Lynch Daniel G, Narayan Raj K, Li Chunyan
Translational Brain Research Laboratory, The Feinstein Institutes for Medical Research, Manhasset, NY 11030, USA.
Zucker School of Medicine at Hofstra/Northwell Health, Hempstead, NY 11549, USA.
J Clin Med. 2023 Mar 11;12(6):2179. doi: 10.3390/jcm12062179.
Traumatic brain injury (TBI) is a leading cause of death and disability worldwide. Despite extensive research efforts, the majority of trialed monotherapies to date have failed to demonstrate significant benefit. It has been suggested that this is due to the complex pathophysiology of TBI, which may possibly be addressed by a combination of therapeutic interventions. In this article, we have reviewed combinations of different pharmacologic treatments, combinations of non-pharmacologic interventions, and combined pharmacologic and non-pharmacologic interventions for TBI. Both preclinical and clinical studies have been included. While promising results have been found in animal models, clinical trials of combination therapies have not yet shown clear benefit. This may possibly be due to their application without consideration of the evolving pathophysiology of TBI. Improvements of this paradigm may come from novel interventions guided by multimodal neuromonitoring and multimodal imaging techniques, as well as the application of multi-targeted non-pharmacologic and endogenous therapies. There also needs to be a greater representation of female subjects in preclinical and clinical studies.
创伤性脑损伤（TBI）是全球范围内导致死亡和残疾的主要原因。尽管进行了广泛的研究，但迄今为止，大多数试验的单一疗法均未能显示出显著疗效。有人认为，这是由于TBI复杂的病理生理学所致，而这可能通过联合治疗干预措施来解决。在本文中，我们回顾了针对TBI的不同药物治疗组合、非药物干预组合以及药物与非药物联合干预。纳入了临床前和临床研究。虽然在动物模型中发现了有前景的结果，但联合疗法的临床试验尚未显示出明显益处。这可能是由于在应用这些疗法时未考虑TBI不断演变的病理生理学。这种模式的改进可能来自于以多模态神经监测和多模态成像技术为指导的新型干预措施，以及多靶点非药物和内源性疗法的应用。在临床前和临床研究中也需要有更多女性受试者的参与。
