In terms of treatments for stroke, "reperfusion therapy" has become the mainstream. What are the effective ways to improve the prognosis of stroke patients by reusing drugs that protect brain cells and promote functional recovery? The concept of "brain cell protection" came into being, and impressive results have been achieved in clinical studies.
On Mar. 11, 2023, the fifth "International Academic Summit on Stroke Updates" sponsored by the Chinese Stroke Association and co-organized by Simcere Pharmaceutical (2096.HK) was successfully held in Nanjing. Professor Marc Fisher, chairman of the World Stroke Organization (WSO), and nearly 500 experts and scholars from all over China were invited to the summit. They had in-depth discussions on various topics of stroke treatment, such as the combination of reperfusion therapy and brain cell protection and the application timing of brain cell protection therapy.
Professor Marc Fisher of Harvard Medical School, WSO chairman, pointed out that with the extension of the time window for intravenous thrombolysis and the development of mechanical thrombectomy, "high-efficiency reperfusion therapy" has become a highly-prescribed therapy for stroke, and the academic community should pay more attention to exploring other treatments, for example, the effective reuse of drugs that protect brain cells and promote functional recovery. Concerning stroke treatment, the concept of "brain cell protection therapy" has been gradually, which means protecting the overall structure of the neurovascular unit (NVU), including neurons, blood vessels, and neuroglia. An ideal drug for the protection of brain cells that not only acts on multiple targets of ischemic cascade, but also combines with existing reperfusion therapy to save ischemic penumbra and ease reperfusion injury. SANBEXIN® provides multi-target protection of brain cells and brings more benefits to stroke patients.
Professor Liu Liping from Beijing Tiantan Hospital, Capital Medical University analyzed the mechanism and management strategy of "ineffective recanalization" in acute ischemic stroke (AIS). "Ineffective recanalization" refers to poor prognosis (mRS > 2 points at Month 3) after successful recanalization (mTICI > 2b/3). According to the real-world RESCUE-RE study in China, the proportion of ineffective recanalization in the country is as high as 49%. How to avoid ineffective recanalization remains a clinical challenge. In 2017, the Stroke Treatment Academic Industry Roundtable (STAIR) proposed to replace "neuroprotection" with "brain cell protection" for the first time; in 2020, STAIR further clarified the definition of "brain cell protection", which should be the protection of the overall "NVU" structure. The TASTE-2 study on the multi-target brain cell protection agent edaravone dexborneol combined with reperfusion therapy has completed the enrollment of subjects, and the agent has the potential for reducing ineffective recanalization.
Professor Niu Xiaoyuan from the First Hospital of Shanxi Medical University said that based on the proven efficacy of SANBEXIN® in reducing disability caused by stroke in the TASTE study, a real-world study (RWS) of SANBEXIN® integrated into a stroke management protocol to review the potential improvement for those at risk for stroke has been initiated. The phased evaluation results of the study indicated that the National Institutes of Health Stroke Scale (NIHSS) scores of discharged patients using SANBEXIN® showed positive signals.
Professor Li Zhenzhong from the Second Hospital of Hebei Medical University said that SARS-CoV-2 viruses can damage various organs, including the brain, and cause "long COVID" symptoms (a form of neurological sequelae) after acute infection. Studies have shown that the injuries of SARS-CoV-2 viruses to the brain include virus-mediated NVU damage. For AIS patients, the occurrence of ischemic cascade will damage the NVU again, destroy the blood-brain barrier, and aggravate the stroke condition. XIANNUOXIN® is the first 3CL inhibitor that has data on Chinese patients showing that it offers the benefits of rapid and substantial reduction of viral load, shortened course of disease, and reduced impact of SARS-CoV-2 on stroke progression. However, the combined use of drugs metabolized by the CYP3A4 pathway will reduce the efficacy of the 3CL inhibitor. As the two components of SANBEXIN® are synergistic, and the pharmacokinetic behavior is not easily affected by CYP inhibitors or inducers, the risk of interaction between the two drugs is low. The combination of etiological treatment for COVID-19 and brain cell protection therapy has the potential to become a new treatment strategy for AIS patients with COVID-19 infection in the post-COVID-19 era.
Professor Yang Qingwu from the Second Hospital Affiliated to Army Medical University shared the latest trend in endovascular treatment at ISC 2023. The ANGEL-ASPECT study confirmed that for patients with large infarct cores, endovascular treatment can better increase the mRS score than traditional drugs. Similar results were also obtained in the SELECT2 study of patients with large infarct cores. In terms of blood pressure management after endovascular treatment, the results of the BEST-II study showed that the model to intervene with a lower 24-hour blood pressure management endpoint is not reasonable, as its safety and efficacy are not clear, and blood pressure management still needs to be optimized in the future to balance the injuries and benefits of reperfusion.
Professor Wu Bo from West China Hospital of Sichuan University talked about the progress of non-endovascular treatment. As there are still many AIS patients who do not receive intravenous thrombolysis in China, comprehensive treatment options other than thrombolysis, e.g., brain cell protection therapy, are of great significance to improve the prognosis of patients. ISC2023 reported various latest advances in brain cell protection, such as clinical research data and key research design of innovative drugs and preclinical data of various multi-target brain cell protection drugs. The launch of new brain cell protection agents is expected.
At the conference, participants had in-depth discussions on stroke treatments such as reperfusion therapy and brain cell protection. The clinical studies of SANBEXIN® showed that both thrombolysis and thrombectomy have a good clinical effect on AIS, and the combined use of the drug has the potential to improve the injuries caused by reperfusion.