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(Stroke. 2004;35:1197.)
© 2004 American Heart Association, Inc.

Original Contributions

Combination Therapy in Ischemic Stroke: Synergistic Neuroprotective Effects of Memantine and Clenbuterol

Carsten Culmsee, PhD; Vera Junker, MD; Wolfram Kremers, PharmD; Serge Thal, MD; Nikolaus Plesnila, MD Josef Krieglstein, MD, PhD

From Institut für Pharmakologie und Toxikologie (C.C., V.J., W.K., J.K.), Philipps-Universität, Marburg, Germany; Department Pharmazie (C.C.) and Institut für Chirurgische Forschung (S.T., N.P.), Ludwig-Maximilians-Universität, München, Germany.

Correspondence to Dr Carsten Culmsee, Biotechnologie, Department Pharmazie, Zentrum für Arzneimittelforschung, Ludwig-Maximilians-Universität, Butenandtstraße 5-13 D, D-81377 München, Germany. E-mail ccuph{at}cup.uni-muenchen.de

Background and Purpose— Although excitotoxic overactivation of glutamate receptors has been identified as a major mechanism of ischemic brain damage, glutamate receptor antagonists failed in stroke trials, in most cases because of limited therapeutic windows or severe adverse effects. Therefore, we chose memantine and clenbuterol, both approved safe and efficient in their respective therapeutical categories, and examined combinations of these neuroprotectants for possible therapeutic interactions in ischemic stroke.

Methods— Combinations of the N-methyl-D-aspartate (NMDA) receptor antagonist memantine (20 mg/kg) with the ß₂-adrenoceptor agonist clenbuterol (0.3 to 3 mg/kg) were tested in a mouse model of permanent focal cerebral ischemia. In addition, combinations of memantine (1 to 10 nmol/L) and clenbuterol (1 to 10 nmol/L) were examined in cultured hippocampal neurons exposed to glutamate (500 µmol/L) or staurosporine (200 nmol/L).

Results— The infarct size was further reduced by combination therapy as compared with effects of the respective neuroprotectants alone. Of note, in combination with memantine, the therapeutic window of clenbuterol was significantly prolonged up to 2 hours after ischemia. Experiments in postnatal cultures of rat hippocampal neurons exposed to glutamate or staurosporine confirmed that neuroprotection by combinations of memantine and clenbuterol exceeded the effects of the individual compounds.

Conclusions— Combinations of memantine with clenbuterol extend the respective therapeutic window and provide synergistic cerebroprotective effects after stroke.

Key Words: cerebral ischemia • N-methyl-D-aspartate • neurons • glutamates

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