Reframing the Biological Basis of Neuroprotection Using Functional Genomics: Differentially Weighted, Time-Dependent Multifactor Pathogenesis of Human Ischemic Brain Damage

Frontiers in Neurology
William A KofkeJoseph E Bavaria

Abstract

Background: Neuroprotection studies are generally unable to demonstrate efficacy in humans. Our specific hypothesis is that multiple pathophysiologic pathways, of variable importance, contribute to ischemic brain damage. As a corollary to this, we discuss the broad hypothesis that a multifaceted approach will improve the probability of efficacious neuroprotection. But to properly test this hypothesis the nature and importance of the multiple contributing pathways needs elucidation. Our aim is to demonstrate, using functional genomics, in human cardiac surgery procedures associated with cerebral ischemia, that the pathogenesis of perioperative human ischemic brain damage involves the function of multiple variably weighted proteins involving several pathways. We then use these data and literature to develop a proposal for rational design of human neuroprotection protocols. Methods: Ninety-four patients undergoing deep hypothermic circulatory arrest (DHCA) and/or aortic valve replacement surgery had brain damage biomarkers, S100β and neurofilament H (NFH), assessed at baseline, 1 and 24 h post-cardiopulmonary bypass (CPB) with analysis for association with 92 single nucleotide polymorphisms (SNPs) (selected by co-author WAK) relat...Continue Reading

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Citations

Nov 28, 2018·PloS One·Elizabeth Mahanna-GabrielliW Andrew Kofke
Jun 27, 2020·Journal of Neurosurgical Anesthesiology·Charu MahajanHemanshu Prabhakar

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Methods Mentioned

BETA
ELISA
ELISAs
sandwich immunoassays
genotyping

Software Mentioned

STAIR
Graph Pad Prism
IMPACT
PART
Multi
ARRIVE

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