Now this just needs to be incorporated into that non-existent stroke strategy so that future research takes this into account on the way to 100% recovery rehab protocols. That will never occur, we have fucking failures of stroke associations just twiddling their thumbs. We have NO STROKE STRATEGY. All because survivors are not in charge, they would never let their eyes off the only goal in stroke, 100% recovery.
Neurorestoration Approach by Biomaterials in Ischemic Stroke
Noelia Esteban-Garcia1, 
Cristina Nombela1,2, 
Javier Garrosa1, 
Fernando J. Rascón-Ramirez3, 
Juan Antonio Barcia3,4 and 
Leyre Sánchez-Sánchez-Rojas1*- 1Regenerative Medicine and Advanced Therapies Lab, Instituto de Investigación Sanitaria San Carlos, Clínico San Carlos Hospital, Madrid, Spain
- 2Department of Biological and Health Psychology, Universidad Autónoma de Madrid, Madrid, Spain
- 3Neurosurgery Department, Clínico San Carlos Hospital, Madrid, Spain
- 4Chair of Neurosurgery Department, Clínico San Carlos Hospital, Madrid, Spain
Ischemic stroke (IS) is the leading cause of disability
in the western world, assuming a high socio-economic cost. One of the
most used strategies in the last decade has been biomaterials, which
have been initially used with a structural support function. They have
been perfected, different compounds have been combined, and they have
been used together with cell therapy or controlled release chemical
compounds. This double function has driven them as potential candidates
for the chronic treatment of IS. In fact, the most developed are in
different phases of clinical trial. In this review, we will show the
ischemic scenario and address the most important criteria to achieve a
successful neuroreparation from the point of view of biomaterials. The
spontaneous processes that are activated and how to enhance them is one
of the keys that contribute to the success of the therapeutic approach.
In addition, the different routes of administration and how they affect
the design of biomaterials are analyzed. Future perspectives show where
this broad scientific field is heading, which advances every day with
the help of technology and advanced therapies.
Background
Stroke is one of the most important health problems
worldwide. Ischemic stroke (IS) constitutes 85–90% of the casuistry
among the types of stroke and is the leading cause of disability in
people over 65 years of age worldwide (Ghuman and Modo, 2016).
Due to the epidemiological importance and the big socio-economic
expenditure involved, it is priority advance in its prevention, control,
and treatment (Kalaria et al., 2016; Benjamin et al., 2017).
The ischemic injury is caused by an interruption of blood supply in one
or more cerebral blood vessels triggering a set of dynamic processes
that affect all brain cells and extracellular matrix (ECM) deteriorating
the “glioneurovascular niche” (Boisserand et al., 2016).
The pathophysiology of IS lies in the restriction or
reduction of the supply of oxygen, glucose, and nutrients in the
affected brain area. The ischemic cascade begins while there is arterial
obstruction causing accidental cell death of core cells damaging tissue
irreversibly. This process is accompanied by events of glutamate
excitotoxicity, oxidative stress, and neuroinflammation, which affect
the homeostatic functioning of the neurons in the affected tissue. The
combination of all of them induces permanent brain lesions (Taylor et al., 2008; Thundyil and Lim, 2015; Thornton et al., 2017).
However, there are regions near the nucleus or ischemic penumbra (IP)
that have had access to a collateral blood circulation, being able to
partially counteract the energy deficit (Fisher and Albers, 2013; Gavaret et al., 2019).
This review will briefly address the limitations and
consequences that arise after the stroke, the endogenous repair
mechanisms activated by the brain damage itself, how to enhance these
mechanisms through tissue engineering and the incorporation of exogenous
cells or growth factors.
More at link.
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