Experimental Neurosurgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, 10117 Berlin, Germany.
Department of Neurosurgery, Cantonal Hospital of Lucerne, 6000 Lucerne, Switzerland.
Int J Mol Sci. 2022 Oct 20;23(20):12618. doi: 10.3390/ijms232012618.
Subarachnoid hemorrhage is associated with severe neurological deficits for survivors. Among survivors of the initial bleeding, secondary brain injury leads to additional brain damage. Apart from cerebral vasospasm, secondary brain injury mainly results from cerebral inflammation taking place in the brain parenchyma after bleeding. The brain's innate immune system is activated, which leads to disturbances in brain homeostasis, cleavage of inflammatory cytokines and, subsequently, neuronal cell death. The toll-like receptor (TLR)4 signaling pathway has been found to play an essential role in the pathophysiology of acute brain injuries such as subarachnoid hemorrhage (SAH). TLR4 is expressed on the cell surface of microglia, which are key players in the cellular immune responses of the brain. The participants in the signaling pathway, such as TLR4-pathway-like ligands, the receptor itself, and inflammatory cytokines, can act as biomarkers, serving as clues regarding the inflammatory status after SAH. Moreover, protein complexes such as the NLRP3 inflammasome or receptors such as TREM1 frame the TLR4 pathway and are indicative of inflammation. In this review, we focus on the activity of the TLR4 pathway and its contributors, which can act as biomarkers of neuroinflammation or even offer potential new treatment targets for secondary neuronal cell death after SAH.
蛛网膜下腔出血会导致幸存者出现严重的神经功能缺损。在初次出血的幸存者中,继发性脑损伤会导致额外的脑损伤。除了脑血管痉挛外,继发性脑损伤主要是由于出血后脑实质中发生的脑炎症引起的。大脑的固有免疫系统被激活,导致脑内平衡紊乱、炎症细胞因子的裂解,进而导致神经元细胞死亡。研究发现,Toll 样受体(TLR)4 信号通路在蛛网膜下腔出血(SAH)等急性脑损伤的病理生理学中起着至关重要的作用。TLR4 表达在小胶质细胞的细胞表面,小胶质细胞是大脑细胞免疫反应的关键参与者。信号通路中的参与者,如 TLR4 通路样配体、受体本身和炎症细胞因子,可以作为生物标志物,提示 SAH 后的炎症状态。此外,蛋白复合物,如 NLRP3 炎性体,或受体,如 TREM1,框定了 TLR4 通路,并提示存在炎症。在这篇综述中,我们重点介绍 TLR4 通路及其组成部分的活性,它们可以作为神经炎症的生物标志物,甚至为 SAH 后继发性神经元细胞死亡提供潜在的新治疗靶点。