2-Iminobiotin for the treatment of perinatal asphyxia

Abstract

Introduction: Perinatal hypoxia–ischemia (HI) continues to be a common underlying cause of brain damage. The outcomes of HI encephalopathy (HIE) are devastating and permanent, making it a major burden for the patient, the family and society. The understanding of the pathways that lead to the injury is vital for finding potential therapies. HI triggers a cascade of several detrimental insults: glutamate-mediated excitotoxicity, nitric oxide (NO) and calcium overload, oxidative stress (OS), stress signaling, inflammation and cell death.

Areas covered: The reader will be introduced to the complex biological processes involved in HI injury and how these mechanisms are exploited for current and emerging therapies. Current knowledge on pathways of damage, as well as ongoing experimental therapies are reviewed, based on a comprehensive literature search employing review articles, book chapters and Medline searches.

Expert opinion: Recent studies have demonstrated a protective effect of antioxidant drugs against apoptosis after cerebral ischemia and reperfusion. Iminobiotin provides long- and short-term neuroprotection hindering apoptotic pathways. As an antioxidant it acts as NO synthetase inhibitor interrupting the vicious circle and the harmful effects of excessive NO formation. More clinical trials are needed to detect safety and effectiveness of iminobiotin and to establish its dose and optimal time of action.

Keywords::

• antioxidants
• hypoxia–ischemia
• iminobiotin
• newborn infant
• oxidative stress

Notes