Chiang Pu-Tien, Tsai Li-Kai, Tsai Hsin-Hsi
Department of Neurology, National Taiwan University Hospital.
Department of Neurology, National Taiwan University Hospital Bei-Hu Branch, Taipei, Taiwan.
Curr Opin Neurol. 2025 Feb 1;38(1):10-17. doi: 10.1097/WCO.0000000000001325. Epub 2024 Sep 25.
Intracerebral hemorrhage (ICH) is a devastating stroke with limited medical treatments; thus, timely exploration of emerging therapeutic targets is essential. This review focuses on the latest strategies to mitigate secondary brain injury post-ICH other than targeting surgery or hemostasis, addressing a significant gap in clinical practice and highlighting potential improvements in patient outcomes.
Promising therapeutic targets to reduce secondary brain injury following ICH have recently been identified, including attenuation of iron toxicity and inhibition of ferroptosis, enhancement of endogenous resorption of hematoma, and modulation of perihematomal inflammatory responses and edema. Additionally, novel insights suggest the lymphatic system of the brain may potentially play a role in hematoma clearance and edema management. Various experimental and early-phase clinical trials have demonstrated these approaches may potentially offer clinical benefits, though most research remains in the preliminary stages.
Continued research is essential to identify multifaceted treatment strategies for ICH. Clinical translation of these emerging targets could significantly enhance the efficacy of therapeutic interventions and potentially reduce secondary brain damage and improve neurological recovery. Future efforts should focus on large-scale clinical trials to validate these approaches, to pave the way for more effective treatment protocols for spontaneous ICH.
脑出血(ICH)是一种具有毁灭性的中风,医学治疗手段有限;因此,及时探索新的治疗靶点至关重要。本综述重点关注脑出血后减轻继发性脑损伤的最新策略,这些策略并非针对手术或止血,填补了临床实践中的重大空白,并突出了患者预后的潜在改善。
最近已确定了有前景的治疗靶点,可减少脑出血后的继发性脑损伤,包括减轻铁毒性和抑制铁死亡、增强血肿的内源性吸收、调节血肿周围的炎症反应和水肿。此外,新的见解表明,脑淋巴系统可能在血肿清除和水肿管理中发挥作用。各种实验和早期临床试验表明,这些方法可能具有临床益处,不过大多数研究仍处于初步阶段。
持续的研究对于确定脑出血的多方面治疗策略至关重要。这些新靶点的临床转化可显著提高治疗干预的疗效,并有可能减少继发性脑损伤,改善神经功能恢复。未来的工作应集中在大规模临床试验上,以验证这些方法,为自发性脑出血更有效的治疗方案铺平道路。