Autophagy after Subarachnoid Hemorrhage: Can Cell Death be Good?

BACKGROUND: Autophagy is a prosurvival, reparative process that maintainsww cellular homeostasis through lyso-somal degradation of selected cytoplasmic components and programmed death of old, dysfunctional, or unnecessary cyto-plasmic entities. According to growing evidence, autophagy shows beneficial effects following subarachnoid hemorrhage (SAH). SAH is considered one of the most devastating forms of stroke. METHODS: In this review lies in revealing the pathophysiological pathways and the effects of autophagy. Current results from animal studies will be discussed focusing on the effects of inhibitors and inducers of autophagy. In addition, this review dis-cusses the clinical translation of potential neuropharmacological targets that can help prevent early brain injury (EBI) follow-ing SAH by incorporating programmed cell death into clinical management. RESULTS: Published data showed that autophagy mechanisms have a prosurvival effect to reduce apoptotic cell death after SAH. However, if SAH exceeds a certain stress threshold, autophagy mechanisms lead to increased apoptotic cell death, more brain injury, and worse outcome. CONCLUSION: Future investigation on the differences and molecular switches between protective mechanisms of autophagy and excessive “self-eating” autophagy leading to cell death is needed to achieve more insight into the complex pathophysiol-ogy of brain injury after SAH. If autophagy after SAH can be controlled to lead to beneficial effects only, as the physiologi-cal self-control mechanism, this could be an important target for treatment