Therapeutic Strategies in Acute Intracerebral Hemorrhage

Brouwers, H. Bart; Goldstein, Joshua N.

doi:10.1007/s13311-011-0091-8

Cited by 47 publications

(28 citation statements)

References 135 publications

(183 reference statements)

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“…Despite advances in the field of stroke and neurocritical care, the 30-day mortality has not changed significantly over the past two decades. The therapeutic interventions that are currently available focus primarily on supportive care and comorbidity management and prevention[5,6,7]. Even in patients who survive the acute ictus (resulting in mass effect and increased intracranial pressure and primary brain injury[8,9]), the extravasated blood and, subsequently, the hemolytic products trigger a series of adverse events within brain parenchyma, causing secondary brain injury, edema and neurological deficits[4,10,11,12,13,14].…”

Section: Intracerebral Hemorrhage Pathobiology and Pparγmentioning

confidence: 99%

Pleiotropic Role of PPARγ in Intracerebral Hemorrhage: An Intricate System Involving Nrf2, RXR, and NF‐κB

Zhao¹,

Gonzales²,

Aronowski³

2014

CNS Neurosci Ther

109

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Intracerebral hemorrhage (ICH) is a subtype of stroke involving formation of hematoma within brain parenchyma, which accounts for 8–15% of all strokes in Western societies and 20–30% among Asian populations, and has a one-year mortality rate greater than 50%. The high mortality and severe morbidity make ICH a major public health problem. Only a few evidence-based targeted treatments are used for ICH management, and interventions focus primarily on supportive care and comorbidity prevention. Even in patients who survive the ictus, extravasated blood (including plasma components) and subsequent intra-hematoma hemolytic products trigger a series of adverse events within the brain parenchyma, leading to secondary brain injury, edema and severe neurological deficits or death. Although the hematoma in humans gradually resolves within months, full restoration of neurologic function can be slow and often incomplete, leaving survivors with devastating neurological deficits. During past years, peroxisome proliferator-activated receptor gamma (PPARγ) transcription factor and its agonists received recognition as important players in regulating not only glucose and lipid metabolism (which underlies its therapeutic effect in type 2 diabetes mellitus), and more recently, as an instrumental pleiotropic regulator of anti-inflammation, anti-oxidative regulation, and phagocyte-mediated cleanup processes. PPARγ agonists have emerged as potential therapeutic target for stroke. The use of PPARγ as a therapeutic target appears to have particularly strong compatibility toward pathogenic components of ICH. In addition to its direct genomic effect, PPARγ may interact with transcription factor, NF-κB, which may underlie many aspects of the anti-inflammatory effect of PPARγ. Furthermore, PPARγ appears to regulate expression of Nrf2, another transcription factor and master regulator of detoxification and anti-oxidative regulation. Finally, the synergistic co-stimulation of PPARγ and retinoid X receptor, RXR, may play an additional role in the therapeutic modulation of PPARγ function. In this article, we outline the main components of the role of PPARγ in ICH pathogenesis.

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Section: Intracerebral Hemorrhage Pathobiology and Pparγmentioning

confidence: 99%

Pleiotropic Role of PPARγ in Intracerebral Hemorrhage: An Intricate System Involving Nrf2, RXR, and NF‐κB

Zhao¹,

Gonzales²,

Aronowski³

2014

CNS Neurosci Ther

109

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“…Edaravone markedly suppresses inflammatory markers and inflammatory factors, including hs-CPR and IL-6, reducing further damage following ACH [18]. In our study, the hs-CRP and IL-6 levels of the two groups decreased dramatically after treatment (p < 0.05), but the reduction was more remarkable in the treatment group (p < 0.05).…”

Section: Discussionmentioning

confidence: 41%

Clinical efficacy and safety of edaravone therapy in acute cerebral haemorrhage

Yu¹,

Zhang²,

Ren³

et al. 2016

Trop. J. Pharm Res

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“…Each 10% enlargement of the hematoma resulting in a 5% increased hazard of death, and an increase of 16% in the likelihood of 1 point worsening on the modified Rankin Scale [18].…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have also demonstrated that hematoma volume is a good predictor of long term mortality, beyond the acute period [28]. In addition, it is associated with poor functional outcome [18]. There is an association between initial hematoma volume and subsequent expansion: the larger the hematoma on presentation, the higher the risk of HE [4].…”

Section: Discussionmentioning

confidence: 99%

Intracerebral haemorrhage growth is influenced by anticoagulation intensity

Ye¹,

Leonid²,

Paltoglou³

et al. 2017

Neurol Disord Therap

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Background: Intracerebral hemorrhage (ICH) is a significant contributor to global health-related morbidity and mortality. Due to improved recognition and treatment of atrial fibrillation by antithrombotics, there is an increase in proportion of ICH caused by warfarin and novel oral anticoagulants. However, the relationship between anticoagulation intensity and hematoma expansion remains unclear. We aimed to investigate the effects of international normalized ratio (INR) on hematoma expansion post ICH.

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Therapeutic Strategies in Acute Intracerebral Hemorrhage

Cited by 47 publications

References 135 publications

Pleiotropic Role of PPARγ in Intracerebral Hemorrhage: An Intricate System Involving Nrf2, RXR, and NF‐κB

Pleiotropic Role of PPARγ in Intracerebral Hemorrhage: An Intricate System Involving Nrf2, RXR, and NF‐κB

Clinical efficacy and safety of edaravone therapy in acute cerebral haemorrhage

Intracerebral haemorrhage growth is influenced by anticoagulation intensity

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