Glyburide is associated with attenuated vasogenic edema in stroke patients.
Author(s): Kimberly WT(1), Battey TW, Pham L, Wu O, Yoo AJ, Furie KL, Singhal AB, Elm JJ,
Stern BJ, Sheth KN.
Affiliation(s): Author information:
(1)Center for Human Genetic Research and Division of Neurocritical Care and
Emergency Neurology, Massachusetts General Hospital, Harvard Medical School,
Boston, MA, USA, wtkimberly@partners.org.
Publication date & source: 2014, Neurocrit Care. , 20(2):193-201
BACKGROUND: Brain edema is a serious complication of ischemic stroke that can
lead to secondary neurological deterioration and death. Glyburide is reported to
prevent brain swelling in preclinical rodent models of ischemic stroke through
inhibition of a non-selective channel composed of sulfonylurea receptor 1 and
transient receptor potential cation channel subfamily M member 4. However, the
relevance of this pathway to the development of cerebral edema in stroke patients
is not known.
METHODS: Using a case-control design, we retrospectively assessed neuroimaging
and blood markers of cytotoxic and vasogenic edema in subjects who were enrolled
in the glyburide advantage in malignant edema and stroke-pilot (GAMES-Pilot)
trial. We compared serial brain magnetic resonance images (MRIs) to a cohort with
similar large volume infarctions. We also compared matrix metalloproteinase-9
(MMP-9) plasma level in large hemispheric stroke.
RESULTS: We report that IV glyburide was associated with T2 fluid-attenuated
inversion recovery signal intensity ratio on brain MRI, diminished the lesional
water diffusivity between days 1 and 2 (pseudo-normalization), and reduced blood
MMP-9 level.
CONCLUSIONS: Several surrogate markers of vasogenic edema appear to be reduced in
the setting of IV glyburide treatment in human stroke. Verification of these
potential imaging and blood biomarkers is warranted in the context of a
randomized, placebo-controlled trial.
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