RNA-based approaches for neuroprotection and recovery in ischemic stroke: current evidence and future directions

Abstract Ischemic stroke remains a leading cause of mortality and long-term disability worldwide, necessitating innovative therapeutic approaches beyond conventional treatments. RNA-based therapeutics have emerged as a promising strategy to modulate key pathological processes involved in stroke, including neuroinflammation, apoptosis, oxidative stress, and neurovascular dysfunction. Small interfering RNA (siRNA) and microRNA (miRNA)-based therapies enable post-transcriptional gene silencing to downregulate deleterious pathways, while messenger RNA (mRNA) and long non-coding RNA (lncRNA)-based strategies promote neuroprotection and neuronal recovery. Despite significant preclinical advancements, several challenges hinder clinical translation, including blood-brain barrier (BBB) permeability, RNA stability, immune responses, off-target effects, and efficient intracellular delivery. Recent breakthroughs in nanoparticle-based delivery systems, exosome-mediated transport, and CRISPR-based RNA editing offer novel solutions to these limitations, paving the way for precision medicine approaches in stroke treatment. Future research must focus on optimizing RNA formulations, refining delivery mechanisms, and conducting rigorous clinical trials to establish their safety and efficacy in stroke patients. If successfully translated into clinical practice, RNA-based therapeutics have the potential to revolutionize stroke management by providing targeted, disease-modifying interventions that enhance functional recovery and reduce long-term neurological deficits.