title: Should the STAIR criteria be modified for preconditioning studies?
abstract: Diverse preconditioning (PC) stimuli protect against a wide variety of neuronal insults in animal models, engendering enthusiasm that PC could be used to protect the brain clinically. Candidate clinical applications include cardiac and vascular surgery, after subarachnoid hemorrhage, and prior to conditions in which acute neuronal injury is anticipated. However, disappointments in clinical validation of multiple neuroprotectants suggest potential problems translating animal data into successful human therapies. Thus, despite strong promise of preclinical PC studies, caution should be maintained in translating these findings into clinical applications. The Stroke Therapy Academic Industry Roundtable (STAIR) working group and the National institute of Neurological Diseases and Stroke (NINDS) proposed working guidelines to improve the utility of preclinical studies that form the foundation of therapies for neurological disease. Here, we review the applicability of these consensus criteria to preconditioning studies and discuss additional considerations for PC studies. We propose that special attention should be paid to several areas, including 1) safety and dosage of PC treatments; 2) meticulously matching preclinical modeling to the human condition to be tested; and 3) timing of both the initiation and discontinuation of the PC stimulus relative to injury ictus.
authors: Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA ; Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, Michigan, USA ; Neurology Service, VA Ann Arbor Healthcare System, Ann Arbor, Michigan USA.
authors: Michael M
authors: MM
authors: Wang
authors: Guohua
authors: G
authors: Xi
authors: Richard F
authors: RF
authors: Keep
mesh_terms: D001921:Brain / Q000098:blood supply*; D002545:Brain Ischemia / Q000628:therapy*; D006801:Humans; D019194:Ischemic Preconditioning; D017410:Practice Guidelines as Topic; D057170:Translational Research, Biomedical
keywords: STAIR; ischemic tolerance; preconditioning; remote ischemic preconditioning; translational research