Charité - Universitätsmedizin Berlin, Department of Neurology with Experimental Neurology, Charitéplatz 1, 10117, Berlin, Germany.
Charité - Universitätsmedizin Berlin, Center for Stroke Research Berlin, Charitéplatz 1, 10117, Berlin, Germany.
Transl Stroke Res. 2023 Oct;14(5):643-666. doi: 10.1007/s12975-022-01090-9. Epub 2022 Oct 11.
The concept of the ischemic penumbra was originally defined as the area around a necrotic stroke core and seen as the tissue at imminent risk of further damage. Today, the penumbra is generally considered as time-sensitive hypoperfused brain tissue with decreased oxygen and glucose availability, salvageable tissue as treated by intervention, and the potential target for neuroprotection in focal stroke. The original concept entailed electrical failure and potassium release but one short of neuronal cell death and was based on experimental stroke models, later confirmed in clinical imaging studies. However, even though the basic mechanisms have translated well, conferring brain protection, and improving neurological outcome after stroke based on the pathophysiological mechanisms in the penumbra has yet to be achieved. Recent findings shape the modern understanding of the penumbra revealing a plethora of molecular and cellular pathophysiological mechanisms. We now propose a new model of the penumbra, one which we hope will lay the foundation for future translational success. We focus on the availability of glucose, the brain's central source of energy, and bioenergetic failure as core pathophysiological concepts. We discuss the relation of mitochondrial function in different cell types to bioenergetics and apoptotic cell death mechanisms, autophagy, and neuroinflammation, to glucose metabolism in what is a dynamic ischemic penumbra.
缺血半影区的概念最初被定义为坏死性中风核心周围的区域,被视为即将进一步受损的组织。如今,半影区通常被认为是对氧合和葡萄糖供应减少的时间敏感的低灌注脑组织,是可以通过干预治疗来挽救的组织,也是局灶性中风神经保护的潜在靶点。最初的概念涉及电衰竭和钾释放,但尚未达到神经元细胞死亡的程度,并且基于实验性中风模型,后来在临床成像研究中得到了证实。然而,尽管基本机制已经很好地转化,通过半影区的病理生理机制提供了脑保护并改善了中风后的神经功能预后,但尚未实现。最近的研究结果塑造了对半影区的现代理解,揭示了大量的分子和细胞病理生理机制。我们现在提出了一个新的半影区模型,我们希望这将为未来的转化成功奠定基础。我们专注于葡萄糖的可用性,即大脑的中央能量来源,以及生物能量衰竭作为核心病理生理概念。我们讨论了不同细胞类型中线粒体功能与生物能量和细胞凋亡死亡机制、自噬以及神经炎症与动态缺血半影区中葡萄糖代谢的关系。