Could Pregnancy Hormone Help Heal Brain Injuries?
GUY RAZ, host:
The National Football League faced a challenge on a different playing field this past week, in the halls of Congress. Commissioner Roger Goodell and the Players Union Chief, DeMaurice Smith, were grilled by the House Judiciary Committee about the effects of concussions on pro football players.
A number of former players have reported bouts with depression and dementia, which they suspect are caused by the debilitating effects of repeated collisions on the field.
Dr. Donald Stein has been studying traumatic brain injuries for decades. He's a professor and researcher at Emory University's School of Medicine and he's been looking into a possible treatment for blunt force brain injuries using the hormone progesterone, which is normally associated with pregnancy. Dr. Stein joins me from Atlanta.
Dr. DONALD STEIN (Professor of Emergency Medicine, Emory University's School of Medicine): Thank you very much.
RAZ: First of all, Dr. Stein, what is progesterone?
Dr. STEIN: Progesterone is a naturally occurring hormone. It's actually made in both males and females. Females make much more of it than do males. Progesterone levels are often associated with fertility, because when a woman becomes pregnant, her progesterone levels increase very dramatically.
One of the reasons that I believe that it remains high all during pregnancy is that it's evolved to protect the fetus during gestation, during development. And many of the processes of repair, whether it's an organ repair, a tissue repair or brain repair, many of those processes that occur in injury are very similar to the processes that occur during development. And I think that the way in which progesterone works is related to that developmental protection.
RAZ: How did you discover the link between progesterone and its possible healing effects on the brain? How did you discover that in the first place?
Dr. STEIN: Well, there have been these anecdotal reports in the literature -single case studies, clinical reports - that women tended to recover better than males. So I had a bunch of students at the time and we talked about, you know, do you think we ought to look at this? It's kind of interesting. And so, we decided to take a look at this in laboratory rats.
And we looked at animals with frontal cortex injury, and we found that when the females were high in progesterone, they did much, much better than when they were higher in estrogen. Then when we gave it to males, initially, the outcomes were just as good as it was in the females. And that led to one thing after the other to, let's explore this systematically, at a time when I think most people thought it was completely nuts to do it.
RAZ: You're still fairly early in the research process here. These still have to be tested on humans.
Assuming those trials are successful, how do you envision this hormone being used? I mean, do you imagine that a team doctor, an NFL team doctor, would have vials of progesterone on the sidelines, for example?
Dr. STEIN: If this works and shows substantial benefit across these large numbers of patients, what will happen, as I estimate, it would become standard in practice care in most emergency and trauma rooms around the country, and perhaps even around the world.
RAZ: So what is the best, sort of best-case scenario? What's the best-case outcome for you here?
Dr. STEIN: Well, I think based on what we've seen already, what we had hope to see is a dramatic reduction in mortality in moderate to severely brain injured patients, and a dramatic - compared to state-of-the-art - current state-of-the-art treatment - a dramatic improvement in functional outcome, measured not just in the short term, but over 30 days, six months and a year.
The best outcome is not just to keep a very severely injured person alive, but rather to ensure that that person enjoys a quality of life as close to what they had before the injury as we could possibly make them.
RAZ: And how long do you expect that to take?
Dr. STEIN: I think it's not something that's going to occur overnight; probably based on the way clinical trials work, probably three years at the very, very earliest.
RAZ: Dr. Donald Stein is a professor of Emergency Medicine at Emory University in Atlanta.
Dr. Stein, thank you for your time.
Dr. STEIN: Thank you. It was a pleasure.
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