Research Into Neuroprotection Must Continue … but With a Different Approach

Abstract

Geoffrey A. Donnan MD, FRACP Stephen M. Davis MD, FRACP Section Editors: Neuroprotective agents disrupting the ischemic cascade and salvaging the ischemic penumbra are being explored as a potential therapeutic option for stroke. Although a number of agents are neuroprotective in animal studies, none of the human trials have been positive, with the exception of the SAINT I trial.1 Unfortunately, the follow-up SAINT II trial had a negative result,2 and a great deal of pessimism regarding the future of neuroprotection has been generated. However, before abandoning neuroprotection as a strategy, it is important to examine where research in neuroprotection has brought us and how we can better design future animal and clinical studies. The main reason for failure has been poor translation from animal studies to clinical trials. Clinical trials often had prolonged therapeutic windows, small sample sizes, and failed to achieve adequate plasma levels of study medications. These problems lead to the Stroke Therapy Academic Industry Roundtable (STAIR) recommendations,3,4 which have greatly improved …