Iadecola Costantino, Buckwalter Marion S, Anrather Josef
Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, New York, USA.
Department of Neurology and Neurological Sciences, Stanford University Medical Center, Stanford, California, USA.
J Clin Invest. 2020 Jun 1;130(6):2777-2788. doi: 10.1172/JCI135530.
Stroke is the second leading cause of death worldwide and a leading cause of disability. Most strokes are caused by occlusion of a major cerebral artery, and substantial advances have been made in elucidating how ischemia damages the brain. In particular, increasing evidence points to a double-edged role of the immune system in stroke pathophysiology. In the acute phase, innate immune cells invade brain and meninges and contribute to ischemic damage, but may also be protective. At the same time, danger signals released into the circulation by damaged brain cells lead to activation of systemic immunity, followed by profound immunodepression that promotes life-threatening infections. In the chronic phase, antigen presentation initiates an adaptive immune response targeted to the brain, which may underlie neuropsychiatric sequelae, a considerable cause of poststroke morbidity. Here, we briefly review these pathogenic processes and assess the potential therapeutic value of targeting immunity in human stroke.
中风是全球第二大致死原因,也是导致残疾的主要原因。大多数中风是由大脑主要动脉闭塞引起的,在阐明缺血如何损害大脑方面已经取得了重大进展。特别是,越来越多的证据表明免疫系统在中风病理生理学中具有双刃剑作用。在急性期,先天免疫细胞侵入脑和脑膜并导致缺血性损伤,但也可能具有保护作用。与此同时,受损脑细胞释放到循环系统中的危险信号会导致全身免疫激活,随后是严重的免疫抑制,从而引发危及生命的感染。在慢性期,抗原呈递引发针对大脑的适应性免疫反应,这可能是神经精神后遗症的基础,而神经精神后遗症是中风后发病的一个重要原因。在此,我们简要回顾这些致病过程,并评估针对人类中风免疫治疗的潜在价值。