在一项大型上肢康复试验队列中的中风病灶很少与常见临床前模型中的病灶相匹配。
Stroke Lesions in a Large Upper Limb Rehabilitation Trial Cohort Rarely Match Lesions in Common Preclinical Models.
作者信息
Edwardson Matthew A, Wang Ximing, Liu Brent, Ding Li, Lane Christianne J, Park Caron, Nelsen Monica A, Jones Theresa A, Wolf Steven L, Winstein Carolee J, Dromerick Alexander W
机构信息
1 Georgetown University, Washington, DC, USA.
2 MedStar National Rehabilitation Hospital, Washington, DC, USA.
出版信息
Neurorehabil Neural Repair. 2017 Jun;31(6):509-520. doi: 10.1177/1545968316688799. Epub 2017 Jan 1.
BACKGROUND
Stroke patients with mild-moderate upper extremity motor impairments and minimal sensory and cognitive deficits provide a useful model to study recovery and improve rehabilitation. Laboratory-based investigators use lesioning techniques for similar goals.
OBJECTIVE
To determine whether stroke lesions in an upper extremity rehabilitation trial cohort match lesions from the preclinical stroke recovery models used to drive translational research.
METHODS
Clinical neuroimages from 297 participants enrolled in the Interdisciplinary Comprehensive Arm Rehabilitation Evaluation (ICARE) study were reviewed. Images were characterized based on lesion type (ischemic or hemorrhagic), volume, vascular territory, depth (cortical gray matter, cortical white matter, subcortical), old strokes, and leukoaraiosis. Lesions were compared with those of preclinical stroke models commonly used to study upper limb recovery.
RESULTS
Among the ischemic stroke participants, median infarct volume was 1.8 mL, with most lesions confined to subcortical structures (61%) including the anterior choroidal artery territory (30%) and the pons (23%). Of ICARE participants, <1% had lesions resembling proximal middle cerebral artery or surface vessel occlusion models. Preclinical models of subcortical white matter injury best resembled the ICARE population (33%). Intracranial hemorrhage participants had small (median 12.5 mL) lesions that best matched the capsular hematoma preclinical model.
CONCLUSIONS
ICARE subjects are not representative of all stroke patients, but they represent a clinically and scientifically important subgroup. Compared with lesions in general stroke populations and widely studied animal models of recovery, ICARE participants had smaller, more subcortically based strokes. Improved preclinical-clinical translational efforts may require better alignment of lesions between preclinical and human stroke recovery models.
背景
患有轻度至中度上肢运动障碍且感觉和认知缺陷极小的中风患者为研究恢复情况和改善康复提供了有用的模型。基于实验室的研究人员使用损伤技术来实现类似目标。
目的
确定上肢康复试验队列中的中风损伤是否与用于推动转化研究的临床前中风恢复模型中的损伤相匹配。
方法
对参与跨学科综合手臂康复评估（ICARE）研究的297名参与者的临床神经影像进行了回顾。根据损伤类型（缺血性或出血性）、体积、血管区域、深度（皮质灰质、皮质白质、皮质下）、陈旧性中风和脑白质疏松症对图像进行了特征描述。将这些损伤与常用于研究上肢恢复的临床前中风模型的损伤进行了比较。
结果
在缺血性中风参与者中，梗死体积中位数为1.8 mL，大多数损伤局限于皮质下结构（61%），包括脉络膜前动脉区域（30%）和脑桥（23%）。在ICARE参与者中，<1%的人有类似于大脑中动脉近端或表面血管闭塞模型的损伤。皮质下白质损伤的临床前模型与ICARE人群最为相似（33%）。颅内出血参与者的损伤较小（中位数为12.5 mL），与临床前的包膜血肿模型最为匹配。
结论
ICARE受试者并不代表所有中风患者，但他们代表了一个在临床和科学上都很重要的亚组。与一般中风人群和广泛研究的恢复动物模型中的损伤相比，ICARE参与者的中风较小，且更多地基于皮质下。改善临床前-临床转化工作可能需要临床前和人类中风恢复模型之间的损伤更好地匹配。
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