Neuroprotection - Drugs, Markets and Companies

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Neuroprotection - Drugs, Markets and Companies Published on September 2011

Report Summary 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 130 companies that have a neuroprotective product or products along with 108 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 are analyzed with suggestions for improving the selection of drugs and design of trials.The report is supplemented with 65 tables and 11 figures. Market analysis of currently used productsthat have a neuroprotective effect are analyzed for the year 2010. 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 2015 when it will constitute a major and important component of the CNS market. Forecasts are made until 2020. By that time neuroprotection will be an established part of the neurological practice and measures will be available to achieve this effectively.

Table of Content Table of Contents 0.Executive Summary23 1.Introduction27 Definitions27 Historical development of neuroprotection27 Intrinsic neuroprotective factors28 Neuroprotective gene expression29 Upregulation of GADD3429 Induction of NR4A proteins by CREB in neurons30 Neurotrophic factors30 Intrinsic nonenzymatic antioxidants30

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>> Get this Report Now by email! Activation of transcription factor Nrf231 Intrinsic neuroprotective proteins31 'B-crystallin31 Excitatory amino acid transporters31 Extracellular serine protease thrombin31 Galanin32 Neuroglobin32 Nuclear factor I-A32 Prion protein33 Rai adaptor protein33 Stem cell factor33 Role of the immune system in neuroprotection34 Induction of DNA repair enzymes for neuroprotection34 Pathomechanisms of CNS injury as basis for neuroprotection35 Biomarkers of neurological disorders and neuroprotection35 CNS biomarker identification using proteomics35 Brain imaging for detection of biomarkers36 Role of neuroprotection in various neurological disorders36 Neuroprotection and neuroregeneration37 Acute versus chronic neuroprotection37 Discovery and evaluation of neuroprotective agents38 Neuroprotective drug discovery38 Discovery of CNS drugs that penetrate the blood-brain barrier39 In vitro assays for the evaluation of neuroprotective agents39 Oxidative injury model to test neuroprotective drugs39 Apoptosis model for designing neuroprotective drugs40 Transgenic mouse models of neurological disorders40 Evaluating effects of neuroprotective drugs on living brain slices40 Role of brain imaging in neuroprotective drug discovery and development41 Positron emission tomography41 Role of single photon emission computed tomography41 Functional CT scanning to evaluate cerebrovascular protection42 Magnetic resonance imaging for the evaluation of neuroprotectives42 Application of nanotechnology to neuroprotection43 Evaluation criteria for potential neuroprotective agents43 2.Neuroprotective Agents45 Classification of neuroprotective agents45 Activated protein C49 Activity-dependent neuroprotective protein49 Adenosine analogs50 Propentofylline50 Antidepressants51 Antidepressant-induced neurogenesis51 Neurogenesis induced by electroconvulsive therapy51 Neuroprotective effect of selective serotonin reuptake inhibitors51 Antiepileptic drugs as neuroprotectives53 Phenytoin54 Valproic acid54

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>> Get this Report Now by email! Ion channel dysfunction in stroke128 Role of oxygen free radicals in cerebral ischemia129 Role of nitric oxide in cerebral ischemia129 Glutamate as a biomarker of stroke129 Cerebral edema in stroke129 Gene expression in response to cerebral ischemia130 Induction of heat shock proteins in stroke130 Role of cytokines and adhesion molecules in stroke130 Tumor necrosis factor-'130 Interleukin-1 and IL-6131 Adhesion molecules131 DNA damage and repair in cerebral ischemia131 Role of neurotrophic factors in stroke132 Problems requiring investigation of the role of NTFs in stroke132 Role of Poly(ADP-ribose) polymerase (PARP) gene132 Role of protease-activated receptor 1133 Reperfusion injury after cerebral ischemia133 Neuroprotection according to zones in cerebral infarction133 Zone of ischemic infarction133 Penumbra134 Current management of stroke134 Neuroprotection in stenosis of intracranial arteries135 Neuroprotection in transient ischemic attacks135 Neuroprotective therapies for stroke135 'B-crystallin as a neuroprotectant in stroke136 Acid-sensing ion channel blockers137 AMPA receptor antagonists as neuroprotectives for stroke137 Zonampanel137 Antiapoptotic neuroprotectives137 NIM811137 Creatine as neuroprotective in stroke138 Lithium as a neuroprotective in stroke138 TUDCA as a neuroprotective in stroke138 Coagulation inhibitors as neuroprotectives138 Heparin and enoxaparin139 Warfarin vs dabigatran139 Apixaban139 Antiepileptic drugs as neuroprotectives in stroke140 Tiagabine140 Topiramate140 Zonisamide140 Anti-HMGB1 monoclonal antibody140 Antioxidant approaches141 Carnosine as a neuroprotective in stroke141 Dehydroascorbic acid141 Tocotrienols142 Uric acid143 Antiglutamate compounds143

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>> Get this Report Now by email! MRZ 2/576143 L-Phenylalanine143 Arimoclomol for stroke143 Cardiac glycosides as neuroprotectives in stroke144 Clenbuterol144 Cox-2 inhibitors for ischemic stroke144 Docosahexaenoic acid for ischemic stroke144 Estrogen for stroke145 Extendin-4146 Flavones for neuroprotection in stroke146 Granulocyte-macrophage colony-stimulating factor for cerebral ischemia147 Modulation of histamine H2-receptors147 Inosine for stroke147 Insulin-like growth factor-I148 Intravenous immunoglobulin as neuroprotective in stroke148 Ischemic preconditioning for neuroprotection in stroke148 Ketone bodies for neuroprotection in stroke149 Mineralocorticoid receptor blockade for neuroprotection149 Multifunctional neuroprotective agents149 Nasal delivery of neuroprotective agents in stroke150 Neuroserpin as a neuroprotective in stroke150 N-2-mercaptopropionyl glycine150 NeuroAid151 Neurotrophic factors as neuroprotectives for stroke151 AX200151 Brain-derived neurotrophic factor151 Fibroblast growth factor152 Glial cell line-derived neurotrophic factor152 Insulin-like growth factor-1152 Neuregulin-1153 NO-based strategies for neuroprotection in cerebral ischemia153 Perlecan domain V154 Peroxisome proliferator-activated receptor-g agonists154 PGE2 EP2 receptor activation154 Pioglitazone for reduction of stroke risk in diabetes154 Progesterone154 Proteosome inhibitors155 Statins for prevention and neuroprotection in stroke155 Sildenafil156 Src receptor blockade156 Stroke vaccine156 SUN N4057157 Thrombosis inhibitors157 Aspirin157 Clopidogrel157 Dipyridamole158 Vitamin E for neuroprotection in stroke158 Neuroprotection in reperfusion injury158

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>> Get this Report Now by email! Simvastatin as neuroprotective in TBI204 Thyrotropin-releasing hormone analogs205 Traxoprodil205 Biological approaches to neuroprotection in TBI205 Antisense approaches to TBI205 Cell therapy for TBI206 Gene therapy for TBI206 Vaccines for TBI206 Non-pharmaceutical approaches to neuroprotection in TBI207 Hyperbaric oxygen therapy for TBI207 Hypothermia207 Reduction of microglial migration after TBI207 Deep brain stimulation for TBI207 Prophylactic neuroprotection against TBI208 Role of helmets in protection against TBI208 Role of physical exercise in protection against TBI208 Clinical trials of neuroprotective agents in TBI209 Ongoing clinical trials in TBI209 Failed clinical trials in TBI210 Differences between clinical trials and studies in animal models of TBI211 Subgroup analysis211 Improving the clinical trial design211 Clinical trials combining multiple treatment strategies212 Shortening the trial time212 Conclusions and future prospects of neuroprotection in TBI212 5.Neuroprotection in Spinal Cord Injury215 Introduction215 Pathophysiology of SCI215 Secondary mechanisms of SCI216 Neurotrophic factor changes in SCI217 Management of SCI218 Pharmacological neuroprotective agents for SCI219 4-aminopyridine219 Antibodies as neurite growth inhibitors in SCI219 Bacterial enzyme chondroitinase ABC219 Docosahexaenoic acid as neuroprotective in SCI220 Erythropoietin as a neuroprotective in SCI220 Free radical scavengers for neuroprotection in SCI220 Gacyclidine221 GYKI 52466221 Immunosuppressants as neuroprotectants in SCI221 Interleukin-10 for neuroprotection in SCI221 Matrix metalloproteinase inhibitors for SCI222 Methylprednisolone222 Minocycline as neuroprotective in SCI222 Neurotrophic factors for neuroprotection after SCI223 Promotion of regeneration of neurons in SCI223 Rho pathway and Rho antagonists in SCI224

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>> Get this Report Now by email! Selenium as a neuroprotective for SCI224 Sialidase for enhancing recovery after SCI224 Targeting the inflammatory response for neuroprotection in SCI225 Uric acid as neuroprotective in SCI225 Non-pharmacological approaches to SCI225 Hyperbaric oxygen therapy225 Hypothermia for SCI225 Cell therapy for SCI226 Autoimmune T cells against CNS myelin-associated peptide226 Fetal neural grafts for SCI226 Olfactory-ensheathing cells for SCI226 Oligodendrocyte precursor cells for treatment of SCI227 Schwann cell transplants for SCI227 Transplantation of glial cells for SCI227 Stem cells for SCI227 Bone marrow stem cells for SCI227 Embryonic stem cells for SCI228 Transplantation of induced pluripotent stem cells in SCI228 Transplantation of MSCs for SCI229 Transplantation of NSCs for SCI229 Transdifferentiation of stem cells into cholinergic neurons for SCI230 Gene therapy for SCI230 Combined approaches to spinal cord injury231 Discovery of new targets for neuroprotective therapies in SCI231 Clinical trials in SCI232 6.Neuroprotection in Neurodegenerative Disorders233 Introduction233 Pathomechanism of neurodegeneration233 Dual role of a-synuclein in neuroprotection and neurodegeneration233 Lack of neurotrophic factors234 Neuroinflammation in neurodegenerative disorders234 Neurodegeneration associated with protein misfolding234 Modulation of neurodegeneration by molecular chaperones234 Intrabodies targeting protein misfolding in neurodegeneration235 Targeting proteins aggregation to prevent amyloid formation235 Tau and neurodegeneration235 TDP-43 proteinopathy and neurodegenerative diseases236 Role of apoptosis in neurodegenerative disorders236 Role of glia in neurodegeneration236 Role of metals in neurodegeneration237 Viral infections and neurodegeneration237 AIDS and the nervous system237 Avian influenza as cause of neurodegeneration238 Genetic disorders with neurodegeneration239 Batten disease239 Friedrich ataxia240 Pathomechanism of FA240 Neuroprotection in FA240

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>> Get this Report Now by email! Neuroprotection in transverse myelitis359 Neuroprotection in decompression sickness359 Neuroprotection in hydrocephalus360 Neuroprotection in normal pressure hydrocephalus360 Neuroprotection in infections of the CNS361 Neuroprotection in bacterial meningitis361 Mechanism of neural injury in bacterial meningitis361 Strategies for neuroprotection361 Neuroprotective approach to rabies362 Neuroprotection in cerebral malaria362 Neuroprotection in hypertensive encephalopathy362 Neuroprotection in toxic encephalopathies363 Hepatic encephalopathy363 Management of hepatic encephalopathy364 Encephalopathy due to organophosphorus poisoning364 Neuroprotection against chemotherapy-induced brain damage365 Neuroprotection against alcohol365 Alcoholic neurologic disorders365 Fetal alcohol syndrome366 Pathogenesis of alcohol-induced damage to the nervous system366 Neuroprotection against neurotoxicity of alcohol366 Neuroprotection in hypoxia-ischemia367 Neuroprotection in neonatal hypoxic-ischemic brain injury367 Neuroprotection in carbon monoxide poisoning369 Pathomechanism of CO poisoning as a basis for neuroprotection369 Management of CO poisoning370 Syndrome of delayed post-hypoxic leukoencephalopathy370 Neuroprotection of the fetus371 Neuroprotection in sleep apnea371 Neuroprotection in hypoglycemic coma372 Neuroprotection in mitochondrial dysfunction373 Mitochondrial permeability transition373 Mitochondrial approaches for neuroprotection373 Methylene blue374 Role of nanolasers in evaluation of mitochondrial neuroprotectants374 Neuroprotection in mitochondrial encephalopathies375 Neuroprotection in psychiatric disorders375 Cognitive impairment in schizophrenia375 Neuroprotection in schizophrenia376 Electroconvulsive therapy and neuroprotection376 Neuroprotection in hearing loss376 Causes of hearing loss377 Pathomechanism of hearing loss377 Prevention and treatment of hearing loss378 Hyperbaric oxygen for hearing loss378 Stem cell therapy for hearing loss378 Auditory hair cell replacement by gene therapy379 Pharmaceutical approaches to hearing loss379

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>> Get this Report Now by email! Neuroprotection of peripheral nerves380 Neuroprotective agents for peripheral nerves380 Acetyl-L-carnitine for peripheral nerve injuries381 Atorvastatin for peripheral nerve injuries381 Erythropoietin for neuroprotection in peripheral nerve injuries381 Neuroprotection in peripheral nerve injuries382 Role of hyperbaric oxygen in peripheral nerve injuries382 Role of neurotrophic factors in peripheral nerve injuries382 Pharmacological approaches to Schwann cells382 Role of gene therapy in neuroprotection of injured peripheral nerves383 Schwann cell transplantation for peripheral nerve injury383 Peripheral neuropathy383 Neuroprotection in diabetic neuropathy383 Cell therapy for neuroprotection in diabetic neuropathy384 Gene therapy with zinc finger DNA-binding proteins384 Neuroprotection in chemotherapy-induced neuropathy384 Chronic inflammatory demyelinating polyradiculoneuropathy385 Neuroprotection in CIDP385 12.Neuroprotection of the Optic nerve and the Retina387 Introduction387 Neuroprotection in optic neuropathy387 Neuroprotection in optic neuritis388 Neuroprotection in optic nerve trauma388 Potential regeneration of the optic nerve389 Subthreshold transpupillary thermotherapy for protection of RGCs389 Neuroprotection of optic nerve in glaucoma389 Aminoguanidine as a neuroprotective in glaucoma39

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