Our aim was to investigate whether antibiotic class was associated with outcome after post-stroke infection. Methods: We analyzed pooled individual participant data from the Virtual International Stroke Trials Archive (VISTA)-Acute. Patients with ischemic stroke and with an infection treated with systemic antibiotic therapy during the first 2 weeks after stroke onset were eligible. Antibiotics were grouped into eight classes, according to antimicrobial mechanism and prevalence. The primary analysis investigated whether antibiotic class for any infection, or for pneumonia, was independently associated with a shift in 90 day modified Rankin Scale (mRS) using ordinal logistic regression. Results: 2,708 patients were eligible (median age [IQR] = 74 [65 to 80] y; 51% female; median [IQR] NIHSS score = 15 [11 to 19]). Pneumonia occurred in 35%. Treatment with macrolides (5% of any infections; 9% of pneumonias) was independently associated with more favorable mRS distribution for any infection [OR (95% CI) = 0.59 (0.42 to 0.83), p = 0.004] and for pneumonia [OR (95% CI) = 0.46 (0.29 to 0.73), p = 0.001]. Unfavorable mRS distribution was independently associated with treatment of any infection either with carbapenems, cephalosporins or monobactams [OR (95% CI) = 1.62 (1.33 to 1.97), p < 0.001], penicillin plus β-lactamase inhibitors [OR (95% CI) = 1.26 (1.03 to 1.54), p = 0.025] or with aminoglycosides [OR (95% CI) = 1.73 (1.22 to 2.46), p = 0.002]. Conclusion: This retrospective study has several limitations including effect modification and confounding by indication. Macrolides may have favorable immune-modulatory effects in stroke-associated infections. Prospective evaluation of the impact of antibiotic class on treatment of post-stroke infections is warranted.
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Affiliation(s)
- Craig J Smith
- Greater Manchester Comprehensive Stroke Centre, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Salford, United Kingdom.,Division of Cardiovascular Sciences, School of Medical Sciences, University of Manchester, Manchester, United Kingdom
| | - Calvin Heal
- Centre for Biostatistics, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Andy Vail
- Centre for Biostatistics, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Adam R Jeans
- Division of Clinical Support Services and Tertiary Medicine, Department of Microbiology, Salford Royal NHS Foundation Trust, Salford, United Kingdom
| | - Willeke F Westendorp
- Department of Neurology, Amsterdam Neuroscience, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Paul J Nederkoorn
- Department of Neurology, Amsterdam Neuroscience, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Diederik van de Beek
- Department of Neurology, Amsterdam Neuroscience, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Lalit Kalra
- Clinical Neurosciences, King's College Hospital NHS Foundation Trust London, London, United Kingdom
| | - Joan Montaner
- Neurovascular Research Laboratory, Vall d' Hebron Institute of Research, Barcelona, Spain.,Stroke Research Program, Department of Neurology, Institute de Biomedicine of Seville, Hospital Universitario Virgen Macarena, IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville, Seville, Spain
| | - Mark Woodhead
- Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Andreas Meisel
- Department of Neurology, NeuroCure Clinical Research Center, Center for Stroke Research Berlin, Charité Universitaetsmedizin Berlin, Berlin, Germany
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13
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Teh WH, Smith CJ, Barlas RS, Wood AD, Bettencourt-Silva JH, Clark AB, Metcalf AK, Bowles KM, Potter JF, Myint PK. Impact of stroke-associated pneumonia on mortality, length of hospitalization, and functional outcome. Acta Neurol Scand 2018; 138:293-300. [PMID: 29749062 DOI: 10.1111/ane.12956] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2018] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Stroke-associated pneumonia (SAP) is common and associated with adverse outcomes. Data on its impact beyond 1 year are scarce. MATERIALS AND METHODS This observational study was conducted in a cohort of stroke patients admitted consecutively to a tertiary referral center in the east of England, UK (January 2003-April 2015). Logistic regression models examined inpatient mortality and length of stay (LOS). Cox regression models examined longer-term mortality at predefined time periods (0-90 days, 90 days-1 year, 1-3 years, and 3-10 years) for SAP. Effect of SAP on functional outcome at discharge was assessed using logistic regression. RESULTS A total of 9238 patients (mean age [±SD] 77.61 ± 11.88 years) were included. SAP was diagnosed in 1083 (11.7%) patients. The majority of these cases (n = 658; 60.8%) were aspiration pneumonia. After controlling for age, sex, stroke type, Oxfordshire Community Stroke Project (OCSP) classification, prestroke modified Rankin scale, comorbidities, and acute illness markers, mortality estimates remained significant at 3 time periods: inpatient (OR 5.87, 95%CI [4.97-6.93]), 0-90 days (2.17 [1.97-2.40]), and 91-365 days (HR 1.31 [1.03-1.67]). SAP was also associated with higher odds of long LOS (OR 1.93 [1.67-2.22]) and worse functional outcome (OR 7.17 [5.44-9.45]). In this cohort, SAP did not increase mortality risk beyond 1 year post-stroke, but it was associated with reduced mortality beyond 3 years. CONCLUSIONS Stroke-associated pneumonia is not associated with increased long-term mortality, but it is linked with increased mortality up to 1 year, prolonged LOS, and poor functional outcome on discharge. Targeted intervention strategies are required to improve outcomes of SAP patients who survive to hospital discharge.
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Affiliation(s)
- W. H. Teh
- Institute of Applied Health Sciences; School of Medicine; Medical Sciences and Nutrition; University of Aberdeen; Aberdeen UK
| | - C. J. Smith
- Greater Manchester Comprehensive Stroke Centre; Manchester Academic Health Science Centre; Salford Royal NHS Foundation Trust; Salford UK
- Faculty of Biology; Medicine and Health; University of Manchester; Manchester UK
| | - R. S. Barlas
- Institute of Applied Health Sciences; School of Medicine; Medical Sciences and Nutrition; University of Aberdeen; Aberdeen UK
| | - A. D. Wood
- Institute of Applied Health Sciences; School of Medicine; Medical Sciences and Nutrition; University of Aberdeen; Aberdeen UK
| | - J. H. Bettencourt-Silva
- Institute of Applied Health Sciences; School of Medicine; Medical Sciences and Nutrition; University of Aberdeen; Aberdeen UK
- Stroke Research Group; Norwich Cardiovascular Research Group; Norwich Research Park; Norwich UK
| | - A. B. Clark
- Norwich Medical School; University of East Anglia; Norwich UK
| | - A. K. Metcalf
- Stroke Research Group; Norwich Cardiovascular Research Group; Norwich Research Park; Norwich UK
- Stroke Services; Norfolk and Norwich University Hospitals NHS Foundation Trust; Norwich UK
| | - K. M. Bowles
- Norwich Medical School; University of East Anglia; Norwich UK
- Stroke Research Group; Norwich Cardiovascular Research Group; Norwich Research Park; Norwich UK
| | - J. F. Potter
- Norwich Medical School; University of East Anglia; Norwich UK
- Stroke Research Group; Norwich Cardiovascular Research Group; Norwich Research Park; Norwich UK
| | - P. K. Myint
- Institute of Applied Health Sciences; School of Medicine; Medical Sciences and Nutrition; University of Aberdeen; Aberdeen UK
- Stroke Research Group; Norwich Cardiovascular Research Group; Norwich Research Park; Norwich UK
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De Doncker W, Dantzer R, Ormstad H, Kuppuswamy A. Mechanisms of poststroke fatigue. J Neurol Neurosurg Psychiatry 2018; 89:287-293. [PMID: 28939684 DOI: 10.1136/jnnp-2017-316007] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 09/05/2017] [Accepted: 09/07/2017] [Indexed: 11/04/2022]
Abstract
Poststroke fatigue is a debilitating symptom and is poorly understood. Here we summarise molecular, behavioural and neurophysiological changes related to poststroke fatigue and put forward potential theories for mechanistic understanding of poststroke fatigue.
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Affiliation(s)
| | - Robert Dantzer
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Heidi Ormstad
- Faculty of Health and Social Sciences, University of South West Norway, Oslo, Norway
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15
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Luo L, Jiang J, Zhang G, Wang L, Wang Z, Yang J, Yu C. Stroke Mortality Attributable to Ambient Particulate Matter Pollution from 1990 to 2015 in China: An Age-Period-Cohort and Spatial Autocorrelation Analysis. Int J Environ Res Public Health 2017; 14:ijerph14070772. [PMID: 28703768 PMCID: PMC5551210 DOI: 10.3390/ijerph14070772] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 07/01/2017] [Accepted: 07/11/2017] [Indexed: 12/18/2022]
Abstract
In this study, we analyzed the temporal and spatial variations of stroke mortality attributable to ambient particulate matter pollution (stroke mortality-PM2.5) in China from 1990 to 2015. Data were collected from the Global Burden of Disease (GBD) 2015 study and analyzed by an age-period-cohort model (APC) with an intrinsic estimator (IE) algorithm, as well as spatial autocorrelation based on the Geographic Information System. Based on APC analysis with the IE method, stroke mortality-PM2.5 increased exponentially with age, its relative risk reaching 42.85 (95% CI: 28.79, 63.43) in the 75–79 age group. The period effects showed a reversed V-shape and its highest relative risk was 1.22 (95% CI: 1.15, 1.27) in 2005. The cohort effects decreased monotonically from 1915–1919 to 1990–1994. The change rate fluctuated from 1920–1924 to 1990–1994, including three accelerating and three decelerating decreases. There was a positive spatial autocorrelation in stroke mortality-PM2.5 from 1990 to 2015. Hot-spots moved from the northeastern areas to the middle and southwestern areas, whereas cold-spots lay mostly in coastal provinces. Besides the aging process in recent years, stroke mortality-PM2.5 had significantly declined from 2005 to 2015 due to socio-economic and healthcare development. Stroke mortality-PM2.5 varied substantially among different regions, and cost-effective prevention and control should be implemented more in the middle and southwestern areas of China.
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Affiliation(s)
- Lisha Luo
- Department of Epidemiology and Biostatistics, School of Health Sciences, Wuhan University, #185 Donghu Road, Wuhan 430071, China.
| | - Junfeng Jiang
- Department of Epidemiology and Biostatistics, School of Health Sciences, Wuhan University, #185 Donghu Road, Wuhan 430071, China.
| | - Ganshen Zhang
- Department of Epidemiology and Biostatistics, School of Health Sciences, Wuhan University, #185 Donghu Road, Wuhan 430071, China.
| | - Lu Wang
- Department of Epidemiology and Biostatistics, School of Health Sciences, Wuhan University, #185 Donghu Road, Wuhan 430071, China.
| | - Zhenkun Wang
- Department of Epidemiology and Biostatistics, School of Health Sciences, Wuhan University, #185 Donghu Road, Wuhan 430071, China.
| | - Jin Yang
- Department of Epidemiology and Biostatistics, School of Health Sciences, Wuhan University, #185 Donghu Road, Wuhan 430071, China.
| | - Chuanhua Yu
- Department of Epidemiology and Biostatistics, School of Health Sciences, Wuhan University, #185 Donghu Road, Wuhan 430071, China.
- Global Health Institute, Wuhan University, #8 Donghu Road, Wuhan 430072, China.
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16
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Xi YG, Tian X, Chen WQ, Zhang S, Zhang S, Ren WD, Pang QJ, Yang GT, Yang ZM. Antibiotic prophylaxis for infections in patients with acute stroke: a systematic review and meta-analysis of randomized controlled trials. Oncotarget 2017; 8:81075-81087. [PMID: 29113368 PMCID: PMC5655263 DOI: 10.18632/oncotarget.19039] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 06/17/2017] [Indexed: 12/18/2022] Open
Abstract
Objective Infections are frequent after stroke and lead to increased mortality and neurological disability. Antibiotic prophylaxis has potential of decreasing the risk of infections and mortality and improving poor functional outcome. Several studies evaluated antibiotic prophylaxis for infections in acute stroke patients have generated conflicting results. The systematic review of randomized clinical trials (RCTs) aimed at comprehensively assessing the evidence of antibiotic prophylaxis for the treatment of acute stroke patients. Materials and Methods PubMed, EMBASE, the Cochrane library and the reference lists of eligible articles were searched to identify all potential studies. We included the studies that investigated the efficacy and safety of antibiotic prophylaxis for the treatment of acute stroke patients. The primary outcome included mortality and infection rate. The secondary outcomes included poor functional outcome and adverse events. Results Seven trials randomizing 4,261 patients were included. Pooled analyses showed that antibiotic prophylaxis did not improve the mortality (risk ratio (RR) = 1.03, 95% confidence interval (CI) 0.84 to 1.26, p = 0.78, I2 = 25%) and poor functional outcome (RR = 0.93, 95% CI 0.80 to 1.08, p = 0.32, I2 = 80%), but reduced the incidence of infection (RR = 0.67, 95% CI 0.53 to 0.84, p = 0.0007, I2 = 49%). No major side effects were reported. Sensitivity analyses confirmed the results of infection rate and poor functional outcome. Conclusions Antibiotic prophylaxis can be used to treat the infectious events of acute stroke patients although it has no potential of decreased mortality and improved functional outcome.
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Affiliation(s)
- Yan-Guo Xi
- Department of Neurosurgery, Cang Zhou Central Hospital, Hebei 061001, China
| | - Xu Tian
- Department of Gastroenterology, Chongqing Cancer Institute and Hospital and Cancer Center, Chongqing 400030, China
| | - Wei-Qing Chen
- Department of Gastroenterology, Chongqing Cancer Institute and Hospital and Cancer Center, Chongqing 400030, China
| | - Sai Zhang
- Department of Neurosurgery, Logistic University Affiliated Hospital, Logistic University of Chinese People's Armed Police Force, Tianjin 300162, China
| | - Shan Zhang
- Department of Neurosurgery, Cang Zhou Central Hospital, Hebei 061001, China
| | - Wei-Dan Ren
- Department of Neurosurgery, Cang Zhou Central Hospital, Hebei 061001, China
| | - Qi-Jun Pang
- Department of Neurosurgery, Cang Zhou Central Hospital, Hebei 061001, China
| | - Guo-Tao Yang
- Department of Neurosurgery, Cang Zhou Central Hospital, Hebei 061001, China
| | - Zhi-Ming Yang
- Department of Neurosurgery, Cang Zhou Central Hospital, Hebei 061001, China
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17
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Shukla V, Shakya AK, Perez-Pinzon MA, Dave KR. Cerebral ischemic damage in diabetes: an inflammatory perspective. J Neuroinflammation 2017; 14:21. [PMID: 28115020 PMCID: PMC5260103 DOI: 10.1186/s12974-016-0774-5] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 12/07/2016] [Indexed: 12/16/2022] Open
Abstract
Stroke is one of the leading causes of death worldwide. A strong inflammatory response characterized by activation and release of cytokines, chemokines, adhesion molecules, and proteolytic enzymes contributes to brain damage following stroke. Stroke outcomes are worse among diabetics, resulting in increased mortality and disabilities. Diabetes involves chronic inflammation manifested by reactive oxygen species generation, expression of proinflammatory cytokines, and activation/expression of other inflammatory mediators. It appears that increased proinflammatory processes due to diabetes are further accelerated after cerebral ischemia, leading to increased ischemic damage. Hypoglycemia is an intrinsic side effect owing to glucose-lowering therapy in diabetics, and is known to induce proinflammatory changes as well as exacerbate cerebral damage in experimental stroke. Here, we present a review of available literature on the contribution of neuroinflammation to increased cerebral ischemic damage in diabetics. We also describe the role of hypoglycemia in neuroinflammation and cerebral ischemic damage in diabetics. Understanding the role of neuroinflammatory mechanisms in worsening stroke outcome in diabetics may help limit ischemic brain injury and improve clinical outcomes.
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Affiliation(s)
- Vibha Shukla
- Cerebral Vascular Disease Research Laboratories, University of Miami School of Medicine, Miami, FL, 33136, USA.,Department of Neurology (D4-5), University of Miami Miller School of Medicine, 1420 NW 9th Ave, NRB/203E, Miami, FL, 33136, USA
| | - Akhalesh Kumar Shakya
- Present address: Department of Microbiology and Immunology, and Center for Molecular and Tumor Virology, Louisiana State University Health Sciences Center, Shreveport, LA, 71130, USA
| | - Miguel A Perez-Pinzon
- Cerebral Vascular Disease Research Laboratories, University of Miami School of Medicine, Miami, FL, 33136, USA.,Department of Neurology (D4-5), University of Miami Miller School of Medicine, 1420 NW 9th Ave, NRB/203E, Miami, FL, 33136, USA.,Neuroscience Program, University of Miami School of Medicine, Miami, FL, 33136, USA
| | - Kunjan R Dave
- Cerebral Vascular Disease Research Laboratories, University of Miami School of Medicine, Miami, FL, 33136, USA. .,Department of Neurology (D4-5), University of Miami Miller School of Medicine, 1420 NW 9th Ave, NRB/203E, Miami, FL, 33136, USA. .,Neuroscience Program, University of Miami School of Medicine, Miami, FL, 33136, USA.
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18
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Abstract
Obesity is a risk factor for stroke and is consequently one of the most common co-morbidities found in patients. There is therefore an identified need to model co-morbidities preclinically to allow better translation from bench to bedside. In preclinical studies, both diet-induced and genetically obese rodents have worse stroke outcome, characterised by increased ischaemic damage and an altered inflammatory response. However, clinical studies have reported an 'obesity paradox' in stroke, characterised by reduced mortality and morbidity in obese patients. We discuss the potential reasons why the preclinical and clinical studies may not agree, and review the mechanisms identified in preclinical studies through which obesity may affects stroke outcome. We suggest inflammation plays a central role in this relationship, as obesity features increases in inflammatory mediators such as C-reactive protein and interleukin-6, and chronic inflammation has been linked to worse stroke risk and outcome.
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Affiliation(s)
- Michael J Haley
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Catherine B Lawrence
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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19
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Lénárt N, Brough D, Dénes Á. Inflammasomes link vascular disease with neuroinflammation and brain disorders. J Cereb Blood Flow Metab 2016; 36:1668-1685. [PMID: 27486046 PMCID: PMC5076791 DOI: 10.1177/0271678x16662043] [Citation(s) in RCA: 115] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 06/28/2016] [Indexed: 12/22/2022]
Abstract
The role of inflammation in neurological disorders is increasingly recognised. Inflammatory processes are associated with the aetiology and clinical progression of migraine, psychiatric conditions, epilepsy, cerebrovascular diseases, dementia and neurodegeneration, such as seen in Alzheimer's or Parkinson's disease. Both central and systemic inflammatory actions have been linked with the development of brain diseases, suggesting that complex neuro-immune interactions could contribute to pathological changes in the brain across multiple temporal and spatial scales. However, the mechanisms through which inflammation impacts on neurological disease are improperly defined. To develop effective therapeutic approaches, it is imperative to understand how detrimental inflammatory processes could be blocked selectively, or controlled for prolonged periods, without compromising essential immune defence mechanisms. Increasing evidence indicates that common risk factors for brain disorders, such as atherosclerosis, diabetes, hypertension, obesity or infection involve the activation of NLRP3, NLRP1, NLRC4 or AIM2 inflammasomes, which are also associated with various neurological diseases. This review focuses on the mechanisms whereby inflammasomes, which integrate diverse inflammatory signals in response to pathogen-driven stimuli, tissue injury or metabolic alterations in multiple cell types and different organs of the body, could functionally link vascular- and neurological diseases and hence represent a promising therapeutic target.
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Affiliation(s)
- Nikolett Lénárt
- Laboratory of Neuroimmunology, Institute of Experimental Medicine, Budapest, Hungary
| | - David Brough
- Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK
| | - Ádám Dénes
- Laboratory of Neuroimmunology, Institute of Experimental Medicine, Budapest, Hungary
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20
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Colbert JF, Traystman RJ, Poisson SN, Herson PS, Ginde AA. Sex-Related Differences in the Risk of Hospital-Acquired Sepsis and Pneumonia Post Acute Ischemic Stroke. J Stroke Cerebrovasc Dis 2016; 25:2399-404. [PMID: 27363622 DOI: 10.1016/j.jstrokecerebrovasdis.2016.06.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 06/03/2016] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Infectious complications after ischemic stroke are frequent and lead to neurological deterioration, poor functional outcomes, and higher mortality. Local and systemic inflammatory responses to brain ischemia differ between males and females, but little is known about differences in poststroke susceptibility to infection by sex. The purpose of this study was to compare sex-related differences in the risk of hospital-acquired sepsis and pneumonia after acute ischemic stroke (AIS). MATERIALS AND METHODS This is a retrospective, secondary analysis of the 2010-2011 California State Inpatient Database. Previously validated International Classification of Disease, Ninth Revision (ICD-9) codes were used to identify adult hospitalizations for AIS. The primary outcome was hospital-acquired sepsis or pneumonia, also identified using ICD-9 codes. Associations between sex and hospital-acquired sepsis or pneumonia were adjusted for baseline characteristics and comorbidities using multivariable logistic regression. RESULTS There were 91,643 hospitalizations for AIS included in this analysis, of which 1027 had hospital-acquired sepsis and 1225 had hospital-acquired pneumonia. The in-hospital mortality without infection was 4.6%; the presence of hospital-acquired infections was associated with higher mortality for sepsis (32.7%) and pneumonia (21.9%). Female (versus male) sex was associated with lower adjusted odds of hospital-acquired sepsis (odds ratio [OR] .74, 95% confidence interval [CI] .65-.84) and pneumonia (OR .69, 95% CI .62-.78). This difference was similar across age strata. Among hospitalizations with either hospital-acquired sepsis or pneumonia, sex did not influence mortality. CONCLUSIONS Female sex was associated with a lower risk of hospital-acquired sepsis and pneumonia after AIS. Further investigation is needed to determine the mechanisms underlying this clinical observation.
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Affiliation(s)
| | | | | | - Paco S Herson
- University of Colorado School of Medicine, Aurora, CO
| | - Adit A Ginde
- University of Colorado School of Medicine, Aurora, CO.
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21
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Björkbacka H, Alm R, Persson M, Hedblad B, Nilsson J, Fredrikson GN. Low Levels of Apolipoprotein B-100 Autoantibodies Are Associated With Increased Risk of Coronary Events. Arterioscler Thromb Vasc Biol 2016; 36:765-71. [PMID: 26916732 DOI: 10.1161/atvbaha.115.306938] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 02/14/2016] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Previous smaller studies have indicated inverse associations between autoantibodies to oxidized low-density lipoprotein epitopes, and cardiovascular disease. The present study investigated associations between autoantibodies against the apolipoprotein B-100 peptides p45 and p210, respectively, and risk of incident cardiovascular disease in a large population-based cohort. APPROACH AND RESULTS Apolipoprotein B-100 autoantibodies were analyzed by ELISA in a prospective study, including 5393 individuals (aged 46-68 years) belonging to the cardiovascular arm of the Malmö Diet and Cancer study with a follow-up time of >15 years. Subjects that suffered an acute coronary event during follow-up (n=382) had lower levels at baseline of IgM autoantibodies recognizing the native and malondialdehyde-modified apolipoprotein B-100 peptides p45 and p210 and also lower IgG levels recognizing native p210, whereas no association was found with risk for stroke (n=317). Subjects in the highest compared with lowest tertile of IgM-p45MDA (hazard ratio [95% confidence interval]: 0.72 [0.55, 0.94]; P=0.017) and IgG-p210native (hazard ratio [95% confidence interval]: 0.73 [0.56, 0.97]; P=0.029) had lower risk for incident coronary events after adjustment for cardiovascular risk factors in Cox proportional hazard regression models. Moreover, subjects with high levels of IgG-p210native were less likely to have carotid plaques as assessed by ultrasonography at baseline (odds ratio=0.81, 95% confidence interval 0.70-0.95, P=0.008 after adjustment for risk factors). CONCLUSIONS This large prospective study demonstrates that subjects with high levels of apolipoprotein B-100 autoantibodies have a lower risk of coronary events supporting a protective role of these autoantibodies in cardiovascular disease.
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Affiliation(s)
- Harry Björkbacka
- From the Department of Clinical Sciences, Skåne University Hospital Malmö, Lund University, Malmö, Sweden
| | - Ragnar Alm
- From the Department of Clinical Sciences, Skåne University Hospital Malmö, Lund University, Malmö, Sweden
| | - Margaretha Persson
- From the Department of Clinical Sciences, Skåne University Hospital Malmö, Lund University, Malmö, Sweden
| | - Bo Hedblad
- From the Department of Clinical Sciences, Skåne University Hospital Malmö, Lund University, Malmö, Sweden
| | - Jan Nilsson
- From the Department of Clinical Sciences, Skåne University Hospital Malmö, Lund University, Malmö, Sweden
| | - Gunilla Nordin Fredrikson
- From the Department of Clinical Sciences, Skåne University Hospital Malmö, Lund University, Malmö, Sweden.
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Gonzalez-Valcarcel J, Sissani L, Labreuche J, Bousser MG, Chamorro A, Fisher M, Ford I, Fox KM, Hennerici MG, Mattle HP, Rothwell PM, Steg PG, Vicaut E, Amarenco P. Paracetamol, Ibuprofen, and Recurrent Major Cardiovascular and Major Bleeding Events in 19 120 Patients With Recent Ischemic Stroke. Stroke 2016; 47:1045-52. [PMID: 26979864 DOI: 10.1161/strokeaha.115.012091] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 02/11/2016] [Indexed: 01/17/2023]
Abstract
BACKGROUND AND PURPOSE The presumed safety of paracetamol in high-cardiovascular risk patients has been questioned. We determined whether paracetamol or ibuprofen use is associated with major cardiovascular events (MACE) or major bleeding in 19 120 patients with recent ischemic stroke or transient ischemic attack of mainly atherothrombotic origin included in the Prevention of cerebrovascular and cardiovascular events of ischemic origin with terutroban in patients with a history of ischemic stroke or transient ischemic attack (PERFORM) trial. METHODS We performed 2 nested case-control analysis (2153 cases with MACE during trial follow-up and 4306 controls matched on Essen stroke risk score; 809 cases with major bleeding matched with 1616 controls) and a separate time-varying analysis. RESULTS 12.3% were prescribed paracetamol and 2.5% ibuprofen. Median duration of treatment was 14 (interquartile range 5-145) days for paracetamol and 9 (5-30) days for ibuprofen. Paracetamol, but not ibuprofen, was associated with increased risk of MACE (odds ratio 1.21, 95% confidence interval [CI] 1.04-1.42) or a major bleeding (odds ratio 1.60, 95% CI 1.26-2.03), with no impact of daily dose and duration of paracetamol treatment. Time-varying analysis found an increased risk of MACE with both paracetamol (hazard ratio 1.22, 95% CI 1.05-1.43) and ibuprofen (hazard ratio 1.47, 95% CI 1.06-2.03) and of major bleeding with paracetamol (hazard ratio 1.95, 95% CI 1.45-2.62). CONCLUSIONS There was a weak and inconsistent signal for association between paracetamol or ibuprofen and MACE or major bleeding, which may be related to either a genuine but modest effect of these drugs or to residual confounding. CLINICAL TRIAL REGISTRATION http://www.isrctn.com. Unique identifier: ISRCTN66157730.
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Affiliation(s)
- Jaime Gonzalez-Valcarcel
- From the Université Paris Diderot, Paris, France (J.G.-V., M.-G.B., P.G.S., E.V., P.A.); INSERM LVTS (Laboratory for VascularTranslational Sciences) 1148 and Département Hospitalo-Universitaire FIRE (Fibrosis, Inflammation, Remodelling), Paris, France (L.S., J.L., P.G.S., P.A.); Department of Neurology and Stroke Centre, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris France (J.G.-V., L.S., J.L., P.A.); Université de Lille, CHU Lille, EA 2694-Santé publique: épidémiologie et qualité des soins, Lille, France (J.L.); Department of Neurology, hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France (M.-G.B.); Department of Neurology, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain (A.C.); Department of Neurology, Harvard University, Brigham and Women Hospital, MA (M.F.); Robertson Centre for Biostatistics, Department of Biostatistics, University of Glasgow, Glasgow, UK (I.F.); Department of Cardiology, NHLI Imperial College, ICMS, Royal Brompton Hospital, London, UK (K.M.F.; P.G.S.); Department of Neurology, University of Heidelberg, UMM, Mannheim, Germany (M.G.H.); Neurologische Klinik und Poliklinik, Universität Bern, Inselspital, Bern (H.P.M.); Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK (P.M.R.); and Department of Biostatistics, Hôpital Fernand Widal, Assistance Publique-Hôpitaux de Paris, Paris France (E.V.)
| | - Leila Sissani
- From the Université Paris Diderot, Paris, France (J.G.-V., M.-G.B., P.G.S., E.V., P.A.); INSERM LVTS (Laboratory for VascularTranslational Sciences) 1148 and Département Hospitalo-Universitaire FIRE (Fibrosis, Inflammation, Remodelling), Paris, France (L.S., J.L., P.G.S., P.A.); Department of Neurology and Stroke Centre, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris France (J.G.-V., L.S., J.L., P.A.); Université de Lille, CHU Lille, EA 2694-Santé publique: épidémiologie et qualité des soins, Lille, France (J.L.); Department of Neurology, hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France (M.-G.B.); Department of Neurology, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain (A.C.); Department of Neurology, Harvard University, Brigham and Women Hospital, MA (M.F.); Robertson Centre for Biostatistics, Department of Biostatistics, University of Glasgow, Glasgow, UK (I.F.); Department of Cardiology, NHLI Imperial College, ICMS, Royal Brompton Hospital, London, UK (K.M.F.; P.G.S.); Department of Neurology, University of Heidelberg, UMM, Mannheim, Germany (M.G.H.); Neurologische Klinik und Poliklinik, Universität Bern, Inselspital, Bern (H.P.M.); Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK (P.M.R.); and Department of Biostatistics, Hôpital Fernand Widal, Assistance Publique-Hôpitaux de Paris, Paris France (E.V.)
| | - Julien Labreuche
- From the Université Paris Diderot, Paris, France (J.G.-V., M.-G.B., P.G.S., E.V., P.A.); INSERM LVTS (Laboratory for VascularTranslational Sciences) 1148 and Département Hospitalo-Universitaire FIRE (Fibrosis, Inflammation, Remodelling), Paris, France (L.S., J.L., P.G.S., P.A.); Department of Neurology and Stroke Centre, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris France (J.G.-V., L.S., J.L., P.A.); Université de Lille, CHU Lille, EA 2694-Santé publique: épidémiologie et qualité des soins, Lille, France (J.L.); Department of Neurology, hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France (M.-G.B.); Department of Neurology, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain (A.C.); Department of Neurology, Harvard University, Brigham and Women Hospital, MA (M.F.); Robertson Centre for Biostatistics, Department of Biostatistics, University of Glasgow, Glasgow, UK (I.F.); Department of Cardiology, NHLI Imperial College, ICMS, Royal Brompton Hospital, London, UK (K.M.F.; P.G.S.); Department of Neurology, University of Heidelberg, UMM, Mannheim, Germany (M.G.H.); Neurologische Klinik und Poliklinik, Universität Bern, Inselspital, Bern (H.P.M.); Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK (P.M.R.); and Department of Biostatistics, Hôpital Fernand Widal, Assistance Publique-Hôpitaux de Paris, Paris France (E.V.)
| | - Marie-Germaine Bousser
- From the Université Paris Diderot, Paris, France (J.G.-V., M.-G.B., P.G.S., E.V., P.A.); INSERM LVTS (Laboratory for VascularTranslational Sciences) 1148 and Département Hospitalo-Universitaire FIRE (Fibrosis, Inflammation, Remodelling), Paris, France (L.S., J.L., P.G.S., P.A.); Department of Neurology and Stroke Centre, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris France (J.G.-V., L.S., J.L., P.A.); Université de Lille, CHU Lille, EA 2694-Santé publique: épidémiologie et qualité des soins, Lille, France (J.L.); Department of Neurology, hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France (M.-G.B.); Department of Neurology, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain (A.C.); Department of Neurology, Harvard University, Brigham and Women Hospital, MA (M.F.); Robertson Centre for Biostatistics, Department of Biostatistics, University of Glasgow, Glasgow, UK (I.F.); Department of Cardiology, NHLI Imperial College, ICMS, Royal Brompton Hospital, London, UK (K.M.F.; P.G.S.); Department of Neurology, University of Heidelberg, UMM, Mannheim, Germany (M.G.H.); Neurologische Klinik und Poliklinik, Universität Bern, Inselspital, Bern (H.P.M.); Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK (P.M.R.); and Department of Biostatistics, Hôpital Fernand Widal, Assistance Publique-Hôpitaux de Paris, Paris France (E.V.)
| | - Angel Chamorro
- From the Université Paris Diderot, Paris, France (J.G.-V., M.-G.B., P.G.S., E.V., P.A.); INSERM LVTS (Laboratory for VascularTranslational Sciences) 1148 and Département Hospitalo-Universitaire FIRE (Fibrosis, Inflammation, Remodelling), Paris, France (L.S., J.L., P.G.S., P.A.); Department of Neurology and Stroke Centre, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris France (J.G.-V., L.S., J.L., P.A.); Université de Lille, CHU Lille, EA 2694-Santé publique: épidémiologie et qualité des soins, Lille, France (J.L.); Department of Neurology, hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France (M.-G.B.); Department of Neurology, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain (A.C.); Department of Neurology, Harvard University, Brigham and Women Hospital, MA (M.F.); Robertson Centre for Biostatistics, Department of Biostatistics, University of Glasgow, Glasgow, UK (I.F.); Department of Cardiology, NHLI Imperial College, ICMS, Royal Brompton Hospital, London, UK (K.M.F.; P.G.S.); Department of Neurology, University of Heidelberg, UMM, Mannheim, Germany (M.G.H.); Neurologische Klinik und Poliklinik, Universität Bern, Inselspital, Bern (H.P.M.); Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK (P.M.R.); and Department of Biostatistics, Hôpital Fernand Widal, Assistance Publique-Hôpitaux de Paris, Paris France (E.V.)
| | - Marc Fisher
- From the Université Paris Diderot, Paris, France (J.G.-V., M.-G.B., P.G.S., E.V., P.A.); INSERM LVTS (Laboratory for VascularTranslational Sciences) 1148 and Département Hospitalo-Universitaire FIRE (Fibrosis, Inflammation, Remodelling), Paris, France (L.S., J.L., P.G.S., P.A.); Department of Neurology and Stroke Centre, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris France (J.G.-V., L.S., J.L., P.A.); Université de Lille, CHU Lille, EA 2694-Santé publique: épidémiologie et qualité des soins, Lille, France (J.L.); Department of Neurology, hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France (M.-G.B.); Department of Neurology, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain (A.C.); Department of Neurology, Harvard University, Brigham and Women Hospital, MA (M.F.); Robertson Centre for Biostatistics, Department of Biostatistics, University of Glasgow, Glasgow, UK (I.F.); Department of Cardiology, NHLI Imperial College, ICMS, Royal Brompton Hospital, London, UK (K.M.F.; P.G.S.); Department of Neurology, University of Heidelberg, UMM, Mannheim, Germany (M.G.H.); Neurologische Klinik und Poliklinik, Universität Bern, Inselspital, Bern (H.P.M.); Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK (P.M.R.); and Department of Biostatistics, Hôpital Fernand Widal, Assistance Publique-Hôpitaux de Paris, Paris France (E.V.)
| | - Ian Ford
- From the Université Paris Diderot, Paris, France (J.G.-V., M.-G.B., P.G.S., E.V., P.A.); INSERM LVTS (Laboratory for VascularTranslational Sciences) 1148 and Département Hospitalo-Universitaire FIRE (Fibrosis, Inflammation, Remodelling), Paris, France (L.S., J.L., P.G.S., P.A.); Department of Neurology and Stroke Centre, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris France (J.G.-V., L.S., J.L., P.A.); Université de Lille, CHU Lille, EA 2694-Santé publique: épidémiologie et qualité des soins, Lille, France (J.L.); Department of Neurology, hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France (M.-G.B.); Department of Neurology, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain (A.C.); Department of Neurology, Harvard University, Brigham and Women Hospital, MA (M.F.); Robertson Centre for Biostatistics, Department of Biostatistics, University of Glasgow, Glasgow, UK (I.F.); Department of Cardiology, NHLI Imperial College, ICMS, Royal Brompton Hospital, London, UK (K.M.F.; P.G.S.); Department of Neurology, University of Heidelberg, UMM, Mannheim, Germany (M.G.H.); Neurologische Klinik und Poliklinik, Universität Bern, Inselspital, Bern (H.P.M.); Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK (P.M.R.); and Department of Biostatistics, Hôpital Fernand Widal, Assistance Publique-Hôpitaux de Paris, Paris France (E.V.)
| | - Kim M Fox
- From the Université Paris Diderot, Paris, France (J.G.-V., M.-G.B., P.G.S., E.V., P.A.); INSERM LVTS (Laboratory for VascularTranslational Sciences) 1148 and Département Hospitalo-Universitaire FIRE (Fibrosis, Inflammation, Remodelling), Paris, France (L.S., J.L., P.G.S., P.A.); Department of Neurology and Stroke Centre, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris France (J.G.-V., L.S., J.L., P.A.); Université de Lille, CHU Lille, EA 2694-Santé publique: épidémiologie et qualité des soins, Lille, France (J.L.); Department of Neurology, hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France (M.-G.B.); Department of Neurology, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain (A.C.); Department of Neurology, Harvard University, Brigham and Women Hospital, MA (M.F.); Robertson Centre for Biostatistics, Department of Biostatistics, University of Glasgow, Glasgow, UK (I.F.); Department of Cardiology, NHLI Imperial College, ICMS, Royal Brompton Hospital, London, UK (K.M.F.; P.G.S.); Department of Neurology, University of Heidelberg, UMM, Mannheim, Germany (M.G.H.); Neurologische Klinik und Poliklinik, Universität Bern, Inselspital, Bern (H.P.M.); Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK (P.M.R.); and Department of Biostatistics, Hôpital Fernand Widal, Assistance Publique-Hôpitaux de Paris, Paris France (E.V.)
| | - Michael G Hennerici
- From the Université Paris Diderot, Paris, France (J.G.-V., M.-G.B., P.G.S., E.V., P.A.); INSERM LVTS (Laboratory for VascularTranslational Sciences) 1148 and Département Hospitalo-Universitaire FIRE (Fibrosis, Inflammation, Remodelling), Paris, France (L.S., J.L., P.G.S., P.A.); Department of Neurology and Stroke Centre, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris France (J.G.-V., L.S., J.L., P.A.); Université de Lille, CHU Lille, EA 2694-Santé publique: épidémiologie et qualité des soins, Lille, France (J.L.); Department of Neurology, hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France (M.-G.B.); Department of Neurology, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain (A.C.); Department of Neurology, Harvard University, Brigham and Women Hospital, MA (M.F.); Robertson Centre for Biostatistics, Department of Biostatistics, University of Glasgow, Glasgow, UK (I.F.); Department of Cardiology, NHLI Imperial College, ICMS, Royal Brompton Hospital, London, UK (K.M.F.; P.G.S.); Department of Neurology, University of Heidelberg, UMM, Mannheim, Germany (M.G.H.); Neurologische Klinik und Poliklinik, Universität Bern, Inselspital, Bern (H.P.M.); Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK (P.M.R.); and Department of Biostatistics, Hôpital Fernand Widal, Assistance Publique-Hôpitaux de Paris, Paris France (E.V.)
| | - Heinrich P Mattle
- From the Université Paris Diderot, Paris, France (J.G.-V., M.-G.B., P.G.S., E.V., P.A.); INSERM LVTS (Laboratory for VascularTranslational Sciences) 1148 and Département Hospitalo-Universitaire FIRE (Fibrosis, Inflammation, Remodelling), Paris, France (L.S., J.L., P.G.S., P.A.); Department of Neurology and Stroke Centre, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris France (J.G.-V., L.S., J.L., P.A.); Université de Lille, CHU Lille, EA 2694-Santé publique: épidémiologie et qualité des soins, Lille, France (J.L.); Department of Neurology, hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France (M.-G.B.); Department of Neurology, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain (A.C.); Department of Neurology, Harvard University, Brigham and Women Hospital, MA (M.F.); Robertson Centre for Biostatistics, Department of Biostatistics, University of Glasgow, Glasgow, UK (I.F.); Department of Cardiology, NHLI Imperial College, ICMS, Royal Brompton Hospital, London, UK (K.M.F.; P.G.S.); Department of Neurology, University of Heidelberg, UMM, Mannheim, Germany (M.G.H.); Neurologische Klinik und Poliklinik, Universität Bern, Inselspital, Bern (H.P.M.); Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK (P.M.R.); and Department of Biostatistics, Hôpital Fernand Widal, Assistance Publique-Hôpitaux de Paris, Paris France (E.V.)
| | - Peter M Rothwell
- From the Université Paris Diderot, Paris, France (J.G.-V., M.-G.B., P.G.S., E.V., P.A.); INSERM LVTS (Laboratory for VascularTranslational Sciences) 1148 and Département Hospitalo-Universitaire FIRE (Fibrosis, Inflammation, Remodelling), Paris, France (L.S., J.L., P.G.S., P.A.); Department of Neurology and Stroke Centre, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris France (J.G.-V., L.S., J.L., P.A.); Université de Lille, CHU Lille, EA 2694-Santé publique: épidémiologie et qualité des soins, Lille, France (J.L.); Department of Neurology, hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France (M.-G.B.); Department of Neurology, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain (A.C.); Department of Neurology, Harvard University, Brigham and Women Hospital, MA (M.F.); Robertson Centre for Biostatistics, Department of Biostatistics, University of Glasgow, Glasgow, UK (I.F.); Department of Cardiology, NHLI Imperial College, ICMS, Royal Brompton Hospital, London, UK (K.M.F.; P.G.S.); Department of Neurology, University of Heidelberg, UMM, Mannheim, Germany (M.G.H.); Neurologische Klinik und Poliklinik, Universität Bern, Inselspital, Bern (H.P.M.); Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK (P.M.R.); and Department of Biostatistics, Hôpital Fernand Widal, Assistance Publique-Hôpitaux de Paris, Paris France (E.V.)
| | - Philippe Gabriel Steg
- From the Université Paris Diderot, Paris, France (J.G.-V., M.-G.B., P.G.S., E.V., P.A.); INSERM LVTS (Laboratory for VascularTranslational Sciences) 1148 and Département Hospitalo-Universitaire FIRE (Fibrosis, Inflammation, Remodelling), Paris, France (L.S., J.L., P.G.S., P.A.); Department of Neurology and Stroke Centre, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris France (J.G.-V., L.S., J.L., P.A.); Université de Lille, CHU Lille, EA 2694-Santé publique: épidémiologie et qualité des soins, Lille, France (J.L.); Department of Neurology, hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France (M.-G.B.); Department of Neurology, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain (A.C.); Department of Neurology, Harvard University, Brigham and Women Hospital, MA (M.F.); Robertson Centre for Biostatistics, Department of Biostatistics, University of Glasgow, Glasgow, UK (I.F.); Department of Cardiology, NHLI Imperial College, ICMS, Royal Brompton Hospital, London, UK (K.M.F.; P.G.S.); Department of Neurology, University of Heidelberg, UMM, Mannheim, Germany (M.G.H.); Neurologische Klinik und Poliklinik, Universität Bern, Inselspital, Bern (H.P.M.); Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK (P.M.R.); and Department of Biostatistics, Hôpital Fernand Widal, Assistance Publique-Hôpitaux de Paris, Paris France (E.V.)
| | - Eric Vicaut
- From the Université Paris Diderot, Paris, France (J.G.-V., M.-G.B., P.G.S., E.V., P.A.); INSERM LVTS (Laboratory for VascularTranslational Sciences) 1148 and Département Hospitalo-Universitaire FIRE (Fibrosis, Inflammation, Remodelling), Paris, France (L.S., J.L., P.G.S., P.A.); Department of Neurology and Stroke Centre, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris France (J.G.-V., L.S., J.L., P.A.); Université de Lille, CHU Lille, EA 2694-Santé publique: épidémiologie et qualité des soins, Lille, France (J.L.); Department of Neurology, hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France (M.-G.B.); Department of Neurology, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain (A.C.); Department of Neurology, Harvard University, Brigham and Women Hospital, MA (M.F.); Robertson Centre for Biostatistics, Department of Biostatistics, University of Glasgow, Glasgow, UK (I.F.); Department of Cardiology, NHLI Imperial College, ICMS, Royal Brompton Hospital, London, UK (K.M.F.; P.G.S.); Department of Neurology, University of Heidelberg, UMM, Mannheim, Germany (M.G.H.); Neurologische Klinik und Poliklinik, Universität Bern, Inselspital, Bern (H.P.M.); Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK (P.M.R.); and Department of Biostatistics, Hôpital Fernand Widal, Assistance Publique-Hôpitaux de Paris, Paris France (E.V.)
| | - Pierre Amarenco
- From the Université Paris Diderot, Paris, France (J.G.-V., M.-G.B., P.G.S., E.V., P.A.); INSERM LVTS (Laboratory for VascularTranslational Sciences) 1148 and Département Hospitalo-Universitaire FIRE (Fibrosis, Inflammation, Remodelling), Paris, France (L.S., J.L., P.G.S., P.A.); Department of Neurology and Stroke Centre, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris France (J.G.-V., L.S., J.L., P.A.); Université de Lille, CHU Lille, EA 2694-Santé publique: épidémiologie et qualité des soins, Lille, France (J.L.); Department of Neurology, hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France (M.-G.B.); Department of Neurology, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain (A.C.); Department of Neurology, Harvard University, Brigham and Women Hospital, MA (M.F.); Robertson Centre for Biostatistics, Department of Biostatistics, University of Glasgow, Glasgow, UK (I.F.); Department of Cardiology, NHLI Imperial College, ICMS, Royal Brompton Hospital, London, UK (K.M.F.; P.G.S.); Department of Neurology, University of Heidelberg, UMM, Mannheim, Germany (M.G.H.); Neurologische Klinik und Poliklinik, Universität Bern, Inselspital, Bern (H.P.M.); Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK (P.M.R.); and Department of Biostatistics, Hôpital Fernand Widal, Assistance Publique-Hôpitaux de Paris, Paris France (E.V.).
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Cui ZW, Xie ZX, Wang BF, Zhong ZH, Chen XY, Sun YH, Sun QF, Yang GY, Bian LG. Carvacrol protects neuroblastoma SH-SY5Y cells against Fe(2+)-induced apoptosis by suppressing activation of MAPK/JNK-NF-κB signaling pathway. Acta Pharmacol Sin 2015; 36:1426-36. [PMID: 26592517 DOI: 10.1038/aps.2015.90] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2015] [Accepted: 08/26/2015] [Indexed: 12/15/2022] Open
Abstract
AIM Carvacrol (2-methyl-5-isopropylphenol), a phenolic monoterpene in the essential oils of the genera Origanum and Thymus, has been shown to exert a variety of therapeutic effects. Here we examined whether carvacrol protected neuroblastoma SH-SY5Y cells against Fe(2+)-induced apoptosis and explored the underlying mechanisms. METHODS Neuroblastoma SH-SY5Y cells were incubated with Fe(2+) for 24 h, and the cell viability was assessed with CCK-8 assay. TUNEL assay and flow cytometric analysis were performed to evaluate cell apoptosis. The mRNA levels of pro-inflammatory cytokines and NF-κB p65 were determined using qPCR. The expression of relevant proteins was determined using Western blot analysis or immunofluorescence staining. RESULTS Treatment of SH-SY5Y cells with Fe(2+) (50-200 μmol/L) dose-dependently decreased the cell viability, which was significantly attenuated by pretreatment with carvacrol (164 and 333 μmol/L). Treatment with Fe(2+) increased the Bax level and caspase-3 activity, and decreased the Bcl-2 level, resulting in cell apoptosis. Furthermore, treatment with Fe(2+) significantly increased the gene expression of IL-1β, IL-6 and TNF-α, and induced the nuclear translocation of NF-κB. Treatment with Fe(2+) also significantly increased the phosphorylation of p38, ERK, JNK and IKK in the cells. Pretreatment with carvacrol significantly inhibited Fe(2+)-induced activation of NF-κB, expression of the pro-inflammatory cytokines, and cell apoptosis. Moreover, pretreatment with carvacrol inhibited Fe(2+)-induced phosphorylation of JNK and IKK, but not p38 and ERK in the cells. CONCLUSION Carvacrol protects neuroblastoma SH-SY5Y cells against Fe(2+)-induced apoptosis, which may result from suppressing the MAPK/JNK-NF-κB signaling pathways.
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Ormstad H, Eilertsen G. A biopsychosocial model of fatigue and depression following stroke. Med Hypotheses 2015; 85:835-41. [DOI: 10.1016/j.mehy.2015.10.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 10/02/2015] [Indexed: 11/28/2022]
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Wirth MD, Shivappa N, Hurley TG, Hébert JR. Association between previously diagnosed circulatory conditions and a dietary inflammatory index. Nutr Res 2015; 36:227-33. [PMID: 26923509 DOI: 10.1016/j.nutres.2015.11.016] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 11/24/2015] [Accepted: 11/26/2015] [Indexed: 12/18/2022]
Abstract
Inflammation is a key contributor to the development or recurrence of circulatory disorders. Diet is a strong modifier of inflammation. It was hypothesized that more pro-inflammatory diets, as indicated by higher Dietary Inflammatory Index (DII) scores, would be associated with self-reported previously diagnosed circulatory disorders using National Health and Nutrition Examination Survey (NHANES) data. This analysis included NHANES respondents from 2005-2010 (n = 15,693). The DII was calculated from micro and macronutrients derived from a single 24-hour recall. Logistic regression, stratified by sex and adjusted for important covariates, was used to determine the odds of previous circulatory disorder diagnoses by quartile of DII scores. Excluding hypertension, which had a prevalence of 30%, the prevalence of any circulatory disorder was 8%. Those in DII quartile 4 were 1.30 (95%CI = 1.06-1.58) times more likely to have a previous circulatory disorder (excluding hypertension) compared to those in DII quartile 1. Similar findings were observed for specific CVDs including congestive heart failure, stroke, and heart attack. Participants in DII quartile 4 were more likely to have a diagnosis of hypertension compared to those in DII quartile 1 (prevalence odds ratio = 1.19, 95%CI = 1.05-1.34). Results tended to be stronger among females. Individuals with a previous circulatory disorder diagnosis from NHANES appear to have more pro-inflammatory diets compared to those without a previous diagnosis. Because inflammation is an important factor related to recurrence of circulatory disorders, the DII could be used in treatment programs to monitor dietary modulators of inflammation among individuals with these conditions.
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Affiliation(s)
- Michael D Wirth
- Cancer Prevention and Control Program, University of South Carolina, 915 Greene Street, Suite 200, Columbia, SC 29208; Department of Epidemiology and Biostatistics, University of South Carolina, 915 Greene Street, Suite 200, Columbia, SC 29208; Connecting Health Innovations, LLC, 1417 Gregg Street, Columbia, SC 29201.
| | - Nitin Shivappa
- Cancer Prevention and Control Program, University of South Carolina, 915 Greene Street, Suite 200, Columbia, SC 29208; Department of Epidemiology and Biostatistics, University of South Carolina, 915 Greene Street, Suite 200, Columbia, SC 29208; Connecting Health Innovations, LLC, 1417 Gregg Street, Columbia, SC 29201
| | - Thomas G Hurley
- Cancer Prevention and Control Program, University of South Carolina, 915 Greene Street, Suite 200, Columbia, SC 29208
| | - James R Hébert
- Cancer Prevention and Control Program, University of South Carolina, 915 Greene Street, Suite 200, Columbia, SC 29208; Department of Epidemiology and Biostatistics, University of South Carolina, 915 Greene Street, Suite 200, Columbia, SC 29208; Connecting Health Innovations, LLC, 1417 Gregg Street, Columbia, SC 29201
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Brough D, Rothwell NJ, Allan SM. Interleukin-1 as a pharmacological target in acute brain injury. Exp Physiol 2015; 100:1488-94. [PMID: 26096539 DOI: 10.1113/ep085135] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 05/04/2015] [Accepted: 06/05/2015] [Indexed: 12/13/2022]
Abstract
NEW FINDINGS What is the topic of this review? This review discusses the latest findings on the contribution of inflammation to brain injury, how inflammation is a therapeutic target, and details of recent and forthcoming clinical studies. What advances does it highlight? Here we highlight recent advances on the role and regulation of inflammasomes, and the latest clinical progress in targeting inflammation. Acute brain injury is one of the leading causes of mortality and disability worldwide. Despite this, treatments for acute brain injuries are limited, and there remains a massive unmet clinical need. Inflammation has emerged as a major contributor to non-communicable diseases, and there is now substantial and growing evidence that inflammation, driven by the cytokine interleukin-1 (IL-1), worsens acute brain injury. Interleukin-1 is regulated by large, multimolecular complexes called inflammasomes. Here, we discuss the latest research on the regulation of inflammasomes and IL-1 in the brain, preclinical efforts to establish the IL-1 system as a therapeutic target, and the promise of recent and future clinical studies on blocking the action of IL-1 for the treatment of brain injury.
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Affiliation(s)
- David Brough
- Faculty of Life Sciences, University of Manchester, Manchester, UK
| | - Nancy J Rothwell
- Faculty of Life Sciences, University of Manchester, Manchester, UK
| | - Stuart M Allan
- Faculty of Life Sciences, University of Manchester, Manchester, UK
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Miao YF, Wu H, Yang SF, Dai J, Qiu YM, Tao ZY, Zhang XH. 5'-adenosine monophosphate-induced hypothermia attenuates brain ischemia/reperfusion injury in a rat model by inhibiting the inflammatory response. Mediators Inflamm 2015; 2015:520745. [PMID: 25873763 DOI: 10.1155/2015/520745] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 09/03/2014] [Accepted: 10/22/2014] [Indexed: 12/24/2022] Open
Abstract
Hypothermia treatment is a promising therapeutic strategy for brain injury. We previously demonstrated that 5′-adenosine monophosphate (5′-AMP), a ribonucleic acid nucleotide, produces reversible deep hypothermia in rats when the ambient temperature is appropriately controlled. Thus, we hypothesized that 5′-AMP-induced hypothermia (AIH) may attenuate brain ischemia/reperfusion injury. Transient cerebral ischemia was induced by using the middle cerebral artery occlusion (MCAO) model in rats. Rats that underwent AIH treatment exhibited a significant reduction in neutrophil elastase infiltration into neuronal cells and matrix metalloproteinase 9 (MMP-9), interleukin-1 receptor (IL-1R), tumor necrosis factor receptor (TNFR), and Toll-like receptor (TLR) protein expression in the infarcted area compared to euthermic controls. AIH treatment also decreased the number of terminal deoxynucleotidyl transferase dUTP nick end labeling- (TUNEL-) positive neuronal cells. The overall infarct volume was significantly smaller in AIH-treated rats, and neurological function was improved. By contrast, rats with ischemic brain injury that were administered 5′-AMP without inducing hypothermia had ischemia/reperfusion injuries similar to those in euthermic controls. Thus, the neuroprotective effects of AIH were primarily related to hypothermia.
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Swarowska M, Janowska A, Polczak A, Klimkowicz-Mrowiec A, Pera J, Slowik A, Dziedzic T. The sustained increase of plasma fibrinogen during ischemic stroke predicts worse outcome independently of baseline fibrinogen level. Inflammation 2014; 37:1142-7. [PMID: 24531853 DOI: 10.1007/s10753-014-9838-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Hyperfibrinogenemia at the beginning of ischemic stroke is associated with poor outcome. We hypothesized that the sustained increase of plasma fibrinogen during stroke predicts outcome independently of baseline fibrinogen concentration. We included 266 patients with first-ever ischemic stroke in whom plasma fibrinogen level was measured on days 1, 7, and 14. The sustained fibrinogen’s increase was defined as the persistent elevation of fibrinogen’s concentration on days 7 and 14 by at least 20 % compared to the level on day 1. The functional outcome on day 30 was assessed using modified Rankin Scale (mRS). Favorable outcome was defined as mRS 0–1. The sustained increase of fibrinogen was found in 17 % of patients. On multivariate logistic regression analysis adjusted for age, NIHSS score, baseline fibrinogen >2.66 mmol/L, presence of infection, and hyperglycemia, the sustained fibrinogen’s level was associated with reduced chance of favorable outcome (OR: 0.17, 95 % CI: 0.06–0.48, P < 0.01).
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Abstract
INTRODUCTION Stroke is the second leading cause of death worldwide and the leading cause of adult neurological disability. Despite advances in stroke unit care, and increasing use of thrombolysis, there remains an urgent need for safe and effective treatments for acute ischaemic stroke. However, this is against a backdrop of multiple failures in translational drug development. Cerebral ischaemia initiates a complex cascade of immune and inflammatory pathways in the brain microvasculature and periphery, which contribute to the evolution of cerebral injury, resolution and repair. Targeting specific inflammatory or immune pathways, therefore, represents an attractive treatment strategy in acute ischaemic stroke. Although anti-inflammatory drugs have already failed in clinical trial development, several are currently at the Phase II developmental stage. AREAS COVERED The authors highlight several candidate drugs, which modulate a range of inflammatory and immune pathways, and have been investigated in pre-clinical and Phase II studies to date. EXPERT OPINION Drugs targeting inflammatory and immune pathways offer theoretical advantages including potentially longer therapeutic time windows and effects complementary to thrombolysis (ameliorating reperfusion injury). Fundamental changes in the approach to pre-clinical and clinical drug development are required to facilitate successful translation of promising candidate drugs into clinical practice.
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Affiliation(s)
- Craig J Smith
- Greater Manchester Comprehensive Stroke Centre, Department of Medical Neurosciences, Salford Royal Foundation Trust , Salford , UK
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30
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Benakis C, Garcia-Bonilla L, Iadecola C, Anrather J. The role of microglia and myeloid immune cells in acute cerebral ischemia. Front Cell Neurosci 2015; 8:461. [PMID: 25642168 PMCID: PMC4294142 DOI: 10.3389/fncel.2014.00461] [Citation(s) in RCA: 147] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Accepted: 12/18/2014] [Indexed: 01/15/2023] Open
Abstract
The immune response to acute cerebral ischemia is a major contributor to stroke pathobiology. The inflammatory response is characterized by the participation of brain resident cells and peripheral leukocytes. Microglia in the brain and monocytes/neutrophils in the periphery have a prominent role in initiating, sustaining and resolving post-ischemic inflammation. In this review we aim to summarize recent literature concerning the origins, fate and role of microglia, monocytes and neutrophils in models of cerebral ischemia and to discuss their relevance for human stroke.
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Affiliation(s)
- Corinne Benakis
- Feil Family Brain and Mind Research Institute, Weill Cornell Medical College New York, NY, USA
| | - Lidia Garcia-Bonilla
- Feil Family Brain and Mind Research Institute, Weill Cornell Medical College New York, NY, USA
| | - Costantino Iadecola
- Feil Family Brain and Mind Research Institute, Weill Cornell Medical College New York, NY, USA
| | - Josef Anrather
- Feil Family Brain and Mind Research Institute, Weill Cornell Medical College New York, NY, USA
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Abstract
In the middle cerebral artery occlusion model of ischemic injury, inflammation primarily occurs in the infarct and peripheral zones. In the ischemic zone, neurons undergo necrosis and apoptosis, and a large number of reactive microglia are present. In the present study, we investigated the pathological changes in a rat model of middle cerebral artery occlusion. Neuronal necrosis appeared 12 hours after middle cerebral artery occlusion, and the peak of neuronal apoptosis appeared 4 to 6 days after middle cerebral artery occlusion. Inflammatory cytokines and microglia play a role in damage and repair after middle cerebral artery occlusion. Serum intercellular cell adhesion molecule-1 levels were positively correlated with the permeability of the blood-brain barrier. These findings indicate that intercellular cell adhesion molecule-1 may be involved in blood-brain barrier injury, microglial activation, and neuronal apoptosis. Inhibiting blood-brain barrier leakage may alleviate neuronal injury following ischemia.
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Affiliation(s)
- Lingfeng Wu
- Nanchang University Medical College, Nanchang, Jiangxi Province, China ; Department of Neurology, People's Hospital of Jiangxi Province, Nanchang, Jiangxi Province, China
| | - Kunnan Zhang
- Nanchang University Medical College, Nanchang, Jiangxi Province, China
| | - Guozhu Hu
- Institution of Neurology, People's Hospital of Jiangxi Province, Nanchang, Jiangxi Province, China
| | - Haiyu Yan
- Institution of Neurology, People's Hospital of Jiangxi Province, Nanchang, Jiangxi Province, China
| | - Chen Xie
- Institution of Neurology, People's Hospital of Jiangxi Province, Nanchang, Jiangxi Province, China
| | - Xiaomu Wu
- Nanchang University Medical College, Nanchang, Jiangxi Province, China
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Mishiro K, Imai T, Sugitani S, Kitashoji A, Suzuki Y, Takagi T, Chen H, Oumi Y, Tsuruma K, Shimazawa M, Hara H. Diabetes mellitus aggravates hemorrhagic transformation after ischemic stroke via mitochondrial defects leading to endothelial apoptosis. PLoS One 2014; 9:e103818. [PMID: 25133692 PMCID: PMC4136737 DOI: 10.1371/journal.pone.0103818] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 07/04/2014] [Indexed: 12/26/2022] Open
Abstract
Diabetes is a crucial risk factor for stroke and is associated with increased frequency and poor prognosis. Although endothelial dysfunction is a known contributor of stroke, the underlying mechanisms have not been elucidated. The aim of this study was to elucidate the mechanism by which chronic hyperglycemia may contribute to the worsened prognosis following stroke, especially focusing on mitochondrial alterations. We examined the effect of hyperglycemia on hemorrhagic transformation at 24 hours after middle cerebral artery occlusion (MCAO) in streptozotocin (STZ) -induced diabetic mice. We also examined the effects of high-glucose exposure for 6 days on cell death, mitochondrial functions and morphology in human brain microvascular endothelial cells (HBMVECs) or human endothelial cells derived from induced pluripotent stem cells (iCell endothelial cells). Hyperglycemia aggravated hemorrhagic transformation, but not infarction following stroke. High-glucose exposure increased apoptosis, capase-3 activity, and release of apoptosis inducing factor (AIF) and cytochrome c in HBMVECs as well as affected mitochondrial functions (decreased cell proliferation, ATP contents, mitochondrial membrane potential, and increased matrix metalloproteinase (MMP)-9 activity, but not reactive oxygen species production). Furthermore, morphological aberration of mitochondria was observed in diabetic cells (a great deal of fragmentation, vacuolation, and cristae disruption). A similar phenomena were seen also in iCell endothelial cells. In conclusion, chronic hyperglycemia aggravated hemorrhagic transformation after stroke through mitochondrial dysfunction and morphological alteration, partially via MMP-9 activation, leading to caspase-dependent apoptosis of endothelial cells of diabetic mice. Mitochondria-targeting therapy may be a clinically innovative therapeutic strategy for diabetic complications in the future.
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Affiliation(s)
- Keisuke Mishiro
- Molecular Pharmacology, Department of Biofunctional Evaluation, Gifu Pharmaceutical University, Gifu, Japan
| | - Takahiko Imai
- Molecular Pharmacology, Department of Biofunctional Evaluation, Gifu Pharmaceutical University, Gifu, Japan
| | - Sou Sugitani
- Molecular Pharmacology, Department of Biofunctional Evaluation, Gifu Pharmaceutical University, Gifu, Japan
| | - Akira Kitashoji
- Molecular Pharmacology, Department of Biofunctional Evaluation, Gifu Pharmaceutical University, Gifu, Japan
| | - Yukiya Suzuki
- Molecular Pharmacology, Department of Biofunctional Evaluation, Gifu Pharmaceutical University, Gifu, Japan
| | - Toshinori Takagi
- Molecular Pharmacology, Department of Biofunctional Evaluation, Gifu Pharmaceutical University, Gifu, Japan
- Departments of Neurosurgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Huayue Chen
- Department of Anatomy, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Yasunori Oumi
- Division of Instrument Analysis, Life Science Research Center, Gifu University, Gifu, Japan
| | - Kazuhiro Tsuruma
- Molecular Pharmacology, Department of Biofunctional Evaluation, Gifu Pharmaceutical University, Gifu, Japan
| | - Masamitsu Shimazawa
- Molecular Pharmacology, Department of Biofunctional Evaluation, Gifu Pharmaceutical University, Gifu, Japan
| | - Hideaki Hara
- Molecular Pharmacology, Department of Biofunctional Evaluation, Gifu Pharmaceutical University, Gifu, Japan
- * E-mail:
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Denes A, Pradillo JM, Drake C, Buggey H, Rothwell NJ, Allan SM. Surgical manipulation compromises leukocyte mobilization responses and inflammation after experimental cerebral ischemia in mice. Front Neurosci 2014; 7:271. [PMID: 24478617 PMCID: PMC3894778 DOI: 10.3389/fnins.2013.00271] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 12/21/2013] [Indexed: 12/11/2022] Open
Abstract
Acute brain injury results in peripheral inflammatory changes, although the impact of these processes on neuronal death and neuroinflammation is currently unclear. To facilitate the translation of experimental studies to clinical benefit, it is vital to characterize the mechanisms by which acute brain injury induces peripheral inflammatory changes, and how these are affected by surgical manipulation in experimental models. Here we show that in mice, even mild surgical manipulation of extracranial tissues induced marked granulocyte mobilization (300%) and systemic induction of cytokines. However, intracranial changes induced by craniotomy, or subsequent induction of focal cerebral ischemia were required to induce egress of CXCR2-positive granulocytes from the bone marrow. CXCR2 blockade resulted in reduced mobilization of granulocytes from the bone marrow, caused an unexpected increase in circulating granulocytes, but failed to affect brain injury induced by cerebral ischemia. We also demonstrate that isoflurane anaesthesia interferes with circulating leukocyte responses, which could contribute to the reported vascular and neuroprotective effects of isoflurane. In addition, no immunosuppression develops in the bone marrow after experimental stroke. Thus, experimental models of cerebral ischemia are compromised by surgery and anaesthesia in proportion to the severity of surgical intervention and overall tissue injury. Understanding the inherent confounding effects of surgical manipulation and development of new models of cerebral ischemia with minimal surgical intervention could facilitate better understanding of interactions between inflammation and brain injury.
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Affiliation(s)
- Adam Denes
- Faculty of Life Sciences, University of Manchester Manchester, UK ; Laboratory of Molecular Neuroendocrinology, Institute of Experimental Medicine Budapest, Hungary
| | - Jesus M Pradillo
- Faculty of Life Sciences, University of Manchester Manchester, UK
| | - Caroline Drake
- Faculty of Life Sciences, University of Manchester Manchester, UK
| | - Hannah Buggey
- Faculty of Life Sciences, University of Manchester Manchester, UK
| | - Nancy J Rothwell
- Faculty of Life Sciences, University of Manchester Manchester, UK
| | - Stuart M Allan
- Faculty of Life Sciences, University of Manchester Manchester, UK
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Zhou R, Yang Z, Tang X, Tan Y, Wu X, Liu F. Propofol protects against focal cerebral ischemia via inhibition of microglia-mediated proinflammatory cytokines in a rat model of experimental stroke. PLoS One. 2013;8:e82729. [PMID: 24349350 DOI: 10.1371/journal.pone.0082729] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 11/05/2013] [Indexed: 11/19/2022] Open
Abstract
Ischemic stroke induces microglial activation and release of proinflammatory cytokines, contributing to the expansion of brain injury and poor clinical outcome. Propofol has been shown to ameliorate neuronal injury in a number of experimental studies, but the precise mechanisms involved in its neuroprotective effects remain unclear. We tested the hypothesis that propofol confers neuroprotection against focal ischemia by inhibiting microglia-mediated inflammatory response in a rat model of ischemic stroke. Sprague-Dawley rats were subjected to middle cerebral artery occlusion (MCAO) for 2 h followed by 24 h of reperfusion. Propofol (50 mg/kg/h) or vehicle was infused intravenously at the onset of reperfusion for 30 minutes. In vehicle-treated rats, MCAO resulted in significant cerebral infarction, higher neurological deficit scores and decreased time on the rotarod compared with sham-operated rats. Propofol treatment reduced infarct volume and improved the neurological functions. In addition, molecular studies demonstrated that mRNA expression of microglial marker Cd68 and Emr1 was significantly increased, and mRNA and protein expressions of proinflammatory cytokines tumor necrosis factor-α, interleukin-1β and interleukin-6 were augmented in the peri-infarct cortical regions of vehicle-treated rats 24 h after MCAO. Immunohistochemical study revealed that number of total microglia and proportion of activated microglia in the peri-infarct cortical regions were markedly elevated. All of these findings were ameliorated in propofol-treated rats. Furthermore, vehicle-treated rats had higher plasma levels of interleukin-6 and C-reactive protein 24 h after MCAO, which were decreased after treatment with propofol. These results suggest that propofol protects against focal cerebral ischemia via inhibition of microglia-mediated proinflammatory cytokines. Propofol may be a promising therapeutic agent for the treatment of ischemic stroke and other neurodegenerative diseases associated with microglial activation.
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Mantani PT, Ljungcrantz I, Andersson L, Alm R, Hedblad B, Björkbacka H, Nilsson J, Fredrikson GN. Circulating CD40+ and CD86+ B cell subsets demonstrate opposing associations with risk of stroke. Arterioscler Thromb Vasc Biol 2013; 34:211-8. [PMID: 24202305 DOI: 10.1161/atvbaha.113.302667] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Accumulating evidence shows that immune cells play an important role in atherosclerosis. Most attention has focused on the role of different T cell subsets, whereas the possible involvement of B cells has been less studied. In this study, we assessed the association of 2 different B cell subsets, CD19(+)CD40(+) and CD19(+)CD86(+) B cells, with risk for development of acute cardiovascular events. APPROACH AND RESULTS The prospective study included 700 subjects randomly selected from the cardiovascular cohort of the Malmö Diet and Cancer study. Mononuclear leukocytes, stored at -140(○)C at the baseline investigation in 1991-1994, were thawed and B cell subsets analyzed by flow cytometry. Cytokine release from CD3/CD28-stimulated mononuclear leukocytes was measured with multiplex ELISA. Baseline carotid intima-media thickness and stenosis were assessed by ultrasonography, and clinical events were monitored through validated national registers during a median/mean follow-up time of 15 years. The subjects in the highest tertile of CD19(+)CD40(+) B cells had a significantly lower risk of incident stroke after adjustment for other risk factors. In contrast, CD19(+)CD86(+) B cells were associated with higher risk for development of a stroke event and increased release of proinflammatory cytokines from mononuclear leukocytes. CONCLUSIONS These observations provide evidence for an involvement of B cells in the incidence of stroke and suggest that both pathogenic and protective B cell subsets exist.
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Affiliation(s)
- Polyxeni T Mantani
- From the Department of Clinical Sciences, Skåne University Hospital Malmö, Lund University, Malmö, Sweden (P.T.M., I.L., L.A., R.A., B.H., H.B., J.N., G.N.F.); and Faculty of Health and Society, Malmö University, Malmö, Sweden (G.N.F.)
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