Department of Neurosurgery, Miami Project to Cure Paralysis, University of Miami, Miami, FL, USA,
Transl Stroke Res. 2013 Feb;4(1):25-39. doi: 10.1007/s12975-012-0226-1. Epub 2012 Nov 15.
Traumatic brain injury (TBI) treatment is now focused on the prevention of primary injury and reduction of secondary injury. However, no single effective treatment is available as yet for the mitigation of traumatic brain damage in humans. Both chemical and environmental stresses applied before injury have been shown to induce consequent protection against post-TBI neuronal death. This concept termed "preconditioning" is achieved by exposure to different pre-injury stressors to achieve the induction of "tolerance" to the effect of the TBI. However, the precise mechanisms underlying this "tolerance" phenomenon are not fully understood in TBI, and therefore even less information is available about possible indications in clinical TBI patients. In this review, we will summarize TBI pathophysiology, and discuss existing animal studies demonstrating the efficacy of preconditioning in diffuse and focal type of TBI. We will also review other non-TBI preconditioning studies, including ischemic, environmental, and chemical preconditioning, which maybe relevant to TBI. To date, no clinical studies exist in this field, and we speculate on possible future clinical situations, in which pre-TBI preconditioning could be considered.
创伤性脑损伤（TBI）的治疗目前集中于预防原发性损伤和减少继发性损伤。然而，目前还没有单一有效的治疗方法可以减轻人类的创伤性脑损伤。研究表明，受伤前的化学和环境应激都可以诱导后续的神经元死亡保护作用。这一概念被称为“预处理”，通过暴露于不同的损伤前应激源来实现对 TBI 效应的“耐受”诱导。然而，在 TBI 中，这种“耐受”现象的确切机制还不完全清楚，因此在临床 TBI 患者中可能的适应症方面的信息就更少了。在这篇综述中，我们将总结 TBI 的病理生理学，并讨论现有的动物研究，这些研究证明了预处理对弥漫性和局灶性 TBI 的疗效。我们还将回顾其他非 TBI 的预处理研究，包括缺血、环境和化学预处理，这些可能与 TBI 有关。迄今为止，该领域还没有临床研究，我们推测在可能的未来临床情况下，可以考虑 TBI 前的预处理。
