Evolving paradigms for neuroprotection: molecular identification of ischemic penumbra.
Evolving paradigms for neuroprotection: molecular identification of ischemic penumbra.
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DOI：
10.1159/000091706
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发表时间：
2006-01-01
期刊：
影响因子：
--
通讯作者：
Castillo, Jose
中科院分区：
文献类型：
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作者：
Castellanos, Mar;Sobrino, Tomas;Castillo, Jose
缺血半暗带定义了存在梗塞风险的组织，因此该组织具有潜在的可挽救性，并且是当前中风再灌注和神经保护治疗的目标。在各个中风患者中，半暗带组织以不同的速率演化为不可逆受损组织，根据该组织梗塞风险的个体持续时间产生不同的治疗窗口。准确识别半暗带是必要的，以便个性化治疗干预的机会窗口。成像技术虽然有用，但可能无法提供有关半影存在的最准确信息，因为识别半影的阈值根据所使用的技术而变化。更好地识别真正的半影组织可能基于导致半影向梗塞组织进化的分子事件级联。考虑到哪个血管被闭塞、缺血的演变时间、缺血的程度以及不同细胞对缺血的敏感性，可以用分子术语来定义多个半暗带。未来的研究有必要阐明增强细胞保护机制和/或阻断细胞毒性机制以确认缺血演化不同时期半暗带的存在是否是有效的神经保护策略。
Ischemic penumbra defines the existence of tissue at risk of infarction and which is, hence, potentially salvageable and the target for current stroke reperfusion and neuroprotective therapies. Penumbral tissue evolves toward irreversibly damaged tissue at different rates in individual stroke patients yielding different therapeutic windows depending on the individual duration of risk of infarction of this tissue. An accurate identification of the penumbra is then necessary in order to individualize the window of opportunity for therapeutic interventions. Imaging techniques, although helpful, may not give the most accurate information as to the existence of penumbra given that the threshold for identification of penumbra varies depending on the technique used. A better identification of the true penumbral tissue might be based on the cascade of molecular events that are responsible for the evolution of the penumbra toward infarcted tissue. Multiple penumbras can be defined in molecular terms taking into account which vessel is occluded, the time of evolution of the ischemia, the degree of the ischemia, and the sensitivity to ischemia of the different cells. Future studies are necessary to clarify whether the enhancement of cytoprotective mechanisms, and/or the block of cytotoxic mechanisms confirming the existence of penumbra at different times of ischemic evolution, are effective neuroprotective strategies.