Basic and Translational Research in Intracerebral Hemorrhage
Limitations, Priorities, and Recommendations
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Hemorrhagic stroke remains a major cause of mortality and permanent disability. There are unmet needs for effective therapies to improve outcomes after hemorrhagic stroke, in particular, intracerebral hemorrhage (ICH). Modeled after the STAIR (Stroke Therapy Academic Industry Roundtable) meetings,1,2 the first HEADS (Hemorrhagic Stroke Academia Industry) roundtable was convened in May 2017. The meeting focused on ICH. Participants were asked to define unmet needs and challenges in the field. They were then divided into 2 working subgroups, basic and clinical research, and tasked with the development of recommendations and benchmark standards to improve the process of researching, developing, and refining therapies for ICH. Emerging recommendations for preclinical and translational research are presented in the current report. Recommendations for clinical research and trial design are discussed in a companion article. Preclinical research into ICH is focused on 3 broad goals: elucidating the mechanisms causing ICH; determining the local and systemic pathways that underlie ICH-induced brain injury, self-defense, and repair; developing preclinical therapies that can translate to the clinic to limit ICH occurrence and expansion, reduce injury severity, and improve repair and functional recovery. Aims of this part of the HEADS roundtable discussion were to (1) highlight limitations in such preclinical research and, thereby, develop priorities for future research and (2) outline recommendations for more effective clinical translation of preclinical research. Although the STAIR guidelines1,2 for preclinical ischemic stroke research has application to hemorrhagic stroke, the outlined discussion particularly focused on identifying specific needs in the ICH field.
Preclinical Modeling of ICH
Preclinical research on ICH has mostly focused on reducing ICH-induced brain injury rather than preventing hemorrhage. There are relatively few preclinical models of spontaneous ICH to test hemorrhage prevention strategies and new models are critical (Table 1), particularly for the more common risk factors of ICH (hypertension and …