NEUROPROTECTIVE MECHANISMS OF HYPOTHERMIA IN BRAIN DAMAGE

• Published in: Актуальні проблеми сучасної медицини Вісник Української медичної стоматологічної академії Vol. 25; no. 2; pp. 262 - 269
• Main Authors: Mohylnyk, A., Tarasenko, K., Davydenko, A., Arkhipovets, O., Sonnik, Ye
• Format: Journal Article
• Language: English
• Published: 29.05.2025
• ISSN: 2077-1096; 2077-1126; 2077-1126
• DOI: 10.31718/2077-1096.25.2.262

Relevance. Against the backdrop of the war in Ukraine, initiated by russia and ongoing for over a decade, large-scale military operations, widespread missile strikes, drone attacks, and the resulting economic and social collapse have led to a steady increase in the incidence of brain injuries of various origins, including neurotrauma. Despite advancements in modern medicine, treatment outcomes for patients with cerebral catastrophes have shown little improvement. The efficacy of pharmacological agents intended for neuroprotection remains controversial in many countries due to a lack of consistent and reliable evidence. In such cases, the primary determinant of favorable outcomes lies in the provision of timely emergency care, rapid evacuation to military hospitals or specialized medical facilities, and the development of dedicated neurosurgical and neurorehabilitation centers. However, despite the proven neuroprotective effects of therapeutic hypothermia, particularly in severe traumatic brain injury, this physical method remains underutilized and largely overlooked in clinical practice in Ukraine. Objective. The study aims to investigate the efficacy, mechanisms of action, and clinical relevance of therapeutic hypothermia in the context of ischemic and traumatic brain damage, while addressing the current gaps in evidence regarding its biochemical and genetic pathways of neuroprotection. Special attention is given to the need for broader implementation of this underutilized method in Ukrainian clinical practice amid increasing rates of neurotrauma during wartime. Results and conclusion. All therapeutic hypothermia methods can be classified into general and selective hypothermia, each with its own advantages and drawbacks. General hypothermia methods help maintain a target core body temperature and offer better control but are associated with more complications and disadvantages. In contrast, selective craniocerebral hypothermia techniques allow for targeted cooling of the brain and its cortex, which is particularly vulnerable to ischemic and hypoxic damage. Evidence suggests that therapeutic hypothermia improves outcomes in patients who have undergone cardiopulmonary and cerebral resuscitation, as well as in neonates with hypoxic-ischemic encephalopathy. Therapeutic hypothermia reduces the development of aseptic inflammation in brain ischemia and neurotrauma by decreasing the release of pro-inflammatory factors, inhibiting leukocyte migration and infiltration into brain tissue, reducing cerebral edema, lowering intracranial pressure, and stabilizing the blood-brain barrier while suppressing apoptotic processes. The beneficial effects of reduced temperature on pathogenic reactions have been demonstrated both in the acute phase of ischemia and during the reperfusion period. Lowering brain temperature suppresses nearly all known mechanisms of excitotoxicity, potentially minimizing the extent of secondary neuronal damage in acute focal ischemia, intracerebral and subarachnoid hemorrhages, and neurotrauma. However, the evidence base for the effectiveness of therapeutic hypothermia in these pathological brain conditions remains insufficient, and the biochemical and genetic mechanisms of neuroprotection are not yet fully understood. This is the focus of our research.