CKLF1作为缺血性脑卒中治疗的潜在靶点

缺血性脑卒中是一种血液循环障碍疾病,可导致严重的神经功能缺损.卒中病人中约有87％的病例为缺血性卒中.神经炎症是中风损伤的主要病理状态之一.CKLF1是2001年发现的非经典CC型趋化因子,对单核细胞、中性粒细胞和淋巴细胞表现出很强的趋化活性.CKLF1在胎儿大脑中含量最高,但在健康成人阶段不存在.越来越多的证据表明,...     

综述与专论：ABCA7与阿尔茨海默病的研究进展

阿尔茨海默病（Alzheimer’s disease,AD）是一种严重的中枢神经系统退行性疾病,也是老年人痴呆最常见的原因,其病因目前尚未阐明。三磷酸腺苷结合盒转运体A7 (ATP-binding cassette transporter A7,ABCA7)在脑中有较高的表达水平,参与脑内脂质代谢、吞噬作用以及免疫反应等过程。自从全基因组关联研究将ABCA7确定为AD的风险基因以后,越来越多的来自体内外和基于人的研究证实,ABCA7是早发和迟发型AD最重要的风险基因之一。本文对ABCA7在AD发生发展中的作用进行综述,以期为AD的防治提供新的治疗靶点和途径。     

创伤性脑损伤后IL-1?茁在神经胶质细胞中经时定位表达的研究*

目的:探讨创伤性脑损伤(TBI)后白细胞介素-1β(IL-1β)在神经胶质细胞中的经时定位表达情况。方法:选择72只SPF级雄性小鼠分为假手术组(sham组)、TBI 6h组、TBI 12h组、TBI 1d组、TBI 4d组与TBI 7d组,每组12只,分别在脑损伤后6h、12h、1d、4d、7d时获取血清和脑组织并且制作切片。ELISA检测损伤后炎症因子IL-1β、白细胞介素-6 (IL-6)和肿瘤坏死因子-α(TNF-α)的表达。Western blot检测钙离子结合蛋白-1(IBA-1)和胶质纤维酸性蛋白(GFAP)的表达。应用免疫荧光双重染色技术观察炎症因子IL-1β在小胶质细胞和星形胶质细胞中的定位表达情况。结果:TBI后6h-7d时炎症因子IL-1β、IL-6和TNF-α的表达量均高于sham组(P0.05)。Western blot结果显示,IBA-1的表达在损伤后6h-7d时高于sham组,GFAP的表达在损伤后1d-7d时高于sham组(P0.05)。免疫荧光双重染色技术显示,6h、12h时IL-1β主要表达在小胶质细胞中,IL-1β和IBA-1共表达细胞数量多于sham组(P0.05);1d、4d、7d时IL-1β主要表达在星形胶质细胞中,IL-1β和GFAP共表达细胞数量多于sham组(P0.05)。结论:TBI诱导了胶质细胞和炎症因子的表达,其表达随脑损伤的时间而变化,IL-1β早期定位表达于小胶质细胞,后期定位表达于星形胶质细胞中。     

银丹心脑通软胶囊联合长春西汀治疗缺血性脑卒中患者的疗效

目的:研究银丹心脑通软胶囊联合长春西汀治疗缺血性脑卒中患者的疗效。方法:选择2016年1月～2018年12月我院的83例缺血性脑卒中患者,随机分为两组。对照组静脉滴注30 mg的长春西汀,每天1次。观察组在长春西汀的基础上,口服4粒银丹心脑通软胶囊,每天3次。比较两组的改良爱丁堡一斯堪的那维亚神经功能缺损量表(Modified Edinburgh Scandinavian neurological deficit scale,MESS)、Barthel指数、血清白细胞介素1β(Interleukin 1β,IL-1β)、单核细胞趋化蛋白-1(Monocyte chemoattractant protein-1,MCP-1)、血管内皮生长因子(Vascular endothelial growth factor,VEGF)水平。结果:观察组的有效率明显高于对照组(P0.05);治疗后,两组的MESS评分明显降低(P0.05),Barthel指数明显升高(P0.05),且观察组的MESS评分和Barthel指数明显优于对照组(P0.05);治疗后,两组的血清IL-1β、MCP-1水平明显降低(P0.05),血清VEGF水平明显升高(P0.05),且观察组上述指标优于对照组(P0.05)。结论:银丹心脑通软胶囊联合长春西汀能降低缺血性脑卒中患者炎症细胞因子的过度表达,改善脑血流灌注和神经功能,有效控制缺血性脑卒中的进展。     

综述与专论: 白质消融性白质脑病研究进展

白质消融性白质脑病（leukoencephalopathy with vanishing white matter,VWM）是一种常染色体隐性遗传性脑白质病,其致病基因EIF2B 1~5分别编码真核细胞蛋白质翻译起始因子2B（eukaryotic initiation factor 2B,eIF2B）的5个亚基α~ε,其中任一编码基因突变均可引起发病。起病多见于婴幼儿及儿童期,临床表型差异大,典型表现为进行性运动功能退行,可伴共济失调和癫痫。应激（发热、外伤等）可导致发作性加重。影像学显示大脑白质进行性液化。尸解神经病理学特征主要表现为广泛性白质稀疏和囊性变性,无神经胶质细胞反应性增生,星形胶质细胞形态异常,过表达祖细胞标志物巢蛋白（Nestin）和胶质纤维酸性蛋白δ（GFAPδ）,少突前体细胞数量增加和成熟少突胶质细胞减少、泡沫化且凋亡增加。VWM致病基因EIF2B 1~5是管家基因,但多数患者通常仅脑白质受累。少数胎儿期及婴儿早期发病的患者可出现多系统受累,成年女性患者可有卵巢功能障碍。目前认为,星形胶质细胞在其致病机制中起着核心作用,病理性星形胶质细胞继发性引起少突胶质细胞成熟障碍和髓鞘形成异常,进而导致脑白质病变。其他疾病机制包括内质网应激后未折叠蛋白反应（UPR）过度激活、线粒体功能障碍、自噬抑制等,尚不完全明确。     

氯吡格雷用于缺血性脑卒中的疗效评价及对血小板活性及血清炎症因子水平的影响

目的:评价氯吡格雷用于缺血性脑卒中的疗效及对血小板活性及血清炎症因子水平的影响。方法:选择我院2016年8月～2018年8月收治的150例缺血性脑卒中患者,按入院先后顺序分为对照组(83例)和研究组(67例)。对照组采用常规治疗,研究组在对照组基础上联合氯吡格雷治疗,比较两组的临床疗效,治疗前后血小板活性指标,血清超敏-C反应蛋白(hypersensitive c-reactive protein,hs-CRP)、白介素-6(Interleukin-6,IL-6)及肿瘤坏死因子-α(Tumor necrosis factor-α,TNF-α)水平,美国国立卫生研究院卒中量表(National Institutes HealthStroke Scale,NIHSS)和日常生活活动能力(Activity of daily living,ADL)评分的变化和不良反应的发生情况。结果:治疗后,研究组总有效率显著高于对照组(91.04%vs. 78.31%,P0.05);两组血小板聚集率、血小板黏附率、P选择素、hs-CRP、IL-6、TNF-α及NIHSS评分均较治疗前明显下降,且研究组以上指标均显著低于对照组,两组ADL评分均较治疗前显著上升,且研究组明显高于对照组(P0.05)。两组治疗期间不良反应总发生率比较差异无统计学意义(P0.05)。结论:氯吡格雷用于缺血性脑卒中的效果明显优于常规治疗,其能够有效抑制血小板活性、降低炎症因子水平、改善患者神经功能和日常生活能力。     

综述与专论: 肠神经胶质细胞在维持肠黏膜稳态与调控炎症中的作用

肠神经胶质细胞分布于消化道黏膜层、黏膜下层和肌层,其具有广泛的异质性和可塑性。黏膜层最靠近肠腔,易受病原体侵袭和炎症影响,因此黏膜稳态备受关注。肠黏膜神经胶质细胞（mucosal enteric glial cells,mEGCs）与肠上皮细胞、血管内皮细胞、免疫细胞等非神经元细胞具有复杂的相互作用关系。从结构和功能的角度来看,mEGCs可能处于中心调控位置。最近研究不断揭示mEGCs的亚型和新功能,表明mEGCs在病理条件下存在功能改变。了解mEGCs如何引起黏膜功能障碍及其在疾病发展中的作用至关重要。本文将总结mEGCs在维持粘膜内环境稳定和调节炎症方面的作用。     

早期非小细胞肺癌患者血清巨噬细胞抑制因子-1、趋化素与临床病理特征及预后的关系

目的:探讨早期非小细胞肺癌(NSCLC)患者血清巨噬细胞抑制因子-1(MIC-1)、趋化素(chemerin)水平与临床病理特征及预后的关系。方法:选择72例NSCLC患者(NSCLC组)、53例肺良性疾病患者(良性组)、50例体检健康人群(对照组),分别检测血清MIC-1、chemerin水平,分析血清MIC-1、chemerin水平与NSCLC患者临床病理参数的关系。Kaplan-Meier法分析不同血清MIC-1、chemerin水平NSCLC患者生存时间的差异,COX比例风险回归分析血清MIC-1、chemerin水平与NSCLC患者预后的关系。结果:NSCLC组患者血清MIC-1、chemerin水平高于良性组和对照组(P0.05)。血清MIC-1水平与NSCLC患者年龄、目前吸烟、肿瘤直径、TNM分期、分化程度、复发或转移、生存状态有关(P0.05),chemerin水平与NSCLC患者目前吸烟、TNM分期、复发或转移、生存状态有关(P0.05)。高MIC-1水平患者生存率低于低MIC-1水平患者(P0.05),高chemerin水平患者生存率低于低chemerin水平患者(P0.05)。COX比例风险回归分析结果显示:血清MIC-1、chemerin、TNM分期与NSCLC不良预后独立相关。结论:血清MIC-1、chemerin水平与NSCLC患者部分临床病理参数和预后相关,可作为早期NSCLC患者预后预测的潜在指标。     

综述与专论：α突触核蛋白作为帕金森病诊断标志物和治疗靶点

帕金森病(PD)是一种隐匿性和进行性发展的神经退行性疾病,在65岁以上人口中约占2%～3%,是第二大常见的神经退行性疾病。PD的致病因素尚未明确,但α突触核蛋白(α-synuclein)的错误折叠和聚集所形成的路易小体被认为是PD的典型病理学改变。由于缺乏可靠的生物标志物,PD的早期诊断较难。本文总结了PD患者不同样本中检测出的α突触核蛋白的最新进展,包括体液(脑脊液、血液、唾液)和周围组织(皮肤、嗅觉黏膜、唾液腺、肠道黏膜),以期进一步了解PD的生物标志物研究。此外,还综述了针对α突触核蛋白治疗PD的新进展。     

黄连素通过SOCS1减轻Aβ淀粉样蛋白诱导的小胶质细胞激活

目的:观察黄连素(Berberine,BBR)对暴露于Aβ淀粉样蛋白(βAmyloid,Aβ)中的小胶质细胞激活的影响,并明确细胞因子沉默蛋白1(Silencing of Cytokine Signaling Factor 1, SOCS1)是否参与了BBR对小胶质细胞激活的影响。方法:将N9小胶质细胞暴露于含5μM Aβ的培养基中模拟阿尔兹海默症(Alzheimer's,AD)中的小胶质细胞激活。随后,将细胞分为5组,分别为Control组、5μM的Aβ损伤组(Aβ)、BBR+Aβ组、SOCS1-siRNA干扰组(SOCS1-siRNA+BBR+Aβ)和乱序si RNA处理组(SC-si RNA+BBR+Aβ),细胞处理24 h后,采用Western blot检测细胞诱导型一氧化氮合酶(Inducible Nitric Oxide Synthase,i NOS)、SOCS1蛋白的表达,酶联免疫吸附法(Enzyme Linked Immunosorbent Assay,ELISA)检测细胞培养基内炎症因子的水平。结果:与正常培养的Control组相比,5μM的Aβ暴露24 h可显著增加细胞i NOS蛋白表达水平和肿瘤坏死因子α(Tumor Necrosis Factorα,TNF-α)、白细胞介素1β(Interleukin 1β,IL-1β)和IL-6的释放(P0.05),但并未对SOCS1蛋白表达产生显著影响(P0.05),5μM的BBR可显著降低i NOS表达和上述3种促炎症因子的释放(P0.05),并上调SOCS1蛋白表达,而SOCS1-siRNA可显著逆转BBR对i NOS和SOCS1蛋白表达及3种炎症因子释放的影响(P0.05)。结论:BBR可能通过SOCS1减轻Aβ淀粉样蛋白对小胶质细胞的激活。     

Upregulation of Microglial ZEB1 Ameliorates Brain Damage after Acute Ischemic Stroke

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Age and the Metabolic Syndrome as Risk Factors for Ischemic Stroke: Improving Preclinical Models of Ischemic Stroke

Ischemic stroke represents a leading cause of morbidity and mortality in thedeveloped world. This disabling and sometimes fatal event puts an everincreasing burden on the family members and medical professionals who care forstroke victims. Preclinical ischemic stroke research has predominantly utilizedyoung adult, healthy animals, a clear discrepancy when considering the clinicalpopulation affected by stroke. A broad spectrum of risk factors such as age,obesity, diabetes, and hypertension has been associated with an increased strokerisk. The effect of these comorbidities on both stroke pathophysiology andoutcome has not been emphasized and has been recognized as a shortcoming ofpreclinical studies. By addressing these conditions in experimental models ofischemic stroke, it may be possible to more accurately represent the clinicalscenario and improve therapeutic translation from bench-to-bedside. In thiswork, we review many of the risk factors associated with increased stroke risk,particularly as each risk factor relates to inflammation. Additionally, weexplore potential animal models that could be utilized in identifying thecontribution of these risk factors to stroke outcome. By investigating the riskfactors for stroke and how these may alter stroke pathophysiology, the presentdiscrepancies between preclinical studies and the clinical reality can bereconciled in an effort to improve therapeutic development and translation frombench-to-bedside.     

The Effect of Annexin A1 as a Potential New Therapeutic Target on Neuronal Damage by Activated Microglia

Brain disease is known to cause irrevocable and fatal loss of biological function once damaged. One of various causes of its development is damage to neuron cells caused by hyperactivated microglia, which function as immune cells in brain. Among the genes expressed in microglia stimulated by various antigens, annexin A1 (ANXA1) is expressed in the early phase of the inflammatory response and plays an important role in controlling the immune response. In this study, we assessed whether ANXA1 can be a therapeutic target gene for the initial reduction of the immune response induced by microglia to minimize neuronal damage. To address this, mouse-origin microglial cells were stimulated to mimic an immune response by lipopolysaccharide (LPS) treatment. The LPS treatment caused activation of ANXA1 gene and expression of inflammatory cytokines. To assess the biological function in microglia by the downregulation of ANXA1 gene, cells were treated with short hairpin RNA-ANXA1. Downregulated ANXA1 affected the function of mitochondria in the microglia and showed reduced neuronal damage when compared to the control group in the co-culture system. Taken together, our results showed that ANXA1 could be used as a potential therapeutic target for inflammation-related neurodegenerative diseases.     

综述: 人类早衰症的发病机制及干预方法

衰老是一种在细胞和组织水平逐渐发生功能衰退的过程.早衰症是一类罕见的人类遗传性疾病,以加速衰老为特征.对早衰症的研究有助于理解人类衰老的生理过程,对衰老相关疾病的防治具有借鉴意义.成人早衰症和儿童早衰症是两种著名的人类早衰症,本文将综述这两种早衰症的发病机制及干预方法.     

研究报告: 急性缺血性卒中患者血清脑红蛋白的动态变化及临床意义

目的 脑红蛋白（neuroglobin,Ngb）又称神经球蛋白,是一种携氧球蛋白。有研究证明Ngb在脑缺血缺氧疾病中具有神经保护作用,对氧具有高亲和力,有助于预防缺氧缺血性脑损伤,并影响急性缺血性卒中（acute ischemic stroke,AIS）的预后。本研究观察了AIS后血清Ngb水平的变化,并评估了Ngb与卒中严重程度及预后的关系。方法 前瞻性地募集AIS患者和健康对照者进行研究。在AIS患者起病后不同时间点（脑梗死发病后72 h内和第14天）及对照组中分别检测血清Ngb水平,并比较AIS患者与对照组之间的血清Ngb水平。对合并与不合并糖尿病的AIS患者的血清Ngb水平进行比较。分析患者血清Ngb水平与梗死体积及国家卫生研究院卒中量表（NIHSS）评分之间的相关性。应用受试者操作特征（ROC）曲线评估Ngb对AIS预后的预测价值。结果 AIS患者的血清Ngb水平在脑梗死后72 h内和第14天时分别为105.7（88.3,123.1）μg/L和72.8（58.7,86.9）μg/L。对照组血清Ngb水平为58.2（35.0,81.6）μg/L。AIS发病后72 h内血清Ngb水平较对照组显著升高（P<0.05）。合并与不合并糖尿病的AIS患者血清Ngb水平在发病后72 h内及第14天均无显著差异（P>0.05）。AIS发病72 h内的血清Ngb水平与NIHSS评分显著相关（Spearman相关系数=0.232,P=0.038）。在各时间点,大体积脑梗死组患者血清Ngb水平与中小体积脑梗死组相比无显著性差异（P>0.05）。ROC曲线分析表明,血清Ngb水平对AIS患者的预后具有良好的预测能力。结论 AIS发病后72 h内血清Ngb水平升高。合并与不合并糖尿病的AIS患者血清Ngb水平无显著差异。发病后72 h内的血清Ngb水平与NIHSS评分显著相关。Ngb可能作为卒中严重程度和预后的预测因子。     

综述:炎症小体信号通路的负调控

炎症小体(inflammasomes)活化后产生的IL-1β和IL-18等促炎因子对天然免疫和适应性免疫具有重要作用.炎症小体持续活化可引起促炎因子过度表达,导致慢性炎症和自身免疫疾病的发生.正常生理状态下,机体存在多种炎症小体负调机制,以维持免疫反应平衡.病理状态下,感染机体的病原微生物通过多种途径抑制炎症小体信号通路的活化及促炎因子的产生,以利于免疫逃逸.本文综述了机体和病原微生物对炎症小体信号通路的负调控机理.阐明炎症小体信号通路负调控机制将为感染性疾病及其他炎症小体相关炎症性疾病的治疗提供策略.     

进展性缺血性卒中预后的相关因素分析

目的:探究进展性缺血性卒中预后的相关危险因素。方法:选取进展性缺血性卒中患者98例,根据复发情况将患者分为复发组和无复发组,分析进展性缺血性卒中复发与二级预防的关系。无复发组的患者按根据随访的mRS评分高低分为:预后良好组(mRS 0~2分)和预后差组(mRS 3~5分),分析影响预后的相关因素。结果:98例进展性缺血性卒中患者六个月复发率为10.2%(10/98)。无复发组较复发组应用降压药、降糖药、抗血小板聚集药物、他汀类降脂药的患者比例较复发组高,两组比较差异均具有统计学意义(P0.05)。无复发组患者出院后一个月、三个月及六个月,单因素分析入院时白细胞计数、LDL、血糖与预后相关(P0.05)。多因素logistic回归分析LDL、血糖和白细胞计数是影响出院后一个月预后的危险因素;血糖和白细胞计数是影响出院后三个月预后的危险因素;LDL和血糖是影响出院后六个月预后的危险因素。结论:良好的二级预防依从性有利于降低进展性缺血性卒中的复发率。入院时白细胞计数、LDL、血糖是影响进展性缺血性卒中预后的相关因素。入院时白细胞计数、LDL及空腹血糖值较高的进展性缺血卒中患者,其预后往往较差。     

Anticoagulation for the Acute Management of Ischemic Stroke

Few prospective studies support the use of anticoagulation during the acute phase of ischemic stroke, though observational data suggest a role in certain populations. Depending on the mechanism of stroke, systemic anticoagulation may prevent recurrent cerebral infarction, but concomitantly carries a risk of hemorrhagic transformation. In this article, we describe a case where anticoagulation shows promise for ischemic stroke and review the evidence that has discredited its use in some circumstances while showing its potential in others.     

WIP1 Phosphatase as a Potential Therapeutic Target in Neuroblastoma

The wild-type p53-induced phosphatase 1 (WIP1) is a serine/threonine phosphatase that negatively regulates multiple proteins involved in DNA damage response including p53, CHK2, Histone H2AX, and ATM, and it has been shown to be overexpressed or amplified in human cancers including breast and ovarian cancers. We examined WIP1 mRNA levels across multiple tumor types and found the highest levels in breast cancer, leukemia, medulloblastoma and neuroblastoma. Neuroblastoma is an exclusively TP53 wild type tumor at diagnosis and inhibition of p53 is required for tumorigenesis. Neuroblastomas in particular have previously been shown to have 17q amplification, harboring the WIP1 (PPM1D) gene and associated with poor clinical outcome. We therefore sought to determine whether inhibiting WIP1 with a selective antagonist, GSK2830371, can attenuate neuroblastoma cell growth through reactivation of p53 mediated tumor suppression. Neuroblastoma cell lines with wild-type TP53 alleles were highly sensitive to GSK2830371 treatment, while cell lines with mutant TP53 were resistant to GSK2830371. The majority of tested neuroblastoma cell lines with copy number gains of the PPM1D locus were also TP53 wild-type and sensitive to GSK2830371A; in contrast cell lines with no copy gain of PPM1D were mixed in their sensitivity to WIP1 inhibition, with the primary determinant being TP53 mutational status. Since WIP1 is involved in the cellular response to DNA damage and drugs used in neuroblastoma treatment induce apoptosis through DNA damage, we sought to determine whether GSK2830371 could act synergistically with standard of care chemotherapeutics. Treatment of wild-type TP53 neuroblastoma cell lines with both GSK2830371 and either doxorubicin or carboplatin resulted in enhanced cell death, mediated through caspase 3/7 induction, as compared to either agent alone. Our data suggests that WIP1 inhibition represents a novel therapeutic approach to neuroblastoma that could be integrated with current chemotherapeutic approaches.