Inclusion Criteria1. Male or female 18 to 85 years of age at the time of signing the informed consent form.
2. Patient or patient's legal representative must understand and voluntarily sign the informed consent form prior to any study-related assessments/procedures are conducted.
3. Able to adhere to the study visit schedule and other protocol requirements.
4. A female of childbearing potential must have a negative serum at screening and negative urine pregnancy test prior to treatment with study therapy. In addition, sexually active females of childbearing potential must agree to use two of the following adequate forms of contraception methods simultaneously: oral, injectable or implantable hormonal contraception; tubal ligation; intrauterine device; barrier contraceptive with spermicide; or vasectomized partner for the duration of the study and the follow-up period. Males, including those who have had a vasectomy, must agree to use barrier contraception (latex condoms) when engaging in reproductive sexual activity with a female of childbearing potential for the duration of study and follow-up period.
5. Must have a diagnosis of ischemic stroke and be stable enough to be randomized to treatment within 5 to 10 days after the onset of stroke symptoms. The stroke event needs to involve the middle cerebral artery (MCA) territory (cortical or subcortical) or posterior cerebral artery (PCA) territory with ischemic stroke confirmed by magnetic resonance imaging (MRI). Ischemic stroke is defined as death of an area of brain tissue (cerebral infarction) resulting from an inadequate supply of blood and oxygen to the brain.
6. National Institute of Health Stroke Scale (NIHSS) score ≥3 but <22 at the time of screening, at least 3 days after the onset of stroke symptoms. Patient should not have shown rapid improvement (≥8 point decrease since the onset of stroke symptoms) or deterioration (≥4 point increase since the beginning of screening) in the NIHSS score from time of initial evaluation to randomization. The time from initial evaluation to initial screening evaluation will be at least 72 hours.
7. New onset of extremity paresis on the affected side, defined as a score of 2 to 4 on the NIHSS Motor Arm (item 5) or Leg (item 6) question.
8. Must be alert or drowsy but easily arousable as defined by a score of 0 to 1 on the NIHSS Level of Consciousness question (item 1).
9. "Slow recovery" defined as change in NIHSS ≤1 point/3 days during the screening period.
10. Able to participate in the evaluation process to the point of accurate assessment with/without help.
11. Willing and able to comply with scheduled visits, lifestyle guidelines, treatment plan, laboratory tests, and other study procedures.
12. Must be willing to discontinue applying any topical preparations containing Vitamin A acids (including all-trans-retinoic acid [tretinoin], 13-cis-retinoic acid [isotretinoin], 9 cisretinoic acid [alitretinoin], vitamin A [retinol], retinal, and their derivatives) to any part of the body starting on Day 1 until study completion. (TF0023 may cause dry and/or itching skin. Curél Ultra Healing Lotion can be applied to the dry and/or itching skin).
Exclusion Criteria1. Pregnant or lactating female.
2. Any condition, including any significant medical or neuropsychiatric condition, including the presence of laboratory abnormalities, which in the judgment of the investigator places the patient at unacceptable risk if he/she were to participate in the study or confounds the ability to interpret data from the study including, but not limited to:
- Aspartate transaminase (AST) or alanine transaminase (ALT) >3 × the upper limit of normal (ULN) at screening.
- Serum creatinine concentration >1.5 times the ULN at screening. Estimated glomerular filtration rate (GFR) <60 mL/min/1.73 m2 is exclusionary.
- Bilirubin or alkaline phosphatase level >2.5 × the ULN at screening.
- Glucose <50 mg/dL or >450 mg/dL despite adequate anti-hyperglycemic treatment.
- Platelet count <100 × 109/L.
3. History of bacteremia or other serious bacterial or fungal infection requiring treatment with intravenous antibiotics within 84 days (12 weeks) prior to treatment with study therapy other than a treated urinary tract infection.
4. Known infection with human immunodeficiency virus (HIV).
5. Seropositive for hepatitis C or hepatitis B.
6. Known history of seizures.
7. Evidence of cerebral hemorrhage within the last 6 months or recent intracerebral hematomas detected by brain CT or MRI.
8. Hypertension with systolic blood pressure (SBP) >185 mmHg or diastolic blood pressure (DBP) >120 mmHG (mean of 3 consecutive arm cuff readings over 20 to 30 minutes).
9. High clinical suspicion of septic embolus.
10. History of major trauma at time of stroke.
11. History of malignancy within 5 years except basal cell or squamous cell carcinoma of the skin or remote history of cancer now considered cured or positive Pap smear with subsequent negative follow up.
12. Known allergy to non-steroidal anti-inflammatory drugs (NSAIDs).
13. Known allergy to both gadolinium and iodine based contrast agents for MRI preventing the ability to conduct either one of these procedures.
14. Patient has received an investigational agent within 90 days or 5 half-lives, whichever is longer, prior to treatment with study therapy or planned participation in another therapeutic trial prior to the completion of this study.
15. Patients with very light neurological symptoms (NIHSS score of <3) or with rapidly improving symptoms before the start of treatment.
16. Patients with serious neurological disorders (NIHSS score ≥22) or serious consciousness disorders before the start of treatment.
17. Patients with functional disorders (mRS score >2) before onset of the stroke.
18. Patients who have been administered drugs that are not allowed to be administered concomitantly with any anti-thrombotic agents after onset of the stroke.
19. Patients who are forbidden to undergo DTI-MRI.
20. Patients with symptoms suggesting subarachnoid hemorrhage (SAH).
21. Patients with hemorrhage (gastrointestinal hemorrhage, urinary hemorrhage, retroperitoneal hemorrhage, or hemoptysis).
22. Patients who have been administered oral anticoagulants with values of the international normalized ratio (INR) of prothrombin time (PT-INR) >1.7.
23. Patients who have a history of intracranial hemorrhage, or who have a disease considered to increase the risk of intracranial hemorrhage such as an intracranial tumor, cerebral aneurysm, or intracranial arteriovenous malformation, etc.
24. Patients who were operated on or injured their head or spinal cord within 3 months before onset of the stroke.
25. Patients who have a history of gastrointestinal or urinary tract hemorrhage within 21 days before onset of the stroke.
26. Patients who had a major surgery or serious trauma (except for head or spinal cord trauma) within 14 days before onset of the stroke.
27. Patients who had an organ biopsy, arterial puncture, or lumbar puncture within 14 days before the onset of the stroke.
28. Patients with severe hepatic dysfunction or severe renal dysfunction.
29. Patients with acute pancreatitis.
30. Patients with concurrent infectious endocarditis, moyamoya disease (Willis circle occlusion syndrome), aortic dissection, or neck trauma, etc.
31. Patients judged to be difficult in monitoring for 4 to 7 months by their physician.
32. In addition to the above exclusion criteria, patients judged to be inadequate to participate in this study by their physician.