L-Arginine, Suatu Peluang Neuroproteksi terhadap Pasien Preeklampsia yang mendapat Problem Neurologis

Abstract

Preeklampsia mengakibatkan komplikasi pada 3–5% dari seluruh kehamilan. Dihubungkan dengan persalinan prematur, solusio plasenta dan lahir mati serta komplikasi stroke iskemik, stroke perdarahan, edema serebri serta kejang. Pasien dengan preeklampsia menunjukkan peningkatan tekanan perfusi otak pada arteri serebri media, anterior dan posterior, disertai perubahan indeks resistensi arteri serebri. Insiden komplikasi serebrovaskuler menyumbangkan 40% kematian maternal. Terjadi gangguan autoregulasi dan pembentukan edema. Gangguan autoregulasi dihubungkan dengan penurunan resistensi serebrovaskuler, hipoperfusi otak, disrupsi sawar darah otak serta edema vasogenik. Terjadi peningkatan sitokin pro inflamasi dan aktivasi sel-sel glia otak. L-Arginine adalah kompleks asam amino yang memiliki bentuk aktif dalam bentuk L-Arginine (2 – amino – 5 guanidino – pentanoic acid). Substrat L-Arginine untuk membentuk nitric oxide (NO) memiliki peran penting pada pembuluh darah. Pemberian L-Arginine secara intravena 5 menit setelah terjadinya cedera mengembalikan nilai aliran darah otak, memperbaiki sirkulasi serebral serta secara signifikan mereduksi volume otak yang memar. Efek neuroprotektif yang sama telah diamati terjadi  pada percobaan lain model cedera otak traumatik dan pada beberapa model iskemia serebri dengan pemberian dini L-Arginine. L-Arginine dapat menjadi agen neuroproteksi potensial yang sangat menarik untuk memperbaiki serebral setelah cedera otak.

L-Arginine, a Neuroprotection Chance for Preeclampsia Patients
with Neurological Problem

Abstract

Preeclampsia complicates 3 – 5% of all pregnancies. Preeclampsia is associated with premature delivery, placental abruption and stillbirth and can lead to complications, such as ischemic stroke, hemorrhagic stroke, cerebral edema and seizures. Patients with preeclampsia shows an increase in cerebral perfussion pressure (CPP) in anterior, middle and posterior cerebral arteries, with accompanying changes in cerebral artery resistance indices. The incident of cerebrovascular complications contributes to 40% of maternal death. Disturbance in autoregulation and subsequent edema formation. Disturbance in CBF autoregulation also associated with decrease in cerebrovascular resistance, brain hypoperfusion, blood brain barrier (BBB) disruption and vasogenic edema. There is also an increase in release of pro inflammatory cytokines and glial cells activation. L- Arginine is an amino acid complex, with active form in L-Arginine (2 – amino – 5 guanidino – pentanoic acid) found in vegetable and animal origin proteins, such as dairy, meat and most of all in fish and nuts. L-Arginine substrate creating Nitric Oxide (NO) plays important role in vascular. Intravenous administration of L-Arginine 5 minutes after brain injury restores cerebral blood flow (CBF) level, improves cerebral circulation and significantly reduces the contused brain volume. The same neuroprotective effect on another traumatic brain injury (TBI) model was observed and also found in cerebral ischaemia model with early administration of L-Arginine. L-Arginine can be a potential neuroprotective agent to improve of cerebral circulation after brain injury