Stroke Renaissance Project, Tokyo Metropolitan Institute of Medical Science, 2-1-6 Kamikitazawa, Setagaya-ku, Tokyo, 156-8506, Japan.
Department of Internal Medicine, Fukuoka Dental College Medical and Dental Hospital, Fukuoka, 814-0193, Japan.
Semin Immunopathol. 2018 Nov;40(6):523-538. doi: 10.1007/s00281-018-0707-8. Epub 2018 Sep 11.
Inflammatory responses play a multifaceted role in regulating both disability and recovery after ischemic brain injury. In the acute phase of ischemic stroke, resident microglia elicit rapid inflammatory responses by the ischemic milieu. After disruption of the blood-brain barrier, peripheral-derived neutrophils and mononuclear phagocytes infiltrate into the ischemic brain. These infiltrating myeloid cells are activated by the endogenous alarming molecules released from dying brain cells. Inflammation after ischemic stroke thus typically consists of sterile inflammation triggered by innate immunity, which exacerbates the pathologies of ischemic stroke and worsens neurological prognosis. Infiltrating immune cells sustain the post-ischemic inflammation for several days; after this period, however, these cells take on a repairing function, phagocytosing inflammatory mediators and cellular debris. This time-specific polarization of immune cells in the ischemic brain is a potential novel therapeutic target. In this review, we summarize the current understanding of the phase-dependent role of innate myeloid cells in ischemic stroke and discuss the cellular and molecular mechanisms of their inflammatory or repairing polarization from a therapeutic perspective.
炎症反应在调节缺血性脑损伤后的残疾和恢复方面发挥着多方面的作用。在缺血性中风的急性期,局部的小胶质细胞通过缺血环境引发迅速的炎症反应。血脑屏障破坏后,外周来源的中性粒细胞和单核吞噬细胞浸润到缺血性大脑中。这些浸润的髓样细胞被来自死亡脑细胞释放的内源性警报分子激活。因此,缺血性中风后的炎症通常包括由先天免疫引发的无菌性炎症,这会加重缺血性中风的病理并恶化神经预后。浸润的免疫细胞在缺血后持续数天引发炎症;然而,在此之后,这些细胞发挥修复功能,吞噬炎症介质和细胞碎片。在缺血性大脑中,免疫细胞的这种时间特异性极化是一个潜在的新的治疗靶点。在这篇综述中,我们总结了目前对先天髓样细胞在缺血性中风中时相依赖性作用的理解,并从治疗的角度讨论了它们炎症或修复极化的细胞和分子机制。