Menounos Spiro, Shen Helen, Tipirneni Shraddha, Bhaskar Sonu M M
Global Health Neurology Lab, Sydney, NSW 2150, Australia.
School of Clinical Medicine, Medicine & Health, University of New South Wales (UNSW), St George and Sutherland Clinical Campuses, Sydney, NSW 2150, Australia.
Biomolecules. 2024 Nov 26;14(12):1507. doi: 10.3390/biom14121507.
Stroke is an often underrecognized albeit significant complication in patients with brain cancer, arising from the intricate interplay between cancer biology and cerebrovascular health. This review delves into the multifactorial pathophysiological framework linking brain cancer to elevated stroke risk, with particular emphasis on the crucial role of the neurotoxic microenvironment (NTME). The NTME, characterized by oxidative stress, neuroinflammation, and blood-brain barrier (BBB) disruption, creates a milieu that promotes and sustains vascular and neuronal injury. Key pathogenic factors driving brain cancer-related stroke include cancer-related hypercoagulability, inflammatory and immunological mechanisms, and other tumor-associated processes, including direct tumor compression, infection-related sequelae, and treatment-related complications. Recent advances in genomic and proteomic profiling present promising opportunities for personalized medicine, enabling the identification of biomarkers-such as oncogenes and tumor suppressor genes-that predict stroke susceptibility and inform individualized therapeutic strategies. Targeting the NTME through antioxidants to alleviate oxidative stress, anti-inflammatory agents to mitigate neuroinflammation, and therapies aimed at reinforcing the BBB could pave the way for more effective stroke prevention and management strategies. This integrative approach holds the potential to reduce both the incidence and severity of stroke, ultimately improving clinical outcomes and quality of life for brain cancer patients. Further research and well-designed clinical trials are essential to validate these strategies and integrate them into routine clinical practice, thereby redefining the management of stroke risk in brain cancer patients.
中风是脑癌患者中一种常常未被充分认识但却很重要的并发症，它源于癌症生物学与脑血管健康之间复杂的相互作用。本综述深入探讨了将脑癌与中风风险升高联系起来的多因素病理生理框架，特别强调了神经毒性微环境（NTME）的关键作用。NTME以氧化应激、神经炎症和血脑屏障（BBB）破坏为特征，营造了一个促进和维持血管及神经元损伤的环境。导致脑癌相关中风的关键致病因素包括癌症相关的高凝状态、炎症和免疫机制，以及其他与肿瘤相关的过程，包括肿瘤直接压迫、感染相关后遗症和治疗相关并发症。基因组和蛋白质组分析的最新进展为个性化医疗带来了有前景的机会，能够识别预测中风易感性并为个体化治疗策略提供依据的生物标志物，如癌基因和肿瘤抑制基因。通过抗氧化剂靶向NTME以减轻氧化应激、使用抗炎药物减轻神经炎症，以及旨在加强血脑屏障的疗法，可能为更有效的中风预防和管理策略铺平道路。这种综合方法有可能降低中风的发生率和严重程度，最终改善脑癌患者的临床结局和生活质量。进一步的研究和精心设计的临床试验对于验证这些策略并将其纳入常规临床实践至关重要，从而重新定义脑癌患者中风风险的管理。
