Advances in brain remodeling, stem cell therapies, and translational barriers in stroke and brain aging.

As the brain ages, it undergoes a series of molecular and cellular changes that affect its structure and function, contributing to age-related disorders-particularly cerebrovascular diseases and diminished regenerative capacity following ischemic injury. Despite significant research efforts, effective therapies for brain rewiring and functional recovery after cerebral ischemia remain elusive. A deeper understanding of the cellular and molecular mechanisms involved in the post-acute phase of stroke may help identify novel therapeutic strategies for age-associated vascular pathologies. Recent advances have highlighted several promising areas, including epigenetic modifications of the vascular wall, blood-brain barrier remodeling, cell- and subcellular-based therapies, and innovative delivery methods. However, despite encouraging preclinical findings, clinical trials have produced mixed results regarding the safety and efficacy of cell-based interventions. These outcomes suggest that successful stroke therapies in aging populations may require a multistage, integrative approach.