A Concerted Appeal for International Cooperation in Preclinical Stroke Research

> Despite dramatic advances in the molecular pathogenesis of disease, translation of basic biomedical research into safe and effective clinical applications remains a slow, expensive, and failure-prone endeavor. > > Francis S. Collins1 The global burden of stroke on patients, their relatives, health systems, and the economies that support them is tremendous. In an unprecedented move, the World Health Organization (WHO) and the United Nations have responded to this challenge by declaring the fight against stroke a top priority in their drive to prevent and to control noncommunicable diseases.2 Indeed, great progress has been made in our understanding of stroke pathophysiology. This has led to the development of thrombolysis, a highly efficient therapy for a subset of patients with acute ischemic stroke. We came to realize that the responses of brain tissue to substrate deprivation are complex, and that not only neurons need to be considered but also glial and vascular cells, as well as local or blood-derived cells of the immune system.3–5 We now know that ischemia triggers a multitude of endogenous protective mechanisms in the brain which help to contain the ischemic lesion evolution and protect the brain from further damage.6 The brain has a tremendous capacity to overcome functional deficits, and as we begin to understand how brain plasticity works, we are actually finding evidence for tissue repair.7 We are also beginning to appreciate the interaction between the ischemic brain and the other organ systems, such as the immune system,8 the cardiovascular system, or systemic metabolism, a multidirectional signaling with tremendous impact on the outcome of patients with stroke.9 Taken together, research during the past few decades has suggested numerous targets for therapeutic intervention to restore perfusion, block mechanisms of damage, or induce endogenous mechanisms of protection, intercept deleterious signaling to …