Failure in Developing Effective Treatment for Cerebral Ischemia: The Stair Recommendations
Journal Title: International Journal of Research in Pharmacy and Science - Year 2011, Vol 1, Issue 1
Abstract
Cerebral ischemia leads to neurological dysfunction and activate complex signalling cascades, which may depreciate survival mechanisms as a result of cellular homeostatic breakdown. For acute ischaemic stroke, safe and effective treatments that offer an extended therapeutic window are urgently needed to decrease disability and aid neurological recovery. The benefit of recombinant tissue-type plasminogen activator (rt-PA) when initiated within 3 hours of stroke onset documents that acute ischemic stroke can indeed respond to treatment. This news is countered by the current lack of documentation that any purported neuroprotective drug significantly improves outcome when given after stroke onset. Lessons have been learned from the innumerable unsuccessful thrombolytic and neuroprotective trials, suggesting that future, better designed trials will likely demonstrate significant benefits with appropriate safe and effective drug treatments initiated within 6 hours of stroke onset. Also, the age of combination drug trials is approaching and combination treatments directed at both the vascular and cellular mechanisms of ischemic brain injury are likely to have the greatest impact upon stroke disability. The apparent failure of neuroprotection for acute ischemic stroke has caused a series of active discussions in both academic and industrial fields, which is fruitful and constructive in attempts to establish criteria for preclinical stroke studies. Since the Stroke Therapy Academic Industry Roundtable (STAIR) published its first criteria in 1999 and updated, quality of study design problems and inflation of reported efficacy of neuroprotectants have continued to be major issues in this field. Translational research of neuroprotection for ischemic stroke has reached its critical stage. A strategic reconsideration is urgently needed to aid in the search for new solutions.
Authors and Affiliations
Binayak Deb, Divya Ramani
Keywords
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