“…26 However, it has also been demonstrated that excessive PARP activation by various triggers resulting in depletion of NAD + and subsequent cellular ATP depletion ultimately leads to a necrotic-type cell death. 5,32,41,49 There is accumulating evidence that excessive PARP activation plays a key role in mediating ischemia-reperfusion-induced cerebral injury 10,11,38,42 and that infarct volume can be dramatically reduced by PARP inhibition and in PARP knock-out mice. 9,37,38 Cerebral ischemia results in massive activation of N-methyl-D-aspartat (NMDA) receptors via an increase of extracellular glutamate leading to elevated intracellular calcium concentrations, activation of neuronal NO synthase (nNOS), increased NO and ROS formation and ultimately to PARP-activating DNA damage.…”