Molecular biomarkers in neurocritical care: The next frontier

With modern advances in life support and resuscitation medicine, neurologic injury in critical illness has become the new and the last frontier in critical care medicine. In addition to preserving life, the "holy grail" of modern critical care is to preserve function and quality of life. Molecular biomarkers have revolutionalized modern medicine, leading to novel gold standard diagnostics such as troponin for myocardial infarction, new disease monitors such as tumor markers, and new"personalizedmedicine" tools for selecting patient likely to respond to certain therapy such as Imatinib (Gleevec) use in Philadelphina chromosome chronic myelogenous leukemia. The central nervous system (CNS) poses a special challenge for diagnostic and therapeutic treatments due to the skull being a barrier to brain monitoring and tissue sampling, the presence of the blood-brain barrier (BBB), the complex relationship between localization and function, and the frequently poor reflection of clinical disease in animal models. Novel molecular biomarkersmay help reflect underlying pathophysiology, monitor disease progression, identify intermediate phenotypes for clinical trials, and improve prognostic accuracy and thereby revolutionize clinical practice in neurocritical care.