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4 Approach for Selecting Nutritional Interventions: Mechanistic Targets
Pages 55-68

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From page 55...
... GENERAL APPROACH FOR SELECTING NUTRITIONAL INTERVENTIONS The committee's approach to identifying nutritional interventions of potential use in the treatment of TBI consisted of expert discussions, literature reviews on the pathophysiology of TBI, initial identification of promising nutrients, and reviews of their effectiveness. Expert Discussions A public workshop was held June 23–24, 2010, in Washington, DC, where invited civilian and military subject-matter experts (e.g., medical experts, nutritionists, and neu 55
From page 56...
... Briefly, brain injuries differ dramatically from patient to patient depending upon the location, type, intensity, and duration of the initiating concussion force. One common feature of severe brain injury is reduced blood flow and oxygen deficiency.
From page 57...
... Neurogenesis * Promising mechanistic target areas for nutritional intervention.
From page 58...
... The table was constructed to demonstrate that those nutrients and food components act on multiple and diverse processes that are common to brain injury, and therefore their effects (beneficial and adverse) should be reviewed.
From page 59...
... 59 APPROACH FOR SELECTING NUTRITIONAL INTERVENTIONS Decreased ATP/ Mitochondrial Neurotrophic Dysfunction Excitotoxicity Revascularization Neuroplasticity Neurogenesis Factors Synapses X X X X X X X X X X X X X X X X X X Intervention: • cetyl-L-carnitine A • mino acids, branched-chain: aminoisobutryic acids, isoleucine, leucine, valine A • ntioxidants A • scorbic acid (vitamin C) A • reatine C • urcumin C • ytidine Disphosphate Choline C • iet therapy or nutritional support D • atty acids, n-3 F • lavonoids: anthocyanins, benzoflavones, biflavonoids, catechin, chalcones, flavanones, flavones, F flavonoligans, flavonols, isoflavones, proanthocyanidins • etogenic diet K • agnesium M • tilbenes (resveratrol)
From page 60...
... Calcium release is normally under tight physiological control, but this normally close regulation is altered by the events following a traumatic brain injury. Calcium released from the endoplasmic reticulum triggers a mass exodus of cytochrome C from mitochondria in the cell, activating caspases and other nuclease enzymes that finalize cell death (Mattson and Chan, 2003)
From page 61...
... Brain injuries such as ischemic brain injury and TBI have also implicated oxidative stress as a key pathological factor in secondary injury progression. Mitochondria, the main source of cellular ATP production under normal aerobic conditions, are susceptible to reactive oxygen species (ROS)
From page 62...
... . Excessive activation of PARP-1 is believed to be a key link between oxidative stress, glutamate excitotoxicity, and cell death (Ying and Xiong, 2010; Yu et al., 2009)
From page 63...
... . The flavanol epicatechin was shown to be neuroprotective in a stroke model of brain injury (Shah et al., 2010)
From page 64...
... Repair and Recovery Studies in the late 1990s showed that the brain has the capacity to generate new cells and that these cells can, under defined conditions, become functional. These findings, together with key studies showing the plasticity of the somatosensory circuits, serve as a foundation for understanding mechanisms of adaptability after a brain injury (see review, Kidd, 2009)
From page 65...
... Nutritional interventions should not be viewed as stand-alone therapies but rather as support for other therapies, and can range from the clinical support provision of essential nutrients and energy for recovery from major trauma, to individual nutrients or phytochemicals that may uniquely affect the neuronal repair process. A number of nutrients, dietary supplements, or specific diets act in biological systems in ways that suggests administration to TBI patients before or after injury could improve patient outcomes.
From page 66...
... . Based on the expert opinion of the committee and the target areas identified as relevant for nutrition, the following nutritional interventions were identified for review: energy needs for severe cases of TBI, acetyl-CoA, antioxidants, branched-chain amino acids, choline, creatine, ketogenic diets, magnesium, nicotinamide adenine dinucleotide (NAD+)
From page 67...
... 2010. Curcumin attenuates cerebral edema following traumatic brain injury in mice: A possible role for aquaporin-4?
From page 68...
... 2006. Dietary curcumin counteracts the outcome of traumatic brain injury on oxidative stress, synaptic plasticity, and cognition.


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