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IntroductionTraumatic brain injury (TBI) is a serious medical condition that may occur after the brain sustains a signifi cant impact via linear or rotational forces. TBI is the leading cause of disability and death in people under 45 with approximately ten million new cases each year worldwide. [ 1 ] The effects of TBI can be severe, including severe neurocognitive, physical, and psychosocial impairment. [ 2 ] Only incremental improvements in treatment have been made over the past century, and there remains a signifi cant unmet need to develop strategies to avoid long-term damage from TBI. The primary phase of TBI describes immediate neuronal damage from contusions or oxygen deprivation caused by global mass effect. [ 3 ] Secondary injury [ 3,4 ] occurs later via such mechanisms as reperfusion injury, delayed cortical edema, blood-brain barrier (BBB) breakdown, and local electrolyte imbalance. [4][5][6] These disturbances themselves result in reactive oxygen species (ROS)-mediated neurodegeneration through calcium release, glutamate toxicity, lipid peroxidation, and mitochondrial dysfunction. [ 7 ] Such secondary injury may occur in brain adjacent to the site of initial supposed injury, yielding the potential for unexpected spread of the zone of damage over months postinjury.With the goal of treating secondary brain injury, ROS scavengers have become an increasingly popular potential treatment option. The compounds poly(ethylene glycol)-conjugated superoxide dismutase and tirilizad have been considered for use in free-radical scavenging, but both antioxidant formulations did not show positive results in improving patient outcome after TBI, [ 3 ] likely because of poor delivery into brain. Preclinical studies suggest progesterone has neuroprotective effects in brain injury models likely by modulating native antioxidant activity levels. [ 8 ] However, other central nervous system injuries treated with progesterone have not shown any improvement, and Phase III clinical trails have shown limited success. [ 9 ] Cyclosporine A is being tested for its neuroprotective properties following TBI in an ongoing phase II study (NeuroSTAT) because of its ability to stabilize mitochondrial function. [ 10 ] Cyclosporin A is thought to decrease excitotoxic and oxidative stress that occurs in secondary damage by stabilizing