The effect of oxidants on biomembranes and cellular metabolism

During the reductive process in the tissues, the aerobes generate a number of oxidants. Unless these oxidants are reduced, oxidative damage and cell death would occur. Oxidation of plasma membrane lipids leads to autocatalytic chain reactions which eventually alter the permeability of the cell. The role of oxidative damage in the pathophysiology of diabetic complications and ischemic reperfusion injury of myocardium, especially the changes in the channel activity which may lead to arrhythmia have been studied. Hyperglycemia activates aldose reductase which could efficiently reduce glucose to sorbitol in the presence of NADPH. Since NADPH is also aldose required by glutathione reductase for reducing oxidants, its diversion would lead to membrane lipid oxidation and permeability changes which are probably responsible for diabetic complications such as cataractogenesis, retinopathy, neuropathy etc. Antioxidants such as butylated hydroxy toluene (BHT) and also reductase inhibitors prevent or delay some of these complications. By using patch-clamp technique in isolated frog myocytes, we have shown that hydroxy radicals generated by ferrous sulfate and ascorbate as well as lipid peroxides such as t-butyl hydroperoxide facilitate the entry of Na⁺ by oxidizing Na⁺-channels. Increased intracellular Na⁺ leads to an increase in Na⁺/Ca²⁺ exchange. The increased Na⁺ concentration by itself may produce electrical disturbance which would result in arrhythmia. Increased Ca²⁺ may affect proteases and may help in the conversion of xanthine dehydrogenase to xanthine oxidase, consequently increased production of super oxide radicals. Increased membrane lipid peroxidation and other oxygen free-radical associated membrane damage in myocytes has been demonstrated.     

Regulation and functional significance of phospholipase D in myocardium

There is now clear evidence that receptor-dependent phospholipase D is present in myocardium. This novel signal transduction pathway provides an alternative source of 1,2-diacylglycerol, which activates isoforms of protein kinase C. The members of the protein kinase C family respond differently to various combinations of Ca²⁺, phosphatidylserine, molecular species of 1,2-diacylglycerol and other membrane phospholipid metabolites including free fatty acids. Protein kinase C isozymes are responsible for phosphorylation of specific cardiac substrate proteins that may be involved in regulation of cardiac contractility, hypertrophic growth, gene expression, ischemic preconditioning and electrophysiological changes. The initial product of phospholipase D, phosphatidic acid, may also have a second messenger role. As in other tissues, the question how the activity of phospholipase D is controlled by agonists in myocardium is controversial. Agonists, such as endothelin-1, atrial natriuretic factor and angiotensin 11 that are shown to activate phospholipase D, also potently stimulate phospholipase C- in myocardium. PMA stimulation of protein kinase C inactivates phospholipase C and strongly activates phospholipase D and this is probably a major mechanism by which agonists that promote phosphatidyl-4,5-bisphosphate hydrolysis secondary activate phosphatidylcholine-hydrolysis. On the other hand, one group has postulated that formation of phosphatidic acid secondary activates phosphatidyl-4,5-bisphosphate hydrolysis in cardiomyocytes. Whether GTP-binding proteins directly control phospholipase D is not clearly established in myocardium. Phospholipase D activation may also be mediated by an increase in cytosolic free Ca²⁺ or by tyrosine-phosphorylation.     

Regulation of and intervention into the oxidative pentose phosphate pathway and adenine nucleotide metabolism in the heart

The capacity of the oxidative pentose phosphate pathway (PPP) in the heart is limited, since the activity of glucose-6-phosphate dehydrogenase (G-6-PD), the first and regulating enzyme of this pathway, is very low. Two mechanisms are involved in the regulation of this pathway. Under normal conditions, G-6-PD is inhibited by NADPH. This can be overcome in the isolated perfused rat heart by increasing the oxidized glutathione and by elevating the NADP⁺/NADPH ratio. Besides this rapid control mechanism, there is a long-term regulation which involves the synthesis of G-6-PD. The activity of G-6-PD was elevated in the rat heart during the development of cardiac hypertrophy due to constriction of the abdominal aorta and in the non-ischemic part of the rat heart subsequent to myocardial infarction. The catecholamines isoproterenol and norepinephrine stimulated the activity of myocardial G-6-PD in a time- and dose-dependent manner. The isoproterenol-induced stimulation was cAMP-dependent and due to increased new synthesis of enzyme protein. The G-6-PD mRNA was elevated by norepinephrine. As a consequence of the stimulation of the oxidative PPP, the available pool of 5-phosphoribosyl-l-pyrophosphate (PRPP) was expanded. PRPP is an important precursor substrate for purine and pyrimidine nucleotide synthesis. The limiting step in the oxidative PPP, the G-6-PD reaction, can be bypassed with ribose. This leads to an elevation of the cardiac PRPP pool. The decline in ATP that is induced in many pathophysiological conditions was attenuated or even entirely prevented by i.v. infusion of ribose. In two in vivo rat models, the overloaded and catecholamine-stimulated heart and the infarcted heart, the normalization of the cardiac adenine nucleotide pool by ribose was accompanied by an improvement of global heart function. Combination of ribose with adenine or inosine in isoproterenol-treated rats was more effective to restore completely the cardiac ATP level within a short period of time than either intervention alone. (Mol Cell Biochem 160/161: 101–109, 1996)     

Engeletin alleviates cerebral ischemia reperfusion-induced neuroinflammation via the HMGB1/TLR4/NF-κB network

High-mobility group box1 (HMGB1) induces inflammatory injury, and emerging reports suggest that it is critical for brain ischemia reperfusion. Engeletin, a natural Smilax glabra rhizomilax derivative, is reported to possess anti-inflammatory activity. Herein, we examined the mechanism of engeletin-mediated neuroprotection in rats having transient middle cerebral artery occlusion (tMCAO) against cerebral ischemia reperfusion injury. Male SD rats were induced using a 1.5 h tMCAO, following by reperfusion for 22.5 h. Engeletin (15, 30 or 60 mg/kg) was intravenously administered immediately following 0.5 h of ischemia. Based on our results, engeletin, in a dose-dependent fashion, reduced neurological deficits, infarct size, histopathological alterations, brain edema and inflammatory factors, namely, circulating IL-1β, TNF-α, IL-6 and IFN-γ. Furthermore, engeletin treatment markedly reduced neuronal apoptosis, which, in turn, elevated Bcl-2 protein levels, while suppressing Bax and Cleaved Caspase-3 protein levels. Meanwhile, engeletin significantly reduces overall expressions of HMGB1, TLR4, and NF-κB and attenuated nuclear transfer of nuclear factor kappa B (NF-κB) p65 in ischemic cortical tissue. In conclusion, engeletin strongly prevents focal cerebral ischemia via suppression of the HMGB1/TLR4/NF-κB inflammatory network.     

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.     

Synthesis of Novel Aryloxyethylamine Derivatives and Evaluation of Their in Vitro and in Vivo Neuroprotective Activities

A series of aryloxyethylamine derivatives were designed, synthesized and evaluated for their biological activity. Their structures were confirmed by ¹H‐NMR, ¹³C‐NMR, FT‐IR and HR‐ESI‐MS. The preliminary screening of neuroprotection of compounds in vitro was detected by MTT, and the anti‐ischemic activity in vivo was tested using bilateral common carotid artery occlusion in mice. Most of these compounds showed potential neuroprotective effects against the glutamate‐induced cell death in differentiated rat pheochromocytoma cells (PC12 cells), especially for (4‐fluorophenyl){1‐[2‐(4‐methoxyphenoxy)ethyl]piperidin‐4‐yl}methanone, {1‐[2‐(4‐methoxyphenoxy)ethyl]piperidin‐4‐yl}(4‐methoxyphenyl)methanone, (4‐bromophenyl){1‐[2‐(4‐methoxyphenoxy)ethyl]piperidin‐4‐yl}methanone, {1‐[2‐(4‐chlorophenoxy)ethyl]piperidin‐4‐yl}(4‐chlorophenyl)methanone, (4‐chlorophenyl)(1‐{2‐[(naphthalen‐2‐yl)oxy]ethyl}piperidin‐4‐yl)methanone, (4‐chlorophenyl){1‐[2‐(4‐methoxyphenoxy)ethyl]piperidin‐4‐yl}methanone and {1‐[2‐(4‐bromophenoxy)ethyl]piperidin‐4‐yl}(4‐chlorophenyl)methanone, which exhibited potent protection of PC12 cells at three doses (0.1, 1.0, 10 μM). Compounds (4‐fluorophenyl){1‐[2‐(4‐methoxyphenoxy)ethyl]piperidin‐4‐yl}methanone, (4‐fluorophenyl){1‐[2‐(naphthalen‐2‐yloxy)ethyl]piperidin‐4‐yl}methanone, {1‐[2‐(4‐methoxyphenoxy)ethyl]piperidin‐4‐yl}(4‐methoxyphenyl)methanone and {1‐[2‐(4‐chlorophenoxy)ethyl]piperidin‐4‐yl}(4‐chlorophenyl)methanone possessed the significant prolongation of the survival time of mice subjected to acute cerebral ischemia and decreased the mortality rate at all five doses tested (200, 100, 50, 25, 12.5 mg/kg) and had significant neuroprotective activity. In addition, (4‐fluorophenyl){1‐[2‐(4‐methoxyphenoxy)ethyl]piperidin‐4‐yl}methanone, {1‐[2‐(4‐methoxyphenoxy)ethyl]piperidin‐4‐yl}(4‐methoxyphenyl)methanone and {1‐[2‐(4‐chlorophenoxy)ethyl]piperidin‐4‐yl}(4‐chlorophenyl)methanone possessed outstanding neuroprotection in vitro and in vivo. These compounds can be used as a promising neuroprotective agents for future development of new anti‐ischemic stroke agents. Basic structure–activity relationships are also presented.     

加味星蒌承气汤对急性缺血性脑卒中患者神经功能及血脂、血液流变学的影响

目的:探讨加味星蒌承气汤对急性缺血性脑卒中患者神经功能及血脂、血液流变学的影响。方法:选取2017年8月～2019年6月期间我院收治的急性缺血性脑卒中患者96例,将入选患者根据随机数字表法分为对照组(n=48)和研究组(n=48),对照组患者予以常规西医治疗,研究组患者在对照组基础上联合加味星蒌承气汤治疗,对比两组患者疗效、神经功能及血脂、血液流变学情况,记录两组患者治疗期间不良反应情况。结果:研究组治疗8 d后的临床总有效率为91.67%(44/48),显著高于对照组患者的72.92%(35/48)(P0.05)。两组治疗8 d后加拿大神经功能评分量表(CNS)、美国国立卫生研究所卒中量表(NIHSS)评分均下降(P0.05),且研究组低于对照组(P0.05)。两组治疗8 d后总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、甘油三酯(TG)、全血黏度高切、全血黏度低切、血浆黏度、纤维蛋白原均下降(P0.05),且研究组低于对照组(P0.05);高密度脂蛋白胆固醇(HDL-C)升高(P0.05),且研究组高于对照组(P0.05)。两组不良反应发生率比较无明显差异(P0.05)。结论:急性缺血性脑卒中患者采用加味星蒌承气汤治疗,疗效显著,可有效改善患者神经功能及血脂、血液流变学,且安全性较好。     

不同病情急性缺血性脑卒中患者血清过氧化还原蛋白1、钙调蛋白、触珠蛋白水平与预后的关系分析

摘要 目的：探讨不同病情急性缺血性脑卒中（AIS）患者血清过氧化还原蛋白1(PRDX1)、钙调蛋白(CAM)、触珠蛋白(HPT)水平与预后的关系。方法：收集2018年4月~2019年4月期间本院收治的127例AIS患者为研究对象,根据患者的病情分为轻度组(39例)、中度组(48例)、重度组(40例),根据患者的改良Rankin 量表( mRS)评分将患者分为预后良好组(73例)和预后不良组(54例),另选同期在我院进行健康检查的健康受试者50例为对照组。对比所有受试者PRDX1、CAM、HPT水平。对比不同预后患者的一般资料、PRDX1、CAM、HPT水平。分析PRDX1、CAM、HPT与NIHSS评分、mRS评分的关系。以多因素Logistic回归分析AIS患者预后的影响因素。结果：轻度组、中度组、中度组的PRDX1、CAM、HPT水平均高于对照组,且随着患者的病情加重,PRDX1、CAM、HPT水平依次升高,差异均有统计学意义(P<0.05)。预后不良组患者的年龄、PRDX1、CAM、HPT均高于预后良好组(P<0.05)。经Pearson检验,AIS患者的PRDX1、CAM、HPT与NIHSS、mRS评分均呈正相关(P<0.05)。经多因素Logistic回归分析可得,年龄较高、PRDX1水平升高、CAM水平升高、HPT水平升高是AIS患者预后不良的危险因素(P<0.05)。结论：AIS患者的PRDX1、CAM、HPT水平异常升高,且与其病情及预后呈现明显的相关性,年龄、PRDX1、CAM、HPT是患者预后的影响因素,对于病情的评估、预后的判断有一定的临床指导价值。     

谷红注射液和丁苯酞注射液联合Solitaire AB型支架取栓治疗急性缺血性脑卒中的临床研究

摘要 目的：探讨谷红注射液和丁苯酞注射液联合Solitaire AB型支架取栓治疗急性缺血性脑卒中（AIS）的临床疗效。方法：选择2018年1月到2020年12月期间攀枝花市中西医结合医院收治的AIS患者98例,依照随机数字表法分为观察组（50例）和对照组（48例）。对照组采用Solitaire AB型支架取栓治疗,观察组给予谷红注射液和丁苯酞注射液联合Solitaire AB型支架取栓治疗,两组均治疗14 d。治疗后进行临床疗效评价,比较两组治疗后的血管再通率和并发症发生率,比较两组治疗前后的美国国立卫生研究院卒中量表（NIHSS）评分、Barthel指数评分及全血高切黏度、全血低切黏度、血小板聚集率。结果：观察组的临床总有效率为84.00%（42/50）,对照组为60.42%（29/48）,两组比较差异有统计学意义（P<0.05）。观察组的血管再通率明显高于对照组（P<0.05）。两组治疗后血小板聚集率、全血低切黏度及全血高切黏度均明显低于治疗前（P<0.05）,且观察组治疗后血小板聚集率、全血低切黏度及全血高切黏度均明显低于对照组（P<0.05）。治疗后观察组Barthel指数评分明显高于对照组（P<0.05）,NIHSS评分明显低于对照组（P<0.05）。观察组的并发症发生率为6.00%（3/50）,对照组为4.17%（2/48）,两组比较差异无统计学意义（P>0.05）。结论：谷红注射液和丁苯酞注射液联合Solitaire AB型支架取栓治疗AIS的临床疗效显著,能够提高血管再通率,减轻神经功能缺损,改善患者的日常生活能力和血液流变学指标,且并发症较轻。