Emerging Therapeutic Candidates for Stroke Treatment

A special issue of Pharmaceuticals (ISSN 1424-8247). This special issue belongs to the section "Medicinal Chemistry".

Deadline for manuscript submissions: closed (10 November 2023) | Viewed by 7276

Special Issue Editors

Multidisciplinary Brain Protection Program (MBPP), Department of Anesthesiology, Duke University Medical Center, P.O. Box 3094, Durham, NC 27710, USA
Interests: brain ischemia; stroke; cardiac arrest; neuroinflammation; neuroprotection; brain stimulation; microglia; astrocyte; ER stress; UPR; proteostasis; SUMO

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Guest Editor
Multidisciplinary Brain Protection Program (MBPP), Duke University Medical Center, P.O. Box 3094, Durham, NC 27710, USA
Interests: brain ischemia; stroke; hemorrhagic stroke; neuroinflammation; oxidative stress; drug development; neuroprotection; pre-clinical testing

Special Issue Information

Dear Colleagues,

Stroke continues to be a leading cause of death and long-term disability worldwide. There are two main types of stroke: ischemic and hemorrhagic stroke. Mechanical/pharmacologic reperfusion therapy is currently the most effective treatment for ischemic stroke, while the medical intervention for hemorrhagic stroke aims to remove the hematoma and stop bleeding, usually through a surgical procedure. Although these treatments are effective, they have a relatively narrow time window and are not readily available in all hospitals. Furthermore, only a portion of stroke patients are eligible for these treatments, and of those who are treated without delay, many do not regain functional independence.

Obviously, current therapeutic options for stroke patients, especially pharmacologic interventions, are very limited. In this regard, at least two categories of potential stroke therapeutics are urgently needed. The first category is cerebroprotective adjuvant agents that can decelerate the progression of stroke-induced brain injury and thus extend the therapeutic window. The second could be administered to augment the beneficial effects of acute treatment and/or promote brain recovery during the chronic stroke phase. Decades of basic research have identified numerous potential targets for stroke therapy, and many have shown preclinical efficacy. This Special Issue is dedicated to publishing both original research articles and reviews with a focus on emerging therapeutic candidates for stroke treatment. We hope that this collection will serve as a valuable resource in the search for novel stroke treatments that will ultimately improve the quality of life of patients suffering from stroke.

Dr. Wei Yang
Dr. Huaxin Sheng
Guest Editors

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Keywords

  • stroke
  • ischemia
  • hemorrhage
  • reperfusion
  • cerebroprotection
  • neuroprotection
  • neurorestoration
  • neurorepair
  • recovery
  • translation
  • preclinical
  • small molecules
  • adjuvant
  • drug discovery

Published Papers (5 papers)

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Research

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17 pages, 1612 KiB  
Article
Neuroprotective Effects of Tryptanthrin-6-Oxime in a Rat Model of Transient Focal Cerebral Ischemia
by Mark B. Plotnikov, Galina A. Chernysheva, Vera I. Smol’yakova, Oleg I. Aliev, Anna M. Anishchenko, Olga A. Ulyakhina, Eugene S. Trofimova, Anastasia A. Ligacheva, Nina D. Anfinogenova, Anton N. Osipenko, Anastasia R. Kovrizhina, Andrei I. Khlebnikov, Igor A. Schepetkin, Anastasia G. Drozd, Evgenii V. Plotnikov, Dmitriy N. Atochin and Mark T. Quinn
Pharmaceuticals 2023, 16(8), 1057; https://doi.org/10.3390/ph16081057 - 25 Jul 2023
Viewed by 1094
Abstract
The activation of c-Jun N-terminal kinase (JNK) plays an important role in stroke outcomes. Tryptanthrin-6-oxime (TRYP-Ox) is reported to have high affinity for JNK and anti-inflammatory activity and may be of interest as a promising neuroprotective agent. The aim of this study [...] Read more.
The activation of c-Jun N-terminal kinase (JNK) plays an important role in stroke outcomes. Tryptanthrin-6-oxime (TRYP-Ox) is reported to have high affinity for JNK and anti-inflammatory activity and may be of interest as a promising neuroprotective agent. The aim of this study was to investigate the neuroprotective effects of TRYP-Ox in a rat model of transient focal cerebral ischemia (FCI), which involved intraluminal occlusion of the left middle cerebral artery (MCA) for 1 h. Animals in the experimental group were administered intraperitoneal injections of TRYP-Ox 30 min before reperfusion and 23 and 47 h after FCI. Neurological status was assessed 4, 24, and 48 h following FCI onset. Treatment with 5 and 10 mg/kg of TRYP-Ox decreased mean scores of neurological deficits by 35–49 and 46–67% at 24 and 48 h, respectively. At these doses, TRYP-Ox decreased the infarction size by 28–31% at 48 h after FCI. TRYP-Ox (10 mg/kg) reduced the content of interleukin (IL) 1β and tumor necrosis factor (TNF) in the ischemic core area of the MCA region by 33% and 38%, respectively, and attenuated cerebral edema by 11% in the left hemisphere, which was affected by infarction, and by 6% in the right, contralateral hemisphere 24 h after FCI. TRYP-Ox reduced c-Jun phosphorylation in the MCA pool at 1 h after reperfusion. TRYP-Ox was predicted to have high blood–brain barrier permeability using various calculated descriptors and binary classification trees. Indeed, reactive oxidant production was significantly lower in the brain homogenates from rats treated with TRYP-Ox versus that in control animals. Our data suggest that the neuroprotective activity of TRYP-Ox may be due to the ability of this compound to inhibit JNK and exhibit anti-inflammatory and antioxidant activity. Thus, TRYP-Ox may be considered a promising neuroprotective agent that potentially could be used for the development of new treatment strategies in cerebral ischemia. Full article
(This article belongs to the Special Issue Emerging Therapeutic Candidates for Stroke Treatment)
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Review

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15 pages, 716 KiB  
Review
Therapeutic Potential of Targeting the PERK Signaling Pathway in Ischemic Stroke
by Xinyuan Yu, Lihong Dang, Ran Zhang and Wei Yang
Pharmaceuticals 2024, 17(3), 353; https://doi.org/10.3390/ph17030353 - 08 Mar 2024
Viewed by 721
Abstract
Many pathologic states can lead to the accumulation of unfolded/misfolded proteins in cells. This causes endoplasmic reticulum (ER) stress and triggers the unfolded protein response (UPR), which encompasses three main adaptive branches. One of these UPR branches is mediated by protein kinase RNA-like [...] Read more.
Many pathologic states can lead to the accumulation of unfolded/misfolded proteins in cells. This causes endoplasmic reticulum (ER) stress and triggers the unfolded protein response (UPR), which encompasses three main adaptive branches. One of these UPR branches is mediated by protein kinase RNA-like ER kinase (PERK), an ER stress sensor. The primary consequence of PERK activation is the suppression of global protein synthesis, which reduces ER workload and facilitates the recovery of ER function. Ischemic stroke induces ER stress and activates the UPR. Studies have demonstrated the involvement of the PERK pathway in stroke pathophysiology; however, its role in stroke outcomes requires further clarification. Importantly, considering mounting evidence that supports the therapeutic potential of the PERK pathway in aging-related cognitive decline and neurodegenerative diseases, this pathway may represent a promising therapeutic target in stroke. Therefore, in this review, our aim is to discuss the current understanding of PERK in ischemic stroke, and to summarize pharmacologic tools for translational stroke research that targets PERK and its associated pathways. Full article
(This article belongs to the Special Issue Emerging Therapeutic Candidates for Stroke Treatment)
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13 pages, 611 KiB  
Review
Senescence and SASP Are Potential Therapeutic Targets for Ischemic Stroke
by Blake Ouvrier, Saifudeen Ismael and Gregory Jaye Bix
Pharmaceuticals 2024, 17(3), 312; https://doi.org/10.3390/ph17030312 - 28 Feb 2024
Viewed by 1329
Abstract
Aging is a known co-morbidity of ischemic stroke with its risk and severity increasing every year past 55+. While many of the current stroke therapies have shown success in reducing mortality, post-stroke morbidity has not seen the same substantial reduction. Recently, the involvement [...] Read more.
Aging is a known co-morbidity of ischemic stroke with its risk and severity increasing every year past 55+. While many of the current stroke therapies have shown success in reducing mortality, post-stroke morbidity has not seen the same substantial reduction. Recently, the involvement of cellular senescence and SASP in brain injury and neurological degeneration has been recognized. Ischemic injury causes oxidative stress and mitochondrial damage that induces senescence through the activation of p21 and p16 pathways, ultimately leading to synthesis and release of senescence-associated secretory phenotype (SASP). This ischemic event causes stress-induced premature senescence (SIPS), aging the brain decades beyond the standard biological age due to an increase in senescent cells in the ischemic core and ipsilateral hemisphere. Therefore, therapies that target the senescent cells and SASP, including senolytics, senomorphic drugs, stem cell therapies, and other cell-specific interventions, may be a new path for stroke treatment. Full article
(This article belongs to the Special Issue Emerging Therapeutic Candidates for Stroke Treatment)
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16 pages, 997 KiB  
Review
SUMOtherapeutics for Ischemic Stroke
by Paramesh Karandikar, Jakob V. E. Gerstl, Ari D. Kappel, Sae-Yeon Won, Daniel Dubinski, Monica Emili Garcia-Segura, Florian A. Gessler, Alfred Pokmeng See, Luca Peruzzotti-Jametti and Joshua D. Bernstock
Pharmaceuticals 2023, 16(5), 673; https://doi.org/10.3390/ph16050673 - 29 Apr 2023
Cited by 2 | Viewed by 1859
Abstract
The small, ubiquitin-like modifier (SUMO) is a post-translational modifier with a profound influence on several key biological processes, including the mammalian stress response. Of particular interest are its neuroprotective effects, first recognized in the 13-lined ground squirrel (Ictidomys tridecemlineatus), in the [...] Read more.
The small, ubiquitin-like modifier (SUMO) is a post-translational modifier with a profound influence on several key biological processes, including the mammalian stress response. Of particular interest are its neuroprotective effects, first recognized in the 13-lined ground squirrel (Ictidomys tridecemlineatus), in the context of hibernation torpor. Although the full scope of the SUMO pathway is yet to be elucidated, observations of its importance in managing neuronal responses to ischemia, maintaining ion gradients, and the preconditioning of neural stem cells make it a promising therapeutic target for acute cerebral ischemia. Recent advances in high-throughput screening have enabled the identification of small molecules that can upregulate SUMOylation, some of which have been validated in pertinent preclinical models of cerebral ischemia. Accordingly, the present review aims to summarize current knowledge and highlight the translational potential of the SUMOylation pathway in brain ischemia. Full article
(This article belongs to the Special Issue Emerging Therapeutic Candidates for Stroke Treatment)
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21 pages, 2685 KiB  
Review
Asialo-rhuEPO as a Potential Neuroprotectant for Ischemic Stroke Treatment
by Farooqahmed S. Kittur, Chiu-Yueh Hung, P. Andy Li, David C. Sane and Jiahua Xie
Pharmaceuticals 2023, 16(4), 610; https://doi.org/10.3390/ph16040610 - 18 Apr 2023
Cited by 1 | Viewed by 1480
Abstract
Neuroprotective drugs to protect the brain against cerebral ischemia and reperfusion (I/R) injury are urgently needed. Mammalian cell-produced recombinant human erythropoietin (rhuEPOM) has been demonstrated to have excellent neuroprotective functions in preclinical studies, but its neuroprotective properties could not be consistently [...] Read more.
Neuroprotective drugs to protect the brain against cerebral ischemia and reperfusion (I/R) injury are urgently needed. Mammalian cell-produced recombinant human erythropoietin (rhuEPOM) has been demonstrated to have excellent neuroprotective functions in preclinical studies, but its neuroprotective properties could not be consistently translated in clinical trials. The clinical failure of rhuEPOM was thought to be mainly due to its erythropoietic activity-associated side effects. To exploit its tissue-protective property, various EPO derivatives with tissue-protective function only have been developed. Among them, asialo-rhuEPO, lacking terminal sialic acid residues, was shown to be neuroprotective but non-erythropoietic. Asialo-rhuEPO can be prepared by enzymatic removal of sialic acid residues from rhuEPOM (asialo-rhuEPOE) or by expressing human EPO gene in glycoengineered transgenic plants (asialo-rhuEPOP). Both types of asialo-rhuEPO, like rhuEPOM, displayed excellent neuroprotective effects by regulating multiple cellular pathways in cerebral I/R animal models. In this review, we describe the structure and properties of EPO and asialo-rhuEPO, summarize the progress on neuroprotective studies of asialo-rhuEPO and rhuEPOM, discuss potential reasons for the clinical failure of rhuEPOM with acute ischemic stroke patients, and advocate future studies needed to develop asialo-rhuEPO as a multimodal neuroprotectant for ischemic stroke treatment. Full article
(This article belongs to the Special Issue Emerging Therapeutic Candidates for Stroke Treatment)
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