Vivek Rai, MD

Zhang L, Micael Chopp M, Teng H, Ding G, Jiang Q, Yang XP, et al. Combination Treatment With N-Acetyl-Seryl-Aspartyl-Lysyl-Proline andTissue Plasminogen Activator Provides Potent Neuroprotection in RatsAfter Stroke. Stroke 2014.

In the setting of acute stroke, neuroprotection aims to restrict neuronal injury and prevent death of salvageable neurons thereby increasing the chances of good recovery. Over eighteen years later, Alteplase (rt-PA) remains the only approved treatment for acute ischemic stroke (AIS). Many promising neuroprotective agents failed to show benefit in clinical trials. The search for an effective neuroprotective agent continues.



Zhang et al studied the effects of N-acetyl-seryl-aspartyl-lysyl-proline (AcSDKP) alone and in combination with thrombolytic therapy in a rat model of embolic focal cerebral ischemia. AcSDKP is an endogenously produced circulating peptide in humans and rodents, exerts anti- inflammatory and cardio-protective activities. The authors report that AcSDKP at 1 hour and in combination with rt-PA at 4hours after stroke onset reduced infarct volume and neurological deficits, without increasing the incidence of brain hemorrhage. Further, they showed that AcSDKP can easily cross blood brain barrier and blocks production of several inflammatory proteins and peptides that are important in regulating thrombosis and inflammatory responses after stroke.

The authors have shown that AcSDKP is a promising neuroprotective agent. Among other things, authors used a study protocol that is applicable to clinical trials and the product itself is naturally occurring with no untoward side effects shown so far. I think a strong case is made here for further development of this product for clinical trials. Whether this particular agent holds its promise of being neuroprotective agent that can be used in humans, only time will tell.