Nanotechnology in Stroke: New Trails with Smaller Scales.
Nanotechnology in Stroke: New Trails with Smaller Scales.
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DOI：
10.3390/biomedicines11030780
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发表时间：
2023-03-04
期刊：
影响因子：
4.7
通讯作者：
中科院分区：
文献类型：
--
作者：
中风是死亡、长期残疾和社会经济成本的主要原因，凸显了有效治疗的迫切需要。在急性期，静脉注射重组组织型纤溶酶原激活剂（tPA）（一种血栓溶解剂）和血管内血栓切除术（EVT）（一种机械干预以取出凝块）是FDA批准的唯一重建脑血流的治疗方法。由于治疗时间窗短和脑出血的潜在风险高，有限数量的急性卒中患者受益于tPA治疗。EVT可以在延长的时间窗内进行，但这种介入仅在较大的、解剖学上更近端的脉管系统中闭塞的患者中进行，并且在专科中心进行。无论哪种方法，在成功再通的情况下，缺血再灌注损伤代表了额外的挑战。此外，tPA破坏血脑屏障的完整性，具有神经毒性，加重再灌注损伤。基于纳米颗粒的方法有可能避免上述问题中的一些，并开发出一种可以在tPA治疗的时间窗之外安全施用的溶栓剂。纳米颗粒的不同属性也正在被探索以开发多功能血栓溶解剂，除了血栓溶解剂之外，该多功能血栓溶解剂还可以包含治疗剂，例如抗炎剂、抗氧化剂、神经/血管保护剂或成像剂，即，一种治疗不可知的药剂这篇综述的重点是突出这些进展，因为它们与脑血管疾病有关，以改善卒中患者的临床结局。
Stroke is a leading cause of death, long-term disability, and socioeconomic costs, highlighting the urgent need for effective treatment. During acute phase, intravenous administration of recombinant tissue plasminogen activator (tPA), a thrombolytic agent, and endovascular thrombectomy (EVT), a mechanical intervention to retrieve clots, are the only FDA-approved treatments to re-establish cerebral blood flow. Due to a short therapeutic time window and high potential risk of cerebral hemorrhage, a limited number of acute stroke patients benefit from tPA treatment. EVT can be performed within an extended time window, but such intervention is performed only in patients with occlusion in a larger, anatomically more proximal vasculature and is carried out at specialty centers. Regardless of the method, in case of successful recanalization, ischemia-reperfusion injury represents an additional challenge. Further, tPA disrupts the blood-brain barrier integrity and is neurotoxic, aggravating reperfusion injury. Nanoparticle-based approaches have the potential to circumvent some of the above issues and develop a thrombolytic agent that can be administered safely beyond the time window for tPA treatment. Different attributes of nanoparticles are also being explored to develop a multifunctional thrombolytic agent that, in addition to a thrombolytic agent, can contain therapeutics such as an anti-inflammatory, antioxidant, neuro/vasoprotective, or imaging agent, i.e., a theragnostic agent. The focus of this review is to highlight these advances as they relate to cerebrovascular conditions to improve clinical outcomes in stroke patients.
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