Stroke: New potential neuroprotectant agent

A new potential neuroprotectant agent has been found to be beneficial for patients with acute ischemic stroke undergoing endovascular thrombectomy in a large placebo-controlled trial, but only for those patients who did not also receive thrombolysis.

There is a dramatic interaction of nerinetide with alteplase. Exist a large benefit of nerinetide in patients not given thrombolysis, but in patients who receive alteplase, this benefit is completely obliterated.

This is the first evidence that neuroprotection is possible in human stroke. This has never been shown before.

The new agent ― known as NA1 or nerinetide ― is a 20 amino acid peptide with a novel mechanism of action; it inhibits signaling that leads to neuronal excitotoxicity.

The drug is given just once at the time of thrombectomy. It is short lived in the blood but detectable in the brain for up to 24 hours.

Cytoprotection aims to augment the resilience of neurons, neurovascular units, and white matter during ischemia until perfusion is restored.