The evidence for hypoperfusion as a factor in multiple sclerosis lesion development.
The evidence for hypoperfusion as a factor in multiple sclerosis lesion development.
复制标题
DOI：
10.1155/2013/598093
复制
发表时间：
2013
影响因子：
2.5
通讯作者：
Juurlink BH
中科院分区：
文献类型：
--
作者：
Juurlink BH
缺氧是导致早期MS病变的促发因素的证据包括缺氧诱导因子-1 α蛋白水平升高、D-110缺氧诱导蛋白的存在、病变中以及邻近正常外观的白色物质（NAWM）中缺氧诱导基因表达增加、早期MS病变髓鞘中髓鞘相关糖蛋白的丢失、缺氧诱导基因的表达增加以及缺氧诱导基因的表达增加。通过NAWM的血流量减少50%，血流量最低的区域发生病变的可能性最大。为什么MS样病变的发展后，低氧血症的侮辱，在一些人，而不是在其他人可能取决于存在的免疫易感因素，是由遗传。灌注不足可能是由于动脉供应减少、静脉回流受限或这些因素的组合。目前正在进行或计划通过血管成形术治疗慢性脑脊髓静脉功能不全（CCSVI）的临床试验。我认为，重要的是，临床试验解决血管问题的MS应检查血管干预如何影响白色物质灌注，并确定灌注恢复和维持这种恢复的程度是否与功能恢复和维持功能恢复。还应考虑到动脉问题在某些MS患者的低灌注中发挥作用的可能性。
The evidence that hypoxia is a precipitating factor in causing early MS lesions includes increased protein levels of hypoxia-inducible factor-1α; presence of the D-110 hypoxia-inducible protein; increased expression of hypoxia-inducible genes in lesions as well as in adjacent normal-appearing white matter (NAWM); loss of myelin-associated glycoprotein in myelin of early MS lesions; a 50% reduction of blood flow through NAWM with areas of lowest blood flow having the greatest probability of lesion development. Why MS-like lesions develop following hypoxemic insults in some individuals but not in others is likely dependent upon the presence of immune predisposing factors that are governed genetically. Hypoperfusion may be due to decreased arterial supply, restricted venous return, or a combination of these. There are clinical trials ongoing or planned to treat chronic cerebrospinal venous insufficiency (CCSVI) through angioplasty. I suggest that it is important that clinical trials addressing vascular issues in MS should examine how the vascular intervention affects white matter perfusion and determine whether the extent of perfusion recovery and maintenance of this recovery is related to functional recovery and maintenance of functional recovery. Consideration should also be given to the possibility of arterial problems playing a role in hypoperfusion in some MS patients.