Fast Neuroprotection (Fast-NPRX) for Acute Ischemic Stroke Victims: the Time for Treatment Is Now
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EDITORIAL
Fast Neuroprotection (Fast-NPRX) for Acute Ischemic Stroke Victims: the Time for Treatment Is Now Paul A. Lapchak
Received: 18 October 2013 / Accepted: 23 October 2013 / Published online: 7 November 2013 # Springer Science+Business Media New York 2013
Introduction Since the inception of Translational Stroke Research, numerous significant scientific breakthroughs have been published as peer-reviewed contributions, and some have lead the way for significant advances in the stroke field, opening up new ways to think about stroke therapy research and development [1–5], animal models [6–9], mechanisms of injury and the ischemic cascade [3, 10–14], and clinical trials [1, 15–18]. Many of the scientific advances are being directly applied to discover therapeutic approaches, but there remain some gaps in the systematic approaches being used to treat stroke patients. The best use or way of using neuroprotective agents and the clinical trial to adequately test them is somewhat of an unfinished puzzle. We have yet to put the pieces together to assemble a coherent picture and have success with a neuroprotectant. “Learning is not attained by chance, it must be sought for with ardor and attended to with diligence.”―Abigail Adams (1744–1818).
Translational Stroke Research: Ways and Means The development of crucial therapies for acute ischemic stroke (AIS) has come to a standstill in many settings including the academia and industry, not because of lack of
P. A. Lapchak (*) Department of Neurology and Neurosurgery, Cedars-Sinai Medical Center, Advanced Health Sciences Pavilion, Rm 8305, 127 S. San Vicente Blvd, Los Angeles, CA 90048, USA e-mail: [email protected]
innovation, novel drugs, or efficacy in standardized accepted animal models, but for two other primary causes. First, for academics, research has slowed or even stopped in some laboratories due to the lack of government and private funding support for translational stroke research. Second, in the pharmaceutical and biotechnology industry, development of novel drugs is not being pursued due to the failure of many highimpact clinical trials (e.g., SAINT, DIAS, NEST) and their cosmic repercussions. For example, the development of novel drug approaches [19–22], thrombolytics [23–26], and devices [27–29] has slowed or halted due to late-stage clinical trial futility even with some efficacy in early rounds of clinical trials. With the exception of tissue plasminogen activator (rtPA) [30] and tenecteplase [31, 32, but also see 33], which has a higher fibrin binding specificity than rt-PA and possibly greater resistance to inactivation by plasminogen activator inhibitor-1 (PAI-1, serpin-1), an endogenous inhibitor of plasminogen activator compared to rt-PA, there continues to be a lack of significant efficacy of all forms of treatment in a diverse and heterogeneous patient population. It should be noted that both thrombolytics were equally efficacious in preclinical studies [34]. There is the perception amongst some in the community that current animal models ma
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