title: Thrombin and hemin as central factors in the mechanisms of intracerebral hemorrhage-induced secondary brain injury and as potential targets for intervention.
abstract: Intracerebral hemorrhage (ICH) is a subtype of stoke that may cause significant morbidity and mortality. Brain injury due to ICH initially occurs within the first few hours as a result of mass effect due to hematoma formation. However, there is increasing interest in the mechanisms of secondary brain injury as many patients continue to deteriorate clinically despite no signs of rehemorrhage or hematoma expansion. This continued insult after primary hemorrhage is believed to be mediated by the cytotoxic, excitotoxic, oxidative, and inflammatory effects of intraparenchymal blood. The main factors responsible for this injury are thrombin and erythrocyte contents such as hemoglobin. Therapies including thrombin inhibitors, N-methyl-D-aspartate antagonists, chelators to bind free iron, and antiinflammatory drugs are currently under investigation for reducing this secondary brain injury. This review will discuss the molecular mechanisms of brain injury as a result of intraparenchymal blood, potential targets for therapeutic intervention, and treatment strategies currently in development.
authors.affiliation: Division of Neurosurgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA.
authors.forename: Ranjith
authors.initials: R
authors.lastname: Babu
authors.forename: Jacob H
authors.initials: JH
authors.lastname: Bagley
authors.forename: Chunhui
authors.initials: C
authors.lastname: Di
authors.forename: Allan H
authors.initials: AH
authors.lastname: Friedman
authors.forename: Cory
authors.initials: C
authors.lastname: Adamson
mesh_terms: D000991:Antithrombins / Q000627:therapeutic use; D002543:Cerebral Hemorrhage / Q000150:complications / Q000378:metabolism* / Q000473:pathology*; D006427:Hemin / Q000037:antagonists & inhibitors / Q000378:metabolism / Q000502:physiology*; D006801:Humans; D007502:Iron Chelating Agents / Q000627:therapeutic use; D009434:Neural Pathways / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology; D015398:Signal Transduction / Q000187:drug effects / Q000502:physiology; D020521:Stroke / Q000209:etiology / Q000378:metabolism* / Q000473:pathology*; D013917:Thrombin / Q000037:antagonists & inhibitors / Q000378:metabolism / Q000502:physiology*
chemical_list: D000991:Antithrombins; D007502:Iron Chelating Agents; D006427:Hemin; D013917:Thrombin