Yang Bosco Seong Kyu, Gusdon Aaron M, Ren Xuefang Sophie, Jeong Han-Gil, Lee Chang-Hun, Blackburn Spiros, Choi Huimahn Alex
The NABI institute, Department of Neurosurgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA.
Department of Neurology and Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea.
Curr Neurol Neurosci Rep. 2024 Dec 26;25(1):14. doi: 10.1007/s11910-024-01396-1.
Early brain injury (EBI) after aneurysmal subarachnoid hemorrhage (SAH) is the most influential clinical determinant of outcomes. Despite significant advances in understanding of the pathophysiology of EBI, currently no treatments to target EBI have been developed. This review summarizes recent advances in EBI research over the past five years with a focus on potential therapeutic targets.
Mechanism-specific translational studies are converging on several pathophysiologic pathways: improved antioxidant delivery and the Sirt1/Nrf2 pathway for reactive oxygen species; NLRP3 inflammasome and microglial polarization for inflammation; and the PI3K/Akt pathway for apoptosis. Recently identified mechanistic components, such as microcirculatory failure and ferroptosis, need particular attention. Clinical studies developing radiographic markers and mechanism-specific, biofluid markers are attempting to bridge the translational therapeutic gap. There has been an exponential growth in EBI research. Further clinical studies which address specific pathophysiology mechanisms need to be performed to identify novel therapeutic approaches.
动脉瘤性蛛网膜下腔出血（SAH）后的早期脑损伤（EBI）是影响预后的最关键临床决定因素。尽管在EBI病理生理学的理解上取得了显著进展，但目前尚未开发出针对EBI的治疗方法。本综述总结了过去五年EBI研究的最新进展，重点关注潜在的治疗靶点。
针对特定机制的转化研究聚焦于几个病理生理途径：改善抗氧化剂递送以及针对活性氧的Sirt1/Nrf2途径；针对炎症的NLRP3炎性小体和小胶质细胞极化；以及针对细胞凋亡的PI3K/Akt途径。最近确定的机制成分，如微循环衰竭和铁死亡，需要特别关注。开发影像学标志物和特定机制的生物流体标志物的临床研究正试图弥合转化治疗差距。EBI研究呈指数级增长。需要进行进一步针对特定病理生理机制的临床研究，以确定新的治疗方法。
