66 AIF = apoptosis-inducing factor; Apaf-1 = apoptotic protease activating factor-1; Bad = Bcl-2 antagonist of cell death; Bax = Bcl-2 associated X protein; Bcl = B-cell lymphoma; BH = Bcl-2 homology; Bid = BH3 interacting death domain agonist; CNS = central nervous system; CSF = cerebrospinal fluid; DEVD = N-benzyloxycarbonyl-Asp-Glu-Val-Asp-fluoromethylketone; ER = endoplasmic reticulum; MAPK = mitogen-activated protein kinase; Mcl-1L = myeloid cell leukemia-1 long; PARP = poly(ADP-ribose) polymerase; PKB = protein kinase B; TBI = traumatic brain injury; TNF = tumor necrosis factor; TUNEL = terminal deoxynucleotidyl transferase-mediated nick-end labeling.
Critical Care February 2005 Vol 9 No 1 Zhang et al.
IntroductionEach year in the USA, more than 1 million patients undergo medical evaluation and treatment for acute head injury [1]. In the USA there were an average of 53,288 annual traumatic brain injury (TBI)-related deaths from 1989 to 1998, or 19.3 per 10,000 [2]. In Germany, the TBI death rate in 1996 was 11.5 per 10,000, with a total of 9415 deaths [3]. A 15-year study in Denmark showed that the mortality of children after TBI was 22%, and among those survivors of severe head injury, significant numbers were found to have serious neurological disabilities [4]. A regional population-based study in France showed that the mortality of hospitalized TBI patients was as high as 30.0% [5]. Similar data can be found in studies from a variety of demographic and cultural settings [6,7]. Acute and long-term care of TBI patients has become a significant social and economic burden around the world [8][9][10].The neurological outcome of TBI victims depends on the extent of the primary brain insult caused by trauma itself, and on the secondary neurochemical and pathophysiological changes occurring as a consequence of the mechanical injury, which leads to additional neuronal cell loss. Although a long list of experimental studies suggest that reduction or
AbstractApoptosis, or programmed cell death, is a physiological form of cell death that is important for normal embryologic development and cell turnover in adult organisms. Cumulative evidence suggests that apoptosis can also be triggered in tissues without a high rate of cell turnover, including those within the central nervous system (CNS). In fact, a crucial role for apoptosis in delayed neuronal loss after both acute and chronic CNS injury is emerging. In the current review we summarize the growing evidence that apoptosis occurs after traumatic brain injury (TBI), from experimental models to humans. This includes the identification of apoptosis after TBI, initiators of apoptosis, key modulators of apoptosis such as the Bcl-2 family, key executioners of apoptosis such as the caspase family, final pathways of apoptosis, and potential therapeutic interventions for blocking neuronal apoptosis after TBI.Keywords apoptosis, Bcl-2, caspase; head injury, programmed cell death, traumatic brain injury 67 Available online http://ccforum.com/content/9/1/66 prevention of sec...