Department of Anatomy & Neurobiology, University of California, Irvine, 200 S Manchester Avenue, Suite 206, Orange, CA 92868, USA.
Pharmacogenomics. 2013 Oct;14(13):1635-43. doi: 10.2217/pgs.13.152.
Relatively few pharmacological agents are part of routine care for neural injury, although several are used or under consideration in acute stroke, chronic stroke, traumatic brain injury and secondary stroke prevention. Tissue plasminogen activator is approved for the treatment of acute ischemic stroke, and genetic variants may impact the efficacy and safety of this drug. In the chronic phase of stroke, several drugs such as L-dopa, fluoxetine and donepezil are under investigation for enhancing rehabilitation therapy, with varying levels of evidence. One potential reason for the mixed efficacy displayed by these drugs may be the influence of genetic factors that were not considered in prior studies. An understanding of the genetics impacting the efficacy of dopaminergic, serotonergic and cholinergic drugs may allow clinicians to target these potential therapies to those patients most likely to benefit. In the setting of stroke prevention, which is directly linked to neural injury recovery, the most highly studied pharmacogenomic interactions pertain to clopidogrel and warfarin. Incorporating pharmacogenomics into neural injury recovery has the potential to maximize the benefit of several current and potential pharmacological therapies and to refine the choice of pharmacological agent that may be used to enhance benefits from rehabilitation therapy.
尽管有几种药物用于急性中风、慢性中风、创伤性脑损伤和中风二级预防，但在神经损伤的常规治疗中，只有相对较少的药物是专门的。组织型纤溶酶原激活物被批准用于治疗急性缺血性中风，遗传变异可能会影响该药物的疗效和安全性。在中风的慢性期，几种药物，如左旋多巴、氟西汀和多奈哌齐，正在被研究用于增强康复治疗，其证据水平各不相同。这些药物疗效不一的一个潜在原因可能是遗传因素的影响，而这些因素在以前的研究中并未考虑到。了解影响多巴胺能、5-羟色胺能和胆碱能药物疗效的遗传因素，可能使临床医生能够将这些潜在的治疗方法针对那些最有可能受益的患者。在与神经损伤恢复直接相关的中风预防方面，研究最多的药物基因组学相互作用与氯吡格雷和华法林有关。将药物基因组学纳入神经损伤恢复中，有可能最大限度地提高几种现有和潜在的药物治疗的效果，并改善选择用于增强康复治疗效果的药物。
