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Evolving Clinical–Translational Investigations of Cerebroprotection in Ischemic Stroke

Ischemic stroke is a highly morbid disease, with over 50% of large vessel stroke (middle cerebral artery or internal carotid artery terminus occlusion) patients suffering disability despite maximal acute reperfusion therapy with thrombolysis and thrombectomy. The discovery of the ischemic penumbra i...

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Autores principales: Li, Yinghui, Schappell, Laurel E., Polizu, Claire, DiPersio, James, Tsirka, Stella E., Halterman, Marc W., Nadkarni, Neil A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10649331/
https://www.ncbi.nlm.nih.gov/pubmed/37959180
http://dx.doi.org/10.3390/jcm12216715
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author Li, Yinghui
Schappell, Laurel E.
Polizu, Claire
DiPersio, James
Tsirka, Stella E.
Halterman, Marc W.
Nadkarni, Neil A.
author_facet Li, Yinghui
Schappell, Laurel E.
Polizu, Claire
DiPersio, James
Tsirka, Stella E.
Halterman, Marc W.
Nadkarni, Neil A.
author_sort Li, Yinghui
collection PubMed
description Ischemic stroke is a highly morbid disease, with over 50% of large vessel stroke (middle cerebral artery or internal carotid artery terminus occlusion) patients suffering disability despite maximal acute reperfusion therapy with thrombolysis and thrombectomy. The discovery of the ischemic penumbra in the 1980s laid the foundation for a salvageable territory in ischemic stroke. Since then, the concept of neuroprotection has been a focus of post-stroke care to (1) minimize the conversion from penumbra to core irreversible infarct, (2) limit secondary damage from ischemia-reperfusion injury, inflammation, and excitotoxicity and (3) to encourage tissue repair. However, despite multiple studies, the preclinical–clinical research enterprise has not yet created an agent that mitigates post-stroke outcomes beyond thrombolysis and mechanical clot retrieval. These translational gaps have not deterred the scientific community as agents are under continuous investigation. The NIH has recently promoted the concept of cerebroprotection to consider the whole brain post-stroke rather than just the neurons. This review will briefly outline the translational science of past, current, and emerging breakthroughs in cerebroprotection and use of these foundational ideas to develop a novel paradigm for optimizing stroke outcomes.
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spelling pubmed-106493312023-10-24 Evolving Clinical–Translational Investigations of Cerebroprotection in Ischemic Stroke Li, Yinghui Schappell, Laurel E. Polizu, Claire DiPersio, James Tsirka, Stella E. Halterman, Marc W. Nadkarni, Neil A. J Clin Med Review Ischemic stroke is a highly morbid disease, with over 50% of large vessel stroke (middle cerebral artery or internal carotid artery terminus occlusion) patients suffering disability despite maximal acute reperfusion therapy with thrombolysis and thrombectomy. The discovery of the ischemic penumbra in the 1980s laid the foundation for a salvageable territory in ischemic stroke. Since then, the concept of neuroprotection has been a focus of post-stroke care to (1) minimize the conversion from penumbra to core irreversible infarct, (2) limit secondary damage from ischemia-reperfusion injury, inflammation, and excitotoxicity and (3) to encourage tissue repair. However, despite multiple studies, the preclinical–clinical research enterprise has not yet created an agent that mitigates post-stroke outcomes beyond thrombolysis and mechanical clot retrieval. These translational gaps have not deterred the scientific community as agents are under continuous investigation. The NIH has recently promoted the concept of cerebroprotection to consider the whole brain post-stroke rather than just the neurons. This review will briefly outline the translational science of past, current, and emerging breakthroughs in cerebroprotection and use of these foundational ideas to develop a novel paradigm for optimizing stroke outcomes. MDPI 2023-10-24 /pmc/articles/PMC10649331/ /pubmed/37959180 http://dx.doi.org/10.3390/jcm12216715 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
Li, Yinghui
Schappell, Laurel E.
Polizu, Claire
DiPersio, James
Tsirka, Stella E.
Halterman, Marc W.
Nadkarni, Neil A.
Evolving Clinical–Translational Investigations of Cerebroprotection in Ischemic Stroke
title Evolving Clinical–Translational Investigations of Cerebroprotection in Ischemic Stroke
title_full Evolving Clinical–Translational Investigations of Cerebroprotection in Ischemic Stroke
title_fullStr Evolving Clinical–Translational Investigations of Cerebroprotection in Ischemic Stroke
title_full_unstemmed Evolving Clinical–Translational Investigations of Cerebroprotection in Ischemic Stroke
title_short Evolving Clinical–Translational Investigations of Cerebroprotection in Ischemic Stroke
title_sort evolving clinical–translational investigations of cerebroprotection in ischemic stroke
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10649331/
https://www.ncbi.nlm.nih.gov/pubmed/37959180
http://dx.doi.org/10.3390/jcm12216715
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