Regulation of the coagulation cascade as a new therapeutic strategy for pulmonary injury following traumatic brain injury

2021 Fiscal Year Final Research Report

• Project/Area Number: 18K16535
• Research Category: Grant-in-Aid for Early-Career Scientists
• Allocation Type: Multi-year Fund
• Review Section: Basic Section 55060:Emergency medicine-related
• Research Institution: Hamamatsu University School of Medicine
• Principal Investigator: Yasui Hideki 浜松医科大学, 臨床研究センター, 特任講師 (60804937)
• Project Period (FY): 2018-04-01 – 2022-03-31
• Keywords: 頭部外傷 / 肺障害

Outline of Final Research Achievements

Extracranial complications frequently occur in patients with traumatic brain injury (TBI). Among them, pulmonary injury is a serious complication that affects the prognosis; however, its mechanism is unclear. In an animal model, activation of the coagulation cascade was seen immediately after TBI. Histological findings of lung injury were also observed immediately after TBI, and these findings were persistent at 60 minutes after TBI. Additionally, we observed a case of pulmonary injury accompanied by neither a catecholamine elevation nor a change in the systemic circulation, both of which have historically been considered to be mechanisms of pulmonary injury after TBI. We also observed a case involving activation of the coagulation cascade immediately after severe brain injury. These findings indicate that activation of the coagulation cascade might be related to the mechanism of lung injury after TBI.

Free Research Field

救急

Academic Significance and Societal Importance of the Research Achievements

頭部外傷は、死亡や身体障害につながる主要な要因であり、頭部外傷後に肺障害を合併することで予後がさらに悪化することが判明している。これまで肺障害の発症メカニズムとしては、頭部外傷後のカテコラミンストームとその後の循環動態の変化が主要な要因と考えられてきた。しかしながら、今回の研究では、頭部外傷後短時間のうちに、上記の現象とは無関係に肺障害を発症することが確認された。一方で、肺障害には凝固カスケードの活性化という新たな機序の関与が示唆され、頭部外傷の治療戦略を考えるうえで意義のある研究であり、更なる研究の継続をする意義があるものと考えられる。