Would this be a possible solution to Inflammatory action leaking through the blood brain barrier. in the neuronal cascade of death? More research needed that will never occur.
http://www.medscape.com/viewarticle/863881?
A possible new treatment for acute ischemic stroke targeting the
blood-brain barrier has shown promising results in an early randomized
clinical trial.
The drug, imatinib, is a tyrosine kinase inhibitor already available for the treatment of certain cancers.
Initial
results in stroke were presented at the recent European Stroke
Organisation Conference (ESOC) 2016 by Nils Wahlgren, MD, Karolinska
Institute, Stockholm, Sweden.
"We believe our results open up an
opportunity for a novel third treatment for acute ischemic stroke to
complement thrombolysis and thrombectomy," he concluded.
Professor
Wahlgren explained that in experimental models, imatinib has preserved
the integrity of the blood-brain barrier, which opens up during ischemic
stroke, allowing an influx of inflammatory cells into the brain, and
contributes to edema, hemorrhagic transformation, and increased
mortality. This effect can be made worse by the use of tissue
plasminogen activator (tPA).
"This preliminary randomized study
suggested that imatinib is safe and generally well tolerated in ischemic
stroke patients treated with IV [intravenous] tPA. The high dose
increased neurological scores, and there was a suggestion of improved
functional independence and reduced risk of hemorrhagic transformation,"
Professor Wahlgren stated.
"The effect may be mediated by
restoring the integrity of the blood-brain barrier, which can lead to
reduced edema and subsequent inflammatory responses," he added.
Commenting for Medscape Medical News,
president of the European Stroke Organisation, Valeria Caso, MD,
University of Perugia, Italy, said the study was very hopeful.
"These are excellent results in this initial early study. We need to now see what happens in larger trials.
"We
have been trying to find agents that improve the efficiency of
thrombolysis for many years," she added. "Many neuroprotective drugs
have been tried without success, but this agent acts differently —
targeting the blood-brain barrier — so it is something novel and it
really does look like it could be a light at the end of the tunnel."
I-STROKE
The
current study — known as I-STROKE — was conducted to clarify whether
imatinib is safe and tolerable in an acute ischemic stroke population
and whether there is any indication of reduced hemorrhage and edema and
improved neurologic function.
The study involved 60 patients with
acute ischemic stroke and a National Institutes of Health Stroke Scale
(NIHSS) score of 7 or greater who received tPA within 4.5 hours of
symptom onset. They were randomly assigned to one of three doses of
imatinib (15 patients each to 400 mg, 600 mg, or 800 mg daily) or no
additional treatment (controls) within 1 hour of completion of
reperfusion therapy.
Results showed no serious treatment-related
adverse events but a few mild reversible effects, such as itching, skin
reactions, and nausea and vomiting.
In terms of efficacy, there
were 28 hemorrhagic transformations in the study, with no overall
difference between the imatinib patients and controls. "However,
interestingly there were no transformations at all in the high-dose
imatinib group, who were treated within 5 hours of symptom onset,"
Professor Wahlgren reported.
In
terms of neurologic outcomes, there was an improvement in NIHSS scores
(from baseline to 90 days) in the control group and then a dose-related
stepwise further improvement in imatinib-treated patients, with the
highest dose showing the best effect and a significant benefit shown
over the control group.
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