摘要
在多发性硬化(MS)斑块的组成细胞类型中,星形胶质细胞被认为在其发病机理中起很小的作用。传统认为,星形胶质细胞间接导致瘢痕形成,在病变形成或修复中几乎不起作用。然而,近来对脱髓鞘性视神经脊髓炎(NMO)的高度关注发现,抗水通道蛋白-4的体液免疫反应引起的星形胶质细胞原发性损害,导致NMO首次被证实为髓鞘性疾病。NMO这一发现促使我们重新审视活动性损害的MS患者的数据和资料。我们的重新评估清楚显示血管周围星形胶质细胞终足和邻近脑实质星形胶质细胞的早期损伤,但难以评估这种损伤是否为急性损伤时伴发的脑水肿和炎症的主要原因。由于恢复中病灶显示髓鞘再生,以及覆盖在血管周围的星形胶质细胞的完整性存在缺陷,星形胶质细胞的损害持续时间长。本研究和相关文献均发现,星形胶质细胞在MS变化发展中所起复杂作用取决于病变时期和病变地形的变化。与星形胶质细胞的抑制性作用不同的是,越来越多的充足证据表明,星形胶质细胞积极参与病变的发展与修复。我们建议,因星形胶质细胞在MS病变中明确的早期选择性作用,星形胶质细胞也许可作为MS治疗的切入点。
Among the constituent cell types of the multiple sclerosis （MS） plaque, the astrocyte has been the least considered as a player in the pathogenesis of the lesion. Traditionally, it has been assigned a secondary scarring role with little or no role in lesion formation or repair. However, the recent upsurge of interest in the demyelinating condition neuromyelitis optica （NMO） has resulted in NMO being identified as the first disease of myelin in which primary damage to astrocytes, resulting from a humoral immune response that forms against the water channel aquaporin-4, has been documented. This finding in NMO prompted us to re-examine data and material from cases of MS displaying active lesions. Our reappraisal revealed unambiguous early damage to perivascular astrocyte end-feet and to hypertrophic astrocytes in the adjacent parenchyma, but whether this was a primary event was difficult to evaluate due to concomitant edema and inflammation in these acute lesions. The astrocyte damage was long-lasting since resolving lesions displaying remyelination also showed defects in the integrity of the astrocytic covering around blood vessels. Analysis of our fmdings and of the astrocytic literature supports multiple roles for the astrocyte in the evolution of changes encountered in MS depending upon lesion stage and lesion topography. At variance with the somewhat inhibitory role of the astrocyte is the abundant and growing evidence for this cell to actively participate in both lesion development and repair. We propose that the unequivocal selective early involvement of the astrocyte in MS lesions may have therapeutic relevance. 2013 Wiley Periodicals, Inc.
出处
《神经损伤与功能重建》
2013年第2期131-138,共8页
Neural Injury and Functional Reconstruction
