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A (mini) pill for stroke?

Malcolm Macleod
DOI: http://dx.doi.org/10.1093/brain/awt365 311-312 First published online: 5 February 2014

In this issue of Brain, Bushra Wali et al. (2014) describe the efficacy of progesterone in an animal model of ischaemic stroke and, in so doing, provide data of importance for clinical translation, while at the same time raising the bar for high quality reporting of in vivo research (Wali et al., 2014).

The development of new treatments for stroke is a tricky business (O'Collins et al., 2006), and so finding an established drug that might have therapeutic efficacy is a tantalizing prospect. Abundant preclinical data support a neuroprotective effect of progesterone in experimental stroke and traumatic brain injury, and a phase III trial is under way. Given that the safety profile of progesterone is already known, such reprovisioning would accelerate drug development. A potential confounding influence is sex- and age-related differences in circulating progesterone. Women who experience stroke are usually post-menopausal, and modelling the menopause in animals is generally achieved by ovariectomy. In a meta-analysis of the effects of progesterone in animal models of focal cerebral ischaemia, Wong et al. (2013) found that progesterone increased mortality in young female hormonally-intact animals, and had no effect on lesion volume in adult ovariectomized females (Wong et al., 2013). In human studies, patients …

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