A genetic approach to ischemic stroke therapy.

Stroke therapy will undergo a great revolution in the present decade. The knowledge of the human genome, gene interactions and proteomics will permit a new concept of drug development for stroke. Gene therapy by modification of gene expression will be useful to treat atherosclerosis and hypertensive microangiopathy, or in the acute phase, we will manipulate the acute gene expression induced by ischemia or the apoptotic gene program. However, a single abnormal gene, as in monogenic diseases, is easier to replace than several genes in complex multigenic disorders. Gene therapy, stem cell therapy and neurological grafts for stroke are still in the experimental phase, and many hurdles will have to be jumped before the introduction of these therapies into human clinical stroke trials. A more immediate clinical application of genetics to stroke therapy is the development of pharmacogenetics that analyzes the influence of genetic variability of individuals on drug response. A new era of personalized therapy is dawning where specific DNA biochips will help stroke clinicians to decide on the better use of thrombolytics, neuroprotectants, antithrombotics, statins or antihypertensives.