Brain injury in premature neonates: A primary cerebral dysmaturation disorder?
Brain injury in premature neonates: A primary cerebral dysmaturation disorder?
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DOI：
10.1002/ana.24132
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发表时间：
2014-04
影响因子：
11.2
通讯作者：
Miller SP
中科院分区：
文献类型：
--
作者：
Back SA;Miller SP
随着新生儿护理的进步，早产儿虽得以存活，但却出现了一系列不断变化的运动和认知障碍，这些障碍似乎与针对大脑灰质和白质的广泛细胞成熟紊乱有关。以前，早产儿极易发生破坏性脑损伤，导致囊性白质损伤以及继发性皮质和皮质下灰质退变，而当代早产儿幸存者群体通常表现出不太严重的损伤，似乎没有明显的神经胶质或神经元丢失。然而，这些较轻形式的损伤也与大脑发育迟缓有关。近期的人类研究和实验研究表明，大脑发育迟缓与灰质和白质的不同反应有关。大脑白质的髓鞘形成障碍与少突胶质前体细胞晚期（preOLs）急性死亡后的异常再生和修复反应有关。在preOL死亡后，早期少突胶质前体细胞迅速增殖和分化，但再生的preOLs无法正常成熟为白质生长所需的髓鞘形成细胞。尽管未成熟神经元似乎比神经胶质细胞对缺氧缺血导致的细胞死亡更具抵抗力，但它们在树突分支的成熟过程中表现出广泛的紊乱，这进一步导致大脑发育迟缓。因此，神经元和pre - OLs这些复杂且不同的反应导致大量细胞在神经回路发育的关键窗口期间无法完全成熟。这些最近被认识到的大脑灰质和白质发育不良的形式带来了新的诊断挑战，并为围绕逆转促进发育不良的过程提出了新的治疗方向。
With advances in neonatal care, preterm neonates are surviving with an evolving constellation of motor and cognitive disabilities that appear to be related to widespread cellular maturational disturbances that target cerebral gray and white matter. Whereas preterm infants were previously at high risk for destructive brain lesions that resulted in cystic white matter injury and secondary cortical and subcortical gray matter degeneration, contemporary cohorts of preterm survivors commonly display less severe injury that does not appear to involve pronounced glial or neuronal loss. Nevertheless, these milder forms of injury are also associated with reduced cerebral growth. Recent human and experimental studies support that impaired cerebral growth is related to disparate responses in gray and white matter. Myelination disturbances in cerebral white matter are related to aberrant regeneration and repair responses to acute death of premyelinating late oligodendrocyte progenitors (preOLs). In response to preOL death, early oligodendrocyte progenitors rapidly proliferate and differentiate, but the regenerated preOLs fail to normally mature to myelinating cells required for white matter growth. Although immature neurons appear to be more resistant to cell death from hypoxia–ischemia than glia, they display widespread disturbances in maturation of their dendritic arbors, which further contribute to impaired cerebral growth. These complex and disparate responses of neurons and pre-OLs thus result in large numbers of cells that fail to fully mature during a critical window in development of neural circuitry. These recently recognized forms of cerebral gray and white matter dysmaturation raise new diagnostic challenges and suggest new therapeutic directions centered on reversal of the processes that promote dysmaturation.
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作者：
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影响因子：
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DOI：
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发表时间：
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影响因子：
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