Abstract
Traumatic brain injury (TBI) is a major cause of mortality and morbidity worldwide. Despite improvements in acute intensive care, there are currently no specific therapies to ameliorate the effects of TBI. Successful therapeutic strategies for TBI should target multiple pathophysiologic mechanisms that occur at different stages of brain injury. The kallikrein–kinin system is a promising therapeutic target for TBI as it mediates key pathologic events of traumatic brain damage, such as edema formation, inflammation, and thrombosis. Selective and specific kinin receptor antagonists and inhibitors of plasma kallikrein and coagulation factor XII have been developed, and have already shown therapeutic efficacy in animal models of stroke and TBI. However, conflicting preclinical evaluation, as well as limited and inconclusive data from clinical trials in TBI, suggests that caution should be taken before transferring observations made in animals to humans. This review summarizes current evidence on the pathologic significance of the kallikrein–kinin system during TBI in animal models and, where available, the experimental findings are compared with human data.
Highlights
Traumatic brain injury (TBI) accounts for one-third of all injuryrelated deaths
This review summarizes current evidence on the pathologic significance of the kallikrein–kinin system during TBI in animal models and, where available, the experimental findings are compared with human data
The direct costs of TBI have been estimated at $13.1 billion per year in the United States (Ma et al, 2014); $64.7 billion per year are lost through missed work and lost productivity, and total medical costs range from $63.4 to $79.1 billion per year (Ma et al, 2014)
Summary
Traumatic brain injury (TBI) accounts for one-third of all injuryrelated deaths. An estimated 1.74 million TBIs occur annually in the United States (Faul et al, 2010; Ma et al, 2014). The kallikrein–kinin system is a promising therapeutic target for TBI as it mediates key pathologic events of traumatic brain damage, such as edema formation, inflammation, and thrombosis.
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