Huang Andrew Jonathan, Kornguth David, Kornguth Steven
University of Wisconsin Hospital, Madison, WI 53726; USA.
Golden Gate Cancer Center, San Francisco, CA 94107, USA.
Brain Sci. 2019 Apr 27;9(5):97. doi: 10.3390/brainsci9050097.
Traumatic brain injury (TBI) resulting from forceful impacts on the torso and head has been of major interest because of the prevalence of such injuries in military personnel, contact sports and the elderly. Cognitive and behavioral changes associated with TBI are also seen following whole brain radiation treatment for cancer and chemotherapy for disseminated tumors. The biological mechanisms involved in the initiation of TBI from impact, radiation, and chemotherapy to loss of cognitive function have several shared characteristics including increases in blood brain barrier permeability, blood vessel density, increases in inflammatory and autoimmune responses, alterations in NMDA and glutamate receptor levels and release of proteins normally sequestered in the brain into the blood and spinal fluid. The development of therapeutic agents that mitigate the loss of cognition and development of behavioral disorders in patients experiencing radiation-induced injury may provide benefit to those with TBI when similar processes are involved on a cellular or molecular level. Increased collaborative efforts between the radiation oncology and the neurology and psychiatry communities may be of major benefit for the management of brain injury from varied environmental insults.
由于此类损伤在军事人员、接触性运动参与者和老年人中普遍存在，因对躯干和头部的强力撞击导致的创伤性脑损伤（TBI）一直备受关注。在针对癌症的全脑放射治疗和针对播散性肿瘤的化疗后，也会出现与TBI相关的认知和行为变化。从撞击、辐射和化疗引发TBI到认知功能丧失所涉及的生物学机制有几个共同特征，包括血脑屏障通透性增加、血管密度增加、炎症和自身免疫反应增强、NMDA和谷氨酸受体水平改变，以及通常在脑内隔离的蛋白质释放到血液和脑脊液中。开发能够减轻经历辐射诱导损伤患者认知丧失和行为障碍发展的治疗药物，当在细胞或分子水平涉及类似过程时，可能会使TBI患者受益。放射肿瘤学与神经学和精神病学领域之间加强合作努力，对于管理因各种环境损伤导致的脑损伤可能具有重大益处。
