Accumulating evidence advances the critical role of autophagy in brain pathology after stroke. Investigations employing autophagy induction or inhibition using pharmacological tools or autophagy-related gene knockout mice have recently revealed the biological significance of intact and functional autophagy in stroke. Most of the reported cases attest to a pro-survival role for autophagy in stroke, by facilitating removal of damaged proteins and organelles, which can be recycled for energy generation and cellular defenses. However, these observations are difficult to reconcile with equally compelling evidence demonstrating stroke-induced upregulation of brain cell death index that parallels enhanced autophagy. This begs the question of whether drug-induced autophagy during stroke culminates in improved or worsened pathological outcomes. A corollary fascinating hypothesis, but presents as a tricky conundrum, involves the effects of autophagy on cell death and inflammation, which are two main culprits in the disease progression of stroke-induced brain injury. Evidence has extended the roles of autophagy in inflammation via cytokine regulation in an unconventional secretion manner or by targeting inflammasomes for degradation. Moreover, in the recently concluded Vancouver Autophagy Symposium (VAS) held in 2014, the potential of selective autophagy for clinical treatment has been recognized. The role of autophagy in ischemic stroke has been reviewed previously in detail. Here, we evaluate the strength of laboratory and clinical evidence by providing a comprehensive summary of the literature on autophagy, and thereafter we offer our perspectives on exploiting autophagy as a drug target for cerebral ischemia, especially in hemorrhagic stroke.

越来越多的证据表明中风后自噬在脑病理学中的关键作用。最近，使用药理学工具或自噬相关基因敲除小鼠进行自噬诱导或抑制的研究表明，完整和功能性自噬在卒中中具有生物学意义。大多数报道的病例通过促进清除受损的蛋白质和细胞器而证明了自噬在卒中中具有生存作用，这些蛋白质和细胞器可以回收用于能量产生和细胞防御。但是，这些观察结果很难与同样令人信服的证据相吻合，这些证据表明中风引起的脑细胞死亡指数上调与自噬增强相平行。这就引出了中风期间药物诱导的自噬最终导致病理结果改善还是恶化的问题。一个引人入胜的假说，但表现为棘手的难题，涉及自噬对细胞死亡和炎症的影响，这是中风诱发的脑损伤疾病进展的两个主要原因。证据通过以非常规的分泌方式调节细胞因子或靶向炎症小体进行降解，从而扩展了自噬在炎症中的作用。此外，在2014年举行的最近结束的温哥华自噬研讨会（VAS）中，人们已经认识到选择性自噬在临床治疗中的潜力。自噬在缺血性中风中的作用已在前面进行了详细的审查。在这里，我们通过提供有关自噬的文献的全面总结来评估实验室和临床证据的实力，