Experimental approaches to enhance functional recovery following cerebral ischemia

Stroke is a major cause of adult disability that poses an enormous healthcare burden. Effective pharmacotherapy for stroke remains an unmet need. Development of restorative therapies has been identified as a potential alternative in stroke. Emerging understanding of brain repair and plasticity mechanisms have revealed therapeutic targets including inhibition of axonal sprouting (e.g., Nogo, MAG), altered perilesional GABA and glutamate receptor signaling, endogenous neurogenesis and angiogenesis. The main advantage with restorative therapies is the delayed treatment after acute necrotic cell death, when patients are stable. In addition, restorative therapies can be combined with intensive rehabilitation and medication for poststroke complications to further facilitate recovery process. The problem with patient studies is, however, that many pharmaceutical companies have scaled down their stroke programs, because of failures with neuroprotective compounds. We should convince industry that restorative drugs target completely different mechanisms with extended therapeutic time window offering an attractive approach to help stroke patients.