Once the TBI's injury occurs, data have shown that the size of the
lesion is dependent not only on the extent and force of the trauma, but
also on amount of subsequent reactive inflammatory and anoxic event
that follow the trauma. Also the baseline level Activity of the Notch
prior to the event is critical in minimizing the incoming effects of the
trauma. As upregulation of the Notch sometime pre-exists in some Nerve
cells such as the one in the Retinal cells. Here such upregulation
seems to contribute to allowing de-differentiation proning cell to
proliferation. Whether MEK is involved is beside the point, This
influence of the Notch seems overall Neuroprotective when it comes to
resisting inflammatory reactions.
The force of the Trauma cannot
be neglected as it can cause a commotion stretching or changing the
axial diameter of the cell sufficiently to induce stress and the c-JUN
pathways, but it can also be sectional, directly killing the
pre-synaptic Neuron. Such a section will disturb profoundly events
occurring at the presynaptic membrane with pertubation and release of
multiple preexcitatory Glutamate and the like, potentially inducing
seizures in the TBI victims. Evidences suggest, TBI inducing such a
trauma induced section of the presynaptic neuron, will impact post
synaptic events not only by lack of normal stimulation, a preliminary
event to Anoikis of the post synaptic Neuron, but also use free NMDA
receptors to potentiate Anoxic events into production of powerful toxic
free radical and Oxidant beyond Nitric Oxide. Without an sufficient
upregulation of both the Nrf2 and the Nicotinamid (NAD) systems, the
targeted Neuron is at risk of dying more likey through the Caspase 1
pathway. Anoikis kills more likely through the Caspase 3 apoptotic
pathway!
The Anoxia described above is evidently more severe if
vascular section resulted from the trauma directly, however vascular
compression coming from swelling of the brain tissue may achieve the
same Anoxia. Stimulation of the VRAC by various liberated toxic
Peptides may affects ions (including Calcium) channels, leading to
significant edema. It is proposed that Tamoxifen may dampen this
reaction and could be of use. The purported effect of Tamoxifen could
be Estrogen Receptor driven since there will more likely be upregulated
under the effect of TNF and Interferon (cytokines) coming from
inflammatory white cells called into the theater of the TBI.
Indeed,
after a trauma that could potention section a blood vessel, or cause
erosion of the endothelial surface, extracellular material such as
Collagen will trigger Platelet derived events (PDGFR and PDGF) which
will also, through CXCL/CCR3 or 4 trigger Macrophage attraction. The
macrophages in turn will expand the reaction by calling T-cells (and
this recruitment is worsen by IL1 through its integrin action at
Endothelial level) but also secrete several cytokine including TGF alpha
which could activate both the p38-MAPK pathways (that upregulate NOTCH
dampens) or the PI3K/AKT pathways
leading to downstream Oxidative
events that may expand into the pCREB/MTOR paricularly if
stress-c-JUN-NF-kB are in play. This cycle will lead to NADH, Free
radicals That could only be Dampened by the involvement of the Nerf (s)
and the Sirtuins and their activators (the Buteins).
And there
you have it Buteins are Neuroprotective. The MTOR inhibitors will be
protective through the activation of c-AMP of course!
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