Transcranial direct current stimulation and neurovascular modulation.
Transcranial direct current stimulation and neurovascular modulation.
复制标题
经颅直流电刺激和神经血管调节。
DOI：
10.1111/ene.15710
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发表时间：
2023
影响因子：
5.1
通讯作者：
Bikson,Marom
中科院分区：
文献类型：
--
作者：
Bikson,Marom
在人类和动物模型中，经颅直流电刺激（tDCS）会改变局部脑血流，尽管反应的性质是大脑状态和剂量依赖性的[1]。鉴于血管和脑转运功能障碍在脑部疾病中的普遍性，与tDCS试验的临床适应症的重叠并不奇怪。是否存在进一步的治疗机制联系？Gellner等人[2]在tDCS小鼠模型中，系统地记录了血流量和皮质微血管通透性的增加，沿着血管周围小胶质细胞活性的增加。他们的工作显示了剂量，时间和目标结构依赖性效应。Gellner等人[2]背景化动物模型中的一系列先前工作，表明tDCS可以调节形成神经血管单位的每种细胞类型，包括神经元、血管周围星形胶质细胞、小胶质细胞和内皮细胞[3，4]。神经血管调制[5]是基于神经血管单位反应[5]解释脑刺激技术（包括tDCS）的框架。几个关键的神经血管调节考虑因素在Gellner et al. [2]的文件。神经血管调节的主要考虑因素是刺激的直接细胞靶是否是神经元、神经胶质、内皮细胞或参与脑运输的细胞外过程。传统的脑刺激理论只考虑神经元极化。但是，在具有内皮细胞[6]的分离的神经胶质[4]的体外模型中，这些细胞类型也被直接刺激。正是由于神经血管耦合，在体内解开哪种细胞类型首先响应电刺激以及哪种细胞类型随后响应是具有挑战性的。
Regional cerebral blood flow is altered by transcranial direct current stimulation (tDCS) in human as well as animal models, though the nature of responses is brain state and dose dependent [1]. Given the pervasiveness of vascular and brain transport dysfunction across brain disease, the overlap with clinical indications for which tDCS is trialed is not surprising. Is there a further therapeutic mechanisms link?Gellner et al.[2] systematically document increases in blood flow and permeability of cortical microvasculature, along with increased perivascular microglia activity, in a mouse model of tDCS. Their work shows dose-, time-, and target structure-dependent effects. Gellner et al.[2] contextualize a range of prior work in animal models indicating tDCS can modulate each cell type forming the neurovascular unit including neurons, perivascular astrocytes, microglia, and endothelial cells [3, 4]. Neurovascular-modulation [5] is a framework for explanations for brain stimulation technology, including tDCS, based on neurovascular unit response [5]. Several key neurovascularmodulation considerations are explored in Gellner et al.[2]. A primary consideration in neurovascular modulation is if the direct cellular targets for stimulation are neurons, glia, endothelial cells, or extracellular processes involved in brain transport. Conventional theories of brain stimulation consider only neuron polarization. But in vitro models with isolated glia [4] of endothelial cells [6] show these cell types are also directly stimulated. Precisely because of neurovascular coupling, it is challenging in vivo to untangle which cell type responds first to electrical stimulation and which cell types follow.