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Sodium butyrate restored TRESK current controlling neuronal hyperexcitability in a mouse model of oxaliplatin-induced peripheral neuropathic pain 丁酸钠可恢复奥沙利铂诱发周围神经痛小鼠模型中控制神经元过度兴奋性的TRESK电流。
IF 5.6 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2025-01-01 DOI: 10.1016/j.neurot.2024.e00481
Idy H.T. Ho , Yidan Zou , Kele Luo , Fenfen Qin , Yanjun Jiang , Qian Li , Tingting Jin , Xinyi Zhang , Huarong Chen , Likai Tan , Lin Zhang , Tony Gin , William K.K. Wu , Matthew T.V. Chan , Changyu Jiang , Xiaodong Liu
Chemotherapy-induced peripheral neuropathy (CIPN) and its related pain are common challenges for patients receiving oxaliplatin chemotherapy. Oxaliplatin accumulation in dorsal root ganglion (DRGs) is known to impair gene transcription by epigenetic dysregulation. We hypothesized that sodium butyrate, a pro-resolution short-chain fatty acid, inhibited histone acetylation in DRGs and abolished K+ channel dysregulation-induced neuronal hyperexcitability after oxaliplatin treatment. Mechanical allodynia and cold hyperalgesia of mice receiving an accumulation of 15 ​mg/kg oxaliplatin, with or without intraperitoneal sodium butyrate supplementation, were assessed using von Frey test and acetone evaporation test. Differential expressions of histone deacetylases (HDACs) and pain-related K+ channels were quantified with rt-qPCR and protein assays. Immunofluorescence assays of histone acetylation at H3K9/14 were performed in primary DRG cultures treated with sodium butyrate. Current clamp recording of action potentials and persistent outward current of Twik-related-spinal cord K+ (TRESK) channel were recorded in DRG neurons with small diameters extract. Accompanied by mechanical allodynia and cold hyperalgesia, HDAC1 was upregulated in mice receiving oxaliplatin treatment. Sodium butyrate enhanced global histone acetylation at H3K9/14 in DRG neurons. In vivo sodium butyrate supplementation restored oxaliplatin-induced Kcnj9 and Kcnk18 expression and pain-related behaviors in mice for at least 14 days. Oxaliplatin-induced increase in action potentials frequencies and decrease in magnitudes of KCNK18-related current were reversed in mice receiving sodium butyrate supplementation. This study suggests that sodium butyrate was a useful agent to relieve oxaliplatin-mediated neuropathic pain.
化疗诱发的周围神经病变(CIPN)及其相关疼痛是接受奥沙利铂化疗的患者面临的共同挑战。众所周知,奥沙利铂在背根神经节(DRGs)中的蓄积会通过表观遗传失调损害基因转录。我们假设丁酸钠(一种促进溶解的短链脂肪酸)可抑制DRGs中的组蛋白乙酰化,并消除奥沙利铂治疗后K+通道失调引起的神经元过度兴奋。用von Frey试验和丙酮蒸发试验评估了小鼠在腹腔补充或不补充15毫克/千克奥沙利铂后的机械异感和冷过痛。组蛋白去乙酰化酶(HDACs)和疼痛相关 K+ 通道的差异表达通过 rt-qPCR 和蛋白质检测进行量化。在经丁酸钠处理的原代DRG培养物中进行了组蛋白乙酰化H3K9/14的免疫荧光检测。在提取小直径的DRG神经元中记录了动作电位的钳夹记录和Twik相关脊髓K+(TRESK)通道的持续外向电流。在接受奥沙利铂治疗的小鼠中,伴随着机械异感和冷超痛症,HDAC1被上调。丁酸钠增强了DRG神经元H3K9/14处的全局组蛋白乙酰化。在体内补充丁酸钠可恢复奥沙利铂诱导的小鼠 Kcnj9 和 Kcnk18 表达以及疼痛相关行为至少 14 天。补充丁酸钠的小鼠可逆转奥沙利铂诱导的动作电位频率增加和 KCNK18 相关电流幅度的降低。这项研究表明,丁酸钠是缓解奥沙利铂介导的神经病理性疼痛的有效药物。
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引用次数: 0
Individualized autoregulation-guided arterial blood pressure management in neurocritical care 神经危重症护理中个体化自我调节引导的动脉血压管理。
IF 5.6 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2025-01-01 DOI: 10.1016/j.neurot.2025.e00526
Jonathan R. Gomez , Bhagyashri U. Bhende , Rohan Mathur , L. Fernando Gonzalez , Vishank A. Shah
Cerebral autoregulation (CA) is the physiological process by which cerebral blood flow is maintained during fluctuations in arterial blood pressure (ABP). There are various validated methods to measure CA, either invasively, with intracranial pressure or brain tissue oxygenation monitors, or noninvasively, with transcranial Doppler ultrasound or near-infrared spectroscopy. Utilizing these monitors, researchers have been able to discern CA patterns in several pathological states, such as but not limited to acute ischemic stroke, spontaneous intracranial hemorrhage, aneurysmal subarachnoid hemorrhage, sepsis, and post-cardiac arrest, and they have found CA to be altered in these patients. CA disturbances predispose patients suffering from these ailments to worse outcomes. Much focus has been placed on CA monitoring in these populations, with an emphasis on arterial blood pressure optimization. Many guidelines recommend universal static ABP targets; however, in patients with altered CA, these targets may make them susceptible to hypoperfusion and further neurological injury. Based on this observation, there has been much investigation on individualized ABP goals and their effect on clinical outcomes. The scope of this review includes (1) a summary of the physiology of CA in healthy adults; (2) a review of the evidence on CA monitoring in healthy individuals; (3) a summary of CA changes and its effect on outcomes in various diseased states including acute ischemic stroke, spontaneous intracranial hemorrhage, aneurysmal subarachnoid hemorrhage, sepsis and meningitis, post-cardiac arrest, hypoxic-ischemic encephalopathy, surgery, and moyamoya disease; and (4) a review of the current evidence on individualized ABP changes in various patient populations.
脑自动调节(CA)是在动脉血压(ABP)波动时维持脑血流的生理过程。有多种经过验证的测量CA的方法,无论是侵入性的,用颅内压或脑组织氧合监测仪,还是非侵入性的,用经颅多普勒超声或近红外光谱。利用这些监测仪,研究人员已经能够识别几种病理状态下的CA模式,如但不限于急性缺血性中风、自发性颅内出血、动脉瘤性蛛网膜下腔出血、败血症和心脏骤停,他们发现这些患者的CA发生了改变。CA干扰使患有这些疾病的患者易患更糟糕的结果。在这些人群中,大量的焦点放在CA监测上,重点放在动脉血压优化上。许多指南推荐通用的静态ABP目标;然而,在CA改变的患者中,这些靶点可能使他们容易发生灌注不足和进一步的神经损伤。基于这一观察,有很多关于个体化ABP目标及其对临床结果的影响的研究。本文综述的范围包括:(1)健康成人CA的生理学综述;(2)健康个体CA监测的证据综述;(3)急性缺血性卒中、自发性颅内出血、动脉瘤性蛛网膜下腔出血、败血症和脑膜炎、心脏骤停后、缺氧缺血性脑病、外科手术和烟雾病等不同疾病状态下CA的变化及其对预后的影响;(4)对不同患者群体个体化ABP变化的现有证据进行综述。
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引用次数: 0
Risk of angioedema and thrombolytic therapy among stroke patients: An analysis of data from the FDA Adverse Event Reporting System database 中风患者血管性水肿与溶栓治疗的风险:美国食品和药物管理局不良事件报告系统数据库数据分析。
IF 5.6 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2025-01-01 DOI: 10.1016/j.neurot.2024.e00474
Hunong Xiang , Yu Ma , Xiaochao Luo , Jian Guo , Minghong Yao , Yanmei Liu , Ke Deng , Xin Sun , Ling Li
The angioedema risk may vary among stroke patients receiving different thrombolytic agents. This study aimed to investigate the angioedema risk associated with different thrombolytic agents and to identify associated risk factors. We conducted a large-scale retrospective pharmacovigilance study using the FDA Adverse Event Reporting System (FAERS) database. Stroke patients receiving thrombolytic therapy (i.e., alteplase or tenecteplase) were identified, and the associations with angioedema were explored using disproportionality analysis and time-to-onset analysis. Additionally, we used adapted Bradford Hill criteria to confirm these associations. Risk factors for angioedema were explored using stepwise logistic regression. A total of 17,776 stroke patients were included, with 2973 receiving alteplase and 278 receiving tenecteplase. Disproportionality analysis revealed that angioedema might be associated with alteplase (adjusted ROR [aROR] 5.13 [95 ​% CI, 4.55–5.79]) or tenecteplase (aROR 2.72 [95 ​% CI, 1.98–3.67]). The adapted Bradford Hill criteria suggested a probable causal relationship between alteplase and angioedema, whereas there was insufficient evidence of a probable causal relationship with tenecteplase. Multivariate analysis revealed that ACE-inhibitors use (aROR 9.73 [95 ​% CI, 7.29–12.98]), female sex (aROR 1.38 [95 ​% CI, 1.13–1.67]) and hypertension (aROR 2.11 [95 ​% CI, 1.52–2.92]) were significant risk factors for angioedema among alteplase-treated stroke patients. Our study suggested that alteplase is associated with a greater risk of angioedema among stroke patients, but there is insufficient evidence to support an association between tenecteplase and angioedema. Clinicians should be vigilant for this potentially life-threatening complication, particularly in patients with identified risk factors. It is also prudent to consider tenecteplase as an alternative, if available.
接受不同溶栓药物治疗的脑卒中患者的血管性水肿风险可能不同。本研究旨在调查与不同溶栓药物相关的血管性水肿风险,并确定相关的风险因素。我们利用 FDA 不良事件报告系统(FAERS)数据库开展了一项大规模回顾性药物警戒研究。我们对接受溶栓治疗(即阿替普酶或替奈替普酶)的脑卒中患者进行了鉴定,并使用比例失调分析和发病时间分析探讨了血管性水肿的相关性。此外,我们还使用了改编的布拉德福德-希尔标准来确认这些关联。血管性水肿的风险因素采用逐步逻辑回归法进行探讨。共纳入了 17776 例中风患者,其中 2973 例接受了阿替普酶治疗,278 例接受了替奈普酶治疗。比例失调分析显示血管性水肿可能与阿替普酶(调整后ROR [aROR] 5.13 [95 % CI, 4.55-5.79])或替奈普酶(aROR 2.72 [95 % CI, 1.98-3.67])有关。改编后的布拉德福德-希尔标准表明,阿替普酶与血管性水肿之间可能存在因果关系,而与替奈普酶之间可能存在因果关系的证据不足。多变量分析显示,使用 ACE 抑制剂(aROR 9.73 [95 % CI, 7.29-12.98])、女性(aROR 1.38 [95 % CI, 1.13-1.67])和高血压(aROR 2.11 [95 % CI, 1.52-2.92])是阿替普酶治疗的卒中患者出现血管性水肿的重要危险因素。我们的研究表明,阿替普酶与脑卒中患者血管性水肿的风险增加有关,但没有足够的证据支持替奈普酶与血管性水肿有关。临床医生应警惕这种可能危及生命的并发症,尤其是具有已识别风险因素的患者。如果可以使用替奈普酶,考虑将其作为替代药物也是谨慎之举。
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引用次数: 0
PET in neurotherapeutic discovery and development PET在神经治疗中的发现和发展。
IF 5.6 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2025-01-01 DOI: 10.1016/j.neurot.2024.e00498
Melissa Chassé , Neil Vasdev
Positron emission tomography (PET) is a highly sensitive, quantitative imaging technique that can track sub-nanomolar quantities of positron-emitting radionuclides throughout the body. By incorporating such radionuclides into molecules of interest, we can directly assess their pharmacokinetic and pharmacodynamic (PK/PD) characteristics in vivo without changing their physicochemical characteristics or eliciting a pharmacological response. As such, PET imaging has long been used as a tool to aid drug discovery programs from preclinical biomarker validation all the way through to clinical trials. In this perspective we discuss the use of PET radioligands in central nervous system (CNS) drug discovery and development, with a focus on recent applications in psychiatry (e.g. 5-HT2A, 11β-HSD1), neuro-oncology (e.g. KRASG12C, ATM, ALK2), and neurodegeneration (e.g. amyloid beta plaques, MAPK p38), while exploring the intricacies associated with developing novel radiotracers for CNS targets. Examples highlight the preclinical and clinical uses of PET for studying biomarker function, drug candidate PK/PD, target occupancy/engagement, dosing regimen determination, clinical trial patient selection, and quantifying biomarker changes in response to treatments.
正电子发射断层扫描(PET)是一种高度敏感的定量成像技术,可以跟踪整个身体中亚纳摩尔量的正电子发射放射性核素。通过将这些放射性核素纳入感兴趣的分子,我们可以直接评估其体内药代动力学和药效学(PK/PD)特性,而不会改变其物理化学特性或引起药理反应。因此,PET成像长期以来一直被用作帮助药物发现项目的工具,从临床前生物标志物验证一直到临床试验。从这个角度来看,我们讨论了PET放射配体在中枢神经系统(CNS)药物发现和开发中的应用,重点是最近在精神病学(例如5-HT2A, 11β-HSD1),神经肿瘤学(例如KRASG12C, ATM, ALK2)和神经变性(例如淀粉样蛋白斑块,MAPK p38)中的应用,同时探索与开发新的CNS靶点放射性示踪剂相关的复杂性。这些例子强调了PET在研究生物标志物功能、候选药物PK/PD、靶标占用/参与、给药方案确定、临床试验患者选择以及量化生物标志物对治疗反应的变化方面的临床前和临床应用。
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引用次数: 0
Intracranial aneurysm instability prediction model based on 4D-Flow MRI and HR-MRI 基于4D-Flow MRI和HR-MRI的颅内动脉瘤不稳定性预测模型。
IF 5.6 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2025-01-01 DOI: 10.1016/j.neurot.2024.e00505
Fei Peng , Jiaxiang Xia , Fandong Zhang , Shiyu Lu , Hao Wang , Jiashu Li , Xinmin Liu , Yao Zhong , Jiahuan Guo , Yonghong Duan , Binbin Sui , Chuyang Ye , Yi Ju , Shuai Kang , Yizhou Yu , Xin Feng , Xingquan Zhao , Rui Li , Aihua Liu
This study aims to develop a reliable predictive model for assessing intracranial aneurysm (IA) instability by utilizing four-dimensional flow magnetic resonance imaging (4D-Flow MRI) and high-resolution MRI (HR-MRI). Initially, we curated a prospective dataset, dubbed the primary cohort, by aggregating patient data that was consecutively enrolled across two centers from November 2018 to November 2021. Unstable aneurysms were defined as those with symptoms, morphological change or ruptured during follow-up periods. We introduce a specialized ensemble learning framework, termed the Hybrid Model, which synergistically combines two heterogeneous base learning algorithms: 4D-Flow logistic regression (4D-Flow-LR) and Multi-crop Attention Branch Network (MicroAB-Net). The ability of the hybrid model to predict aneurysm instability was compared with baseline models: PHASES (population, hypertension, age, size, earlier rupture, and site) LR, ELAPSS (earlier subarachnoid hemorrhage, location, age, population, size, and shape) LR, aneurysm wall enhancement (AWE) LR, and Radiomics using the area under the curve (AUC) with Delong's test. Finally, the Hybrid Model was further validated in the validation cohort (patients enrolled between December 2021 to May 2022). In the primary cohort, 189 patients (144 women [76.2 ​%]; aged 58.90 years ​± ​10.32) with 213 IAs were included. In the validation cohort, 48 patients (35 women [72.9 ​%]; aged 55.0 years ​± ​10.77) with 53 IAs were included. The Hybrid Model achieved the highest performance both in the primary cohort (AUC ​= ​0.854) and the validation cohort (AUC ​= ​0.876). The Hybrid model provided a promising prediction of aneurysm instability.
本研究旨在利用四维流磁共振成像(4D-Flow MRI)和高分辨率MRI (HR-MRI)建立可靠的预测模型来评估颅内动脉瘤(IA)的不稳定性。最初,我们通过汇总2018年11月至2021年11月在两个中心连续入组的患者数据,策划了一个前瞻性数据集,称为初级队列。不稳定动脉瘤定义为在随访期间出现症状、形态改变或破裂的动脉瘤。我们介绍了一个专门的集成学习框架,称为混合模型,它协同结合了两种异构基础学习算法:4D-Flow逻辑回归(4D-Flow- lr)和多作物注意分支网络(MicroAB-Net)。混合模型预测动脉瘤不稳定性的能力与基线模型进行比较:阶段(人群、高血压、年龄、大小、早期破裂和部位)LR、ELAPSS(早期蛛网膜下腔出血、位置、年龄、人口、大小和形状)LR、动脉瘤壁增强(AWE) LR和使用Delong测试的曲线下面积(AUC)的放射组学。最后,在验证队列(2021年12月至2022年5月入组的患者)中进一步验证混合模型。在主要队列中,189例患者(144例女性,76.2%);年龄58.90岁±10.32岁,IAs 213例。在验证队列中,48例患者(女性35例,占72.9%);年龄55.0岁±10.77岁,53例IAs。混合模型在主要队列(AUC = 0.854)和验证队列(AUC = 0.876)中均取得了最高的表现。Hybrid模型为预测动脉瘤不稳定性提供了一种很有希望的方法。
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引用次数: 0
Strategies to innovate emergency care of status epilepticus 创新癫痫持续状态急诊护理策略。
IF 5.6 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2025-01-01 DOI: 10.1016/j.neurot.2024.e00514
Jaideep Kapur
Generalized Convulsive status epilepticus (SE) is a neurological emergency because prolonged convulsions can cause respiratory compromise and neuronal injury. Compromised GABA-mediated inhibition is a defining feature of SE, and many current therapies are benzodiazepines, which are allosteric modulators of GABA-A receptors. Many patients with medically refractory epilepsy are at risk for SE. Newly available nasally delivered benzodiazepines: midazolam and diazepam given for seizure clusters may prevent SE. Although three different benzodiazepines, diazepam, lorazepam and midazolam terminate early SE, midazolam is preferred. It is administered via the intramuscular route, which saves time and is at least as practical or more effective than intravenous lorazepam. Unfortunately, many early SE patients are receiving inadequate doses of benzodiazepines. Patients who fail to respond to adequate doses of benzodiazepines are considered to be in established SE. Levetiracetam, fosphenytoin, and valproic acid are equally safe and effective in treating established SE. The rate of cardiovascular complications: cardiac arrhythmias and hypotension were low in patients treated with phenytoin, levetiracetam, or valproic acid. In contrast, overall, 25 ​% of patients in established SE were intubated, and this was in response to respiratory compromise in many patients. Interestingly, children treated with fosphenytoin were more likely to require intubation than those treated with valproic acid or levetiracetam. Better therapies are needed for the treatment established SE, because all three drugs were effective in less than 50 ​% of the patients.
全身性惊厥癫痫持续状态(SE)是一种神经系统急症,因为长时间的惊厥可引起呼吸损害和神经元损伤。gaba介导的抑制受损是SE的一个决定性特征,目前许多治疗方法是苯二氮卓类药物,它是GABA-A受体的变构调节剂。许多医学上难治性癫痫患者都有SE的风险。新获得的经鼻给药苯二氮卓类药物:咪达唑仑和地西泮可预防癫痫发作。虽然三种不同的苯二氮卓类药物,安定、劳拉西泮和咪达唑仑终止早期SE,但咪达唑仑是首选。它通过肌肉注射的方式给药,这节省了时间,至少与静脉注射劳拉西泮一样实用或更有效。不幸的是,许多早期SE患者接受的苯二氮卓类药物剂量不足。对足够剂量的苯二氮卓类药物没有反应的患者被认为是已建立的SE。左乙乙胺、磷酸苯妥英和丙戊酸在治疗SE方面同样安全有效。心血管并发症发生率:使用苯妥英、左乙拉西坦或丙戊酸治疗的患者心律失常和低血压发生率较低。相比之下,总体而言,25%的SE患者插管,这是对许多患者呼吸损伤的反应。有趣的是,用磷妥英治疗的儿童比用丙戊酸或左乙拉西坦治疗的儿童更有可能需要插管。需要更好的治疗方法来治疗已建立的SE,因为所有三种药物对不到50%的患者有效。
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引用次数: 0
Nuclear respiratory factor-1 (NRF1) induction drives mitochondrial biogenesis and attenuates amyloid beta-induced mitochondrial dysfunction and neurotoxicity. 核呼吸因子-1 (NRF1)诱导线粒体生物发生,减轻淀粉样蛋白诱导的线粒体功能障碍和神经毒性。
IF 5.6 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-12-26 DOI: 10.1016/j.neurot.2024.e00513
Matteo Massaro, Gherardo Baudo, Hyunho Lee, Haoran Liu, Elvin Blanco

Mitochondrial dysfunction is an important driver of neurodegeneration and synaptic abnormalities in Alzheimer's disease (AD). Amyloid beta (Aβ) in mitochondria leads to increased reactive oxygen species (ROS) production, resulting in a vicious cycle of oxidative stress in coordination with a defective electron transport chain (ETC), decreasing ATP production. AD neurons exhibit impaired mitochondrial dynamics, evidenced by fusion and fission imbalances, increased fragmentation, and deficient mitochondrial biogenesis, contributing to fewer mitochondria in brains of AD patients. Nuclear respiratory factor-1 (NRF1) is a regulator of mitochondrial biogenesis through its activation of mitochondrial transcription factor A (TFAM). Our hypothesis posited that NRF1 induction in neuronal cells exposed to amyloid β1-42 (Aβ1-42) would increase de novo mitochondrial synthesis and improve mitochondrial function, restoring neuronal survival. Following NRF1 messenger RNA (mRNA) transfection of Aβ1-42-treated SH-SY5Y cells, a marked increase in mitochondrial mass was observed. Metabolic programming toward enhanced oxidative phosphorylation resulted in increased ATP production. Oxidative stress in the form of mitochondrial ROS accumulation was reduced and mitochondrial membrane potential preserved. Mitochondrial homeostasis was maintained, evidenced by balanced fusion and fission processes. Ultimately, improvement of mitochondrial function was associated with significant decreases in Aβ1-42-induced neuronal death and neurite disruption. Our findings highlight the potential of NRF1 upregulation to counteract Aβ1-42-associated mitochondrial dysfunction and neurodegenerative cell processes, opening avenues for innovative therapeutic approaches aimed at safeguarding mitochondrial health in AD neurons.

线粒体功能障碍是阿尔茨海默病(AD)神经变性和突触异常的重要驱动因素。线粒体中的β淀粉样蛋白(a β)导致活性氧(ROS)产生增加,导致氧化应激与有缺陷的电子传递链(ETC)协同的恶性循环,减少ATP的产生。AD神经元表现出线粒体动力学受损,表现为融合和裂变失衡、碎片化增加和线粒体生物发生缺陷,导致AD患者大脑中线粒体减少。核呼吸因子-1 (NRF1)通过激活线粒体转录因子a (TFAM)调控线粒体生物发生。我们的假设是,暴露于淀粉样蛋白β1-42 (Aβ1-42)的神经元细胞中NRF1的诱导会增加线粒体的新生合成并改善线粒体功能,从而恢复神经元的存活。转染NRF1信使RNA (mRNA)后,a β1-42处理的SH-SY5Y细胞线粒体质量明显增加。朝着增强氧化磷酸化的代谢程序导致ATP的产生增加。线粒体ROS积累形式的氧化应激减少,线粒体膜电位保留。线粒体的内稳态得以维持,这可以从平衡的融合和裂变过程中得到证明。最终,线粒体功能的改善与a β1-42诱导的神经元死亡和神经突破坏的显著减少有关。我们的研究结果强调了NRF1上调的潜力,以抵消a β1-42相关的线粒体功能障碍和神经退行性细胞过程,为旨在保护AD神经元线粒体健康的创新治疗方法开辟了道路。
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引用次数: 0
Cross-species RNAi therapy via AAV delivery alleviates neuropathic pain by targeting GCH1. 通过AAV传递的跨物种RNAi治疗通过靶向GCH1缓解神经性疼痛。
IF 5.6 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-12-14 DOI: 10.1016/j.neurot.2024.e00511
Heesue Chang, Kyoung Jin Lee, Minkyung Park, Ha-Na Woo, Ji Hyun Kim, Im Kyeung Kang, Hyochan Park, Chan Hee Chon, Heuiran Lee, Hyun Ho Jung

Tetrahydrobiopterin (BH4) expression is normally strictly controlled; however, its intracellular levels increase considerably following nerve damage. GTP cyclohydrolase I (GCH1) plays a crucial role in regulating BH4 concentration, with an upregulation observed in the dorsal root ganglion in cases of neuropathic pain. In this study, we aimed to develop and evaluate the clinical potential of an RNA interference-based adeno-associated virus (AAV) targeting GCH1 across various species to decrease BH4 levels and, consequently, alleviate neuropathic pain symptoms. We identified universal small-interfering RNA sequences effective across species and developed an AAV-u-shRNA that successfully suppressed GCH1 expression with minimal off-target effects. Male Sprague Dawley rats were divided into four groups: normal, spared nerve injury, AAV-shCON, and AAV-u-shGCH1. The rats were sacrificed on post-injection day 28 to collect blood for BH4 level assessment. The AAV-u-shGCH1 group demonstrated remarkable improvement in the mechanical withdrawal threshold by PID 28, significantly outperforming the normal, spared nerve injury, and AAV-shCON groups. Plasma BH4 levels confirmed that AAV-u-shGCH1 effectively reduced neuropathic pain by inhibiting BH4 synthesis in vivo, introducing a novel, multispecies-compatible therapeutic strategy. Our results suggest that a single application of AAV-u-shGCH1 could offer a viable solution for neuropathic pain relief.

四氢生物蝶呤(BH4)的表达通常受到严格控制,但神经损伤后其细胞内水平会显著增加。GTP 环氢酶 I(GCH1)在调节 BH4 浓度方面起着至关重要的作用,在神经病理性疼痛病例中,背根神经节中的 BH4 浓度被观察到上调。在本研究中,我们旨在开发和评估基于 RNA 干扰的腺相关病毒(AAV)在不同物种中靶向 GCH1 的临床潜力,以降低 BH4 水平,从而缓解神经病理性疼痛症状。我们确定了跨物种有效的通用小干扰 RNA 序列,并开发了一种 AAV-u-shRNA,它能成功抑制 GCH1 的表达,且脱靶效应最小。雄性 Sprague Dawley 大鼠被分为四组:正常组、神经损伤幸免组、AAV-shCON 组和 AAV-u-shGCH1 组。大鼠在注射后第 28 天被处死,以采集血液进行 BH4 水平评估。到第 28 天时,AAV-u-shGCH1 组大鼠的机械撤退阈值有了显著改善,明显优于正常组、神经损伤缺损组和 AAV-shCON 组。血浆BH4水平证实,AAV-u-shGCH1通过抑制体内BH4的合成有效减轻了神经病理性疼痛,从而引入了一种新型、多物种兼容的治疗策略。我们的研究结果表明,单次应用 AAV-u-shGCH1 可为缓解神经病理性疼痛提供可行的解决方案。
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引用次数: 0
A brain-penetrant bispecific antibody lowers oligomeric alpha-synuclein and activates microglia in a mouse model of alpha-synuclein pathology. 在α-突触核蛋白病理小鼠模型中,一种脑穿透性双特异性抗体可降低低聚α-突触核蛋白并激活小胶质细胞。
IF 5.6 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-12-14 DOI: 10.1016/j.neurot.2024.e00510
Dag Sehlin, Sahar Roshanbin, Olof Zachrisson, Martin Ingelsson, Stina Syvänen

Parkinson's disease (PD) is characterized by a progressive loss of dopaminergic neurons, linked to aggregation of alpha-synuclein (αSYN) into Lewy bodies. Current treatments are symptomatic and do not halt or reverse the neurodegeneration. Immunotherapy targeting aggregated αSYN shows potential, but therapeutic efficacy is limited by poor brain penetration of antibodies. We developed a bispecific antibody, RmAb38E2-scFv8D3, based on αSYN oligomer selective RmAb38E2 fused to a transferrin receptor (TfR)-binding domain to enhance brain delivery. Both RmAb38E2 and RmAb38E2-scFv8D3 showed higher affinity for αSYN oligomers than for monomers or fibrils. In vivo, RmAb38E2-scFv8D3 exhibited higher brain and lower blood concentrations compared to RmAb38E2, suggesting a better brain uptake and reduced peripheral exposure for the bispecific antibody. Treatment over five days of 3-4 months old transgenic L61 mice, which overexpress human αSYN, with three doses of RmAb38E2-scFv8D3 reduced brain αSYN oligomer levels and increased microglial activation, as indicated by elevated soluble TREM2 levels. Treatment with the monospecific RmAb38E2, however, showed no significant effect compared to PBS. This study demonstrates that TfR-mediated delivery enhances the therapeutic potential of αSYN-targeted immunotherapy by resulting in a higher concentration and a more uniform distribution of antibodies in the brain. The use of bispecific antibodies offers a promising strategy to improve the efficacy of antibody therapies in PD and other α-synucleinopathies.

帕金森病(PD)的特征是多巴胺能神经元的逐渐丧失,这与α-突触核蛋白(αSYN)聚集成路易体有关。目前的治疗方法只能对症下药,无法阻止或逆转神经变性。针对聚集的αSYN的免疫疗法显示出潜力,但由于抗体的脑穿透性较差,疗效受到限制。我们开发了一种双特异性抗体--RmAb38E2-scFv8D3,它基于αSYN寡聚体选择性RmAb38E2与转铁蛋白受体(TfR)结合域的融合,以增强脑部递送能力。RmAb38E2和RmAb38E2-scFv8D3对αSYN寡聚体的亲和力均高于对单体或纤维的亲和力。在体内,与 RmAb38E2 相比,RmAb38E2-scFv8D3 的脑浓度更高,而血药浓度更低,这表明双特异性抗体的脑摄取能力更强,外周暴露减少。用三种剂量的 RmAb38E2-scFv8D3 对 3-4 个月大的过度表达人类 αSYN 的转基因 L61 小鼠进行为期五天的治疗,可降低脑部 αSYN 寡聚体的水平,并增加小胶质细胞的活化,可溶性 TREM2 水平的升高表明了这一点。然而,与 PBS 相比,使用单特异性 RmAb38E2 治疗没有明显效果。这项研究表明,TfR介导的递送能提高αSYN靶向免疫疗法的治疗潜力,使抗体在大脑中的浓度更高、分布更均匀。双特异性抗体的使用为提高针对帕金森病和其他α-突触核蛋白病的抗体疗法的疗效提供了一种前景广阔的策略。
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引用次数: 0
Ruxolitinib-dependent reduction of seizure load and duration is accompanied by spatial memory improvement in the rat pilocarpine model of temporal lobe epilepsy. 在匹罗卡平颞叶癫痫大鼠模型中,鲁索利替尼依赖性癫痫发作负荷和持续时间的减少伴随着空间记忆的改善。
IF 5.6 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-12-05 DOI: 10.1016/j.neurot.2024.e00506
Andrew Carrel, Eleonora Napoli, Kathryn Hixson, Jessica Carlsen, Yasmin Cruz Del Angel, Dana Strode, Nicolas Busquet, Vijay Kumar, Michael F Wempe, Shelley J Russek, Amy R Brooks-Kayal

Molecules with optimized pharmacokinetic properties selectively aimed at the inhibition of STAT3 phosphorylation in brain have recently emerged as potential disease modifying therapies for epilepsy. In the current study, pharmacological inhibition of JAK1/2 with the orally available, FDA-approved drug ruxolitinib, produced nearly complete inhibition of hippocampal STAT3 phosphorylation, and reduced the expression of its downstream target Cyclin D1, when administered to rats 30 ​min and 3 ​h after onset of pilocarpine-induced status epilepticus (SE). This effect was accompanied by significantly shorter seizure duration and lower overall seizure frequency throughout the 4 weeks of EEG recording, but did not completely prevent the development of epilepsy in ruxolitinib-treated male rats. Compared to DMSO-treated animals, administration of ruxolitinib also improved memory (Y maze) but did not impact motor function (open field) following SE. Taken together with our previous findings, the results of this study provide further evidence that inhibition of the JAK/STAT pathway may be a promising disease modifying strategy to reduce severity of acquired epilepsy after brain injury, but also point to the need to better understand and optimize inhibitors of this pathway.

具有优化药代动力学特性的分子选择性地抑制大脑中STAT3磷酸化,最近成为癫痫的潜在疾病修饰疗法。在目前的研究中,fda批准的口服药物ruxolitinib对JAK1/2的药理学抑制,在匹罗卡品诱导的癫痫持续状态(SE)发作后30分钟和3小时给药时,几乎完全抑制海马STAT3磷酸化,并降低其下游靶点Cyclin D1的表达。在4周的脑电图记录中,这种作用伴随着癫痫发作持续时间明显缩短和总体发作频率明显降低,但并不能完全阻止鲁索利替尼治疗的雄性大鼠癫痫的发展。与dmso处理的动物相比,鲁索利替尼也改善了SE后的记忆(Y迷宫),但不影响运动功能(开放场)。结合我们之前的研究结果,本研究的结果进一步证明,抑制JAK/STAT通路可能是一种有希望的疾病调节策略,可以降低脑损伤后获得性癫痫的严重程度,但也指出需要更好地了解和优化该通路的抑制剂。
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Neurotherapeutics
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