Molecular mechanisms and management of traumatic brain injury – missing the link?
© Flierl et al; licensee BioMed Central Ltd. 2009
Received: 16 February 2009
Accepted: 04 March 2009
Published: 04 March 2009
We read with great interest the recent review article by Veenith et al. published in the World Journal of Emergency Surgery . In this paper, the authors provide an overview on the epidemiology and pathophysiology of traumatic brain injury (TBI), and present an update on TBI-induced apoptosis, intracranial gene regulation and pharmacological approaches to ameliorate secondary brain injury. The authors are to be congratulated for outlining this important and constantly evolving topic of global importance. Unfortunately, our initial excitement about this paper, which promised to disclose the "missing link" between molecular pathology and new treatment concepts for TBI , was not justified. We believe that important pathways in the pathophysiology of TBI and resulting therapeutic concepts were not addressed in the review article. We would therefore like to comment on the missing aspects in the article by Veenith and colleagues , in order to provide a more balanced and comprehensive perspective on the topic.
Finally, as a minor comment, the authors should pay more attention to accuracy in the citation of the pertinent literature. For example, reference #10 is claimed to support a statement on interleukins and cerebral edema, when in fact the citation refers to a publication on programmed cell death in nematodes. Several other examples of inadequate reference to the literature could be mentioned. Finally, the title chosen by the authors appears problematic. The authors claim to provide the "missing link" between molecular mechanisms and therapeutic concepts in TBI. Unfortunately, the review article fails to provide a bridge between the two entities. In addition, many of the current therapeutic approaches and promising new strategies in search of the pharmacological "golden bullet" are missing . While alterations in gene expression may be an interesting finding and promising target for future scientific approaches, we are still far from bringing the gene therapy concept from "bench to bedside" for an acute traumatic disorder such as TBI.
In summary, we realize that providing an encompassing and scientifically accurate review on the topic represents a virtually impossible task. We are therefore grateful for the review by Veenith et al.  and we hope to contribute to the authors' search of the "missing link" between molecular pathophysiology and new therapeutic concepts in TBI by the identification of additional pathways of interest (Fig. 1).
- Veenith T, Goon SH, Burnstein RM: Molecular mechanisms of traumatic brain injury – the missing link in management. World J Emerg Surg. 2009, 4 (1): 7-10.1186/1749-7922-4-7.PubMed CentralView ArticlePubMedGoogle Scholar
- Beauchamp K, Mutlak H, Smith WR, Shohami E, Stahel PF: Pharmacology of traumatic brain injury: where is the "golden bullet"?. Mol Med. 2008, 14 (11–12): 731-740.PubMed CentralPubMedGoogle Scholar
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