Accepted Manuscript Glibenclamide for acute brain edema. Is the good news coming? Leonardo C. Welling, Mariana S. Welling, Manoel J. Teixeira, Eberval Gadelha Figueiredo PII:
S1878-8750(15)00007-8
DOI:
10.1016/j.wneu.2015.01.003
Reference:
WNEU 2657
To appear in:
World Neurosurgery
Please cite this article as: Welling LC, Welling MS, Teixeira MJ, Figueiredo EG, Glibenclamide for acute brain edema. Is the good news coming?, World Neurosurgery (2015), doi: 10.1016/j.wneu.2015.01.003. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT Glibenclamide for acute brain edema. Is the good news coming?
Leonardo C. Welling1, Mariana S. Welling1, Manoel J. Teixeira2, Eberval Gadelha Figueiredo2
University of Ponta Grossa – Parana – Brazil
2University
of Sao Paulo – Sao Paulo - Brazil
RI PT
1State
Despite several attempts to influence inflammation, excitotoxicity, and
SC
vascularization, clinical treatment of post-traumatic brain edema is still a challenge. Osmotherapy has been the mainstay of this entity for many years, although there is no treatment available that already prevents the development
M AN U
of brain edema (1).
Glibenclamide is a member of the sulfonylurea class of drugs and has been in clinical use as an oral hypoglycemic agent since 1969. All sulfonylurea drugs works via similar mechanism – inhibition of the sulfonylurea receptor 1 (Sur 1). Since the works of Simard JM et al (2), in which newly expressed SUR1-
TE D
regulated NC(Ca-ATP) channel mediates cerebral edema after ischemic stroke, more attention has been given to this protein and its blockade in brain injuries, especially traumatic brain lesions. Depletion of ATP, as it can frequently be observed in the peri-contusional area following trauma, causes despolarization
EP
and opening of this channel. In situations of mechanical stress, inflammation, and hypoxia an up-regulation of the Abcc8 gene that encodes for SUR1 receptors
AC C
could be observed.
In an interesting paper of Zweckberger et al.(3), using an animal model of
brain trauma, glibenclamide-treated Sprague-Dawley rats
presented a
significant reduction in the development of tissue water content and smaller volumes of the brain lesions. In addition to laboratory investigations, retrospective studies of patients with diabetes mellitus type 2 suffering from ischemic stroke suggest that being on a sulfonylurea drug and staying on it during hospitalization for stroke improves outcome at the time of discharge, and reduces the incidence of symptomatic hemorrhagic transformation and mortality (4).
ACCEPTED MANUSCRIPT Based on these preliminary results, a phase II trial is underway
to
examine the efficacy of intravenous glyburide (glibenclamide) in the prevention of malignant edema in severe anterior circulation ischemic stroke. Study completion in February 2015 is expected (5). Can we extrapolate their results to brain trauma? Can be it the light in the
RI PT
end of the tunnel for the prevention of cerebral edema? Keep calm and wait for the results...
1) Marks JA, Li S, Gong W, Sanati P, Eisenstadt R, Sims C, Smith DH, Reilly PM,
SC
Pascual JL. Similar effects of hypertonic saline and mannitol on the inflammation of the blood-brain barrier microcirculation after brain injury in a mouse model. J Trauma Acute Care Surg 2012; 73(2): 351-357
M AN U
2) Simard JM, Chen M, Tarasov KV, Bhatta S, Ivanova S, Melnitchencko L, Tsymbalyuk N, West GA, Gerzanich V. Newly expressed SUR-1 regulated NC Ca-ATP channel mediates cerebral edema after ischemic stroke. Nat Med 2006; 12(4): 433-440.
3) Zweckberger K, Hackenberg K, Jung CS, Hertle DN, Kiening KL, Unterberg
TE D
AW, Sakowitz OW. Glibenclamide reduces secondary brain damage after experimental traumatic brain injury. Neuroscience 2014 (in press), http://dx.doi.org/10.1016/j.neuroscience.2014.04.040 4) Kunte H, Busch MA, Trosdorf K, Vollnberg B, Harms L, Mehta RI, Castellani
EP
RJ, Mandava P, Kent TA, Simard JM. Hemorrhagic transformation of ischemic stroke in diabetics on sulfonylureas. Ann Neurol 2012; 72: 799-
AC C
806.
5) Khanna A, Walcott BP, Kahle KT, Simard JM. Effecto of glibenclamide on the prevention of secondary brain injury following ischemic stroke in humans. Neurosurg Focus 2014; 36(1): E11.
ACCEPTED MANUSCRIPT Legends:
Figure 1: Brain edema related to ischemic lesions is a very difficult lesion to
AC C
EP
TE D
M AN U
SC
RI PT
manage. New therapeutic strategies may improve clinical outcomes.
AC C
EP
TE D
M AN U
SC
RI PT
ACCEPTED MANUSCRIPT
S1878-8750(15)00007-8
DOI:
10.1016/j.wneu.2015.01.003
Reference:
WNEU 2657
To appear in:
World Neurosurgery
Please cite this article as: Welling LC, Welling MS, Teixeira MJ, Figueiredo EG, Glibenclamide for acute brain edema. Is the good news coming?, World Neurosurgery (2015), doi: 10.1016/j.wneu.2015.01.003. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT Glibenclamide for acute brain edema. Is the good news coming?
Leonardo C. Welling1, Mariana S. Welling1, Manoel J. Teixeira2, Eberval Gadelha Figueiredo2
University of Ponta Grossa – Parana – Brazil
2University
of Sao Paulo – Sao Paulo - Brazil
RI PT
1State
Despite several attempts to influence inflammation, excitotoxicity, and
SC
vascularization, clinical treatment of post-traumatic brain edema is still a challenge. Osmotherapy has been the mainstay of this entity for many years, although there is no treatment available that already prevents the development
M AN U
of brain edema (1).
Glibenclamide is a member of the sulfonylurea class of drugs and has been in clinical use as an oral hypoglycemic agent since 1969. All sulfonylurea drugs works via similar mechanism – inhibition of the sulfonylurea receptor 1 (Sur 1). Since the works of Simard JM et al (2), in which newly expressed SUR1-
TE D
regulated NC(Ca-ATP) channel mediates cerebral edema after ischemic stroke, more attention has been given to this protein and its blockade in brain injuries, especially traumatic brain lesions. Depletion of ATP, as it can frequently be observed in the peri-contusional area following trauma, causes despolarization
EP
and opening of this channel. In situations of mechanical stress, inflammation, and hypoxia an up-regulation of the Abcc8 gene that encodes for SUR1 receptors
AC C
could be observed.
In an interesting paper of Zweckberger et al.(3), using an animal model of
brain trauma, glibenclamide-treated Sprague-Dawley rats
presented a
significant reduction in the development of tissue water content and smaller volumes of the brain lesions. In addition to laboratory investigations, retrospective studies of patients with diabetes mellitus type 2 suffering from ischemic stroke suggest that being on a sulfonylurea drug and staying on it during hospitalization for stroke improves outcome at the time of discharge, and reduces the incidence of symptomatic hemorrhagic transformation and mortality (4).
ACCEPTED MANUSCRIPT Based on these preliminary results, a phase II trial is underway
to
examine the efficacy of intravenous glyburide (glibenclamide) in the prevention of malignant edema in severe anterior circulation ischemic stroke. Study completion in February 2015 is expected (5). Can we extrapolate their results to brain trauma? Can be it the light in the
RI PT
end of the tunnel for the prevention of cerebral edema? Keep calm and wait for the results...
1) Marks JA, Li S, Gong W, Sanati P, Eisenstadt R, Sims C, Smith DH, Reilly PM,
SC
Pascual JL. Similar effects of hypertonic saline and mannitol on the inflammation of the blood-brain barrier microcirculation after brain injury in a mouse model. J Trauma Acute Care Surg 2012; 73(2): 351-357
M AN U
2) Simard JM, Chen M, Tarasov KV, Bhatta S, Ivanova S, Melnitchencko L, Tsymbalyuk N, West GA, Gerzanich V. Newly expressed SUR-1 regulated NC Ca-ATP channel mediates cerebral edema after ischemic stroke. Nat Med 2006; 12(4): 433-440.
3) Zweckberger K, Hackenberg K, Jung CS, Hertle DN, Kiening KL, Unterberg
TE D
AW, Sakowitz OW. Glibenclamide reduces secondary brain damage after experimental traumatic brain injury. Neuroscience 2014 (in press), http://dx.doi.org/10.1016/j.neuroscience.2014.04.040 4) Kunte H, Busch MA, Trosdorf K, Vollnberg B, Harms L, Mehta RI, Castellani
EP
RJ, Mandava P, Kent TA, Simard JM. Hemorrhagic transformation of ischemic stroke in diabetics on sulfonylureas. Ann Neurol 2012; 72: 799-
AC C
806.
5) Khanna A, Walcott BP, Kahle KT, Simard JM. Effecto of glibenclamide on the prevention of secondary brain injury following ischemic stroke in humans. Neurosurg Focus 2014; 36(1): E11.
ACCEPTED MANUSCRIPT Legends:
Figure 1: Brain edema related to ischemic lesions is a very difficult lesion to
AC C
EP
TE D
M AN U
SC
RI PT
manage. New therapeutic strategies may improve clinical outcomes.
AC C
EP
TE D
M AN U
SC
RI PT
ACCEPTED MANUSCRIPT
