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Exploring New Routes for Neuroprotective Drug Development in Traumatic Brain Injury

The methods and devices used in the clinical management of neurological patients can provide data to facilitate progress in treating brain trauma. Saving the Brain Although encased in a bony shell, the human brain is still vulnerable to traumatic damage. A powerful blow, an accident, or even the oxygen deprivation of a stroke can set off a chain reaction of metabolic disturbances that extends the regions of permanently injured brain far beyond its initial locale. Ever since we learned that at least some of this damage is from glutamate release, many preclinical studies in animals have succeeded in minimizing or halting this injury-triggered damage. However, none of these treatments has been effective when they have been tried in patients, surely one of the worst track records in any field of biomedicine. Janowitz and Menon propose a new approach. They suggest that translation from animal models would be accelerated by using the wide array of experimental tools available today to ask questions in the most relevant organism, the human patient. They outline the experimental medicine methods that can now be applied to the injured human brain, pointing the way to a new approach to this most thorny of problems. Worldwide, traumatic brain injury (TBI) is a major cause of mortality and morbidity with a substantial predicted increase in incidence. Despite an obvious need, there are no pharmacological treatment options for TBI because translation of neuroprotection from preclinical studies to clinical practice has so far failed. Here, we identify potential causes for this failure. We suggest that the monitoring and investigation tools that are commonly used in patients with TBI may provide an experimental medicine route to facilitate a more rational approach to translational research. This suggestion is underpinned by existing research data on disease biology, drug delivery, and treatment response obtained with these methods.