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Moving to human trials for argon neuroprotection in neurological injury: a narrative review.

Accepted version
Peer-reviewed

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Type

Article

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Authors

Gardner, AJ 
Menon, DK 

Abstract

Despite the global burden of brain injury, neuroprotective agents remain elusive. There are no clinically effective therapies which reduce mortality or improve long-term cognitive outcome. Ventilation could be an easily modifiable variable in resuscitation; gases are relatively simple to administer. Xenon is the prototypic agent of a new generation of experimental treatments which show promise. However, use is hindered by its prohibitive cost and anaesthetic properties. Argon is an attractive option, being cheaper, easy to transport, non-sedating, and mechanistically distinct from xenon. In vitro and in vivo models provide evidence of argon reducing brain injury, with improvements in neurocognitive, histological, and biomarker metrics, as well as improved survival. Current data suggest that the effect of argon is mediated via the toll-like receptors 2 and 4, the extracellular signal-regulated kinase 1/2, and phosphatidylinositol 3 kinase (PI-3K)-AKT pathways. Ventilation with argon appears to be safe in pigs and preliminary human trials. Given recent evidence that arterial hyperoxia may be harmful, the supplementation of high-concentration argon may not necessitate changes to clinical practice. Given the logistic benefits, and the evidence for argon neuroprotection summarized in this manuscript, we believe that the time has come to consider developing Phase II clinical trials to assess its benefit in acute neurological injury.

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Keywords

acute brain injuries, argon, neuroprotection, Animals, Argon, Brain Injuries, Disease Models, Animal, Humans, Neuroprotection, Neuroprotective Agents

Journal Title

Br J Anaesth

Conference Name

Journal ISSN

0007-0912
1471-6771

Volume Title

120

Publisher

Elsevier BV