You won't be complaining about cost when you're the 1 in 4 per WHO that has a stroke.) So you changed the name from neuroprotection to cytoprotection, it still gives no sense of urgency. Whereas the neuronal cascade of death suggests immediate action needed,
The High Cost of Stroke and Stroke Cytoprotection Research
Abstract
Acute ischemic stroke is inadequately treated in the USA and worldwide due to a lengthy history of neuroprotective drug failures in clinical trials. The majority of victims must endure life-long disabilities that not only affect their livelihood, but also have an enormous societal economic impact. The rapid development of a neuroprotective or cytoprotective compound would allow future stroke victims to receive a treatment to reduce disabilities and further promote recovery of function. This opinion article reviews in detail the enormous costs associated with developing a small molecule to treat stroke, as well as providing a timely overview of the cell-death time-course and relationship to the ischemic cascade. Distinct temporal patterns of cell-death of neurovascular unit components provide opportunities to intervene and optimize new cytoprotective strategies. However, adequate research funding is mandatory to allow stroke researchers to develop and test their novel therapeutic approach to treat stroke victims.
Introduction
Stroke, in particular acute ischemic stroke is a major problem worldwide that is escalating as the worldwide population dramatically shifts to an aged state. With a global stroke incidence of 10.3–16.9 million annually, at least 5.9 million stroke-related deaths, and 25.7–33 million survivors that require some form of therapy or novel treatment, the former has still not been achieved and may not be achieved for decades if the current pace of research and level of funding are maintained.
There are two ways to address the societal problem related to stroke, either prevent the occurrence of stroke, or design practical efficacious therapies to treat stroke. The discovery and development of the elusive neuroprotective therapy, which will herein be called “cytoprotective” for stroke is a time intensive process that is high cost and it can be high reward when a therapy is translated into the target patient population. There are no short cuts, no inexpensive drug screens, and no inexpensive model efficacy testing if the development process is to be transparent and adheres to current elevated research standards required for publication in Translational stroke research, stroke, Journal of Cerebral Blood Flow and Metabolism, and other high impact stroke-related journals.
The recent success of endovascular procedures with an extended therapeutic window has re-energized stroke cytoprotection research and increased optimism that we can now make advances, consolidate efforts, and develop an effective cytoprotective therapy to be used in combination with endovascular procedures, or with recombinant tissue plasminogen activator (rt-PA), the only Food and Drug administration (FDA)-approved drug, a biologic for stroke. If we can demonstrate additional and significant clinical improvement with a cytoprotective compound in standardized translational embolic stroke models, in patients undergoing thrombolytic/endovascular procedures, then it should also be proposed to determine the clinical efficacy of the therapy. Another scenario is that the cytoprotective compound may reduce the side-effects of thrombolysis and make the treatment safer, thus reducing complications in stroke victims.
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