Research Focus: Neuroprotective agents
Helmi Lutsep, M.D., Associate Director,
Oregon Stroke Center
at OHSU Vice Chair, Department of Neurology
While the standard treatment for acute ischemic stroke remains tissue plasminogen activator (tPA), neuroprotective agents have been researched for decades, with the goal of saving ischemic neurons from permanent damage. Although there has not yet been a neuroprotectant that has worked in clinical stroke, OHSU is currently offering several clinical trials.
Clinical trials at OHSU Brain Institute
One clinical trial that OHSU has been involved in compared albumin vs. placebo administered within the first 5 hours of a stroke, and ideally as soon as possible, and allowed the use of tPA. Age criterion was 18-83 years, with a National Institutes of Health stroke scale of 6 or greater. This trial was stopped by the Data safety Monitoring Board on Sept. 10, 2012 prior to the recruitment goal of 1,100 patients throughout the U.S. and Canada. Results have yet to be presented.
Another clinical trial taking place at OHSU is an unusual approach: NEST 3. Rather than using a drug, laser light or a placebo is applied with a probe in order to provide neuroprotection, perhaps by activating mitochondria and providing energy to cells. The light is applied to the scalp over designated areas through a cap; hair is shaved beforehand. Treatment is given from 4.5 to 24 hours after stroke onset. While this is a later time window than that for tPA, this trial is contraindicated for patients who have received tPA.
Other clinical trials in the field include paramedic initiation of magnesium sulfate vs. placebo to limit activation of N-methyl-D-aspartate (NMDA) receptors in patients with acute stroke, as well as clinical trials involving stem cells; the latter, however, is focused more toward later healing of injured cells than neuroprotection.