Selective Brain and Heart Hypothermia – A Path Toward Targeted Organ Resuscitation and Protection

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Background

Ischemic diseases of the brain and heart are leading causes for mortality and long-term morbidity. Recently, advances in endovascular technology and techniques and positive results from randomized clinical trials have led to the establishment of interventional treatment standards (e.g. mechanical thrombectomy) that have significantly improved the outcome in patients with acute ischemic stroke. Applying the principles of anatomic engineering, endovascular devices recanalize narrowed or occluded vessels and restore organ blood flow. This therapeutic effect is amplified by other factors, such as targeted local treatment and minimal invasiveness.



However, challenges remain. Although anatomic engineering principles are effective in addressing the causative correlate of organ ischemia, they are less suited to resolve the clinically relevant and adverse tissue metabolic processes that are 1) triggered by ischemia, such as excitotoxicity, disturbance of ion homeostasis, increased apoptosis, inflammation, and cell edema, and 2) potential consequences of recanalization therapy itself, known as ‘reperfusion injury’. Therapeutic hypothermia has been long recognized as a powerful tissue- and neuroprotectant, appealing as a potential panacea to the vast and unresolved metabolic disturbances caused by ischemia. Unlike animals that are capable of undergoing the process of hibernation (repeatedly and unscathed), a state of minimal metabolism at very low body temperatures, humans and patients with acute hypometabolic organ conditions, such as acute coronary syndrome or stroke, do not tolerate a body temperature reduction of even a few degrees Celsius below what is considered clinically normal. In fact, out-of-hospital cardiac arrest, a devastating condition of whole-body ischemia, is the only acute condition where systemic hypothermia has shown benefit.



In contrast, selective organ hypothermia may offer a new ‘tissue metabolic engineering’ concept that allows to reap the benefits of therapeutic hypothermia while reducing the adverse impact on the body due to its better targeted and minimally invasive application and ultimately, improve the outcome in patients with stroke and coronary syndromes. As a novel clinical area, selective organ hypothermia has not received much attention. In this Research Topic, we envision to provide an opportunity for contributions from the fields of clinical and experimental neurology to highlight challenges and solutions, present original data and systematic reviews, and outline hypotheses and future scenarios around selective brain hypothermia. Similarly, reperfusion therapies for myocardial ischemia are widespread and frequent interventions that, like interventions for brain ischemia, attempt to save as much organ tissue as possible. The clinical challenges for saving brain and cardiac tissues are quite similar. As such, for this collection, we ask for contributions relating to ‘selective brain hypothermia’ and extend this invitation to authors from the fields of clinical and experimental cardiology.



Thus, topic editors will welcome any types of manuscripts - research article, brief research article, review, and mini-review- about, but not limited to the following themes:

• Selective Hypothermic neuroprotection – Clinical

• Selective Hypothermic neuroprotection – Experimental

• Mechanisms of ischemic brain injury and challenges of reperfusion therapy

• Selective Hypothermic cardioprotection – Clinical

Topic Editors John Pile-spellman & Jae H. Choi are the co-founders of Hybernia Medical, LLC. The other Topic Editors declare no competing interests with regard to the Research Topic subject.

Keywords: Selective Hypothermia, Neuroprotection, Ischemic Brain Injury, Reperfusion, Cardioprotection

Important note: All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.

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