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将黏液溶解剂氨溴索重新用于治疗亚急性和慢性缺血性中风。

Repurposing the mucolytic agent ambroxol for treatment of sub-acute and chronic ischaemic stroke.

作者信息

Patzwaldt Kristin, Berezhnoy Georgy, Ionescu Tudor, Schramm Linda, Wang Yi, Owczorz Miriam, Calderón Eduardo, Poli Sven, Serna Higuita Lina M, Gonzalez-Menendez Irene, Quintanilla-Martinez Leticia, Herfert Kristina, Pichler Bernd, Trautwein Christoph, Castaneda-Vega Salvador

机构信息

Werner Siemens Imaging Center, Department of Preclinical Imaging and Radiopharmacy, Eberhard Karls University Tuebingen, Tuebingen 72076, Germany.

Hertie Institute for Clinical Brain Research, Department for Neurology, University Hospital Tuebingen, Tuebingen 72076, Germany.

出版信息

Brain Commun. 2023 Mar 29;5(2):fcad099. doi: 10.1093/braincomms/fcad099. eCollection 2023.

Abstract

Ambroxol is a well-known mucolytic expectorant, which has gained much attention in amyotrophic lateral sclerosis, Parkinson's and Gaucher's disease. A specific focus has been placed on ambroxol's glucocerebrosidase-stimulating activity, on grounds that the point mutation of the gene, which codes for this enzyme, is a risk factor for developing Parkinson's disease. However, ambroxol has been attributed other characteristics, such as the potent inhibition of sodium channels, modification of calcium homeostasis, anti-inflammatory effects and modifications of oxygen radical scavengers. We hypothesized that ambroxol could have a direct impact on neuronal rescue if administered directly after ischaemic stroke induction. We longitudinally evaluated 53 rats using magnetic resonance imaging to examine stroke volume, oedema, white matter integrity, resting state functional MRI and behaviour for 1 month after ischemic stroke onset. For closer mechanistic insights, we evaluated tissue metabolomics of different brain regions in a subgroup of animals using nuclear magnetic resonance spectroscopy. Ambroxol-treated animals presented reduced stroke volumes, reduced cytotoxic oedema, reduced white matter degeneration, reduced necrosis, improved behavioural outcomes and complex changes in functional brain connectivity. Nuclear magnetic resonance spectroscopy tissue metabolomic data at 24 h post-stroke proposes several metabolites that are capable of minimizing post-ischaemic damage and that presented prominent shifts during ambroxol treatment in comparison to controls. Taking everything together, we propose that ambroxol catalyzes recovery in energy metabolism, cellular homeostasis, membrane repair mechanisms and redox balance. One week of ambroxol administration following stroke onset reduced ischaemic stroke severity and improved functional outcome in the subacute phase followed by reduced necrosis in the chronic stroke phase.

摘要

氨溴索是一种著名的黏液溶解祛痰剂,在肌萎缩侧索硬化症、帕金森病和戈谢病中备受关注。人们特别关注氨溴索的葡萄糖脑苷脂酶刺激活性,因为编码这种酶的基因突变是帕金森病发病的一个危险因素。然而,氨溴索还具有其他特性,如对钠通道的强效抑制、钙稳态的改变、抗炎作用以及对氧自由基清除剂的改变。我们假设,在缺血性中风诱导后直接给予氨溴索可能会对神经元拯救产生直接影响。我们纵向评估了53只大鼠,使用磁共振成像检查中风体积、水肿、白质完整性、静息态功能磁共振成像以及缺血性中风发作后1个月的行为。为了更深入了解机制,我们使用核磁共振波谱法评估了一组动物不同脑区的组织代谢组学。接受氨溴索治疗的动物中风体积减小、细胞毒性水肿减轻、白质变性减轻、坏死减少、行为结果改善以及脑功能连接发生复杂变化。中风后24小时的核磁共振波谱组织代谢组学数据提出了几种能够将缺血性损伤降至最低的代谢物,与对照组相比,这些代谢物在氨溴索治疗期间出现了显著变化。综合考虑所有因素,我们认为氨溴索可促进能量代谢、细胞稳态、膜修复机制和氧化还原平衡的恢复。中风发作后给予一周的氨溴索可降低缺血性中风的严重程度,并改善亚急性期的功能结局,随后在慢性中风期减少坏死。

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