Bednar M M, Gross C E, Russell S R, Fuller S P, Ahern T P, Howard D B, Falck J R, Reddy K M, Balazy M
Division of Neurosurgery, University of Vermont, Burlington 05405-0068, USA.
Neurosurgery. 2000 Dec;47(6):1410-8; discussion 1418-9.
Activated polymorphonuclear leukocytes (PMNs) have been suggested to contribute to the development of increased intracranial pressure (ICP). We recently demonstrated that human PMNs produce a novel cytochrome P450-derived arachidonic acid metabolite, 1 6(R)-hydroxyeicosatetraenoic acid [16(R)-HETE], that modulates their function. It was thus of interest to examine this novel mediator in an acute stroke model.
16-HETE was assessed initially in a variety of human PMN and platelet in vitro assays and subsequently in an established rabbit model of thromboembolic stroke. A total of 50 rabbits completed a randomized, blinded, four-arm study, receiving 16(R)-HETE, tissue plasminogen activator, both, or neither. Experiments were completed 7 hours after autologous clot embolization. The primary end point for efficacy was the suppression of increased ICP.
In in vitro assays, 16(R)-HETE selectively inhibited human PMN adhesion and aggregation and leukotriene B4 synthesis. In the thromboembolic stroke model, animals that received 16(R)-HETE demonstrated significant suppression of increased ICP (7.7 +/- 1.2 to 13.1 +/- 2.7 mm Hg, baseline versus final 7-h time point, mean +/- standard error), compared with either the vehicle-treated group (7.7 +/- 0.9 to 15.8 +/- 2.6 mm Hg) or the tissue plasminogen activator-treated group (7.6 +/- 0.6 to 13.7 +/- 2.1 mm Hg). The group that received the combination of 16(R)-HETE plus tissue plasminogen activator demonstrated no significant change in ICP for the duration of the protocol (8.6 +/- 0.6 to 11.1 +/- 1.2 mm Hg).
16(R)-HETE suppresses the development of increased ICP in a rabbit model of thromboembolic stroke and may serve as a novel therapeutic strategy in ischemic and inflammatory pathophysiological states.
活化的多形核白细胞(PMN)被认为与颅内压(ICP)升高的发展有关。我们最近证明,人类PMN产生一种新的细胞色素P450衍生的花生四烯酸代谢产物,16(R)-羟基二十碳四烯酸[16(R)-HETE],它可调节其功能。因此,在急性中风模型中研究这种新型介质很有意义。
首先在各种人类PMN和血小板体外试验中评估16-HETE,随后在已建立的血栓栓塞性中风兔模型中进行评估。共有50只兔子完成了一项随机、盲法、四臂研究,接受16(R)-HETE、组织型纤溶酶原激活剂、两者或两者都不接受。自体血凝块栓塞7小时后完成实验。疗效的主要终点是抑制ICP升高。
在体外试验中,16(R)-HETE选择性抑制人类PMN粘附、聚集和白三烯B4合成。在血栓栓塞性中风模型中,与载体治疗组(7.7±0.9至15.8±2.6 mmHg)或组织型纤溶酶原激活剂治疗组(7.6±0.6至13.7±2.1 mmHg)相比,接受16(R)-HETE的动物ICP升高得到显著抑制(基线时为7.7±1.2至最终7小时时间点时为13.1±2.7 mmHg,平均值±标准误差)。接受16(R)-HETE加组织型纤溶酶原激活剂组合的组在方案持续时间内ICP无显著变化(8.6±0.6至11.1±1.2 mmHg)。
16(R)-HETE抑制血栓栓塞性中风兔模型中ICP升高的发展,可能作为缺血和炎症病理生理状态下的一种新型治疗策略。