Second Department of Neurology, "Attikon University Hospital", School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, United States.
Curr Pharm Des. 2018;24(6):668-674. doi: 10.2174/1381612824666180116100310.
Despite the proven efficacy of anti-thrombotic, lipid-lowering, anti-hypertensive therapies and lifestyle modification changes for secondary ischemic stroke prevention, the risk of recurrent stroke, coronary events and vascular death remains substantial even for patients treated with high rates of established secondary preventive medications.
In the present review, we summarize available literature data on the association between systemic inflammation and symptomatic atherosclerosis including recurrent cerebral ischemia. We also highlight the potential role of colchicine in the suppression of atherosclerosis-induced inflammation, plaque stabilization and thromboembolism prevention.
Accumulating evidence suggests that inflammation is of key importance in the pathophysiology of atherosclerotic plaque de-stabilization and thromboembolism, with inflammatory cells being involved in all stages of atherosclerosis development. Therefore, anti-inflammatory therapies targeting the atherosclerotic plaque inflammation may be important contributors in plaque stabilization and in the prevention of thromboembolic events. Colchicine is known to have multiple anti-inflammatory properties including inhibition of microtubule polymerization, leading to reduced secretion in monocyte-macrophages. Currently the randomized controlled CONVINCE trial is enrolling stroke patients to evaluate the effect of a daily low-dose of colchicine in reducing the rate of recurrent stroke and major vascular events.
Inflammatory pathways seem to be key mediators in the development of atherosclerotic process, atheromatous plaque destabilization and thromboembolism. Colchicine as a novel therapeutic agent could be a safe and effective inhibitor of the inflammation cascade in patients with extra- or intracranial atherosclerosis or arteriolosclerosis, resulting in reduced vascular events.
尽管抗血栓、降脂、降压治疗和生活方式改变已被证实能有效预防继发性缺血性中风，但即使在接受高比例既定二级预防药物治疗的患者中，复发性中风、冠心病事件和血管死亡的风险仍然很大。
在本综述中，我们总结了关于全身炎症与症状性动脉粥样硬化（包括复发性脑缺血）之间关联的现有文献数据。我们还强调了秋水仙碱在抑制动脉粥样硬化诱导的炎症、斑块稳定和血栓栓塞预防方面的潜在作用。
越来越多的证据表明，炎症在动脉粥样硬化斑块不稳定和血栓形成的病理生理学中具有重要意义，炎症细胞参与了动脉粥样硬化发展的所有阶段。因此，针对动脉粥样硬化斑块炎症的抗炎治疗可能是斑块稳定和预防血栓栓塞事件的重要因素。秋水仙碱具有多种抗炎特性，包括抑制微管聚合，从而减少单核细胞-巨噬细胞的分泌。目前，随机对照 CONVINCE 试验正在招募中风患者，以评估每日低剂量秋水仙碱在降低复发性中风和主要血管事件发生率方面的效果。
炎症途径似乎是动脉粥样硬化过程、动脉粥样硬化斑块不稳定和血栓形成的关键介质。秋水仙碱作为一种新型治疗药物，可能是一种安全有效的炎症级联抑制剂，可减少颅内或颅外动脉粥样硬化或小动脉硬化患者的血管事件。
