Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
Shiraz University of Applied Science and Technology (UAST), Shiraz, Iran.
J Neurosci Res. 2023 Sep;101(9):1433-1446. doi: 10.1002/jnr.25202. Epub 2023 May 14.
Dimethyl fumarate (DMF) is an immunomodulatory drug currently approved for the treatment of multiple sclerosis and psoriasis. Its benefits on ischemic stroke outcomes have recently come to attention. To date, only tissue plasminogen activators (tPAs) and clot retrieval methods have been approved by the FDA for the treatment of ischemic stroke. Ischemic conditions lead to inflammation through diverse mechanisms, and recanalization can worsen the state. DMF and the nuclear factor erythroid-derived 2-related factor 2 (Nrf2) pathway it regulates seem to be important in postischemic inflammation, and animal studies have demonstrated that the drug improves overall stroke outcomes. Although the exact mechanism is still unknown, studies indicate that these beneficial impacts are due to the modulation of immune responses, blood-brain barrier permeability, and hemodynamic adjustments. One major component evaluated before, during, and after tPA therapy in stroke patients is blood pressure (BP). Recent studies have found that DMF may impact BP. Both hypotension and hypertension need correction before treatment, which may delay the appropriate intervention. Since BP management is crucial in managing stroke patients, it is important to consider DMF's role in this matter. That being said, it seems further investigations on DMF may lead to an alternative approach for stroke patients. In this article, we discuss the mechanistic roles of DMF and its potential role in stroke based on previously published literature and laboratory findings.
富马酸二甲酯（DMF）是一种免疫调节剂药物，目前已被批准用于治疗多发性硬化症和银屑病。其对缺血性脑卒中结局的益处最近引起了关注。迄今为止，只有组织型纤溶酶原激活剂（tPA）和血栓清除方法被 FDA 批准用于治疗缺血性脑卒中。缺血条件通过多种机制导致炎症，再通可能使病情恶化。DMF 及其调节的核因子红细胞衍生 2 相关因子 2（Nrf2）途径似乎在缺血后炎症中很重要，动物研究表明该药物改善了整体脑卒中结局。尽管确切的机制尚不清楚，但研究表明这些有益影响是由于免疫反应、血脑屏障通透性和血液动力学调节的调节。在接受 tPA 治疗前后，评估脑卒中患者的一个主要指标是血压（BP）。最近的研究发现 DMF 可能会影响 BP。在治疗前，低血压和高血压都需要纠正，这可能会延迟适当的干预。由于血压管理对脑卒中患者的管理至关重要，因此需要考虑 DMF 在这方面的作用。也就是说，对 DMF 的进一步研究可能会为脑卒中患者提供一种替代治疗方法。在本文中，我们根据已发表的文献和实验室研究结果，讨论了 DMF 的作用机制及其在脑卒中治疗中的潜在作用。
