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中风的免疫反应:免疫系统如何在中风后导致损伤和促进修复,以及这些知识如何转化为更好的治疗方法?

Immune responses in stroke: how the immune system contributes to damage and healing after stroke and how this knowledge could be translated to better cures?

机构信息

Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, WI, USA.

Neuroscience Training Program, University of Wisconsin-Madison, Madison, WI, USA.

出版信息

Immunology. 2018 Jul;154(3):363-376. doi: 10.1111/imm.12918. Epub 2018 Mar 26.

Abstract

Stroke is one of the leading causes of death and disability worldwide. The long-standing dogma that stroke is exclusively a vascular disease has been questioned by extensive clinical findings of immune factors that are associated mostly with inflammation after stroke. These have been confirmed in preclinical studies using experimental animal models. It is now accepted that inflammation and immune mediators are critical in acute and long-term neuronal tissue damage and healing following thrombotic and ischaemic stroke. Despite mounting information delineating the role of the immune system in stroke, the mechanisms of how inflammatory cells and their mediators are involved in stroke-induced neuroinflammation are still not fully understood. Currently, there is no available treatment for targeting the acute immune response that develops in the brain during cerebral ischaemia. No new treatment has been introduced to stroke therapy since the discovery of tissue plasminogen activator therapy in 1996. Here, we review current knowledge of the immunity of stroke and identify critical gaps that hinder current therapies. We will discuss advances in the understanding of the complex innate and adaptive immune responses in stroke; mechanisms of immune cell-mediated and factor-mediated vascular and tissue injury; immunity-induced tissue repair; and the importance of modulating immunity in stroke.

摘要

中风是全球范围内导致死亡和残疾的主要原因之一。长期以来,中风是一种血管疾病的观念一直受到质疑,因为有大量临床发现表明免疫因素与中风后的炎症有关。这些发现已在使用实验动物模型的临床前研究中得到证实。现在人们普遍认为,炎症和免疫介质在血栓性和缺血性中风后急性和长期的神经元组织损伤和修复中至关重要。尽管有越来越多的信息描述了免疫系统在中风中的作用,但炎症细胞及其介质如何参与中风引起的神经炎症的机制仍未完全阐明。目前,针对脑缺血期间大脑中发生的急性免疫反应,尚无可用的治疗方法。自 1996 年发现组织型纤溶酶原激活剂治疗以来,中风治疗没有引入新的治疗方法。在这里,我们回顾了中风免疫的现有知识,并确定了阻碍当前治疗方法的关键空白。我们将讨论在中风中理解复杂的先天和适应性免疫反应、免疫细胞介导和因子介导的血管和组织损伤的机制、免疫诱导的组织修复以及调节中风免疫的重要性方面的进展。

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