Effect of Exercise Gene Expression and Histone Modifications in Patients With Hemiplegia

NCT ID: NCT06726941

Last Updated: 2024-12-27

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

48 participants

Study Classification

INTERVENTIONAL

Study Start Date

2024-12-20

Study Completion Date

2026-09-09

Brief Summary

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The aim of this study is to demonstrate the effect of routine exercise program on neuroplasticity through histone acetylation and gene expression changes in acute stroke survivors from an epigenetic perspective and to investigate the correlation of epigenetic effects with its effects on motor function and quality of life.

Detailed Description

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Stroke is one of the leading causes of disability worldwide. Hemiplegia is the name of the clinical condition that occurs after a stroke. It is the loss of strength in the arm, leg and sometimes the face on one side of the body. Rehabilitation is vital to minimize the sequelae after a stroke, and patients who undergo continuous professional and systematic rehabilitation after the acute phase tend to recover rapidly. An important therapeutic goal of motor recovery is to maximize neuronal plasticity and facilitate motor tasks through motor learning during therapeutic exercise in the neurorehabilitation of patients with motor dysfunction. In particular, intact motor-related regions of the brain are expected to compensate for the impaired neuronal systems. Therefore, therapeutic exercise is expected to compensate for the impaired neuronal system by altering the (cortical) neuronal network as well as the expression of postsynaptic receptors, presynaptic neurotransmitters, regeneration, modulation and synaptic formation at cortical synapses. Epigenetic mechanisms regulate gene transcription based on modifications of DNA promoter regions and histones in chromatin. Epigenetic mechanisms include various DNA and histone modifications (i.e., methylation and acetylation of DNA and histones). In particular, the acetylation level of specific lysine residues in histones is one of the most powerful epigenetic modifications and is essential for transcriptional regulation. Studies show that exercise reduces the expression and activity of HDACs and increases histone acetylation, upregulating the expression of genes important for neuroplasticity.

Some genes associated with neuroplasticity are:Brain-Derived Neurotrophic Factor (BDNF) , Cyclic adenosine monophasphate Response Element-Binding Protein (CREB1), Growth Associated Protein 43 (GAP43), Neurotrophic Receptor Tyrosine Kinase 2 (NTRK2), Synapsin I (SYN1).

Histone H3 Lysine 27 Acetylation (H3K27ac) plays a critical role in the epigenetic regulation of gene expression and is associated with processes such as neuroplasticity, memory, and learning. Various studies have shown that environmental factors such as exercise can increase H3K27ac levels and thus support neuroplasticity.

In this study, participants with acute hemiplegia will be given the same routine rehabilitation program. Neuroplasticity-related gene expression and histone acetylation levels will be compared in venous blood taken from the patient before and after exercise.

In addition, the patient will be examined before and after exercise, and routine Mini-Mental Test, Brunnstrom, Fulg-Meyer upper and lower extremity evaluation, Spasticity evaluation with modified ashworth scale, Functional Independence Scale, ABILHAND Stroke Hand Function Questionnaire, Stroke Impact Questionnaire, 10-meter walking test will be performed to evaluate quality of life and motor function.

Conditions

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Ischemic Stroke, Acute Acute Hemiparesis

Keywords

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ischemic stroke acute hemiplegia epigenetics

Study Design

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Allocation Method

NA

Intervention Model

SINGLE_GROUP

All participants enrolled will receive the same treatment. Gene analysis, histone acetylation levels, motor function and quality of life changes will be assessed.
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Experimental Group

This group consists of post-stroke hemiplegia participants who will be included in a physiotherapy and rehabilitation program to evaluate the effects on neuroplasticity-related gene expression and histone modification levels, spasticity levels, motor functions, daily living activities, and quality of life.

Group Type EXPERIMENTAL

Physiotherapy and Rehabilitation Practices

Intervention Type OTHER

It was planned to give the participants a routine stroke rehabilitation program consisting of 45 minutes of active, passive range of motion exercises and strengthening exercises, balance exercises, walking training and 20 minutes of bicycle ergometry, accompanied by a physiotherapist with at least 5 years of experience in stroke rehabilitation. It was planned to give passive bicycle ergometry to patients without voluntary muscle movement and muscle strength, and active bicycle ergometry to participants with voluntary muscle movement and muscle strength, with the bicycle rehabilitation. It was planned to apply the exercise program to the patients for 5 days a week and for a total of 30 sessions. It will be recommended that they continue the medical treatment they are using during the treatment program. Routine evaluations will be made by the physiatrist before the rehabilitation program starts and 2 tubes of venous blood will be taken from the patients by an experienced nurse

Interventions

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Physiotherapy and Rehabilitation Practices

It was planned to give the participants a routine stroke rehabilitation program consisting of 45 minutes of active, passive range of motion exercises and strengthening exercises, balance exercises, walking training and 20 minutes of bicycle ergometry, accompanied by a physiotherapist with at least 5 years of experience in stroke rehabilitation. It was planned to give passive bicycle ergometry to patients without voluntary muscle movement and muscle strength, and active bicycle ergometry to participants with voluntary muscle movement and muscle strength, with the bicycle rehabilitation. It was planned to apply the exercise program to the patients for 5 days a week and for a total of 30 sessions. It will be recommended that they continue the medical treatment they are using during the treatment program. Routine evaluations will be made by the physiatrist before the rehabilitation program starts and 2 tubes of venous blood will be taken from the patients by an experienced nurse

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

1. Participants who applied to Afyonkarahisar Health Sciences University Physical Therapy and Rehabilitation Clinic for rehabilitation purposes and had a stroke for the first time
2. Participants with ischemia as the etiology of stroke
3. Participants between the ages of 25-65
4. Drugs that have been used for at least 1 month and up to 6 months after a cerebrovascular accident

Exclusion Criteria

1. Participants whose stroke etiology is other than ischemia
2. Participants with clinically significant neurological disease other than stroke
3. Participants with systemic and musculoskeletal diseases that will not tolerate neurological rehabilitation and prevent them from participating
Minimum Eligible Age

25 Years

Maximum Eligible Age

65 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Afyonkarahisar Health Sciences University

OTHER

Sponsor Role lead

Responsible Party

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Hasan Toktaş

Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Hasan Toktas, Professor

Role: PRINCIPAL_INVESTIGATOR

Afyonkarahisar Health Sciences University

Locations

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Afyonkarahisar Health Sciences University

Afyonkarahisar, , Turkey (Türkiye)

Site Status RECRUITING

Countries

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Turkey (Türkiye)

Central Contacts

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Hasan Toktaş, Professor

Role: CONTACT

Phone: +905052212901

Email: [email protected]

Büşra B Kurt, M.D.

Role: CONTACT

Phone: +905447289558

Email: [email protected]

Facility Contacts

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Büşra B Kurt, MD

Role: primary

References

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Xing Y, Bai Y. A Review of Exercise-Induced Neuroplasticity in Ischemic Stroke: Pathology and Mechanisms. Mol Neurobiol. 2020 Oct;57(10):4218-4231. doi: 10.1007/s12035-020-02021-1. Epub 2020 Jul 20.

Reference Type BACKGROUND
PMID: 32691303 (View on PubMed)

Maejima H, Kitahara M, Takamatsu Y, Mani H, Inoue T. Effects of exercise and pharmacological inhibition of histone deacetylases (HDACs) on epigenetic regulations and gene expressions crucial for neuronal plasticity in the motor cortex. Brain Res. 2021 Jan 15;1751:147191. doi: 10.1016/j.brainres.2020.147191. Epub 2020 Nov 2.

Reference Type BACKGROUND
PMID: 33152341 (View on PubMed)

Penna LG, Pinheiro JP, Ramalho SHR, Ribeiro CF. Effects of aerobic physical exercise on neuroplasticity after stroke: systematic review. Arq Neuropsiquiatr. 2021 Sep;79(9):832-843. doi: 10.1590/0004-282X-ANP-2020-0551.

Reference Type BACKGROUND
PMID: 34669820 (View on PubMed)

Related Links

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http://pubmed.ncbi.nlm.nih.gov/32691303/

A Review of Exercise-Induced Neuroplasticity in Ischemic Stroke.

http://pubmed.ncbi.nlm.nih.gov/33152341/

Effects of exercise and pharmacological inhibition of histone deacetylases (HDACs) on epigenetic regulations and gene expressions crucial for neuronal plasticity in the motor cortex.

http://pubmed.ncbi.nlm.nih.gov/34669820/

Effects of aerobic physical exercise on neuroplasticity after stroke.

Other Identifiers

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BBBEPIGENETIC

Identifier Type: -

Identifier Source: org_study_id