Editorial [Hot topic: Stroke as a Target in Medicinal Chemistry and Drug Discovery (Guest Editor: Antonino Tuttolomondo)]

“Time Is Brain”, this is the guide principle of American Guidelines of Stroke Management [1]. This principle derives from the notion that neurons die within a few minutes of oxygen deprivation. Thus, some neuronal death occurs in areas of no blood flow within minutes of stroke onset. Around such areas of necrosis exist regions of hypoperfused, electrically silent tissue that barely receives enough blood flow to keep neurons alive. This tissue area is called the “ischemic penumbra”. A major goal of acute stroke management is resuscitation of the ischemic penumbra. If reperfusion of the penumbra occurs expeditiously, neurons recover and the patient improves; with no reperfusion, a time-related attrition converts ailing neurons to frank infarction. Because of the time-dependent death of neurons in the ischemic penumbra, emphasis should be placed on the earliest possible intervention. Due to the complexity of the brain and the heterogenicity of the disease, ischemic stroke (IS) treatment has been known to be challenging and risky. Current therapies to treat IS are severely limited and most treatments have a narrow therapeutic window after the onset of the disease and often lead to severe side effects such as internal bleeding. Nevetheless, ischemic stroke is a potential treatable disease. Because of the limited treatment options currently available and significant unmet medical needs, opportunities exist for the development of novel, safer, more effective IS treatments with a broader therapeutic window. Possible therapeutic targets in acute stroke treatment are: Neuron damage (neuroprotection) Lysing the thrombus Inflammation (immuno-inflammatory activation of the acute phase) High arterial blood pressure of the acute phase to blood pressure of the acute phase High glucose blood levels of the acute levels High cholesterol plasma levels Platelet hyperactivity