Macrophage polarization: a key event in the secondary phase of acute spinal cord injury.
Macrophage polarization: a key event in the secondary phase of acute spinal cord injury.
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DOI：
10.1111/jcmm.13034
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发表时间：
2017-05
影响因子：
5.3
通讯作者：
Gao J
中科院分区：
文献类型：
--
作者：
Kong X;Gao J
急性脊髓损伤（SCI）已成为现代社会的流行病。尽管对发病机制的理解取得了进展，早期识别和治疗也有所改善，但它仍然是一种毁灭性的事件，往往造成严重和永久性残疾。SCI有两个阶段：急性和继发性。虽然急性期的特点是严重的局部和全身事件，如组织挫伤，缺血，出血和血管损伤，SCI的结果主要受继发期的影响。SCI通过激活导致继发性损伤的先天免疫反应引起炎症反应，其中基于极化的巨噬细胞活化是标志。聚集在震中内的巨噬细胞和损伤脊髓的血肿在这种炎症中起重要作用。根据其表型和活化状态，巨噬细胞可启动继发性损伤机制和/或促进CNS再生和修复。当涉及到SCI的治疗时，很少有能在急性期进行的。然而，由于巨噬细胞活化和极化开关对微环境的变化非常敏感，因此已经进行了一些试验来调节巨噬细胞极化以利于SCI的恢复。鉴于此，重要的是要了解巨噬细胞和SCI如何在分子病理生理水平上相互关联和相互作用。本文主要从以下几个方面综述了急性SCI的免疫病理生理学特征：（i）急性SCI的病理生理学概述;（ii）巨噬细胞在急性SCI中的作用，特别是其极化开关;（iii）新开发的调节急性SCI中巨噬细胞极化的神经保护疗法。
Acute spinal cord injury (SCI) has become epidemic in modern society. Despite advances made in the understanding of the pathogenesis and improvements in early recognition and treatment, it remains a devastating event, often producing severe and permanent disability. SCI has two phases: acute and secondary. Although the acute phase is marked by severe local and systemic events such as tissue contusion, ischaemia, haemorrhage and vascular damage, the outcome of SCI are mainly influenced by the secondary phase. SCI causes inflammatory responses through the activation of innate immune responses that contribute to secondary injury, in which polarization‐based macrophage activation is a hallmarker. Macrophages accumulated within the epicentre and the haematoma of the injured spinal cord play a significant role in this inflammation. Depending on their phenotype and activation status, macrophages may initiate secondary injury mechanisms and/or promote CNS regeneration and repair. When it comes to therapies for SCI, very few can be performed in the acute phase. However, as macrophage activation and polarization switch are exquisitely sensitive to changes in microenvironment, some trials have been conducted to modulate macrophage polarization towards benefiting the recovery of SCI. Given this, it is important to understand how macrophages and SCI interrelate and interact on a molecular pathophysiological level. This review provides a comprehensive overview of the immuno‐pathophysiological features of acute SCI mainly from the following perspectives: (i) the overview of the pathophysiology of acute SCI, (ii) the roles of macrophage, especially its polarization switch in acute SCI, and (iii) newly developed neuroprotective therapies modulating macrophage polarization in acute SCI.