Preconditioning and tolerance against cerebral ischaemia: from experimental strategies to clinical use.
Preconditioning and tolerance against cerebral ischaemia: from experimental strategies to clinical use.
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DOI：
10.1016/s1474-4422(09)70054-7
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发表时间：
2009-04
期刊：
影响因子：
48
通讯作者：
Meisel, Andreas
中科院分区：
文献类型：
--
作者：
Dirnagl, Ulrich;Becker, Kyra;Meisel, Andreas
急性脑损伤患者的神经保护和脑修复仍是未满足的主要医疗需求。药物治疗要么无效，要么因副作用而混淆。因此，人们正在研究大脑保护自己免受有害刺激并从损伤中恢复的内源性机制。在过去的十年里，对预处理的研究，也被称为诱导耐受性，已经为急性脑损伤患者的治疗带来了各种有希望的策略。其中一些策略正在随机临床试验中进行测试。此外，对预适应的研究已经产生了预防性诱导保护的想法，例如那些接受脑外科手术的患者，那些有短暂性缺血发作或蛛网膜下腔出血的患者，他们在不久的将来有很高的脑损伤风险。在这篇综述中，我们关注与大脑预处理和耐受性相关的临床问题；具体来说，我们讨论了可能受益于这些程序的临床情况。我们还讨论了预处理和耐受性是否在大脑中自然发生，并评估了正在研究的最有希望的候选策略。
Neuroprotection and brain repair in patients after acute brain damage are still major unfulfilled medical needs. Pharmacological treatments are either ineffective or confounded by adverse effects. Consequently, endogenous mechanisms by which the brain protects itself against noxious stimuli and recovers from damage are being studied. Research on preconditioning, also known as induced tolerance, over the past decade has resulted in various promising strategies for the treatment of patients with acute brain injury. Several of these strategies are being tested in randomised clinical trials. Additionally, research into preconditioning has led to the idea of prophylactically inducing protection in patients such as those undergoing brain surgery and those with transient ischaemic attack or subarachnoid haemorrhage who are at high risk of brain injury in the near future. In this Review, we focus on the clinical issues relating to preconditioning and tolerance in the brain; specifically, we discuss the clinical situations that might benefit from such procedures. We also discuss whether preconditioning and tolerance occur naturally in the brain and assess the most promising candidate strategies that are being investigated.