[In vivo exploration of cerebral ischemia: use of neuroprotective agents in animal studies]. 2002

P Lestage, and B Lockhart, and A Roger
Division de Pathologie, Cérébrale, Institut de Recherches Servier, Croissy-sur-Seine, France. pierre.lestage@fr.netgrs.com

A "good" in vivo animal model of stroke must reproduce the etiology, anatomical, functional and metabolic consequences of human pathology and must also permit the study of anti-ischemic drugs in conditions pertinent to the clinical therapeutics. As stroke is a very heterogeneous clinical entity, such a model could only mimic a limited part of stroke. Animal data are usually collected in healthy laboratory rodents of the same age, in which a standardized amount of cerebral ischemia is induced by a reproducible intervention. In contrast, aetiology, location and severity of ischaemic stroke in patients is very heterogeneous. Among the various animal models of stroke, two of them are particularly used: a model of global transient ischemia by occlusion of the 4-vessels in the rat (Pulsinelli's model), which induces a delayed neuronal death in the hippocampus and model(s) of permanent or transient focal cerebral ischemia occluding the middle cerebral artery in rodents. A large number of compounds have been shown to be active using these two animal models, but unfortunately, none of them were found to be active in clinical trials. Various factors could be responsible for this major discrepancy and some of them are not related to pre-clinical studies, but to the complexities of the clinical problem of stroke. Failure in the translation of results from animals models to humans implicates potential limitations of the current drug development process. Retrospective analysis of studies suggests possible improvements at several stages during pre-clinical studies. Standardized guidelines for preclinical evaluation of neuroprotective drugs may improve chances of success. For example, preclinical studies should be performed in at least 2 species and 2 strains for a specific specie in order to take into account known strain and species differences. Moreover, while neuroprotection drug development is dominated by volumetric histology as the outcome measure, the demonstration of functional benefits must be performed both after short and long periods of recovery. Attempts should be made to use multiple models such as stroke-prone spontaneously hypertensive rats, outbred rodents and aged animals that more closely simulate clinical conditions. In addition, treatment in animals should not be given immediately after ischaemia, but after a delay, as most patients are not treated within minutes of stroke onset. Animal models should be used to determine dosage and duration of therapy, which will vary with the pharmacokinetic properties of different agents. Moreover, complete dose-response curves should be established as bell-shaped dose-responses curves may predict dose-limiting adverse effects that hinder subsequent efficacy trials. Finally, physiological monitoring (cerebral blood flow, blood pressure and gazes, body temperature, glycemia, ...) should be performed to eliminate confounding variables and to observe adverse systemic effects. The future of neuroprotection for stroke remains bright in spite of previous disappointments.

UI MeSH Term Description Entries
D002545 Brain Ischemia Localized reduction of blood flow to brain tissue due to arterial obstruction or systemic hypoperfusion. This frequently occurs in conjunction with brain hypoxia (HYPOXIA, BRAIN). Prolonged ischemia is associated with BRAIN INFARCTION. Cerebral Ischemia,Ischemic Encephalopathy,Encephalopathy, Ischemic,Ischemia, Cerebral,Brain Ischemias,Cerebral Ischemias,Ischemia, Brain,Ischemias, Cerebral,Ischemic Encephalopathies
D004195 Disease Models, Animal Naturally-occurring or experimentally-induced animal diseases with pathological processes analogous to human diseases. Animal Disease Model,Animal Disease Models,Disease Model, Animal
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000818 Animals Unicellular or multicellular, heterotrophic organisms, that have sensation and the power of voluntary movement. Under the older five kingdom paradigm, Animalia was one of the kingdoms. Under the modern three domain model, Animalia represents one of the many groups in the domain EUKARYOTA. Animal,Metazoa,Animalia
D018696 Neuroprotective Agents Drugs intended to prevent damage to the brain or spinal cord from ischemia, stroke, convulsions, or trauma. Some must be administered before the event, but others may be effective for some time after. They act by a variety of mechanisms, but often directly or indirectly minimize the damage produced by endogenous excitatory amino acids. Neuroprotectant,Neuroprotective Agent,Neuroprotective Drug,Neuroprotectants,Neuroprotective Drugs,Neuroprotective Effect,Neuroprotective Effects,Agent, Neuroprotective,Agents, Neuroprotective,Drug, Neuroprotective,Drugs, Neuroprotective,Effect, Neuroprotective,Effects, Neuroprotective
D020521 Stroke A group of pathological conditions characterized by sudden, non-convulsive loss of neurological function due to BRAIN ISCHEMIA or INTRACRANIAL HEMORRHAGES. Stroke is classified by the type of tissue NECROSIS, such as the anatomic location, vasculature involved, etiology, age of the affected individual, and hemorrhagic vs. non-hemorrhagic nature. (From Adams et al., Principles of Neurology, 6th ed, pp777-810) Apoplexy,Cerebral Stroke,Cerebrovascular Accident,Cerebrovascular Apoplexy,Vascular Accident, Brain,CVA (Cerebrovascular Accident),Cerebrovascular Accident, Acute,Cerebrovascular Stroke,Stroke, Acute,Acute Cerebrovascular Accident,Acute Cerebrovascular Accidents,Acute Stroke,Acute Strokes,Apoplexy, Cerebrovascular,Brain Vascular Accident,Brain Vascular Accidents,CVAs (Cerebrovascular Accident),Cerebral Strokes,Cerebrovascular Accidents,Cerebrovascular Accidents, Acute,Cerebrovascular Strokes,Stroke, Cerebral,Stroke, Cerebrovascular,Strokes,Strokes, Acute,Strokes, Cerebral,Strokes, Cerebrovascular,Vascular Accidents, Brain

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