Cerebral microbleeds in vascular dementia from clinical aspects to host-microbial interaction
Cerebral microbleeds in vascular dementia from clinical aspects to host-microbial interaction
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DOI：
10.1016/j.neuint.2021.105073
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发表时间：
2021-06-29
影响因子：
4.2
通讯作者：
Gyanwali, Bibek
中科院分区：
文献类型：
--
作者：
Tonomura, Shuichi;Gyanwali, Bibek
在全球老年人口中，血管性痴呆是仅次于阿尔茨海默病的第二大痴呆症原因。脑微出血(CMBS)是老年人常见的MRI表现，被认为是一种可能的替代标记物。CMBS的数量和位置反映了疾病的严重程度，潜在的病理可能涉及脑淀粉样血管病变或高血压血管病变。越来越多的证据证明了CMBS的临床病理差异，CMBS与其他脑小血管疾病、认知障碍、血清和脑脊液生物标志物的MRI标志物的临床意义。此外，新出现的证据表明，遗传因素和基因-环境相互作用可能有助于揭示CMBS的潜在病因，重点是血脑屏障和炎症。在这篇综述中，我们介绍了最近的遗传学和微生物组研究，作为一种前沿的方法，通过“微生物-脑-口腔轴”和“微生物组-脑-肠轴”来找出CMBS的病因。最后，我们提出了“微血管基质”和“不平衡蛋白平衡”的新概念，这可能为阐明CMBS的病理生理机制和以CMBS作为替代标记物治疗血管性痴呆的未来发展提供更好的前景。
Vascular dementia is the second leading cause of dementia after Alzheimer's disease in the elderly population worldwide. Cerebral microbleeds (CMBs) are frequently observed in MRI of elderly subjects and considered as a possible surrogate marker. The number and location of CMBs reflect the severity of diseases and the underlying pathologies may involve cerebral amyloid angiopathy or hypertensive vasculopathy. Accumulating evidence demonstrated the clinicopathological discrepancies of CMBs, the clinical significance of CMBs associated with other MRI markers of cerebral small vessel disease, cognitive impairments, serum, and cerebrospinal fluid biomarkers. Moreover, emerging evidence has shown that genetic factors and gene-environmental interactions might shed light on the underlying etiologies of CMBs, focusing on blood-brain-barrier and inflammation. In this review, we introduce recent genetic and microbiome studies as a cutting-edge approach to figure out the etiology of CMBs through the "microbe-brain-oral axis" and "microbiome-brain-gut axis." Finally, we propose novel concepts, "microvascular matrisome" and "imbalanced proteostasis," which may provide better perspectives for elucidating the pathophysiology of CMBs and future development of therapeutics for vascular dementia using CMBs as a surrogate marker.