A look at the current study situation on cerebrolysin in the treatment of TBI
Introduction
Traumatic brain injury (TBI) is one of the most common causes of permanent neurological damage and long-term disability. Every year, millions of people worldwide suffer a TBI, ranging from mild concussions to severe traumatic brain injuries. Treatment options are limited and many patients struggle with long-term cognitive and motor deficits.
Cerebrolysin, a neuropeptide preparation derived from porcine brain protein, has been discussed for years as a potential neuroprotective and neurorestorative therapy for various neurological diseases. In a recent systematic review and meta-analysis published in Brain Sciences (Jarosz et al., 2023), the efficacy of cerebrolysin in TBI was investigated. The results are promising, but also raise new questions about the optimal application.
What is cerebrolysin?
Cerebrolysin is a low molecular weight peptide preparation made from purified porcine brain proteins. It contains biologically active peptides that have been shown to have neuroprotective and neurorestorative properties. Previous preclinical and clinical studies indicate that Cerebrolysin:
- can modulate inflammatory reactions in the brain,
- supports the regeneration of nerve cells,
- promotes synaptic plasticity and
- improves cognitive abilities after neurological damage.
These properties have sparked interest in Cerebrolysin as a potential treatment for patients with TBI.
Study overview: Methodology of the meta-analysis
The systematic review by Jarosz et al. (2023) analyzed 10 clinical trials with a total of 8749 patients who received cerebrolysin after a TBI. The studies were extracted from PubMed, Cinahl, Web of Science and Embase and selected according to strict scientific criteria.
Inclusion criteria for the analysis:
✅ Adult patients (>18 years)
✅ Diagnosis of mild, moderate or severe TBI
✅ Treatment with cerebrolysin in a clinical setting
Parameters analyzed:
🔹 Glasgow Outcome Scale (GOS) → Assessment of functional recovery
🔹 Glasgow Coma Scale (GCS) → Measurement of the state of consciousness
🔹 Mortality (death rate)
🔹 Length of stay in hospital (LOS – Length of Stay)
The studies used different doses of Cerebrolysin (10-50 ml per day) over a period of 5 to 30 days.
Results of the meta-analysis
The most important findings from the analysis are:
✅ Improvement in neurological functions: Patients who received Cerebrolysin showed a significant improvement in GCS and GOS compared to the control group(p < 0.05). This indicates that Cerebrolysin can positively influence functional recovery after TBI.
❌ No significant reduction in mortality: Treatment with Cerebrolysin had no significant effect on the mortality rate(p = 0.111).
❌ No reduction in the length of hospital stay: The patients who received Cerebrolysin did not have to stay in hospital for a shorter period of time than the control group(p = 0.634).
Interpretation of the results
The improvement in GOS and GCS shows that cerebrolysin can support neurological recovery after TBI. However, the lack of effect on mortality and length of hospitalization means that the therapy cannot be considered an acute life-saving measure.
How does cerebrolysin work? – Mechanisms of neuroprotection
Cerebrolysin unfolds its effect through several mechanisms:
🧠 Neuroprotection: Reduction of inflammation, inhibition of free radicals and protection of neurons from oxidative stress.
🧬 Neuroplasticity: Promotion of synapse formation and maintenance of neuronal communication.
🔬 Regeneration: Activation of signaling pathways such as the Sonic Hedgehog (Shh) pathway, which stimulate the growth of new nerve cells.
⚡ Influencing neurotransmitters: modulation of the GABA and cholinergic systems, which can lead to improved cognitive functions.
Of particular interest is the finding that Cerebrolysin can show positive effects even months after the original injury. This could make it a valuable addition to the long-term rehabilitation of TBI patients.
Critical view and open questions
Despite the positive results, there are some unanswered questions:
🔹 Optimal dosage and treatment duration: In the studies analyzed, dosages between 10 and 50 ml per day were used. However, there is no consensus on which dose is most effective.
🔹 Timing of treatment: Some studies started treatment within 24 hours of the injury, others only after several months. Previous research suggests that early administration could be more effective.
🔹 Long-term effects: There is not yet enough data on how long the positive effects of Cerebrolysin last and whether repeated treatment cycles are necessary.
🔹 Side effects: While most patients tolerate Cerebrolysin well, there is a small risk of allergic reactions, including anaphylactic shock.
Conclusion and future research
The systematic review by Jarosz et al. (2023) shows that cerebrolysin has promising neuroprotective properties in TBI. In particular, the improvement in GCS and GOS suggests that cerebrolysin may promote functional recovery.
However, it remains unclear which patients benefit most from the therapy and which dosage is optimal. Future randomized, multicenter trials are needed to clarify these questions and possibly establish cerebrolysin as a standard treatment for TBI.
Sources:
Jarosz, K., Kojder, K., Andrzejewska, A., Solek-Pastuszka, J., & Jurczak, A. (2023). Cerebrolysin in Patients with TBI: Systematic Review and Meta-Analysis. Brain Sci. 2023, 13, 507. DOI: 10.3390/brainsci13030507
Did you like this article?
💬 Share your opinion in the comments! Do you have experience with Cerebrolysin or other questions about TBI? Discuss with us! 😊