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Clot-busting drug could harm stroke treatment response

A clot-busting drug may stop promising stroke medicine from working properly, research reveals.
Researchers at the University of Manchester found the clot-busting therapy, known as tissue plasminogen activator (tPA), interacts negatively with the anti-inflammatory treatment anakinra, highlighting the need for new stroke therapies alongside existing standard care.
Results from the study on mice, published in the American Heart Association Stroke journal, show the timing of anakinra delivery must be adjusted to avoid reducing the benefits of tPA.
Anakinra, an interleukin1 receptor antagonist (IL-1Ra), blocks IL1 and has shown promise in reducing inflammation in both laboratory and early clinical studies of stroke.
“Our findings suggest that IL-1Ra can interfere with tPA’s ability to dissolve clots when the two drugs are present in the bloodstream at the same time,” said Dr Ioana-Emilia Mosneag, lead author on the study.
“The results also help explain why IL-1Ra levels were lower in patients who received tPA first, as plasmin generated during clot-busting appears to break down IL-1Ra.
“However, the effect of tPA on IL-1Ra – the opposite order – isn’t necessarily a problem as IL-1RA was still active in reducing IL-6 in the SCIL-STROKE study, but this needs further evaluation.”
Trial results ‘raise questions’ about drug interaction
Stroke is the second leading cause of death and disability worldwide, as experts estimate the number of people affected could rise by more than 80% over the next 25 years.
Despite decades of research and thousands of experimental drugs, the only approved medicines for treating the most common type of stroke, ischaemic stroke, are clot-busting drugs known as plasminogen activators, like tPA.
Though tPA can be lifesaving for acute ischaemic stroke, about 2–6% of treated patients develop potentially fatal brain bleeding, according to the ECASS III trial of the early 2000s.
Scientists now know that inflammation plays a major role in worsening brain injury after a stroke, mostly driven by a molecule called interleukin1 (IL1). The IL-1RA anakinra is a therapy used to reduce inflammation.
However, a Phase II clinical trial (SCILSTROKE) found that IL1Ra did not improve patient recovery overall.
“The findings of SCILSTROKE raise questions about whether the drug might interact negatively with standard clotbusting treatment,” said Mosneag.
Wirth nearly three quarters of patients in the SCILSTROKE trial receiving the clotbusting drug tPA before IL-1Ra, researchers set out to investigate whether the two treatments might negatively interact with each other.
They re-examined data from the SCILSTROKE trial and discovered that patients who received tPA before IL-1Ra had significantly lower levels of IL-1Ra in their blood, suggesting the drug was being broken down.
Laboratory research confirmed that IL-1Ra can be cut apart by plasmin, an enzyme produced during tPA treatment, meaning the anti-inflammatory drug may be degraded before it can work.
Timing of drug delivery ‘very likely to be a critical factor’
Following results from the SCILSTROOKE trial, researchers tested drug interaction in a mouse model of stroke, using dosing schedules that matched those used in the clinical trial.
When IL-1Ra was given after tPA, no harmful interaction was seen and the protective effects of tPA were preserved.
However, when IL-1Ra was given at the same time as tPA — during the clot-busting process — the benefits of tPA were dramatically reduced, with brain damage shrinking by only 15% compared to 68% with tPA alone.
The mice receiving both drugs together also showed poorer blood flow in the brain, more inflammatory immune cells entering damaged tissue, and higher levels of harmful structures called neutrophil extracellular traps. This indicates that the drug interaction is also detrimental to the anti-inflammatory effect of IL-1Ra.
“This study shows that timing is very likely to be a critical factor in the efficacy of IL-1Ra, which will be beneficial if given after tPA rather than alongside it,” said Professor Stuart Allan, co-author on the study.
“We also need to test whether similar interactions occur with other clot-busting drugs such as tenecteplase, which may be less likely to break down IL-1Ra due to its greater specificity.”
The post Clot-busting drug could harm stroke treatment response appeared first on Drug Discovery World (DDW).
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Federal government could improve infectious disease monitoring, says federal government
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What dish will health secretary Robert F. Kennedy Jr. make on the first episode of his new cooking show? Wrong answers only.
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Opinion: What a recent op-ed got wrong about our Covid study
First Opinion is STAT’s platform for interesting, illuminating, and provocative articles about the life sciences writ large, written by biotech insiders, health care workers, researchers, and others.
To encourage robust, good-faith discussion about issues raised in First Opinion essays, STAT publishes selected Letters to the Editor received in response to them. You can submit a Letter to the Editor here, or find the submission form at the end of any First Opinion essay.
First Opinion is STAT’s platform for interesting, illuminating, and provocative articles about the life sciences writ large, written by biotech insiders, health care workers, researchers, and others.
To encourage robust, good-faith discussion about issues raised in First Opinion essays, STAT publishes selected Letters to the Editor received in response to them. You can submit a Letter to the Editor here, or find the submission form at the end of any First Opinion essay.
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Spatiotemporal Multiomics Charts Cellular Dynamics of Liver Metastasis
Metastasis remains one of cancer’s most difficult biological transitions to capture: tumor cells must leave a primary tumor, survive circulation, enter a distant organ, and then either disappear, persist, or eventually grow into clinically detectable lesions. A spatiotemporal study in mice and human samples identifies transient tumor-cell and immune-niche states that may offer windows for intercepting metastatic colonization.
A new study published in Science provides a high-resolution look at that process in liver cancer, suggesting that metastatic colonization unfolds through ordered changes in both disseminated tumor cells and the immune microenvironments that surround them.
In the study, “Spatiotemporal multiomics uncover tumor ecosystem dynamics during metastatic colonization,” researchers led by Yunfan Sun, MD, PhD, at Zhongshan Hospital, Fudan University, applied spatiotemporal multiomics to experimental hepatocellular carcinoma mouse models and human metastatic samples. Their goal was to reconstruct how disseminated tumor cells, or DTCs, survive the earliest stages of lung colonization and later transition into metastatic outgrowth.
The team integrated high-resolution spatial transcriptomics, single-cell RNA sequencing, and chromatin-accessibility profiling across nine sequential stages of lung colonization in mouse models. The resulting atlas followed liver cancer cells from their first arrival in the lungs through later metastatic progression, while also mapping changes in nearby immune cells.
The analysis indicated that early metastatic seeding is not simply a random survival event. “After a massive innate immune clearance, primarily by neutrophils and natural killer (NK) cells, a rare subpopulation of DTCs survived by entering a transient, quiescent Phgdhhigh state,” the authors write. These cells were associated with an immune-scarce niche, allowing them to avoid elimination during a vulnerable early window.
Mechanistically, the authors linked this state to metabolic and epigenetic remodeling. Alveolar type 2 cells enriched near surviving DTCs appeared to promote the Phgdhhigh phenotype. Elevated PHGDH activity fueled one-carbon metabolism and increased levels of S-adenosylmethionine (SAM). That shift was tied to H3K27me3-mediated silencing of proinflammatory chemokine genes, including Ccl2 and Cxcl10, which would otherwise help recruit immune cells to the niche.
Perturbing this axis genetically or pharmacologically restored chemokine expression, increased immune surveillance, and reduced metastatic outgrowth in the models, according to the study. Lineage-tracing experiments further suggested that many macrometastases derived from ancestors that had passed through the transient Phgdhhigh state.
The researchers also identified a second niche-remodeling step before rapid metastatic expansion. At this stage, Cx3cr1high interstitial macrophages accumulated in the DTC niche. These “macrophages recruited immunosuppressive cells (T regulatory cells, neutrophils, and alveolar macrophages) and provided growth signals through the IGF1-IGF1R axis that trigger the transition of DTCs from quiescence to rapid proliferation,” the authors report in the study. Depleting these macrophages reduced metastatic burden in mouse experiments.
Together, the findings point to metastatic colonization as a temporally organized process shaped by reciprocal interactions between tumor cells and their local microenvironment. First, a rare tumor-cell state helps establish early immune evasion. Later, macrophage-driven remodeling appears to convert a quiescent niche into one that supports metastatic outgrowth.
Although the work is largely preclinical, the authors suggest that these transient states may represent vulnerabilities for micrometastasis-targeting approaches. By defining when and how early DTCs evade immune attack, the study offers a framework for developing interventions aimed not only at established metastases, but also at the earliest stages of metastatic colonization.
The post Spatiotemporal Multiomics Charts Cellular Dynamics of Liver Metastasis appeared first on GEN – Genetic Engineering and Biotechnology News.
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