Therapeutic Hypothermia: Neuroprotective Treatment
Therapeutic Hypothermia is the promising therapy, which prevents cascading pathological events causing damage to already injured brain.
Therapeutic hypothermia is a new treatment that increases survival and quality of life in patients suffering from ischemic insults such as stroke, cardiac arrest, and neurogenic fever following brain injury. Neuronal cells are the most sensitive cells for hypoxic injury and as soon as hypoxia sets in there is inflammation, free radical injury and excitotoxicity furthering brain damage to next level.
Reducing core body temperature to 92 Fahrenheit within 6-12 hours is the key to save brain from more damage.
Hypothermia is neuroprotective and has also been reported to reduce the degree of diffuse axonal damage in traumatic brain injury.
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Mechanisms of neuroprotective effects of Hypothermia
- Reduced cerebral metabolism
Reduction in temperature will be slowing cerebral metabolism, leading to decreased glucose and oxygen consumption. This reduced consumption saves more neuronal cells as demand-supply equation status is lower down. Demand is reduced to make-up best from reduced supply, which saves cells from further injury.
- Apoptosis and mitochondrial dysfunction
Effects of hypothermia include inhibition of caspase enzyme activation and prevention of mitochondrial dysfunction, modification of intracellular ion concentrations, and reduce overload of excitatory neurotransmitters.
Mild hypothermia markedly reduces ischemia/reperfusion-induced endothelial cell apoptosis and the expression of cleaved caspase-3 which interrupts the apoptotic pathway.
- Excitotoxicity reduction
Reperfusion and ischemia interrupt the delicate balance between calcium influx and sequestration at the cellular level. Calcium influx and eventual Neuroexcitatory cascade can be prevented by reduction in core body temperature.
- Reduced inflammation following brain injury
Therapeutic hypothermia suppresses ischemia-induced inflammatory reactions and the release of proinflammatory cytokines, it also reduced free radical formation and injury associated with it.
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