Introduction
thrombotic obstruction, stroke, Stroke
CLOT, STROKE, EPP, STROKE, INFLAMMATION, ERYTHROPOIETIC PROTOPORPHYRIA, ADVERSE EFFECTS
Stroke is a leading cause of mortality and morbidity worldwide [Current revascularisation therapies in AIS include thrombolysis and endovascular clot retrieval. They are aimed at removing the thrombotic obstruction and retaining blood flow to the ischemic tissue but cannot prevent injury to the BBB or inflammatory reactions. They are also restricted by several limitations. Both are time dependent, limited by patient selection, need specially trained professional and available only in selected centres. Only about 10–20% of AIS patients would qualify for these therapies and of those only 30–40% of patients will achieve functional independence [Neuroprotective agents reduce inflammation, may repair or minimise the damage to the BBB and thus can protect neurons. They also have the potential not only to improve the eligibility but also the outcomes of stroke revascularisation therapies and in those unable to receive revascularisation. However, despite more than 1000 pre-clinical studies and over 200 clinical trials, no effective neuroprotective agent has been found [The neuropeptide hormones α-melanocyte stimulating hormone (α-MSH) and melanocortin are favourably implicated in AIS for their neuroprotective effects and strong anti-inflammatory properties [Afamelanotide is a synthetic, highly potent, non-selective agonist of α-MSH analogue, currently licenced for erythropoietic protoporphyria (EPP). Ample evidence is available from clinical studies that it is generally safe and well tolerated [The aim of this study was to assess the feasibility and safety of afamelanotide for the first time in AIS patients. The hypothesis was that afamelanotide would positively affect the infarcted area (core) and the ischaemic zone of tissue (penumbra) in patients with AIS, with no major adverse effects. Validating the safety of afamelanotide in AIS patients would set the course for larger trials to test its neuroprotective properties in AIS patients.