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Ischemic cerebrovascular diseases are leading cause of mortality and disability worldwide. Given the need for a pharmacological treatment for these diseases, agmatine has gained great interest due to its neuroprotective properties.

This article explores these properties of agmatine in ischemic events and their underlying mechanisms. Agmatine, considered as a neuromodulator, exerts its effects through its interaction with various molecular targets, including glutamate receptors, nitric oxide synthase, and metalloproteinases. Its ability to cross the blood-brain barrier and its role in neurotransmission processes postulate agmatine as a potential candidate for neuroprotection. Agmatine has a positive effect in the central nervous system to counteract excitotoxicity, oxidative stress, inflammation, alteration of the blood-brain barrier and energy disorders during ischemic events. This review describes the multiple interactions of agmatine within the ischemic cascade known to date, showing its ability to mitigate free radical formation, attenuate excitotoxicity, modulate inflammatory responses, stabilize the blood-brain barrier, and preserve mitochondrial function.

These properties position agmatine as a promising therapeutic agent for ischemic cerebrovascular diseases.