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Title: The 2007 Feinberg lecture: a new road map for neuroprotection.
Austin Authors: Donnan, Geoffrey A 
Affiliation: National Stroke Research Institute, Austin Health, University of Melbourne, Waterdale Road, Heidelberg Heights, 3081, Australia
Issue Date: 29-Nov-2007
Publication information: Stroke; A Journal of Cerebral Circulation 2007; 39(1): 242
Abstract: There have now been numerous phase III trials of neuroprotection that have failed to live up to the expectations created by preclinical testing in animal models, the most recent of which was the second pivotal trial of the spin trap agent NXY-059. We have reached a stage at which research in this area should stop altogether or radical new approaches adopted. The purpose of this article is to review how we reached this stage and make recommendations for a new approach to neuroprotection research.The background to neuroprotection research is reviewed and its problems are highlighted based on the research of others and of our own research group. From this, a series of questions are posed that require answers if the field is to progress. A road map for future research is then proposed.The road map involves the following steps for putative neuroprotectants: (1) better proof of efficacy in animal models; (2) in vivo evidence of efficacy in human tissue using cell cultures or brain slices; (3) in vivo studies of their distribution in the normal and ischemic human brain, particularly focusing on the ischemic penumbra; (4) demonstration of efficacy in novel human models of cerebral ischemia; and (5) phase II and III clinical trails with penumbral selection using imaging techniques.The accumulated evidence suggests that neuroprotection failure in clinical trial is due to identifiable preclinical and clinical factors. Neuroprotection research should be pursued but with a very different and more rigorous approach.
Gov't Doc #: 18048866
DOI: 10.1161/STROKEAHA.107.493296
Type: Journal Article
Subjects: Animals
Benzenesulfonates.therapeutic use
Brain Ischemia.drug therapy.prevention & control
Cardiovascular Agents.therapeutic use
Clinical Trials, Phase II as Topic
Clinical Trials, Phase III as Topic
Disease Models, Animal
Free Radical Scavengers.therapeutic use
Neuroprotective Agents.therapeutic use
Stroke.drug therapy
Appears in Collections:Journal articles

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