Translational Stroke Research on Blood-Brain Barrier Damage: Challenges, Perspectives, and Goals

Excerpt

Over the past few decades, basic and clinical research has identified numerous risk factors for the development of stroke and led to major improvements in health management in the USA. As a result of these efforts, the relative rate of stroke death dropped by 33.7 %, and the actual occurrence of stroke deaths fell by 18.2 % in the decade spanning from 2003 to 2013, according to the American Heart Association. Thus, stroke fell from the fourth to the fifth leading cause of death in 2013, behind heart disease, cancer, chronic lower respiratory diseases, and unintentional injuries. These improvements are largely attributed to superior control of hypertension, diabetes mellitus, high cholesterol, and tobacco use [1]. To date, the treatment of acute ischemic stroke is largely dependent on recanalization using recombinant tissue-type plasminogen activator (tPA) in the appropriate patient population [2, 3]. Encouragingly, recent clinical trials have demonstrated significant benefits for intra-arterial thrombectomy in a subset of acute stroke patients with intracranial large artery occlusion [4]. Despite these improvements in population health and stroke treatment, stroke still remains a leading cause of long-term disability and approximately 795,000 people experience a new or recurrent stroke every year [1]. Thus, basic and clinical investigations of the mechanisms underlying ischemic brain injury must remain an urgent priority in order to promote the discovery of novel therapeutic targets and improve the safety and efficacy of current tPA and thrombectomy treatments. …