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Published on: January 24, 2013
Circadian rhythms in ischemic stroke: From pathogenesis to chronotherapy
Hongli Fan1, Zhuorao Wu2, Jianqiao Zhao1
1Department of Rehabilitation, Mianyang Hospital of Traditional Chinese Medicine, Mianyang, Sichuan, China.
Insights
Circadian rhythms impact ischemic stroke risk factors and recovery. Understanding chronobiology may lead to personalized chronotherapy for better stroke treatment and outcomes.
Area of Science:
- Neuroscience
- Chronobiology
- Cardiovascular Medicine
Background:
- Circadian rhythms, regulated by the biological clock, are increasingly recognized for their significant role in ischemic stroke pathophysiology.
- These rhythms influence key stroke risk factors such as blood pressure, glucose metabolism, lipid homeostasis, and atrial fibrillation.
Purpose of the Study:
- To systematically review the influence of circadian rhythms on stroke risk factors and recovery.
- To explore the mechanistic basis of circadian influence across different stroke phases.
- To assess the potential of chronobiology-informed interventions for ischemic stroke.
Main Methods:
- Systematic literature review focusing on circadian rhythms and ischemic stroke.
- Analysis of preclinical and clinical studies on chronobiology and stroke pathophysiology.
- Evaluation of current and potential chronotherapy strategies.
Main Results:
- Circadian rhythms modulate stroke risk factors and influence metabolic, excitotoxic, oxidative, and inflammatory processes post-stroke.
- Chronobiology impacts neuroinflammation, glial scar formation, and neural remodeling during recovery.
- Existing stroke interventions like thrombolysis and rehabilitation may be optimized by considering circadian timing.
Conclusions:
- Circadian rhythms are critical determinants of ischemic stroke onset, progression, and recovery.
- Chronotherapy holds promise for developing personalized, precision medicine approaches to ischemic stroke.
- Addressing challenges in circadian assessment and intervention translation is crucial for clinical application.
Abstract:
Circadian rhythms significantly influence the onset, development, and outcome of ischemic stroke, with the biological clock likely playing a key role in its pathophysiology. In this review, we provide a systematic summary of the influence of circadian rhythms on stroke risk factors, including blood pressure, glucose metabolism, lipid homeostasis, and atrial fibrillation, and further explore their impact across different stages of recovery post-stroke. These encompass metabolic alterations in the ischemic penumbra during the hyperacute phase, excitotoxicity, oxidative stress, and neuroinflammation in the acute phase, as well as glial scar formation and neural remodeling during the subacute and chronic recovery phases. Building on this mechanistic foundation, we assess the role of chronobiology in stroke interventions, including thrombolysis, thrombectomy, neuroprotective strategies, and rehabilitation training. We also discuss key challenges in the field, such as barriers to translating preclinical findings to clinical applications, limitations in circadian rhythm assessment, and practical challenges in implementing circadian-based interventions. Ultimately, this review aims to evaluate the potential of chronotherapy in ischemic stroke and to advance the development of personalized, precision medicine approaches.
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