Genistein and its use as a neuroprotective agent in stroke

Despite dramatic improvements in the use of thrombolytics and endovascular clot retrieval in the United States and other developed nations, ischemic stroke remains the second leading cause of death and disability worldwide, yet only one class of drug, thrombolytics, has shown clinical success. Because cerebral ischemia/reperfusion is a complex injury, including energy depletion, excitotoxicity, oxidative stress, inflammation, and other processes, it may not be surprising that targeting single molecules with pharmacological agents has not been successful. In contrast, pleiotropic agents may provide a better potential for reducing stroke injury. One potential agent is the isoflavone genistein, which is present in legumes and other vegetables. Growing evidence supports both preventative and therapeutic uses of genistein for cerebral ischemia. This chapter will review the mechanisms of action of genistein and its potential to prevent and treat focal cerebral ischemia through actions on the vascular system, lipid metabolism, inflammation, and cell survival.