Standard operating procedures (SOP) in experimental stroke research: SOP for middle cerebral artery occlusion in the mouse

Systematic reviews have found quantitative evidence that low study quality may have introduced a bias into preclinical stroke research. Monitoring, auditing, and standard operating procedures (SOPs) are already key elements of quality control in randomized clinical trials and will hopefully be widely adopted by preclinical stroke research in the near future. Increasingly, funding bodies and review boards overseeing animal experiments are taking a proactive stance, and demand auditable quality control measures in preclinical research. Every good quality control system is based on its SOPs. This article introduces the concept of quality control and presents a SOP in experimental stroke research

Lithium inhibits tryptophan catabolism via the inflammation‐induced kynurenine pathway in human microglia

Despite its decades' long therapeutic use in psychiatry, the biological mechanisms underlying lithium's mood-stabilizing effects have remained largely elusive. Here, we investigated the effect of lithium on tryptophan breakdown via the kynurenine pathway using immortalized human microglia cells, primary human microglia isolated from surgical specimens, and microglia-like cells differentiated from human induced pluripotent stem cells. Interferon (IFN)-gamma, but not lipopolysaccharide, was able to activate immortalized human microglia, inducing a robust increase in indoleamine-2,3-dioxygenase (IDO1) mRNA transcription, IDO1 protein expression, and activity. Further, chromatin immunoprecipitation verified enriched binding of both STAT1 and STAT3 to the IDO1 promoter. Lithium counteracted these effects, increasing inhibitory GSK3 beta(S9) phosphorylation and reducing STAT1(S727) and STAT3(Y705) phosphorylation levels in IFN-gamma treated cells. Studies in primary human microglia and hiPSC-derived microglia confirmed the anti-inflammatory effects of lithium, highlighting that IDO activity is reduced by GSK3 inhibitor SB-216763 and STAT inhibitor nifuroxazide via downregulation of P-STAT1(S727) and P-STAT3(Y705). Primary human microglia differed from immortalized human microglia and hiPSC derived microglia-like cells in their strong sensitivity to LPS, resulting in robust upregulation of IDO1 and anti-inflammatory cytokine IL-10. While lithium again decreased IDO1 activity in primary cells, it further increased release of IL-10 in response to LPS. Taken together, our study demonstrates that lithium inhibits the inflammatory kynurenine pathway in the microglia compartment of the human brain

Interaction of ARC and Daxx: a novel endogenous target to preserve motor function and cell loss after focal brain ischemia in mice

The aim of this study was to explore the signaling and neuroprotective effect of transactivator of transcription (TAT) protein transduction of the apoptosis repressor with CARD (ARC) in in vitro and in vivo models of cerebral ischemia in mice. In mice, transient focal cerebral ischemia reduced endogenousARCprotein in neurons in the ischemic striatum at early reperfusion time points, and in primary neuronal cultures, RNA interference resulted in greater neuronal susceptibility to oxygen glucose deprivation (OGD).TAT.ARC protein delivery led to a dose-dependent better survival after OGD. Infarct sizes 72 h after 60 min middle cerebral artery occlusion (MCAo) were on average 30±8% (mean±SD; p=0.005; T2-weighted MRI) smaller in TAT.ARC-treated mice (1ug intraventricularly during MCAo) compared with controls. TAT.ARC-treated mice showed better performance in the pole test compared with TAT.β-Gal-treated controls. Importantly, post-stroke treatment (3 h after MCAo) was still effective in affording reduced lesion volume by 20±7% (mean±SD; p˃0.05) and better functional outcome compared with controls. Delayed treatment in mice subjected to 30 min MCAo led to sustained neuroprotection and functional behavior benefits for at least 28 d. Functionally, TAT.ARC treatment inhibited DAXX–ASK1–JNK signaling in the ischemic brain. ARC interacts with DAXX in a CARD-dependent manner to block DAXX trafficking and ASK1–JNK activation. Our work identifies for the first time ARC–DAXX binding to block ASK1–JNK activation as an ARC-specific endogenous mechanism that interferes with neuronal cell death and ischemic brain injury. Delayed delivery of TAT.ARC may present a promising target for stroke therapy

In Support of a Patient-Driven Initiative and Petition to Lower the High Price of Cancer Drugs

Comment in Lowering the High Cost of Cancer Drugs--III. [Mayo Clin Proc. 2016] Lowering the High Cost of Cancer Drugs--I. [Mayo Clin Proc. 2016] Lowering the High Cost of Cancer Drugs--IV. [Mayo Clin Proc. 2016] In Reply--Lowering the High Cost of Cancer Drugs. [Mayo Clin Proc. 2016] US oncologists call for government regulation to curb drug price rises. [BMJ. 2015

New mechanistic insights, novel treatment paradigms, and clinical progress in cerebrovascular diseases

The past decade has brought tremendous progress in diagnostic and therapeutic options for cerebrovascular diseases as exemplified by the advent of thrombectomy in ischemic stroke, benefitting a steeply increasing number of stroke patients and potentially paving the way for a renaissance of neuroprotectants. Progress in basic science has been equally impressive. Based on a deeper understanding of pathomechanisms underlying cerebrovascular diseases, new therapeutic targets have been identified and novel treatment strategies such as pre- and post-conditioning methods were developed. Moreover, translationally relevant aspects are increasingly recognized in basic science studies, which is believed to increase their predictive value and the relevance of obtained findings for clinical application.This review reports key results from some of the most remarkable and encouraging achievements in neurovascular research that have been reported at the 10th International Symposium on Neuroprotection and Neurorepair. Basic science topics discussed herein focus on aspects such as neuroinflammation, extracellular vesicles, and the role of sex and age on stroke recovery. Translational reports highlighted endovascular techniques and targeted delivery methods, neurorehabilitation, advanced functional testing approaches for experimental studies, pre-and post-conditioning approaches as well as novel imaging and treatment strategies. Beyond ischemic stroke, particular emphasis was given on activities in the fields of traumatic brain injury and cerebral hemorrhage in which promising preclinical and clinical results have been reported. Although the number of neutral outcomes in clinical trials is still remarkably high when targeting cerebrovascular diseases, we begin to evidence stepwise but continuous progress towards novel treatment options. Advances in preclinical and translational research as reported herein are believed to have formed a solid foundation for this progress

Regeneration for stroke treatment

Regeneration stellt ein bisher zu wenig beachtetes Prinzip zur Therapie des ischämischen Schlaganfalls dar. Dabei bieten gerade die komplexen Langzeitprozesse nach Schlaganfall vielfältige Ansatzpunkte zur Modulation und Stimulation, um letztlich eine Verbesserung des neurobehavioralen Defizits und Langzeitergebnisses nach Schlaganfall herbeizuführen. Blutgefäßneubildung nach Schlaganfall kann durch verschiedene Interventionen stimuliert werden und das Schlaganfallergebnis verbessern. Hierbei müssen jedoch Maturationsvorgänge beachtet werden, die zur Ausbildung einer intakten und funktionsfähigen neurovaskulären Einheit führen. Das Prinzip der neuro-vaskulären Nische zeigt auf, wie durch Blutgefäßneubildung nach Schlaganfall optimale Bedingungen geschaffen werden, um eine neuronale Regeneration auch unter pathologischen Bedingungen zu ermöglichen. Dies schließt die Differenzierung und erfolgreiche Integration neuronaler Vorläuferzellen, die Aktivierung alternativer neuronaler Netzwerke und die Stimulation von neuronaler Plastizität mit ein. Zusammenfassend erscheint die Erforschung regenerativer Vorgänge nach Schlaganfall als ein realistischer Ansatz mit großem Potential für die Translation in klinische Behandlungsstrategien. Nachdem bislang die therapeutischen Bemühungen auf die Akutphase der zerebralen Ischämie fokussierten, könnte die Förderung von spezifischen regenerativen Prozessen eine neue Perspektive in der Behandlung von Schlaganfallpatienten eröffnen.Regenerative strategies have long been overlooked as a potential treatment for stroke. However, the complex long-term adaptations taking place after brain ischemia offer many starting points for improving stroke outcome and functional recovery. For instance, angiogenesis can be stimulated by different therapeutic interventions. Here, processes of vessel maturation must be taken into consideration, so that an intact and viable neurovascular unit can be formed. The concept of the 'neuro-vascular niche’ explains how neovascularization creates an environment to further support neuronal regeneration even under pathological conditions. This includes the differentiation and successful integration of neuronal progenitor cells, activation of alternative neuronal networks and stimulation of neuronal plasticity. Taken together, regenerative pathways and mechanisms appear as a promising approach with high translational potential. Since all therapeutic efforts have so far been geared toward acute stroke treatment, exploitation of specific regenerative processes could open new vistas on stroke treatment

Endotheliale Stickstoffmonoxidsynthase-vermittelte Effekte von HMG-CoA-Reduktase-Inhibitoren und körperlicher Aktivität im experimentellen Schlaganfallmodell

HMG-CoA-Reduktasehemmer, sogenannte Statine, und regelmäßige körperliche Aktivität sind mit vermindertem Auftreten zerebrovaskulärer Ereignisse und Zunahme der endothelialen Stickstoffmonoxidsynthase (eNOS) assoziiert. Die Erhöhung der eNOS-mRNA ist mit verbessertem zerebralen Blutfluß und Neuroprotektion bei einer zerebralen Ischämie verbunden. Vor dem Hintergrund, daß Thrombosen und Thrombembolien die häufigste Ursache zerebro- und kardiovaskulärer Ereignisse darstellen, sind NO-vermittelte antithrombotische Effekte jedoch kaum untersucht. Ebenso wenig ist über mögliche Absetzeffekte nach Beendigung einer Statintherapie bekannt. Daher untersuchten wir, ob die Statine Atorva- und Rosuvastatin eNOS-abhängig zu Neuroprotektion führen und verglichen die Effekte mit einem zweiten eNOS-regulierenden Mechanismus: der regelmäßigen körperlichen Aktivität. Dazu quantifizierten wir nach entsprechender Vorbehandlung eNOS auf mRNA- und Proteinebene aus Aorten, Hirngewebe sowie Thrombozyten und bestimmten die Läsionsvolumina im experimentellen Schlaganfallmodell. Außerdem untersuchten wir nach Statingabe Thrombozytenfunktionsparameter sowie Blutungszeit und Thrombusformation in vivo. Zwei bzw. vier Tage nach Absetzen der Statinbehandlung wiederholten wir die eNOS-Messungen, Schlaganfallexperimente und Gerinnungsanalysen. Wir fanden nach Statinvorbehandlung cholesterinunabhängig eine Zunahme der eNOS, was mit Neuroprotektion im Schlaganfallmodell und verminderter Gerinnungsaktivität verbunden war. Nach Absetzen der Behandlung kam es jedoch zu einer drastischen Abnahme der eNOS, was mit deutlichem Anstieg der Thrombozytenmarker im Plasma und schnellem Verlust der beobachteten positiven Effekte auf Läsionsgröße und Gerinnungssystem einherging. Regelmäßige körperliche Aktivität führt ebenfalls eNOS-abhängig zu verbessertem zerebralen Blutfluß und kleineren Läsionsvolumina bei zerebraler Ischämie. Diese Ergebnisse sind mit den Daten nach Statingabe vergleichbar. Wir demonstrieren einen Klasseneffekt der Statine für eNOS-vermittelte Neuroprotektion im zerebralen Ischämiemodell. Durch die zusätzliche gerinnungshemmende Wirkung könnte diese Wirkstoffklasse neue Ansätze zur prophylaktischen Schlaganfallbehandlung unabhängig vom Cholesterinspiegel eröffnen. Ein Absetzen der Statinbehandlung kann jedoch zu einer Zunahme der Schlaganfallgröße führen und sollte möglicherweise bei Risikopatienten vermieden werden. Regelmäßiges körperliches Training führt zu vergleichbarer Erhöhung der eNOS sowie Neuroprotektion und bietet damit eine sinnvolle Verknüpfung aus prophylaktischer Schlaganfallbehandlung und Rehabilitation.HMG-CoA-reductase inhibitors, so called statins and regular physical activity are associated with less cerebrovascular events and increase of endothelial nitric oxide synthase (eNOS). Raise of eNOS-mRNA results in cerebral blood flow (CBF) augmentation which refers neuroprotection after ischemic stroke. It is known that thromboses cause the most cerebrovascular events, but nitric oxide (NO) dependent antithrombotic effects are poor examined. In addition there are little information about effects after withdrawal of statin treatment. That is why we investigated Atorva- and Rosuvastatin regarding eNOS dependent neuroprotection and compared the effects with regular physical activity, the second eNOS enhancing mechanism. Therefore after corresponding pretreatment we quantified eNOS-mRNA and protein from aortas, brain tissue and thrombocytes and determined lesion volume after experimental middle cerebral artery occlusion (MCAo). Furthermore after statin treatment we measured marker of thrombocyte activation, as well as bleeding time and thrombus formation in vivo. Two and four days after withdrawal of statin treatment we repeated eNOS measurements, neuroprotection studies and coagulation analyses. We found eNOS upregulation independent from serum cholesterol level after statin pretreatment and this was associated with neuroprotection after ischemic stroke and decreased platelet activation. But after withdrawal of statin treatment eNOS expression was downregulated, which went along with clear upregulation of platelet activation and a rapid loss of the observed positive effects on lesion volume and hemostasis. Regular physical activity leads to an increase of eNOS, which we could correlate with CBF augmentation and improved outcome after MCAo. These results were comparable to the data after statin treatment. We demonstrate a class effect of statins for eNOS-dependent neuroprotection in our ischemia modell. Because of the additional antithrombotic effects statins may present a new approach to prophylactic stroke treatment independent from cholesterol level. Withdrawal of statin treatment may refer increased cerebral lesion volume and should be avoided in patients with risk for cerebrovascular events. Regular physical activity results in comparable eNOS dependent neuroprotection and offers a useful combination between prophylactic stroke treatment and rehabilitation

Focal brain ischemia in mice does not cause electrophysiological signs of critical illness neuropathy

Objective: Critical illness polyneuropathy (CIP) is a common complication of severe systemic illness treated in intensive care medicine. Ischemic stroke leads to an acute critical injury of the brain with hemiparesis, immunosuppression and subsequent infections, all of which require extended medical treatment. Stroke-induced sarcopenia further contributes to poor rehabilitation and is characterized by muscle wasting and denervation in the paralytic, but also the unaffected limbs. Therefore, we asked whether stroke leads to an additional CIP-like neurodegeneration. Results: Focal brain ischemia was induced in adult mice by 60-min middle cerebral artery occlusion (MCAo) following reperfusion and led to functional deficits and marked hemispheric brain atrophy. Nerve conduction function and muscle potentials were measured in the ipsilateral sciatic nerve and gastrocnemius and quadriceps muscle with electroneurography/-myography on days 10, 22, 44 after stroke. An additional crush-injury to the sciatic nerve was included in two sham mice as positive control (sham +). We found no differences in nerve conduction function nor spontaneous electromyographic activity between MCAo and sham animals. Sham + mice developed marked reduction of the motor action potential amplitudes and conduction velocities with pathologic spontaneous activity. In conclusion, we found no peripheral nerve dysfunction/degeneration as signs of a CIP-like phenotype after MCAo

The case against coprescribing opioids and antidepressants.

Comment on Medication prescriptions in 322 motor functional neurological disorder patients in a large UK mental health service: A case control study