Where will the next generation of stroke treatments come from?

• Published in: PLoS medicine Vol. 7; no. 3; p. e1000224
• Main Authors: Howells, D W, Donnan, G A
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 01-03-2010; Public Library of Science (PLoS)
• Subjects: Antilipemic agents; Atherosclerosis; Biomarkers; Blood platelets; Blood pressure; Cardiac arrhythmia; Disease; Disease prevention; Drug therapy; Forecasts and trends; Genomes; Heart attacks; Humans; Neurological Disorders/Cerebrovascular Disease; Neuroscience; Pharmaceutical industry; Production management; Research in Translation; Stroke; Stroke (Disease); Stroke - prevention & control; Stroke - therapy; Veins & arteries; Australia; Stroke; Humans
• ISSN: 1549-1676; 1549-1277; 1549-1676
• DOI: 10.1371/journal.pmed.1000224

Remarkable progress has occurred over the last two decades in stroke interventions. Many have been developed on the basis of their efficacy in other disorders. This "inheritance" approach should continue, but two areas where completely novel therapeutic targets might emerge are the stimulation of neuroplasticity and unraveling the genetic code of stroke heterogeneity (Table 2). For the former, the next steps are to identify small-molecule, nontoxic compounds that most effectively enhance plasticity in animal models, and then subject them to clinical trial in humans. For the latter, more and larger-scale cooperative GWASs in carefully phenotyped stroke populations are required to better understand the polygenic nature of cerebrovascular disease. Then, the physiological relevance of genetic abnormalities can be determined in in vitro and in vivo systems before candidate compounds are developed.