打破“神经保护”僵局：院前条件下远程缺血性调控和米诺环素的联合治疗.docVIP

打破“神经保护”僵局：院前条件下远程缺血性调控及米诺环素的联合治疗 尽管学科界已经试验了数百种神经保护剂和治疗方法，但1996年才被FDA批准的组织纤溶酶原激活剂目前仍是FDA批准的唯一能够治疗缺血性脑卒中的药物。最近，MR CLEAN试验表明，动脉内干预取出血块装置对急性缺血性卒中患者有效，如果能在发病时间6小时内应用，可提高3个月的临床治疗结果。 美国乔治亚摄政大学David C. Hess教授认为，现在比以往任何时候都需要辅助治疗这些再灌注策略，以“冻结半影”和延长“时间窗口”的方式让更多的患者受益。第一种方式“冻结”半影就是诱导大脑中的“保护表型”，并使大脑对缺血更有抵抗力；第二个办法是增加脑血流量，增加侧支血流并向大动脉血管再通“要时间”。由于FDA要求每种药剂都需要进行单独和联合测试，因此他们采用2×2析因设计使用远程缺血性预处理和米诺环素，该设计使其中每个干预措施都能被单独和联合测试。远程缺血性预处理能增加脑血流量并触发缺血抗性表型，而二甲胺四环素可抑制PARP1，使小胶质细胞活化，过氧亚硝酸盐和MMP-9。米诺环素已经被证明能够延长静脉内组织纤溶酶原激活物时间窗，并减少组织纤溶酶原激活物相关的出血症状。相关内容发表在2015年4月第4期《中国神经再生研究（英文版）》杂志上。 Article: Breaking out from the neuroprotective logjam: combined treatment with remote ischemic conditioning and minocycline in the prehospital setting by Jung Mi Park, David C. Hess (Departments of Neurology, Georgia Regent’s University, Augusta, GA, USA) Park JM, Hess DC (2015) Breaking out from the neuroprotective logjam: combined treatment with remote ischemic conditioning and minocycline in the prehospital setting. Neural Regen Res 10(4):537-539. 欲获更多资讯： Breaking out from the neuroprotective logjam: combined treatment with remote ischemic conditioning and minocycline in the prehospital setting The only two treatments effective for acute ischemic stroke are reperfusion therapies. Despite testing of hundreds of neuroprotective agents and treatments, tissue plasminogen activator (tPA), approved by the Food and Drug Administration (FDA) in 1996, remains the only FDA-approved drug for the treatment of ischemic stroke. Recently, the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN) trial demonstrated that intra-arterial interventions (IA) with clot retrieval devices are effective in acute ischemic stroke patients with large artery occlusions at improving 3 month clinical outcomes if used within 6 hours of symptom onset. Prof. David C. Hess from Georgia Regent’s University considered that more than ever, adjunctive therapies to these reperfusion strategi