Gauberti Maxime, De Lizarrondo Sara Martinez, Vivien Denis
Institut National de la Santé et de la Recherche Médicale (INSERM), INSERM UMR-S U919, Serine Proteases and Pathophysiology of the Neurovascular Unit, GIP Cyceron, Caen, France. University of Caen Normandy, Caen, France.
Eur Stroke J. 2016 Mar;1(1):20-27. doi: 10.1177/2396987316630249. Epub 2016 Mar 1.
The objective of the present review is to provide an overview of the available clinical and preclinical data supporting the existence of an "inflammatory penumbra" in ischemic stroke.
Recent data from clinical trials suggest the existence of an inflammatory area at risk, surrounding the initial ischemic lesion and secondarily infiltrated by lymphocytes, that is ultimately recruited by the ischemic core: called the "inflammatory penumbra." Experimental results support this concept. Lymphocytes, especially T-cells, enter the brain in the perilesional area in a vascular-cell adhesion molecule-1 dependent manner and participate in delayed neuronal cell death.
For writing this review, we used the more recent publications in the field, including the preclinical and clinical studies. We have also used our own experise in the field of in vivo imaging of inflammatory processes.
Consequently, the intensity of the inflammatory reaction and the size of the inflammatory penumbra may vary considerably in patients, as it is the case in experimental stroke models in mice. By analogy with the ischemic penumbra of the acute phase of stroke, this secondary inflammatory penumbra represents a therapeutic opportunity during the subacute phase of stroke. Large clinical trials that target lymphocyte trafficking are currently taking place. However, to improve the benefit of such therapeutic strategies, adequate patient selection may be mandatory.
In this context, innovative imaging methods including magnetic resonance imaging of adhesion molecules may contribute to noninvasively detect this inflammatory penumbra and thus to select patients eligible for such therapy.
本综述的目的是概述支持缺血性卒中存在“炎症半暗带”的现有临床和临床前数据。
临床试验的最新数据表明，存在一个处于风险中的炎症区域，该区域围绕着最初的缺血性病变，并继发淋巴细胞浸润，最终被缺血核心所募集，称为“炎症半暗带”。实验结果支持这一概念。淋巴细胞，尤其是T细胞，以血管细胞黏附分子-1依赖的方式进入病灶周围区域的大脑，并参与延迟性神经元细胞死亡。
为撰写本综述，我们使用了该领域的最新出版物，包括临床前和临床研究。我们还运用了自己在炎症过程体内成像领域的专业知识。
因此，炎症反应的强度和炎症半暗带的大小在患者中可能有很大差异，正如在小鼠实验性卒中模型中一样。与卒中急性期的缺血半暗带类似，这个继发性炎症半暗带代表了卒中亚急性期的一个治疗机会。目前正在进行针对淋巴细胞运输的大型临床试验。然而，为了提高此类治疗策略的益处，可能必须进行适当的患者选择。
在这种情况下，包括黏附分子磁共振成像在内的创新成像方法可能有助于无创检测这个炎症半暗带，从而选择适合此类治疗的患者。
