Progesterone in the clinical treatment of acute traumatic brain injury

IMPORTANCE OF THE FIELD: Traumatic brain injury (TBI) has yet to find a safe and effective acute-stage neuroprotective treatment. Experimental drugs targeting a single receptor mechanism, gene, or brain locus have failed. AREAS COVERED IN THIS REVIEW: We review the latest clinical trials using progesterone (PROG) to treat moderate to severe TBI, and present background showing why this hormone and some of its metabolites should be considered as candidates for neuroprotective therapy. TBI is a complex disease caused by a cascade of systemic toxic events in the brain and throughout the body. Attention is now turning to combinatorial or pleiotropic drugs that act on multiple genomic, proteomic and metabolic pathways to enhance morphological and functional outcomes. WHAT THE READER WILL GAIN: PROG has long been considered merely a female reproductive hormone with little role in neuroprotection after brain injury. This review will help readers to understand that PROG and its metabolites have multiple neuroprotective mechanisms, and may be among the first safe, low-cost, easily administered, effective treatments for a variety of CNS disorders. TAKE HOME MESSAGE: The idea that PROG is just a female reproductive hormone is outdated. We propose that PROG has substantial pleiotropic properties as a neuroprotective agent in a variety of CNS injury models.