Table 1.
Main results of therapeutic studies with trophic factors or drugs with trophic effects in cerebral infarct animal models and human clinical trials
| Animal models | Clinical trials | |
|---|---|---|
| Trophic factors | ||
| Basic fibroblast growth factor (bFGF) | Promotes neurogenesis [18] Enhances functional recovery and stimulates progenitor cell proliferation [19] | Phase III (286 patients). Prematurely stopped [53] |
| Brain-derived neurotrophic factor (BDNF) | Cellular and functional recovery [21] Protects and promotes nerve fibreregeneration [22] Promotes prostacyclin biosynthesis [23] | No studies |
| Vascular endothelial growth factor (VEGF) | Reduces neuronal cell death, increases angiogenesis and vascular permeability [116, 117] reduces infarct volume, improves behavioural recovery [30] | No studies |
| Erythropoietin (EPO) | Reduces infarct size and improves neurobehavioral deficits [41] | Safety: open label (13 patients); Efficacy: double-blind randomized proof of concept trial (40 patients): Improvement in neurological outcome, and smaller lesion size [55] Phase II/III (522 patients): negative results and safety concerns [56] |
| Granulocyte colony-stimulating factor (G-CSF) | Promotes new blood vessel formation, has anti-inflammatory, anti-excytotoxic, neuroprotective properties [43] and survival-enhancing capacity and effects on functional outcome [44] | Safety: Phase IIb (60 patients): [58] Safety and efficacy: AXIS-2 Trial finished. Results not yet published |
| EPO + G-CSF | Enhances angiogenesis and tissue plasticity, leading to greater functional recovery [45] | No studies |
| Drugs with trophic effects | ||
| CDP-choline (citicoline) | Increases neuronal plasticity and contributes to sensorimotor function recovery [48] Promotes protective and repair mechanisms [46, 47, 49] | Efficacy and safety: Individual pooled data analysis [61] Efficacy: Phase III (ICTUS Trial; 2078 patients) finished 62. Results not yet published |
| Porcine brain derived peptide (cerebrolysin) | Reduces infarct volume and improves recovery [50] with increased neurogenesis [51], efficacy in neurological recovery, reduction of neuronal death, increased cell proliferation and decreased inflammatory response [52] | Safety and efficacy: Phase II clinical trial (146 patients) [63] and Cochrane Syst Rev [64]: not enough evidence for efficacy. No safety concerns Safety and efficacy: Phase IV Clinical trial finished: CASTA (1070 patients) safety confirmed; possible efficacy in more severe strokes [66] |
A non-systematic selection of the main results of therapeutic studies with trophic factors or drugs with trophic effects in animal models and clinical trials of cerebral ischaemia is provided. The reference number for each study is shown in brackets. Information from ongoing clinical trials can be consulted in the PubMed (http://www.ncbi.nlm.nih.gov/pubmed/) and clinical trials (http://clinicaltrials.gov/) databases.