The complement cascade as a therapeutic target in intracerebral hemorrhage

• Published in: Experimental neurology Vol. 219; no. 2; pp. 398 - 403
• Main Authors: Ducruet, Andrew F., Zacharia, Brad E., Hickman, Zachary L., Grobelny, Bartosz T., Yeh, Mason L., Sosunov, Sergey A., Connolly, E. Sander
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier Inc 01-10-2009; Elsevier
• Subjects: Animals; Biological and medical sciences; Cerebral Hemorrhage - physiopathology; Cerebral Hemorrhage - therapy; Complement Activation - drug effects; Complement C3 - metabolism; Complement cascade; Disease Progression; Edema; Hemoglobin; Humans; Inflammation Mediators - pharmacology; Inflammation Mediators - therapeutic use; Intracerebral hemorrhage; Mechanism; Medical sciences; Neurology; Vascular diseases and vascular malformations of the nervous system; Hemoglobin; Edema; Complement cascade; Intracerebral hemorrhage; Mechanism; Nervous system diseases; Cardiovascular disease; Complement; Cerebral disorder; Vascular disease; Treatment; Cerebral hemorrhage; Central nervous system disease; Cerebrovascular disease
• ISSN: 0014-4886; 1090-2430
• DOI: 10.1016/j.expneurol.2009.07.018

Intracerebral hemorrhage (ICH) is the second most common and deadliest form of stroke. Currently, no pharmacologic treatment strategies exist for this devastating disease. Following the initial mechanical injury suffered at hemorrhage onset, secondary brain injury proceeds through both direct cellular injury and inflammatory cascades, which trigger infiltration of granulocytes and monocytes, activation of microglia, and disruption of the blood–brain barrier with resulting cerebral edema. The complement cascade has been shown to play a central role in the pathogenesis of secondary injury following ICH, although the specific mechanisms responsible for the proximal activation of complement remain incompletely understood. Cerebral injury following cleavage of complement component 3 (C3) proceeds through parallel but interrelated pathways of anaphylatoxin-mediated inflammation and direct toxicity secondary to membrane attack complex-driven erythrocyte lysis. Complement activation also likely plays an important physiologic role in recovery following ICH. As such, a detailed understanding of the variation in functional effects of complement activation over time is critical to exploiting this target as an exciting translational strategy for intracerebral hemorrhage.