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Rethinking the initial changes in subarachnoid haemorrhage: focusing on real-time metabolism during early brain injury

Rethinking the initial changes in subarachnoid haemorrhage: focusing on real-time metabolism during early brain injury
Rethinking the initial changes in subarachnoid haemorrhage: focusing on real-time metabolism during early brain injury
Over the last two decades, neurological researchers have uncovered many pathophysiological mechanisms associated with subarachnoid haemorrhage (SAH), with early brain injury and delayed cerebral ischaemia both contributing to morbidity and mortality. The current dilemma in SAH management inspired us to rethink the nature of the insult in SAH: sudden bleeding into the subarachnoid space and hypoxia due to disturbed cerebral circulation and increased intracranial pressure, generating exogenous stimuli and subsequent pathophysiological processes. Exogenous stimuli are defined as factors which the brain tissue is not normally exposed to when in the healthy state. Intersections of these initial pathogenic factors lead to secondary brain injury with related metabolic changes after SAH. Herein, we summarized the current understanding of efforts to monitor and analyse SAH-related metabolic changes to identify those precise pathophysiological processes and potential therapeutic strategies; in particular, we highlight the restoration of normal cerebrospinal fluid circulation and the normalization of brain-blood interface physiology to alleviate early brain injury and delayed neurological deterioration after SAH.
Biomarker, Cerebrospinal fluid, Early brain injury, Metabolomic, Microcirculation, Subarachnoid haemorrhage
2352-3964
Chen, Yujie
d7752e38-6370-4c62-9773-20a64602f4d6
Galea, Ian
66209a2f-f7e6-4d63-afe4-e9299f156f0b
Macdonald, R. Loch
43efde5d-403c-485b-8a16-2c74eddd6e17
Wong, George Kwok Chu
1a152888-bb57-476b-9138-3f5261f3d9ba
Zhang, John H.
5ab6c046-216c-4fb7-8d9a-f448e622d27d
Chen, Yujie
d7752e38-6370-4c62-9773-20a64602f4d6
Galea, Ian
66209a2f-f7e6-4d63-afe4-e9299f156f0b
Macdonald, R. Loch
43efde5d-403c-485b-8a16-2c74eddd6e17
Wong, George Kwok Chu
1a152888-bb57-476b-9138-3f5261f3d9ba
Zhang, John H.
5ab6c046-216c-4fb7-8d9a-f448e622d27d

Chen, Yujie, Galea, Ian, Macdonald, R. Loch, Wong, George Kwok Chu and Zhang, John H. (2022) Rethinking the initial changes in subarachnoid haemorrhage: focusing on real-time metabolism during early brain injury. EBioMedicine, 83, [104223]. (doi:10.1016/j.ebiom.2022.104223).

Record type: Review

Abstract

Over the last two decades, neurological researchers have uncovered many pathophysiological mechanisms associated with subarachnoid haemorrhage (SAH), with early brain injury and delayed cerebral ischaemia both contributing to morbidity and mortality. The current dilemma in SAH management inspired us to rethink the nature of the insult in SAH: sudden bleeding into the subarachnoid space and hypoxia due to disturbed cerebral circulation and increased intracranial pressure, generating exogenous stimuli and subsequent pathophysiological processes. Exogenous stimuli are defined as factors which the brain tissue is not normally exposed to when in the healthy state. Intersections of these initial pathogenic factors lead to secondary brain injury with related metabolic changes after SAH. Herein, we summarized the current understanding of efforts to monitor and analyse SAH-related metabolic changes to identify those precise pathophysiological processes and potential therapeutic strategies; in particular, we highlight the restoration of normal cerebrospinal fluid circulation and the normalization of brain-blood interface physiology to alleviate early brain injury and delayed neurological deterioration after SAH.

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Chen et al 2022 - Version of Record
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Accepted/In Press date: 30 July 2022
e-pub ahead of print date: 13 August 2022
Published date: September 2022
Additional Information: Funding Information: This work was supported by National Natural Science Foundation of China (82030036), National Institutes of Health (R01 NS117179) and State Key Laboratory of Trauma, Burn and Combined Injury (SKLYQ202002). The funders have not roles in study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication. Publisher Copyright: © 2022 The Author(s)
Keywords: Biomarker, Cerebrospinal fluid, Early brain injury, Metabolomic, Microcirculation, Subarachnoid haemorrhage

Identifiers

Local EPrints ID: 470395
URI: http://eprints.soton.ac.uk/id/eprint/470395
ISSN: 2352-3964
PURE UUID: 9686cd8f-ce62-482b-88c2-0d64b7685515
ORCID for Ian Galea: ORCID iD orcid.org/0000-0002-1268-5102

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Date deposited: 07 Oct 2022 16:53
Last modified: 08 Oct 2022 01:39

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Contributors

Author: Yujie Chen
Author: Ian Galea ORCID iD
Author: R. Loch Macdonald
Author: George Kwok Chu Wong
Author: John H. Zhang

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