Winkler Tilo, Suki Béla
Massachusetts General Hospital and Harvard Medical School, Department of Anesthesia, Critical Care and Pain Medicine, Boston, Massachusetts, USA.
Crit Rev Biomed Eng. 2011;39(4):263-80. doi: 10.1615/critrevbiomedeng.v39.i4.20.
Structure-function relationships in the respiratory system are often a result of the emergence of self-organized patterns or behaviors that are characteristic of certain respiratory diseases. Proper description of such self-organized behavior requires network models that include nonlinear interactions among different parts of the system. This review focuses on 2 models that exhibit self-organized behavior: a network model of the lung parenchyma during the progression of emphysema that is driven by mechanical force-induced breakdown, and an integrative model of bronchoconstriction in asthma that describes interactions among airways within the bronchial tree. Both models suggest that the transition from normal to pathologic states is a nonlinear process that includes a tipping point beyond which interactions among the system components are reinforced by positive feedback, further promoting the progression of pathologic changes. In emphysema, the progressive destruction of tissue is irreversible, while in asthma, it is possible to recover from a severe bronchoconstriction. These concepts may have implications for pulmonary medicine. Specifically, we suggest that structure-function relationships emerging from network behavior across multiple scales should be taken into account when the efficacy of novel treatments or drug therapy is evaluated. Multiscale, computational, network models will play a major role in this endeavor.
呼吸系统中的结构 - 功能关系通常是某些呼吸系统疾病所特有的自组织模式或行为出现的结果。对这种自组织行为的恰当描述需要网络模型，该模型要包含系统不同部分之间的非线性相互作用。本综述聚焦于两种展现出自组织行为的模型：一种是在肺气肿进展过程中由机械力诱导破坏驱动的肺实质网络模型，另一种是描述支气管树内气道间相互作用的哮喘支气管收缩综合模型。两种模型均表明，从正常状态到病理状态的转变是一个非线性过程，其中包括一个临界点，超过该点后系统组件之间的相互作用会通过正反馈得到加强，进而进一步促进病理变化的进展。在肺气肿中，组织的渐进性破坏是不可逆的，而在哮喘中，从严重支气管收缩中恢复是有可能的。这些概念可能对肺病医学有启示意义。具体而言，我们建议在评估新治疗方法或药物治疗的疗效时，应考虑跨多个尺度的网络行为所产生的结构 - 功能关系。多尺度、计算性的网络模型将在这一努力中发挥主要作用。
