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Advanced Neurology Inflammation in diabetic stroke: Treatment target

and urinary tract infection, such as screening for high- fruits and vegetables, have potent anti-inflammatory activities.
risk individuals and the use of antibiotics. A meta-analysis Galangin, a natural flavonol, exerts its anti-inflammatory
has shown that preventive antibiotic therapy in acute function by suppressing NF-κB activation, but whether it
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stroke patients is not beneficial. A more selective and is beneficial in modulating chronic inflammation in diabetes
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neuroinflammation modulating approach may reduce which remains unknown. Phytochemicals – the secondary
these off-target side effects. metabolites of plants, such as vegetables, fruits, and herbs –
For post-stroke depression and post-stroke fatigue, a are known to possess antioxidative and anti-inflammatory
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few studies have explored the effectiveness of serotonin activities. Herb-based traditional Chinese medicines
reuptake inhibitors and modafinil. A meta-analysis offer a more comprehensive range of benefits. Chuanxiong,
has suggested that antidepressants are beneficial, while tetramethylpyrazine, is a crude herbal drug used in China
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modafinil seems to improve fatigue in a specific subgroup to treat cardiovascular and cerebrovascular disease.
of stroke patients. Recent studies have shown that Preclinical data have shown that tetramethylpyrazine
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fluoxetine has anti-inflammatory, antiapoptotic, and can decrease the levels of TNF-α and IL-1β. It exerts
antioxidant properties. Although a pilot randomized trial neuroprotection by inhibiting macrophage/microglia
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demonstrated that fluoxetine may be beneficial in vision activation, decreasing cerebral edema and BBB permeability,
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recovery after stroke, its clinical effects are uncertain, and promoting neurogenesis. Ginkgo biloba extract
and the potential bone fracture risk has limited its use in is a mixture of various medical ingredients extracted
patients with acute ischemic stroke. 103 from ginkgo biloba leaves. It has been shown to inhibit
neuroinflammation and apoptosis. The use of traditional
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Stem cell-based therapies are an emerging paradigm Chinese medicine as an adjunct therapy has been shown
in stroke treatment. Mesenchymal stem cells (MSCs) to improve overall survival in stroke patients with type 2
are an appealing candidate for ischemic stroke due diabetes. At present, phytochemicals-rich traditional
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to their easy accessibility and low immunogenicity. medicines are widely used for treatment purposes in China.
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MSCs also have multipotential differentiation ability However, to further improve their efficacy, extraction
and immunoregulatory properties. Compared to the process and mechanistic analysis of medical ingredients
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traditional cell replacement avenues, MSC-based therapies need to be constantly refined.
are gaining traction by virtue of their paracrine activities
and secretome properties. The secretome of MSCs can cross There is a growing body of evidence pointing to
the BBB readily. MSCs exert diverse anti-inflammatory the development of chronic neuroinflammation after
responses depending on the intensity of inflammation in ischemic stroke, which may interfere with neuronal
the target area, and attenuate inflammasome activities. 105,106 repair and contribute to post-stroke fatigue, depression,
MSCs can also reduce oxidative stress and provide and dementia. Since data concerning stroke patients
healthy mitochondria. 104-106 At present, the effectiveness with diabetes are limited, further studies are warranted,
of stem cell-based therapies is being tested in patients especially to characterize neuroinflammation during
with acute and subacute ischemic stroke (NCT04093336, subacute and chronic phases of stroke in diabetic patients,
NCT05008588, and CT04631406). to yield useful findings for facilitating the enhancement of
targeted treatments.
Post-stroke inflammation can be sustained for
several months, resulting in further tissue injury, that is, 5. Future directions
secondary neurodegeneration, which may play a crucial Despite growing evidence on successful neuroprotective
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role in post-stroke depression and fatigue. An open label treatments in preclinical models, the vast majority of
phase I/II clinic trial has shown that intrathecal injection clinical trials have failed to demonstrate efficacy. One
of autologous M2 macrophages at 1 – 12 months after of the primary reasons for this high failure rate is that
stroke resulted in a improved neurological recovery at preclinical studies may not accurately recapitulate the
6 months follow-up. The role of B-cells in stroke is still complexities of clinical stroke. First, most preclinical
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poorly understood. It has been postulated that neuro- studies employed the use of young male animals, while
antigen exposure after stroke triggers an immune response ischemic stroke commonly occurs in elderly populations,
that may contribute to post-stroke dementia. Anti-CD20 with worse outcomes in female patients. A pre-stroke
treatment in mice prevents delayed cognitive deficits. chronic systemic inflammation could create a “primed”
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To the best of our knowledge, there are no clinical data on inflammatory environment in elderly individuals. There
anti-CD20 in stroke to date. is evidence that age alters the immunological response to
Many plants are known to boast anti-inflammatory stroke, resulting in worse neuronal damage and poorer
properties. Flavonols, which are present in a wide variety of outcomes. 115,116 Second, healthy animals were used in most

Volume 3 Issue 2 (2024) 7 doi: 10.36922/an.1694