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Patzwaldt K, Berezhnoy G, Ionescu T, Schramm L, Wang Y, Owczorz M, Calderón E, Poli S, Serna Higuita LM, Gonzalez-Menendez I, Quintanilla-Martinez L, Herfert K, Pichler B, Trautwein C, Castaneda-Vega S. Repurposing the mucolytic agent ambroxol for treatment of sub-acute and chronic ischemic stroke. Brain Commun 2023; 5:fcad099. [PMID: 37065090 PMCID: PMC10090797 DOI: 10.1093/braincomms/fcad099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 01/31/2023] [Accepted: 03/27/2023] [Indexed: 03/31/2023] Open
Abstract
Abstract
Ambroxol is a well-known mucolytic expectorant, which has gained much attention in Amyotrophic lateral sclerosis, Parkinson’s and Gaucher’s disease. A specific focus has been placed on Ambroxol’s glucocerebrosidase-stimulating activity, on grounds that the point mutation of the gba1 gene, which codes for this enzyme, is a risk factor for developing Parkinson’s disease. However, Ambroxol has been attributed other characteristics, such as the potent inhibition of sodium channels, modification of calcium homeostasis, anti-inflammatory effects and modifications of oxygen radical scavengers. We hypothesized that Ambroxol could have a direct impact on neuronal rescue if administered directly after ischemic stroke induction.
We longitudinally evaluated 53 rats using magnetic resonance imaging to examine stroke volume, edema, white matter integrity, resting state functional magnetic resonance imaging and behavior for one month after ischemic stroke onset. For closer mechanistic insights, we evaluated tissue metabolomics of different brain regions in a subgroup of animals using ex-vivo nuclear magnetic resonance spectroscopy.
Ambroxol-treated animals presented reduced stroke volumes, reduced cytotoxic edema, reduced white matter degeneration, reduced necrosis, improved behavioral outcomes and complex changes in functional brain connectivity. Nuclear magnetic resonance spectroscopy tissue metabolomic data at 24 h post stroke proposes several metabolites that are capable of minimizing post-ischemic damage and that presented prominent shifts during Ambroxol treatment in comparison to controls. Taking everything together, we propose that Ambroxol catalyzes recovery in energy metabolism, cellular homeostasis, membrane repair mechanisms and redox balance. One week of Ambroxol administration following stroke onset reduced ischemic stroke severity and improved functional outcome in the subacute phase followed by reduced necrosis in the chronic stroke phase.
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Affiliation(s)
- Kristin Patzwaldt
- Werner Siemens Imaging Center, Department of Preclinical Imaging and Radiopharmacy, Eberhard Karls University Tuebingen, Tuebingen 72076, Germany
| | - Georgy Berezhnoy
- Werner Siemens Imaging Center, Department of Preclinical Imaging and Radiopharmacy, Eberhard Karls University Tuebingen, Tuebingen 72076, Germany
| | - Tudor Ionescu
- Werner Siemens Imaging Center, Department of Preclinical Imaging and Radiopharmacy, Eberhard Karls University Tuebingen, Tuebingen 72076, Germany
| | - Linda Schramm
- Werner Siemens Imaging Center, Department of Preclinical Imaging and Radiopharmacy, Eberhard Karls University Tuebingen, Tuebingen 72076, Germany
| | - Yi Wang
- Hertie Institute for Clinical Brain Research, Department for Neurology, University Hospital Tuebingen, Tuebingen 72076, Germany
| | - Miriam Owczorz
- Werner Siemens Imaging Center, Department of Preclinical Imaging and Radiopharmacy, Eberhard Karls University Tuebingen, Tuebingen 72076, Germany
| | - Eduardo Calderón
- Department of Nuclear Medicine and Clinical Molecular Imaging, University Hospital Tuebingen, Tuebingen 72076, Germany
| | - Sven Poli
- Hertie Institute for Clinical Brain Research, Department for Neurology, University Hospital Tuebingen, Tuebingen 72076, Germany
| | - Lina M Serna Higuita
- Institute for Clinical Epidemiology and Applied Biostatistics, University Hospital Tuebingen, Tuebingen 72076, Germany
| | - Irene Gonzalez-Menendez
- Institute of Pathology and Neuropathology, Comprehensive Cancer Center, Eberhard Karls University, Tuebingen 72076, Germany
- Cluster of Excellence iFIT (EXC 2180) ‘Image-Guided and Functionally Instructed Tumor Therapies’, Eberhard Karls University Tuebingen, Tuebingen 72076, Germany
| | - Leticia Quintanilla-Martinez
- Institute of Pathology and Neuropathology, Comprehensive Cancer Center, Eberhard Karls University, Tuebingen 72076, Germany
- Cluster of Excellence iFIT (EXC 2180) ‘Image-Guided and Functionally Instructed Tumor Therapies’, Eberhard Karls University Tuebingen, Tuebingen 72076, Germany
| | - Kristina Herfert
- Werner Siemens Imaging Center, Department of Preclinical Imaging and Radiopharmacy, Eberhard Karls University Tuebingen, Tuebingen 72076, Germany
| | - Bernd Pichler
- Werner Siemens Imaging Center, Department of Preclinical Imaging and Radiopharmacy, Eberhard Karls University Tuebingen, Tuebingen 72076, Germany
- Cluster of Excellence iFIT (EXC 2180) ‘Image-Guided and Functionally Instructed Tumor Therapies’, Eberhard Karls University Tuebingen, Tuebingen 72076, Germany
| | | | - Salvador Castaneda-Vega
- Correspondence to: Salvador Castaneda Vega, Werner Siemens Imaging Center, Department of Preclinical Imaging and Radiopharmacy, Eberhard Karls University of Tuebingen, Roentgenweg 13, 72076 Tuebingen, Germany. E-mail:
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