Abstract
Summary
This report describes the role of neuroprotection in acute disorders such as
stroke and injuries of the nervous system as well as in chronic diseases such
as neurodegenerative disorders because many of the underlying mechanisms of
damage to neural tissues are similar in all these conditions and several
products are used in more than one disorder. Over 500 products have been
investigated for neuroprotective effects including those from the categories
of free radical scavengers, anti-excitotoxic agents, apoptosis (programmed
cell death) inhibitors, anti-inflammatory agents, neurotrophic factors, metal
ion chelators, ion channel modulators and gene therapy. Some of the agents are
old established pharmaceuticals whereas others are new biotechnology products.
Pathomechanisms of diseases are described with steps at which neuroprotective
therapies are directed. Diseases covered include cerebrovascular disorders,
traumatic brain injury, spinal cord injury, Alzheimer' s disease, Parkinson' s
disease, Huntington' s disease, amyotrophic lateral sclerosis, multiple
sclerosis, epilepsy and ischemic optic neuropathy as well as retinal
degeneration. Although anesthetics such as propofol are neuroprotective as
well, neuroprotection during surgery and anesthesia is discussed with the aim
of preventing and treating complications that result in CNS damage.
The report contains a profile of 134 companies that have a neuroprotective
product or products along with 98 collaborations. Some of the products in
development at academic institutions that do not have a commercial sponsor are
also included. Although an up-to-date search of the literature was performed
and selected 850 references are included, a considerable amount of information
has not been published anywhere else. Clinical trials of various
neuroprotective agents are described and failures of trials in stroke and head
injury are analyzed with suggestions for improving the selection of drugs and
design of trials.The report is supplemented with 63 tables and 10 figures.
Market analysis of currently used productsthat have a neuroprotective effect
are analyzed for the year 2008. Some of these products are approved for other
indications but are known to have a neuroprotective effect. With the approval
of new products and takeover of markets for obsolete symptomatic therapies,
the neuroprotection market value will rise by the year 2013 when it will
constitute a major and important component of the CNS market. Forecasts are
made until 2018. By that time neuroprotection will be an established part of
the neurological practice and measures will be available to achieve this
effectively.
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