Biomarkers of chemical- and drug-induced neurotoxicity: A review of mechanistic insights and neuroprotective strategies.

Chemical- and drug-induced neurotoxicity remains a concern in environmental health and clinical pharmacology due to the nervous system's vulnerability and limited regeneration. This review explores biomarkers for detecting, monitoring, and mitigating neurotoxicity, and discusses underlying mechanisms. It covers neurotoxic agents like pesticides, heavy metals, solvents, pollutants, and drugs such as chemotherapeutics, immunosuppressants, and antibiotics. Despite diverse exposures, they share mechanisms like oxidative stress, mitochondrial dysfunction, excitotoxicity, neuroinflammation, and apoptosis, leading to neuronal injury and cognitive issues. Biomarkers-including proteins (neurofilament light chain, GFAP, UCH-L1), genetic/epigenetic tools (DNA methylation, microRNAs), metabolic markers (oxidative stress, neurotransmitter metabolites), imaging (MRI, PET), electrophysiology (EEG, ERPs), and new platforms like extracellular vesicles-provide multidimensional insights. They enable early detection and mechanistic understanding vital for neuroprotective strategies. The review highlights biomarker-guided therapies, such as antioxidants, mitochondrial stabilizers, anti-inflammatory drugs, nutritional supplements, lifestyle changes, and multimodal approaches. It emphasizes validation, standardization, and clinical integration of biomarkers to support personalized medicine. Overall, biomarkers are crucial for advancing neurotoxicity prevention, diagnosis, and treatment, bridging research and clinical practice to safeguard neural health.