Cellular and Molecular Neurobiology

, Volume 38, Issue 7, pp 1383–1397 | Cite as

The Synergistic Combination of Everolimus and Paroxetine Exerts Post-ischemic Neuroprotection In Vitro

  • V. S. Suvanish Kumar
  • Etheresia Pretorius
  • G. K. Rajanikant
Original Research


Ischemic stroke is a debilitating multi-factorial cerebrovascular disorder, representing an area of tremendous unmet medical need. Combination treatment has been proposed as a promising therapeutic approach towards combating ischemic stroke. The present study employs in vitro oxygen glucose deprivation (OGD) model to evaluate the post-ischemic neuroprotective efficacy of Everolimus and Paroxetine, alone and in combination. Post-OGD treatment with Everolimus and Paroxetine, alone or in combination, significantly improved the cell survival (~ 80%) when compared to the cells subjected to ischemic injury alone. The individual neuroprotective doses of Everolimus and Paroxetine were found to be at 6.25 and 25 nM, respectively. Whereas, the synergistic neuroprotective dose for Everolimus:Paroxetine was 2:10 nM, calculated using the Chou-Talalay combination index and other four mathematical models. The synergistic combination dose downregulated neuroinflammatory genes (Tnf-α, Il1b, Nf-κB, and iNos) and upregulated the neuroprotective genes (Bcl-2, Bcl-xl, Hif-1, and Epo). The mitochondrial functioning and ROS neutralizing ability increased with combination treatment. Further, the active role of nitric oxide synthase and calmodulin were revealed while exploring the bio-activity of Everolimus and Paroxetine through network pharmacology. The present study for the first time demonstrates the synergistic post-ischemic neuroprotective efficacy of combination treatment with Everolimus and Paroxetine in vitro. Taken together, these findings clearly suggest that Everolimus in combination with Paroxetine may represent a promising therapeutic strategy for the treatment of ischemic stroke, further supporting the combination treatment strategy for this debilitating disorder.


Combination therapy Neuroprotection Ischemic stroke Paroxetine Everolimus Oxygen glucose deprivation 



This work was supported by the Department of Biotechnology, Government of India (Grant Number: BT/PR15112/GBD/27/323/2011 dated 16/03/2011). The network pharmacology study was carried out at the Bioinformatics Infrastructure Facility for Biology Teaching through Bioinformatics (BIF-BTBI), funded by the Department of Biotechnology, Government of India, (Grant Number: BT/BI/25/001/2006 dated 25/03/2011).

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

This article does not contain any studies with human participants or animals performed by any of the authors.


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Authors and Affiliations

  1. 1.School of BiotechnologyNational Institute of Technology CalicutCalicutIndia
  2. 2.Department of Physiological SciencesStellenbosch UniversityMatielandSouth Africa

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