Neuroinflammation and comorbidities are frequently ignored factors in CNS pathology.
Neuroinflammation and comorbidities are frequently ignored factors in CNS pathology.
复制标题
DOI：
10.4103/1673-5374.165208
复制
发表时间：
2015-09
影响因子：
6.1
通讯作者：
Popa-Wagner A
中科院分区：
文献类型：
--
作者：
Sandu RE;Buga AM;Uzoni A;Petcu EB;Popa-Wagner A
几乎所有在实验性中风中临床前成功的药物干预都未能在临床环境中证明其疗效。这可以部分解释为人类疾病的复杂性和异质性以及相关的共病，这可能使神经保护药物在临床实践中的有效性降低。在中风的病理生理学中至关重要的一个方面是尚未完全理解的神经炎症。目前，越来越明显的是，微妙的，但持续的神经炎症可以提供基础的疾病，如脑小血管疾病。此外，老龄化和一些高度流行的风险因素，如肥胖，高血压，糖尿病和动脉粥样硬化，可以作为“沉默的贡献者”，促进慢性促炎状态。这可能会加重各种病理实体的结果，并可能导致许多随后的中风后并发症，如痴呆症，抑郁症和神经变性，从而形成病理恶性循环。此外，最近的数据表明，炎症过程可能与抑郁症相关的多种神经退行性通路密切相关。此外，促炎细胞因子在抑郁症和痴呆症的病理生理学中起着重要作用。
Virtually all drug interventions that have been successful pre-clinically in experimental stroke have failed to prove their efficacy in a clinical setting. This could be partly explained by the complexity and heterogeneity of human diseases as well as the associated co-morbidities which may render neuroprotective drugs less efficacious in clinical practice. One aspect of crucial importance in the physiopathology of stroke which is not completely understood is neuroinflammation. At the present time, it is becoming evident that subtle, but continuous neuroinflammation can provide the ground for disorders such as cerebral small vessel disease. Moreover, advanced aging and a number of highly prevalent risk factors such as obesity, hypertension, diabetes and atherosclerosis could act as “silent contributors” promoting a chronic proinflammatory state. This could aggravate the outcome of various pathological entities and can contribute to a number of subsequent post-stroke complications such as dementia, depression and neurodegeneration creating a pathological vicious cycle. Moreover, recent data suggests that the inflammatory process might be closely linked with multiple neurodegenerative pathways related to depression. In addition, pro-inflammatory cytokines could play a central role in the pathophysiology of both depression and dementia.