Chinese Herbal Medicines for Neuroprotection in Ischemic Stroke: Promise and Reality

Abstract

Worldwide, stroke is the third leading cause of death and the leading cause of long-term disability. To date, intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA, Alteplase®) is the only effective treatment for ischemic stroke. Unfortunately, rt-PA only benefits patients when it is administered within 4.5 h, whereas most stroke victims (between 70 % and 98 % depending on location) do not reach the hospital within this very narrow time frame. In 1999, we proposed that traditional Chinese herbal medicines might provide a source of structurally diverse compounds that could serve as leads for the development of novel stroke drugs. The basic hypothesis underlying the research was that Chinese herbal stroke medicines might contain natural products that exhibited neuroprotective properties and could be used as effective and safe neuroprotective drugs or serve as leads for the development of such drugs. China’s efforts in promoting traditional Chinese medicine in Western countries on the background of the lack of promising drug candidates in the pipeline of the pharmaceutical industry have contributed to an explosive growth in the last decade of the scientific literature devoted to both studies aimed at identifying lead compounds from herbal extracts as well as the characterization of neuroprotective effects of single herbs and complex formulations. In this chapter, we review published work in the field on the background of a critical reevaluation of the neuroprotection hypothesis. Although the literature provides clear experimental evidence for neuroprotective effects of single compounds that have been isolated from Chinese herbal medicines in animal studies, there is no definitive evidence to date for beneficial therapeutic effects of any Chinese herbal medicine in stroke patients. In the face of the apparent failure to translate the basic research into successful stroke therapies, we propose to establish a Web-based social network of basic scientists, clinicians, industry partners, and governmental regulators for community-driven drug development. Participants could develop guidelines for preclinical research involving complex mixtures of compounds (multicomponent drugs and herbal extracts) complementing the criteria previously developed by the Stroke Therapy Academic Industry Roundtable (STAIR).