Matuszak Jasmin, Tabuchi Arata, Kuebler Wolfgang M
Institute of Physiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
The Keenan Research Centre for Biomedical Science at St. Michael's, Toronto, ON, Canada.
Front Physiol. 2020 Apr 3;11:291. doi: 10.3389/fphys.2020.00291. eCollection 2020.
Intravital microscopy (IVM) offers unique possibilities for the observation of biological processes and disease related mechanisms . Especially for anatomically complex and dynamic organs such as the lung and its main functional unit, the alveolus, IVM provides exclusive advantages in terms of spatial and temporal resolution. By the use of lung windows, which have advanced and improved over time, direct access to the lung surface is provided. In this review we will discuss two main topics, namely alveolar dynamics and perfusion from the perspective of IVM-based studies. Of special interest are unanswered questions regarding alveolar dynamics such as: What are physiologic alveolar dynamics? How do these dynamics change under pathologic conditions and how do those changes contribute to ventilator-induced lung injury? How can alveolar dynamics be targeted in a beneficial way? With respect to alveolar perfusion IVM has propelled our understanding of the pulmonary microcirculation and its perfusion, as well as pulmonary vasoreactivity, permeability and immunological aspects. Whereas the general mechanism behind these processes are understood, we still lack a proper understanding of the complex, multidimensional interplay between alveolar ventilation and microvascular perfusion, capillary recruitment, or vascular immune responses under physiologic and pathologic conditions. These are only part of the unanswered questions and problems, which we still have to overcome. IVM as the tool of choice might allow us to answer part of these questions within the next years or decades. As every method, IVM has advantages as well as limitations, which have to be taken into account for data analysis and interpretation, which will be addressed in this review.
活体显微镜检查（IVM）为观察生物过程和疾病相关机制提供了独特的可能性。特别是对于解剖结构复杂且动态变化的器官，如肺及其主要功能单位肺泡，IVM在空间和时间分辨率方面具有独特优势。通过使用随着时间不断改进的肺窗，可以直接观察肺表面。在本综述中，我们将从基于IVM的研究角度讨论两个主要主题，即肺泡动力学和灌注。特别值得关注的是关于肺泡动力学的一些尚未解决的问题，例如：生理状态下的肺泡动力学是什么？在病理条件下这些动力学如何变化，以及这些变化如何导致呼吸机相关性肺损伤？如何以有益的方式针对肺泡动力学进行干预？关于肺泡灌注，IVM推动了我们对肺微循环及其灌注、肺血管反应性、通透性和免疫学方面的理解。虽然这些过程背后的一般机制已为人所知，但我们仍缺乏对生理和病理条件下肺泡通气与微血管灌注、毛细血管募集或血管免疫反应之间复杂的多维相互作用的恰当理解。这些只是我们仍需克服的部分未解决的问题。作为首选工具，IVM可能使我们在未来几年或几十年内回答其中部分问题。与每种方法一样，IVM有其优点和局限性，在数据分析和解释时必须予以考虑，本综述将对此进行讨论。
