In Search of Clinical Neuroprotection After Brain Ischemia

Meloni, Bruno P.; Campbell, Kym; Zhu, Hongdong; Knuckey, Neville W.

doi:10.1161/strokeaha.108.542381

Cited by 50 publications

(11 citation statements)

References 33 publications

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“…Synergistic effects of hypothermia with intravenous magnesium, caffeine, and alcohol have been proposed for study. 823,824 Ongoing feasibility and larger clinical trials of induced hypothermia, either alone or in combination with other therapies, will likely increase our understanding of the role of hypothermia in acute cerebral ischemia. Until then, there remains insufficient clinical evidence to establish a class of recommendation for induced hypothermia in acute stroke.…”

Section: Hypothermiamentioning

confidence: 99%

Guidelines for the Early Management of Patients With Acute Ischemic Stroke

Jauch¹,

Saver²,

Adams³

et al. 2013

Stroke

5,336

1,801

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Background and Purpose-The authors present an overview of the current evidence and management recommendations for evaluation and treatment of adults with acute ischemic stroke. The intended audiences are prehospital care providers, physicians, allied health professionals, and hospital administrators responsible for the care of acute ischemic stroke patients within the first 48 hours from stroke onset. These guidelines supersede the prior 2007 guidelines and 2009 updates. Methods-Members of the writing committee were appointed by the American Stroke Association Stroke Council's Scientific Statement Oversight Committee, representing various areas of medical expertise. Strict adherence to the American Heart Association conflict of interest policy was maintained throughout the consensus process. Panel members were assigned topics relevant to their areas of expertise, reviewed the stroke literature with emphasis on publications since the prior guidelines, and drafted recommendations in accordance with the American Heart Association Stroke Council's Level of Evidence grading algorithm. Results-The goal of these guidelines is to limit the morbidity and mortality associated with stroke. The guidelines support the overarching concept of stroke systems of care and detail aspects of stroke care from patient recognition; emergency medical services activation, transport, and triage; through the initial hours in the emergency department and stroke unit. The guideline discusses early stroke evaluation and general medical care, as well as ischemic stroke, specific interventions such as reperfusion strategies, and general physiological optimization for cerebral resuscitation. The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest. Guidelines for the Early Management of PatientsThis statement was approved by the American Heart Association Science Advisory and Coordinating Committee on December 12, 2012. A copy of the document is available at http://my.americanheart.org/statements by selecting either the "By Topic" link or the "By Publication Date" link. To purchase additional reprints, call 843-216-2533 or e-mail kelle.ramsay@wolterskluwer.com.The Executive Summary is available as an online-only Data Supplement with this article at http://stroke.ahajournals.org/lookup/suppl/ doi:10.1161/STR.0b013e318284056a/-/DC1.The American Heart Association requests that this document be cited as follows: Jauch EC, Saver JL, Adams HP Jr, Bruno A, Connors JJ, Demaerschalk BM, Khatri P, McMullan PW Jr, Qureshi AI, Rosenfield K, Scott PA, Summers DR, Wang DZ, Wintermark M, Yonas H; on behalf of the American Heart Association Stroke Council, Council on Cardio...

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Section: Hypothermiamentioning

confidence: 99%

Guidelines for the Early Management of Patients With Acute Ischemic Stroke

Jauch¹,

Saver²,

Adams³

et al. 2013

Stroke

5,336

1,801

View full text Add to dashboard Cite

show abstract

“…Such patients need prophylaxis of lignocaine, providing deep anaesthesia, use of ganglionic blockers, antihypertensive agents and narcotics. [20,21] Alpha-2 adrenoceptor agonists diminish cardiovascular responses to laryngoscopy and endotracheal intubation. It also lessens MAC of inhaled anaesthetics by up to 50% and increases effects of opioids by exciting alpha-2 receptors in the spinal cord where they supplement endogenous opiate release and control the descending noradrenergic pathways involved in spinal nociceptive processing.…”

Section: Discussionmentioning

confidence: 99%

Variations in Circulatory Responses to Laryngoscopy - Dexmedetomidine vs. Magnesium Sulphate

Alam¹,

Kumar²,

Hussain³

et al. 2017

Ann. Int. Med. Den. Res.

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“…Although there is currently no promising pharmacotherapy for ischemic stroke aside from rt-PA treatment, therapeutic hypothermia has been shown to improve neurological outcome in animal models of both focal and global ischemia for decades (Yanamoto et al 1999;Meloni et al 2009), and is one of the most extensively studied and powerful neuroprotective strategies for the treatment of acute ischemic stroke (Chang and Marshall 2012;Yenari and Han 2012;Wu and Grotta 2013). Moreover, recent studies show that therapeutic hypothermia also has strong effects on the inflammatory response (Kawamura et al 2006;Gu et al 2014).…”

Section: Discussionmentioning

confidence: 99%

A novel caffeoyl triterpene attenuates cerebral ischemic injury with potent anti‐inflammatory and hypothermic effects

Ruan

Wang

Huang

et al. 2015

Journal of Neurochemistry

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Despite the intense efforts in searching for stroke therapies, an urgent need still exists to explore novel neuroprotective agents for ischemic stroke that have high efficacy and wide therapeutic time-window. Here, we provide the first demonstration that 28-O-caffeoyl betulin (B-CA), a novel derivative of naturally occurring caffeoyl triterpene, could significantly alleviate brain infarction and neurological deficit when given as late as 6 h after transient middle cerebral artery occlusion in the rat. Moreover, post-ischemia B-CA administration exhibited long-term (14 days post stroke) protective effects on both brain infarction and functional (i.e., motor and sensory) deficits. Protective B-CA effects correlated with decreased inflammatory responses as indicated by inhibition of microglia and astrocyte activation [stained with ionized calcium-binding adapter molecule 1 (Iba-1) and glial fibrillary acidic protein (GFAP) antibody, respectively], as well as suppression of tumor necrosis factor-a, interleukin-1b, and cyclooxygenase-2 overproduction in the ipsilateral cortex of ischemic rat. B-CA administration caused significant hypothermia in the focal cerebral ischemic rat, which may contribute to its ameliorative effects on brain damage and inflammation. In view of its potency in wide therapeutic time-window, robust anti-inflammatory and hypothermic effects, this novel caffeoyl triterpene derivative may lead toward the development of effective therapeutic strategies for the treatment of ischemic stroke. Keywords: caffeoyl triterpene, hypothermia, inflammation, ischemic stroke, neuroprotection, therapeutic time window. Ischemic stroke is one of the leading causes of morbidity and mortality in the world (Go et al. 2014). Currently, the only US Food and Drug Administration-approved acute intervention for ischemic stroke is thrombolytic therapy using recombinant tissue plasminogen activator (rt-PA). Although rt-PA treatment can provide acute recanalization and improves functional outcome post stroke, it has a narrow therapeutic time window of < 4.5 h post stroke with risk of hemorrhage and may exacerbate the cerebral injury (Fonarow et al. 2011). While on the other hand, the neuroprotective approach has gained increasing attention and considered as a promising alternative treatment for ischemic stroke (Schmidt Abbreviations used: B-CA, 28-O-caffeoyl betulin; COX-2, cyclooxygenase-2; ERK, extracellular regulated protein kinases; GFAP, glial fibrillary acidic protein; Iba-1, ionized calcium-binding adapter molecule 1; IL-1b, interleukin-1b; IL-6, interleukin-6; MCAO, middle cerebral artery occlusion; MMP-9, matrix metallopeptidase 9; mNSS, modified neurological severity score; MTT, 3-(4,5-dimethylthiazol-2-yl)-2,5 diphenyltetrazolium bromide; OGD, oxygen and glucose deprivation; PSD-95, postsynaptic density 95; rCBF, regional cerebral blood flow; rt-PA, recombinant tissue plasminogen activator; TNF-a, tumor necrosis factor-a; TRPV1, the transient receptor potential cation channel subfamily V member 1; TTC, tri...

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In Search of Clinical Neuroprotection After Brain Ischemia

Cited by 50 publications

References 33 publications

Guidelines for the Early Management of Patients With Acute Ischemic Stroke

Guidelines for the Early Management of Patients With Acute Ischemic Stroke

Variations in Circulatory Responses to Laryngoscopy - Dexmedetomidine vs. Magnesium Sulphate

A novel caffeoyl triterpene attenuates cerebral ischemic injury with potent anti‐inflammatory and hypothermic effects

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