Diabetes mellitus: A common comorbidity increasing hemorrhagic transformation after tPA thrombolytic therapy for ischemic stroke
Intravenous tissue type plasminogen activator thrombolytic therapy has long been a mainstay in acute ischemic stroke therapy. However, patients receiving IV tPA therapy may have variable response with some subsets of patients having worsened outcomes. Diabetes mellitus, a clinically important and co...
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| Format: | Article |
| Language: | English |
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KeAi Communications Co., Ltd.
2021-09-01
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| Series: | Brain Hemorrhages |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2589238X20300656 |
| _version_ | 1818718732991594496 |
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| author | Yinghua Jiang Jinrui Han Pierce Spencer Yadan Li Samuel J. Vodovoz Ming-Ming Ning Ning Liu Xiaoying Wang Aaron S. Dumont |
| author_facet | Yinghua Jiang Jinrui Han Pierce Spencer Yadan Li Samuel J. Vodovoz Ming-Ming Ning Ning Liu Xiaoying Wang Aaron S. Dumont |
| author_sort | Yinghua Jiang |
| collection | DOAJ |
| description | Intravenous tissue type plasminogen activator thrombolytic therapy has long been a mainstay in acute ischemic stroke therapy. However, patients receiving IV tPA therapy may have variable response with some subsets of patients having worsened outcomes. Diabetes mellitus, a clinically important and common vascular co-morbidity in AIS patients, can result in increased risk of hemorrhagic transformation after IV tPA therapy. In this short-review, we summarize the recent advances in understanding the mechanisms underlying the exacerbated HT after IV tPA therapy in AIS patients with DM. Potential precipitating factors including more severe blood–brain barrier disruption, enhanced oxidative stress, neuroinflammation and apoptosis, as well as several others contributors such as abnormal protein glycation, extracellular proteolytic dysfunction and impairment of collateral flow in DM are discussed. Additionally, several tPA combination approaches from experimental studies that may help to ameliorate the aggravation of post IV tPA-induced HT in AIS patients with DM are also briefly summarized. Urgently, more clinical and experimental studies aiming to better understand the mechanisms involved in DM-related exacerbation of HT after IV tPA therapy in AIS are needed for developing potential approaches protecting against this harmful complication in the management of AIS patients with DM. |
| first_indexed | 2024-12-17T19:55:44Z |
| format | Article |
| id | doaj.art-e3a16ba095dc4754ae4514af9b6925e7 |
| institution | Directory Open Access Journal |
| issn | 2589-238X |
| language | English |
| last_indexed | 2024-12-17T19:55:44Z |
| publishDate | 2021-09-01 |
| publisher | KeAi Communications Co., Ltd. |
| record_format | Article |
| series | Brain Hemorrhages |
| spelling | doaj.art-e3a16ba095dc4754ae4514af9b6925e72022-12-21T21:34:37ZengKeAi Communications Co., Ltd.Brain Hemorrhages2589-238X2021-09-0123116123Diabetes mellitus: A common comorbidity increasing hemorrhagic transformation after tPA thrombolytic therapy for ischemic strokeYinghua Jiang0Jinrui Han1Pierce Spencer2Yadan Li3Samuel J. Vodovoz4Ming-Ming Ning5Ning Liu6Xiaoying Wang7Aaron S. Dumont8Clinical Neuroscience Research Center, Departments of Neurosurgery and Neurology, Tulane University School of Medicine, New Orleans, LA 70122, USA; Corresponding authors at: Clinical Neuroscience Research Center, Departments of Neurosurgery and Neurology, Tulane University School of Medicine, New Orleans, LA 70122, USA.Clinical Neuroscience Research Center, Departments of Neurosurgery and Neurology, Tulane University School of Medicine, New Orleans, LA 70122, USAClinical Neuroscience Research Center, Departments of Neurosurgery and Neurology, Tulane University School of Medicine, New Orleans, LA 70122, USAClinical Neuroscience Research Center, Departments of Neurosurgery and Neurology, Tulane University School of Medicine, New Orleans, LA 70122, USAClinical Neuroscience Research Center, Departments of Neurosurgery and Neurology, Tulane University School of Medicine, New Orleans, LA 70122, USANeuroprotection Research Laboratory, Departments of Radiology and Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02129, USAClinical Neuroscience Research Center, Departments of Neurosurgery and Neurology, Tulane University School of Medicine, New Orleans, LA 70122, USAClinical Neuroscience Research Center, Departments of Neurosurgery and Neurology, Tulane University School of Medicine, New Orleans, LA 70122, USAClinical Neuroscience Research Center, Departments of Neurosurgery and Neurology, Tulane University School of Medicine, New Orleans, LA 70122, USA; Corresponding authors at: Clinical Neuroscience Research Center, Departments of Neurosurgery and Neurology, Tulane University School of Medicine, New Orleans, LA 70122, USA.Intravenous tissue type plasminogen activator thrombolytic therapy has long been a mainstay in acute ischemic stroke therapy. However, patients receiving IV tPA therapy may have variable response with some subsets of patients having worsened outcomes. Diabetes mellitus, a clinically important and common vascular co-morbidity in AIS patients, can result in increased risk of hemorrhagic transformation after IV tPA therapy. In this short-review, we summarize the recent advances in understanding the mechanisms underlying the exacerbated HT after IV tPA therapy in AIS patients with DM. Potential precipitating factors including more severe blood–brain barrier disruption, enhanced oxidative stress, neuroinflammation and apoptosis, as well as several others contributors such as abnormal protein glycation, extracellular proteolytic dysfunction and impairment of collateral flow in DM are discussed. Additionally, several tPA combination approaches from experimental studies that may help to ameliorate the aggravation of post IV tPA-induced HT in AIS patients with DM are also briefly summarized. Urgently, more clinical and experimental studies aiming to better understand the mechanisms involved in DM-related exacerbation of HT after IV tPA therapy in AIS are needed for developing potential approaches protecting against this harmful complication in the management of AIS patients with DM.http://www.sciencedirect.com/science/article/pii/S2589238X20300656Ischemic strokeTissue-type plasminogen activatorDiabetes mellitusHyperglycemiaHemorrhagic transformationIntracerebral hemorrhage |
| spellingShingle | Yinghua Jiang Jinrui Han Pierce Spencer Yadan Li Samuel J. Vodovoz Ming-Ming Ning Ning Liu Xiaoying Wang Aaron S. Dumont Diabetes mellitus: A common comorbidity increasing hemorrhagic transformation after tPA thrombolytic therapy for ischemic stroke Brain Hemorrhages Ischemic stroke Tissue-type plasminogen activator Diabetes mellitus Hyperglycemia Hemorrhagic transformation Intracerebral hemorrhage |
| title | Diabetes mellitus: A common comorbidity increasing hemorrhagic transformation after tPA thrombolytic therapy for ischemic stroke |
| title_full | Diabetes mellitus: A common comorbidity increasing hemorrhagic transformation after tPA thrombolytic therapy for ischemic stroke |
| title_fullStr | Diabetes mellitus: A common comorbidity increasing hemorrhagic transformation after tPA thrombolytic therapy for ischemic stroke |
| title_full_unstemmed | Diabetes mellitus: A common comorbidity increasing hemorrhagic transformation after tPA thrombolytic therapy for ischemic stroke |
| title_short | Diabetes mellitus: A common comorbidity increasing hemorrhagic transformation after tPA thrombolytic therapy for ischemic stroke |
| title_sort | diabetes mellitus a common comorbidity increasing hemorrhagic transformation after tpa thrombolytic therapy for ischemic stroke |
| topic | Ischemic stroke Tissue-type plasminogen activator Diabetes mellitus Hyperglycemia Hemorrhagic transformation Intracerebral hemorrhage |
| url | http://www.sciencedirect.com/science/article/pii/S2589238X20300656 |
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