Evolving Clinical-Translational Investigations of Cerebroprotection in Ischemic Stroke.
Evolving Clinical-Translational Investigations of Cerebroprotection in Ischemic Stroke.
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缺血性卒中脑保护的临床转化研究进展
DOI：
10.3390/jcm12216715
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发表时间：
2023-10-24
影响因子：
3.9
通讯作者：
中科院分区：
文献类型：
--
作者：
缺血性卒中是一种发病率很高的疾病，超过50%的大血管卒中(大脑中动脉或颈内动脉末端闭塞)患者尽管进行了最大限度的急性再灌注治疗，但仍进行了溶栓和取栓治疗。20世纪80年代缺血半暗带的发现为缺血性卒中的可挽救领域奠定了基础。从那时起，神经保护的概念一直是卒中后护理的重点：(1)最大限度地减少从半暗带到核心不可逆梗死的转化，(2)限制缺血再灌注损伤、炎症和兴奋性毒性造成的继发性损害，以及(3)鼓励组织修复。然而，尽管有多项研究，但临床前研究企业还没有创造出一种可以缓解中风后结果的药物，而不仅仅是溶栓和机械取血。这些翻译差距并没有阻止科学界，因为代理人正在接受持续的调查。美国国立卫生研究院最近提出了脑保护的概念，以考虑中风后的整个大脑，而不仅仅是神经元。这篇综述将简要概述脑保护过去、现在和正在取得的突破的转化科学，并利用这些基本思想开发一种优化中风预后的新范式。
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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