Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Department of Neurosurgery, Iwate Medical University, Morioka, Japan.
Neurotherapeutics. 2020 Apr;17(2):446-456. doi: 10.1007/s13311-020-00840-7.
Traumatic brain injury (TBI) is the leading cause of morbidity and mortality worldwide. Although TBI leads to mechanical damage during initial impact, secondary damage also occurs as results from delayed neurochemical process and intracellular signaling pathways. Accumulated animal and human studies demonstrated that apoptotic mechanism contributes to overall pathology of TBI. Apoptotic cell death has been identified within contusional brain lesion at acute phase of TBI and in region remote from the site directly injured in days to weeks after trauma. TBI is also dynamic conditions that cause neuronal decline overtime and is likely due to neurodegenerative mechanisms years after trauma. Current studies have even suggested association of neuronal damage through apoptotic pathway with mild TBI, which contributes chronic persistent neurological symptoms and cognitive deficits. Thus, a better understanding of the acute and chronic consequences of apoptosis following TBI is required. The purpose of this review is to describe (1) neuronal apoptotic pathway following TBI, (2) contribution of apoptosis to acute and chronic phase of TBI, and (3) current treatment targeting on apoptotic pathway.
创伤性脑损伤(TBI)是全球发病率和死亡率的主要原因。尽管 TBI 在最初的撞击时会导致机械损伤,但继发性损伤也会由于延迟的神经化学过程和细胞内信号通路而发生。积累的动物和人类研究表明,细胞凋亡机制有助于 TBI 的整体病理学。在 TBI 的急性期和创伤后数天至数周远离直接损伤部位的区域,已经在挫伤性脑损伤中发现了凋亡细胞死亡。TBI 也是一个动态的情况,会导致神经元随着时间的推移而下降,这可能是由于创伤后数年的神经退行性机制所致。目前的研究甚至表明,通过凋亡途径的神经元损伤与轻度 TBI 有关,这会导致慢性持续的神经症状和认知缺陷。因此,需要更好地了解 TBI 后凋亡的急性和慢性后果。本文的目的是描述(1)TBI 后的神经元凋亡途径,(2)凋亡对 TBI 的急性和慢性阶段的贡献,以及(3)针对凋亡途径的当前治疗方法。