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Perispinal etanercept stroke trial design: PESTO and beyond.
Expert Opin Biol Ther
October 2024
Institute of Neurological Recovery, Boca Raton, FL, USA.
Introduction: Perispinal etanercept (PSE) is an innovative treatment designed to improve stroke recovery by addressing chronic post-stroke neuroinflammation. Basic science evidence, randomized clinical trial (RCT) evidence and 14 years of favorable clinical experience support the use of PSE to treat chronic stroke. This article provides guidance for the design of future PSE RCTs in accordance with current FDA recommendations.
View Article and Find Full Text PDFPerispinal Etanercept to improve STroke Outcomes (PESTO): Protocol for a multicenter, international, randomized placebo-controlled trial.
Eur Stroke J
September 2024
Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, VIC, Australia.
Rationale: A large proportion of stroke survivors will have long-lasting, debilitating neurological impairments, yet few efficacious medical treatment options are available. Etanercept inhibits binding of tumor necrosis factor to its receptor and is used in the treatment of inflammatory conditions. Perispinal subcutaneous injection followed by a supine, head down position may bypass the blood brain barrier.
View Article and Find Full Text PDFAutocrine positive feedback of tumor necrosis factor from activated microglia proposed to be of widespread relevance in chronic neurological disease.
Pharmacol Res Perspect
October 2023
St Vincent's Hospital Centre for Applied Medical Research, St Vincent's Hospital, Darlinghurst, Australia.
Over a decade's experience of post-stroke rehabilitation by administering the specific anti-TNF biological, etanercept, by the novel perispinal route, is consistent with a wide range of chronically diminished neurological function having been caused by persistent excessive cerebral levels of TNF. We propose that this TNF persistence, and cerebral disease chronicity, largely arises from a positive autocrine feedback loop of this cytokine, allowing the persistence of microglial activation caused by the excess TNF that these cells produce. It appears that many of these observations have never been exploited to construct a broad understanding and treatment of certain chronic, yet reversible, neurological illnesses.
View Article and Find Full Text PDFThe Potential Role of Etanercept in the Management of Post-stroke Pain: A Literature Review.
Cureus
March 2023
Neurocritical Care, University of Texas Southwestern Medical Center, Dallas, USA.
Strokes are the second leading cause of death and disability worldwide. The brain injury resulting from stroke produces a persistent neuroinflammatory response in the brain, resulting in a spectrum of neurologic dysfunction affecting stroke survivors chronically, also known as post-stroke pain. Excess production of tumor necrosis factor alpha (TNF alpha) in the cerebrospinal fluid (CSF) of stroke survivors has been implicated in post-stroke pain.
View Article and Find Full Text PDFRapid improvement in severe long COVID following perispinal etanercept.
Curr Med Res Opin
December 2022
Institute of Neurological Recovery, Boca Raton, FL, USA.
Article Synopsis
- The study investigated the effects of perispinal etanercept on a patient experiencing severe brain dysfunction due to long COVID, highlighting its potential to improve neurological conditions.
- Improvements were measured using various standardized tests assessing cognitive function, depression, fatigue, and motor skills, after administering a single 25 mg dose of etanercept.
- Results showed an immediate enhancement in neurological functions within 24 hours, including reduced fatigue and depression, as well as significant gains in cognitive performance and physical coordination.
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