Righy Cássia, Bozza Marcelo T, Oliveira Marcus F, Bozza Fernando A
Avenida Brasil 4.365, Manguinhos, Rio de Janeiro-RJ, CEP 21.040-900, Pavilhão Gaspar Viana.
Curr Neuropharmacol. 2016;14(4):392-402. doi: 10.2174/1570159x14666151230110058.
Hemorrhagic stroke is a disease with high incidence and mortality rates. In addition to the mass lesions that result from hemorrhagic stroke, substances such as the blood-derived products (BDP) (hemoglobin (Hb), heme and iron) induce a potent inflammatory response and exert direct toxic effects on neurons, astrocytes, and microglia. In the present review, we discuss the mechanisms of brain injury secondary to hemorrhagic stroke, focusing on the involvement of BDP as major players of cellular redox imbalance, inflammation, and glutamate excitotoxicity. Potential natural mechanisms of protection against free Hb and heme such as haptoglobin and hemopexin, respectively, are highlighted. We finally discuss the experimental and clinical trials targeting free iron and heme scavenging as well as inflammation, as potential new therapies to minimize the devastating effects of hemorrhagic stroke on brain structure and function.
出血性中风是一种发病率和死亡率都很高的疾病。除了出血性中风导致的占位性病变外，诸如血液衍生产物（BDP）（血红蛋白（Hb）、血红素和铁）等物质会引发强烈的炎症反应，并对神经元、星形胶质细胞和小胶质细胞产生直接毒性作用。在本综述中，我们讨论了出血性中风继发脑损伤的机制，重点关注BDP作为细胞氧化还原失衡、炎症和谷氨酸兴奋性毒性的主要参与者所起的作用。分别强调了针对游离Hb和血红素的潜在天然保护机制，如触珠蛋白和血红素结合蛋白。我们最后讨论了针对游离铁和血红素清除以及炎症的实验和临床试验，这些试验作为潜在的新疗法，旨在将出血性中风对脑结构和功能的破坏性影响降至最低。
