A Phase 3 interventional study of Trimetazidine in Acute Ischemic Stroke, sponsored by Ain Shams University. Completed at 1 site in Egypt. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2025-09-08.
Sponsored by Ain Shams University · Phase 3, Interventional, and Treatment
The investigators need to test the effect of Trimetazidine on the pro-inflammatory marker Interleukin - 18 , NIHSS score, and mRs score of acute ischemic stroke patients.
Trimetazidine is a well-known anti-anginal drug that exerts its effect by converting the cell's metabolism from fatty acid oxidation to glucose oxidation. This is contrary to what occurs during a stroke event, in which the cell's metabolism is shifted to fatty acid metabolism. It also improves the activity of pyruvate dehydrogenase, the enzyme that allows the entry of pyruvate from the cytosol into the mitochondria for subsequent oxidation in the Krebs cycle. Therefore, attenuating lactic acid production, controlling intracellular acidosis and calcium ion overload, thus conserving valuable ATP stores to meet energy requirements and preventing the occurrence of further ischemia. Clinical reports indicate that trimetazidine restores energy homeostasis and attenuates free radical generation to exhibit benefits in ischemia and angina pectoris.
An increasing number of studies have focused on the effect of Trimetazidine on myocardial I/R injury, and some studies have proposed possible hypotheses. Trimetazidine protects against myocardial I/R injury and is presumed to be related to autophagy, apoptosis, and oxidative stress, which are all pathways in stroke.
An in vitro study proving the role of Trimetazidine in apoptosis found that trimetazidine protected muscle cells against starvation or inflammation-induced atrophy by inhibiting protein degradation and inducing autophagy. It has recently been shown to ameliorate lipopolysaccharide (LPS)-induced cardiomyocyte pyroptosis: which plays an important role in the development of muscle atrophy by promoting neutrophil migration to cardiac tissue. It was shown that Trimetazidine mitigated the mRNA expression of pyroptosis-related molecules, including NLRP3, Caspase-1, and GSDMD.25 In another in vitro study, it was found that TMZ reduced the myocardial infarct size and decreased the expression of TLR4, MyD88, phospho-NF-κB p65, and the NLRP3 inflammasome.
Furthermore, a study assessing the effect of TMZ on cerebral I/R injury proved that it reduced infarct volume compared with the vehicle-treated reperfused animals and significantly decreased the percentage of brain swelling in the TMZ-treated groups.
Trimetazidine in a clinical study added to the standard of care with or without interventional and/or surgical reperfusion reduced oxidative stress, endothelial dysfunction, inflammation, and major acute cardiovascular events, whereas, in patients with chronic coronary syndrome, TMZ decreased oxidative stress and readmission for ACS and heart failure.
Moreover, there is a recent clinical trial that has proven that Trimetazidine significantly reduced the serum levels of interleukin - 18 in patients with acute viral myocarditis compared to the control group.
This makes it possible to detect the severity of the stroke event by measuring the serum levels of interleukin - 18. It is a pro-inflammatory cytokine, that is encoded by the IL-18 gene in humans. It is likely to be the first line of immune defense for the brain, primarily secreted by macrophage cells and mononuclear cells in humans. It is initially expressed as the inactive precursor pro-IL-18. It is then converted into an active form by proteolytic cleavage, mainly by the cysteine protease caspase-1, which is also known as IL-1B converting enzyme (ICE).
Some researchers have proposed the hypothesis that a pro-inflammatory profile induced by increased IL-18 levels creates a prothrombotic and pro-atherosclerotic environment, which may eventually contribute to stroke in older people. These results are consistent with the results of a meta-analysis study which proved that there is a significant association between IL-18 level and NIHSS scores that makes it a strong tool for reflecting the severity of stroke and for predicting the prognosis.
2,612 studies on the registry are indexed under Ischemic Stroke; 971 are open to participants now.
This study's enrollment of 60 is below the median of 120 across 1,776 interventional studies indexed under Ischemic Stroke.
Browse Ischemic Stroke studies →Ain Shams University is the lead sponsor of 1,950 studies on the registry; 429 are open to participants now.
Of its 35 completed or terminated interventional studies of FDA-regulated products, 0 (0%) have results posted.
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Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.
Exclusion Criteria:
Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Blood tests of how long blood takes to clot. The INR is the prothrombin time (PT) put on a common scale; about 1 is usual for someone not taking a blood thinner.
Criteria often make an exception for people on a blood thinner such as warfarin, whose INR is raised on purpose.
Two enzymes measured in a routine blood test of the liver. Higher levels can mean the liver is under strain or damaged. SGPT and SGOT are older names for ALT and AST.
Criteria usually give a limit as a multiple of the upper limit of normal (ULN), often higher when cancer has spread to the liver.
Blood cells that help blood clot. Too few raises the risk of bleeding and bruising. A usual adult range is about 150–400 × 10⁹/L (150,000–400,000 per µL); each lab has its own reference range.
How quickly the kidneys clear creatinine, a waste product, from the blood. A study may estimate it from a blood test with age, weight and sex (often by the Cockcroft–Gault formula), or measure it using blood and urine collected over a set time. Given in mL/min; higher is better.
A reason a treatment, test or procedure should not be given to a particular person, such as an allergy, another illness or a medicine they take.
An allergy, or another reaction of the immune system, to a substance. “Hypersensitivity to the study drug” means a known allergic reaction to it — not every side effect a medicine can have.
INR, PT and aPTT (clotting tests)
Blood tests of how long blood takes to clot. The INR is the prothrombin time (PT) put on a common scale; about 1 is usual for someone not taking a blood thinner.
Criteria often make an exception for people on a blood thinner such as warfarin, whose INR is raised on purpose.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
ALT and AST (liver enzymes)
Two enzymes measured in a routine blood test of the liver. Higher levels can mean the liver is under strain or damaged. SGPT and SGOT are older names for ALT and AST.
Criteria usually give a limit as a multiple of the upper limit of normal (ULN), often higher when cancer has spread to the liver.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Platelets
Blood cells that help blood clot. Too few raises the risk of bleeding and bruising. A usual adult range is about 150–400 × 10⁹/L (150,000–400,000 per µL); each lab has its own reference range.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Creatinine clearance (CrCl)
How quickly the kidneys clear creatinine, a waste product, from the blood. A study may estimate it from a blood test with age, weight and sex (often by the Cockcroft–Gault formula), or measure it using blood and urine collected over a set time. Given in mL/min; higher is better.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Contraindication
A reason a treatment, test or procedure should not be given to a particular person, such as an allergy, another illness or a medicine they take.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Hypersensitivity
An allergy, or another reaction of the immune system, to a substance. “Hypersensitivity to the study drug” means a known allergic reaction to it — not every side effect a medicine can have.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
AIS patients receiving standard of care and Trimetazidine 35mg/12hrs within 12 hours of admission
Drug: Trimetazidine
AIS patients receiving standard of care only.
an anti-ischemic medication.
Also known as: Vastarel Mr, Metacardia Mr
Serum level of interleukin -18
A decrease in the serum level of the pro-inflammatory marker.
Time frame: 7 days
National Institutes of Health Stroke Scale
An improvement in the NIHSS score Minimum: 1 Maximum: 42
Time frame: 7 days
The Modified Rankin Score
An improvement in the mRs score Minimum: 0 Maximum: 6
Time frame: 90 days
Adverse Effects
Any adverse effect that appeared on the patients.
Time frame: Till we reach out sample size: 60 patients (assessed within 1 year)
This study is completed, as verified in Aug 2025. You cannot join it, but the record below documents what was studied.
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