J Stroke.  2021 Sep;23(3):312-326. 10.5853/jos.2020.03006.

Mechanisms of Preconditioning Exercise-Induced Neurovascular Protection in Stroke

Affiliations
  • 1Department of Pharmaceutical Sciences, College of Pharmacy Mercer University, Atlanta, GA, USA
  • 2Neurology Department, Augusta University, Augusta, GA, USA
  • 3College of Pharmacy Larkin University, Miami, FL, USA

Abstract

Ischemic stroke is a leading cause of death and disability. Tissue plasminogen activator is the only U.S. Food and Drug Administration approved thrombolytic therapy for ischemic stroke patients till date. However, its use is limited due to increased risk of bleeding and narrow therapeutic window. Most of the preclinically tested pharmacological agents failed to be translated to the clinic. This drives the need for alternative therapeutic approaches that not only provide enhanced neuroprotection, but also reduce the risk of stroke. Physical exercise is a sort of preconditioning that provides the body with brief ischemic episodes that can protect the body from subsequent severe ischemic attacks like stroke. Physical exercise is known to improve cardiovascular health. However, its role in providing neuroprotection in stroke is not clear. Clinical observational studies showed a correlation between regular physical exercise and reduced risk and severity of ischemic stroke and better outcomes after stroke. However, the underlying mechanisms through which prestroke exercise can reduce the stroke injury and improve the outcomes are not completely understood. The purpose of this review is to: demonstrate the impact of exercise on stroke outcomes and show the potential role of exercise in stroke prevention and recovery; uncover the underlying mechanisms through which exercise reduces the neurovascular injury and improves stroke outcomes aiming to develop novel therapeutic approaches.

Keyword

Stroke; Exercise therapy; Neuroprotection; Ischemic stroke

Figure

  • Figure 1. Diagrammatic representation summarizing the different mechanisms employed in the preconditioning exercise-induced neurovascular protection in stroke. Preconditioning exercise may induce neurovascular protection by reducing post-stroke expression and activation of inflammatory cytokines like tumor necrosis factor alpha (TNFα), interleukins (ILs), and nuclear factor kappa B (NF-κB), which in turn reduces post-stroke inflammation; [44-53] increasing the expression of vascular endothelial growth factor (VEGF), VEGF receptors, caveolin, and angiopoietin in the brain, which in turn may increase angiogenesis and neovascularization;[56-58] reducing post-stroke expression and activation of matrix metalloproteases (MMPs) and increasing the expression of integrins proteins which may reduce blood-brain barrier (BBB) disruption;[46-48,54,55] increasing endothelial nitric oxide synthase (eNOS) activation and nitric oxide (NO) production which may increase post-stroke cerebral blood flow (CBF);[62-64] increasing expression and activation of hypoxia-inducible factor 1 alpha (HIF-1α), heat shock proteins (HSPs), brain derived neurotrophic factor (BDNF); and inhibition of glutamate and caspase activities which may increase neurogenesis and reduce neuronal death through.[68-86] Collectively, these mechanism may lead to reduction in brain infarction and edema, reduction in BBB disruption and improvement in neurological and functional outcomes.


Reference

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