The role of the brain renin-angiotensin system (RAS) in mild traumatic brain injury (TBI)

Document Type

Article

Publication Date

2-1-2021

Publication Title

Pharmacology & Therapeutics

Keywords

Angiotensin Receptors, Concussion, Neurodegeneration, Renin-Angiotensin System, Traumatic Brain Injury

ISSN

0163-7258

Volume

218

First Page

107684

Abstract

There is considerable interest in traumatic brain injury (TBI) induced by repeated concussions suffered by athletes in sports, military personnel from combat-and non-combat related activities, and civilian populations who suffer head injuries from accidents and domestic violence. Although the renin-angiotensin system (RAS) is primarily a systemic cardiovascular regulatory system that, when dysregulated, causes hypertension and cardiovascular pathology, the brain contains a local RAS that plays a critical role in the pathophysiology of several neurodegenerative diseases. This local RAS includes receptors for angiotensin (Ang) II within the brain parenchyma, as well as on circumventricular organs outside the blood-brain-barrier. The brain RAS acts primarily via the type 1 Ang II receptor (ATR), exacerbating insults and pathology. With TBI, the brain RAS may contribute to permanent brain damage, especially when a second TBI occurs before the brain recovers from an initial injury. Agents are needed that minimize the extent of injury from an acute TBI, reducing TBI-mediated permanent brain damage. This review discusses how activation of the brain RAS following TBI contributes to this damage, and how drugs that counteract activation of the ATR including ATR blockers (ARBs), renin inhibitors, angiotensin-converting enzyme (ACE) inhibitors, and agonists at type 2 Ang II receptors (AT) and at Ang (1-7) receptors (Mas) can potentially ameliorate TBI-induced brain damage.

ORCID ID

0000-0002-6434-2142

DOI

10.1016/j.pharmthera.2020.107684

Link to Full Text
Peer Reviewed

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