The neurovascular unit in the setting of stroke.

The neurovascular unit in the setting of stroke.
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DOI:
10.1111/j.1365-2796.2009.02199.x
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发表时间:
2010-02
影响因子:
11.1
通讯作者:
del Zoppo GJ
del Zoppo GJ
中科院分区:
医学1区
文献类型:
--
作者:
del Zoppo GJ

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微血管和神经元迅速,同时在局部缺血性损伤的反应,以这种方式表明,可以协调的反应。神经元调节激活区域中脑血流的能力是由神经血管耦合引起的。但是对于这种关系的微血管到神经元方向知之甚少。介入胶质细胞的存在和参与意味着微血管、胶质细胞和神经元在“神经血管单位”中的关联。这个理论单位的细胞和基质成分的相互依赖的功能还没有被严格地探索,除了在损伤的条件下,在大多数情况下,只有单一的成分或组织样本进行了研究。尽管在人类和动物模型中维持或及时重建血流减少了组织和神经元损伤,但尽管存在神经血管偶联的固有机制,但对人类神经元功能的保护并没有阻止损伤的发展。然而,阻塞流向大脑的血流可以快速识别血管危险区域内的神经血管脆弱性区域。这些合并成为成熟的缺血性病变。失败,到目前为止,神经元保护剂的临床试验,以实现可检测的组织挽救可以解释的脆弱性(和缺乏保护)的基本组成部分的“单位”。本报告总结了关于这一主题的证据和想法。这些支持需要了解组件内的神经血管单位的相互作用。
Microvessels and neurons respond rapidly and simultaneously in focal regions of ischaemic injury in such a way as to suggest that the responses could be coordinated. The ability of neurons to modulate cerebral blood flow in regions of activation results from neurovascular coupling. But little is known about the microvessel-to-neuron direction of the relationship. The presence and participation of intervening glial cells implies the association of microvessels, glia, and neurons in a ‘neurovascular unit’. The interdependent functions of the cellular and matrix components of this theoretical unit have not been rigorously explored, except under conditions of injury where, for the most part, only single components or tissue samples have been studied. Whereas maintenance or timely re-establishment of flow reduces tissue and neuron injury in both humans and animal models, protection of neuron function in humans has not prevented the evolution of injury despite the inherent mechanisms of neurovascular coupling. However, occlusion of flow to the brain rapidly identifies regions of neuron-vascular vulnerability within the vascular territory-at-risk. These coalesce to become the mature ischaemic lesion. The failure, so far, of clinical trials of neuron protectant agents to achieve detectable tissue salvage could be explained by the vulnerability (and lack of protection) of essential components of the ‘unit’. This presentation summarizes evidence and thoughts on this topic. These support the need to understand component interactions within the neurovascular unit.
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