The interesting case report by Zhang et al on a 39 years-old male with Charcot-Marie-Tooth disease type 1X has several limitations.The causal relation between the two episodes of asyndesis,dysphagia,and dyspnea 37 d a...The interesting case report by Zhang et al on a 39 years-old male with Charcot-Marie-Tooth disease type 1X has several limitations.The causal relation between the two episodes of asyndesis,dysphagia,and dyspnea 37 d after the second dose of the inactivated severe acute respiratory syndrome-coronavirus-2(SARS-CoV-2)vaccine(Beijing Institute of Biological Products Co.,Ltd.,Beijing,China)remains unproven.SARS-CoV-2 vaccination cannot trigger a genetic disorder.It also remains unsupported that the patient had a stroke-like episode(SLE).SLEs occur in mitochondrial disorders but not in hereditary neuropathies.Because of the episodic nature of the neurological symptoms,it is critical to rule out seizures.Overall,the causal relation between vaccination and the neurological complications remains unsupported and the interpretation of symmetric diffusionweighted imaging lesions on cerebral magnetic resonance imaging should be carefully revised.展开更多
Objective To study the characteristics of spectra on proton magnetic resonance spectroscopy （^1H-MRS） and its value in patients with mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes （ME...Objective To study the characteristics of spectra on proton magnetic resonance spectroscopy （^1H-MRS） and its value in patients with mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes （MELAS）. Methods Seven clinically diagnosed patients with MELAS underwent magnetic resonance imaging （MRI） and ^1H-MRS examinations. The ^1H-MRS techniques, characteristics of the spectra, and its correlation with the laboratory tests were analyzed. Reaults Cerebral abnormalities were revealed in all 7 patients on conventional MR images, and most abnormal signals were observed in bilateral occipital, parietal, and temporal lobes. We found 4 cases with basal ganglia involvement, 2 cases with mild frontal lobe lesions, and 1 case with involvement of lateral cerebral peduncles and thalami. Additionally, 1 patient was involved with left insular lobe. Spectra from prominent lesions in brain parenchyma showed lactate doublet peak in 6 patients, 3 of whom were also noted lactate peak in ventricular cerehrospinal fluid （CSF）. Conclusion ^1H-MRS may provide more direct information about the metabolism changes, which aids to affirm the diagnosis, and may replace the conventional invasive method of quantifying lactate in CSF.展开更多
This report presents a case of massive mucosal necrosis of the small intestine in a patient with mitochondrial myopathy,encephalopathy,lactic acidosis,and stroke-like episodes(MELAS),which particularly affects the bra...This report presents a case of massive mucosal necrosis of the small intestine in a patient with mitochondrial myopathy,encephalopathy,lactic acidosis,and stroke-like episodes(MELAS),which particularly affects the brain,nervous system and muscles.A 45-year-old Japanese female,with an established diagnosis of MELAS,presented with vomiting.Computed tomography showed portomesenteric venous gas and pneumatosis intestinalis.She underwent a resection of the small intestine.A microscopic study showed necrosis of the mucosa and vacuolar degeneration of smooth muscle cells in the arterial wall.Immunohistochemistry showed anti-mitochondrial antibody to be highly expressed in the crypts adjacent the necrotic mucosa.The microscopic and immunohistochemical findings suggested the presence of a large number of abnormal mitochondria in MELAS to be closely linked to mucosal necrosis of the small intestine.展开更多
In a recent article Fu et al reported about a 52 years old female with a mitochondrial disorder due to the variant m.10158T>C in the mtDNA located gene MT-ND3.The study has a number of shortcomings.The study would ...In a recent article Fu et al reported about a 52 years old female with a mitochondrial disorder due to the variant m.10158T>C in the mtDNA located gene MT-ND3.The study has a number of shortcomings.The study would particularly profit from providing more data about multisystem disease,from providing the current medication,the cerebro-spinal fluid findings,the detailed phenotypic presentation,and the genotype of first-degree relatives.Since the index patient had experienced recurrent seizures it is crucial to know the current and previous anti-seizure medication as it may strongly determine the outcome.Some of them are mitochondrion-toxic and particularly valproic acid may exhibit fatal side effects.The outcome may also depend on the degree of multisystem involvement why it is crucial to prospectively investigate the patient for subclinical involvement of organs not obviously affected.Additionally,the outcome of the stroke-like lesions on imaging would be interesting to see.Strokelike lesions may completely disappear or may end up as white matter lesion,laminar cortical necrosis,focal atrophy,cyst,or as the so-called toenail sign.There is also a need of discussing more profoundly the imaging findings and their diagnostic significance and to investigate first degree relatives of the index patient clinically and genetically.Though highly interesting,the presentation of this case of a mitochondrial disorder lacks clinical and genetic data of the patient and his relatives.Outcome parameters,such as severity of disease,degree of progression,drugs,pathogenicity of the mutation,and multisystem involvement require a profound discussion.展开更多
BACKGROUND Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) vaccinations have been administered worldwide, with occasional reports of associated neurological complications. Specifically, the impact of vacci...BACKGROUND Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) vaccinations have been administered worldwide, with occasional reports of associated neurological complications. Specifically, the impact of vaccinations on individuals with Xlinked Charcot-Marie-Tooth disease type 1(CMTX1) is unclear. Patients with CMTX1 can have stroke-like episodes with posterior reversible encephalopathy syndrome on magnetic resonance imaging(MRI), although this is rare.CASE SUMMARY A 39-year-old man was admitted with episodic aphasia and dysphagia for 2 d. He received SARS-CoV-2 vaccination 39 d before admission. Physical examination showed pes cavus and reduced tendon reflexes. Brain MRI showed bilateral, symmetrical, restricted diffusion with T2 hyperintensities in the cerebral hemispheres. Nerve conduction studies revealed peripheral nerve damage. He was diagnosed with Charcot-Marie-Tooth disease, and a hemizygous mutation in the GJB1 gene on the X chromosome, known to be pathogenic for CMTX1, was identified. Initially, we suspected transient ischemic attack or demyelinating leukoencephalopathy. We initiated treatment with antithrombotic therapy and immunotherapy. At 1.5 mo after discharge, brain MRI showed complete resolution of lesions, with no recurrence.CONCLUSION SARS-CoV-2 vaccination could be a predisposing factor for CMTX1 and trigger a sudden presentation.展开更多
Objective： Mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes （MELAS） is a progressive, multisystem affected mitochondrial disease associated with a number of disease-related defectiv...Objective： Mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes （MELAS） is a progressive, multisystem affected mitochondrial disease associated with a number of disease-related defective genes. M ELAS has unpredictable presentations and clinical course, and it can be commonly misdiagnosed as encephalitis, cerebral infarction, or brain neoplasms. This review aimed to update the diagnosis progress in MELAS, which may provide better understanding of the disease nature and help make the right diagnosis as well. Data Sources： The data used in this review came fi-om published peer review articles from October 1984 to October 2014, which were obtained fiom PubMed. The search term is ＂MELAS＂, Study Selection： lnfornmtion selected from those reported studies is mainly based on the progress on clinical tkatures, blood biochemistry, neuroimaging, muscle biopsy, and genetics in diagnosing MELAS. Results： MELAS has a wide heterogeneity in genetics and clinical manifestations. The relationship between mutations and phenotypes remains unclear. Advanced serial functional magnetic resonance imaging （MRI） can provide directional information on this disease. Muscle biopsy has meaningflil value in diagnosing MELAS, which shows the presence of ragged red fibers and mosaic appearance of cytochrome oxidase negative fibers. Genetic studies have reported that approximately 80% of MELAS cases are caused by the lnutation in.3243A〉G of the mitochondrial transfer RNA （Leu （UU R）） gene （MT-TLI）. Conclusions： MELAS involves multiple systems with variable clinical symptoms and recurrent episodes. The prognosis of MELAS patients depends on timely diagnosis. Therefore, overall diagnosis of MELAS should be based on the maternal inheritance family history, clinical manifestation, and findings from serial MR1, muscle biopsy, and genetics.展开更多
Objective：To summarize the clinical presentation,pathogenesis,neuroimaging,treatment,and outcome of stroke-like migraine attacks after radiation therapy （SMART） syndrome,and to propose diagnostic criteria for this ...Objective：To summarize the clinical presentation,pathogenesis,neuroimaging,treatment,and outcome of stroke-like migraine attacks after radiation therapy （SMART） syndrome,and to propose diagnostic criteria for this disorder.Data Sources：We searched the PubMed database for articles in English published from 1995 to 2015 using the terms of ＂stroke-like AND migraine AND radiation.＂ Reference lists of the identified articles and reviews were used to retrieve additional articles.Study Selection：Data and articles related to late-onset effects of cerebral radiation were selected and reviewed.Results：SMART is a rare condition that involves complex migraines with focal neurologic deficits following cranial irradiation for central nervous system malignancies.The recovery,which ranges from hours to days to weeks,can be partial or complete.We propose the following diagnostic criteria for SMART：（1） Remote history of therapeutic external beam cranial irradiation for malignancy;（2） prolonged,reversible clinical manifestations mostly years after irradiation,which may include migraine,seizures,hemiparesis,hemisensory deficits,visuospatial defect,aphasia,confusion and so on;（3） reversible,transient,unilateral cortical gadolinium enhancement correlative abnormal T2 and fluid-attenuated inversion recovery signal of the affected cerebral region;（4） eventual complete or partial recovery,the length of duration of recovery ranging from hours to days to weeks;（5） no evidence of residual or recurrent tumor;（6） not attributable to another disease.To date,no specific treatment has been identified for this syndrome.Conclusions：SMART is an extremely rare delayed complication of brain irradiation.However,improvements in cancer survival rates have resulted in a rise in its frequency.Hence,awareness and recognition of the syndrome is important to make a rapid diagnosis and avoid aggressive interventions such as brain biopsy and cerebral angiography.展开更多
The first description of a syndrome including stroke-like episodes, lactic acidaemia, and ragged red fibres, was reported by Shapira et al in 1975. 1 Pavlakis et al 2 described further cases, introduced the acr...The first description of a syndrome including stroke-like episodes, lactic acidaemia, and ragged red fibres, was reported by Shapira et al in 1975. 1 Pavlakis et al 2 described further cases, introduced the acronym MELAS (mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes), and suggested that this represented a distinct mitochondrial disease phenotype. In 1990, Goto et al 3 identified A3243G mutation in the transfer RNA (tRNA) leucine (UUR) gene in some patients with MELAS. Although this mutation has now been established to be the commonest mtDNA defect it is often misdiagnosed. Here we report a kindred of MELAS including a mother and a son. Clinical, pathological and genetic studies are proceeding.展开更多
目的基于核苷酸结合寡聚化结构域样受体3/半胱氨酸蛋白酶-1(NLRP3/caspase-1)信号通路探究二甲双胍对2型糖尿病(T2DM)合并脑卒中患者认知功能的改善作用。方法选取2021年2月至2022年5月就诊于邯郸市中心医院的63例T2DM,按照随机数字表...目的基于核苷酸结合寡聚化结构域样受体3/半胱氨酸蛋白酶-1(NLRP3/caspase-1)信号通路探究二甲双胍对2型糖尿病(T2DM)合并脑卒中患者认知功能的改善作用。方法选取2021年2月至2022年5月就诊于邯郸市中心医院的63例T2DM,按照随机数字表法将其分为对照组(n=32)与试验组(n=31),对照组给予钠-葡萄糖共转运蛋白2抑制剂(SGLT-2i)类药物治疗,试验组在对照组基础上给予二甲双胍治疗,两组患者均连续治疗12周。收集患者临床资料,对比治疗前后两组简易精神量表(MMSE)得分、蒙特利尔认知评估量表(MoCA)得分、空腹血糖(FBG)、糖化血红蛋白(HbA1c)、餐后2小时血糖(2 hPBG)、外周单核细胞中NLRP3炎性小体蛋白表达水平、caspase-1蛋白表达水平及血清IL-8、IL-1β水平;采用Pearson线性相关分析治疗后NLRP3、caspase-1、IL-18、IL-1β与FBG的相关性。结果治疗后,试验组MMSE、MoCA得分均增高,且明显高于对照组(P<0.05),试验组FBG、HbA1c、2 h PBG水平低于对照组(P<0.05),试验组NLRP3、caspase-1蛋白水平和IL-18、IL-1β水平较对照组明显更低(P<0.05);经Pearson线性相关分析显示,治疗后NLRP3、caspase-1、IL-18、IL-1β与FBG呈正相关(P<0.05)。结论二甲双胍治疗能够改善T2DM合并脑卒中患者的认知功能,降低血糖水平和炎症反应,这可能与其对NLRP3/caspase-1信号通路的调节作用有关。展开更多
文摘The interesting case report by Zhang et al on a 39 years-old male with Charcot-Marie-Tooth disease type 1X has several limitations.The causal relation between the two episodes of asyndesis,dysphagia,and dyspnea 37 d after the second dose of the inactivated severe acute respiratory syndrome-coronavirus-2(SARS-CoV-2)vaccine(Beijing Institute of Biological Products Co.,Ltd.,Beijing,China)remains unproven.SARS-CoV-2 vaccination cannot trigger a genetic disorder.It also remains unsupported that the patient had a stroke-like episode(SLE).SLEs occur in mitochondrial disorders but not in hereditary neuropathies.Because of the episodic nature of the neurological symptoms,it is critical to rule out seizures.Overall,the causal relation between vaccination and the neurological complications remains unsupported and the interpretation of symmetric diffusionweighted imaging lesions on cerebral magnetic resonance imaging should be carefully revised.
文摘Objective To study the characteristics of spectra on proton magnetic resonance spectroscopy （^1H-MRS） and its value in patients with mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes （MELAS）. Methods Seven clinically diagnosed patients with MELAS underwent magnetic resonance imaging （MRI） and ^1H-MRS examinations. The ^1H-MRS techniques, characteristics of the spectra, and its correlation with the laboratory tests were analyzed. Reaults Cerebral abnormalities were revealed in all 7 patients on conventional MR images, and most abnormal signals were observed in bilateral occipital, parietal, and temporal lobes. We found 4 cases with basal ganglia involvement, 2 cases with mild frontal lobe lesions, and 1 case with involvement of lateral cerebral peduncles and thalami. Additionally, 1 patient was involved with left insular lobe. Spectra from prominent lesions in brain parenchyma showed lactate doublet peak in 6 patients, 3 of whom were also noted lactate peak in ventricular cerehrospinal fluid （CSF）. Conclusion ^1H-MRS may provide more direct information about the metabolism changes, which aids to affirm the diagnosis, and may replace the conventional invasive method of quantifying lactate in CSF.
文摘This report presents a case of massive mucosal necrosis of the small intestine in a patient with mitochondrial myopathy,encephalopathy,lactic acidosis,and stroke-like episodes(MELAS),which particularly affects the brain,nervous system and muscles.A 45-year-old Japanese female,with an established diagnosis of MELAS,presented with vomiting.Computed tomography showed portomesenteric venous gas and pneumatosis intestinalis.She underwent a resection of the small intestine.A microscopic study showed necrosis of the mucosa and vacuolar degeneration of smooth muscle cells in the arterial wall.Immunohistochemistry showed anti-mitochondrial antibody to be highly expressed in the crypts adjacent the necrotic mucosa.The microscopic and immunohistochemical findings suggested the presence of a large number of abnormal mitochondria in MELAS to be closely linked to mucosal necrosis of the small intestine.
文摘In a recent article Fu et al reported about a 52 years old female with a mitochondrial disorder due to the variant m.10158T>C in the mtDNA located gene MT-ND3.The study has a number of shortcomings.The study would particularly profit from providing more data about multisystem disease,from providing the current medication,the cerebro-spinal fluid findings,the detailed phenotypic presentation,and the genotype of first-degree relatives.Since the index patient had experienced recurrent seizures it is crucial to know the current and previous anti-seizure medication as it may strongly determine the outcome.Some of them are mitochondrion-toxic and particularly valproic acid may exhibit fatal side effects.The outcome may also depend on the degree of multisystem involvement why it is crucial to prospectively investigate the patient for subclinical involvement of organs not obviously affected.Additionally,the outcome of the stroke-like lesions on imaging would be interesting to see.Strokelike lesions may completely disappear or may end up as white matter lesion,laminar cortical necrosis,focal atrophy,cyst,or as the so-called toenail sign.There is also a need of discussing more profoundly the imaging findings and their diagnostic significance and to investigate first degree relatives of the index patient clinically and genetically.Though highly interesting,the presentation of this case of a mitochondrial disorder lacks clinical and genetic data of the patient and his relatives.Outcome parameters,such as severity of disease,degree of progression,drugs,pathogenicity of the mutation,and multisystem involvement require a profound discussion.
基金Supported by Shenzhen Science and Technology Project,No. SGLH20180628161804465The Clinical Research Project of The First Affiliated Hospital of Shenzhen University,No. 20203357035 and No. 20223357021。
文摘BACKGROUND Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) vaccinations have been administered worldwide, with occasional reports of associated neurological complications. Specifically, the impact of vaccinations on individuals with Xlinked Charcot-Marie-Tooth disease type 1(CMTX1) is unclear. Patients with CMTX1 can have stroke-like episodes with posterior reversible encephalopathy syndrome on magnetic resonance imaging(MRI), although this is rare.CASE SUMMARY A 39-year-old man was admitted with episodic aphasia and dysphagia for 2 d. He received SARS-CoV-2 vaccination 39 d before admission. Physical examination showed pes cavus and reduced tendon reflexes. Brain MRI showed bilateral, symmetrical, restricted diffusion with T2 hyperintensities in the cerebral hemispheres. Nerve conduction studies revealed peripheral nerve damage. He was diagnosed with Charcot-Marie-Tooth disease, and a hemizygous mutation in the GJB1 gene on the X chromosome, known to be pathogenic for CMTX1, was identified. Initially, we suspected transient ischemic attack or demyelinating leukoencephalopathy. We initiated treatment with antithrombotic therapy and immunotherapy. At 1.5 mo after discharge, brain MRI showed complete resolution of lesions, with no recurrence.CONCLUSION SARS-CoV-2 vaccination could be a predisposing factor for CMTX1 and trigger a sudden presentation.
基金a grant from the key project of the National Science Foundation of China
文摘Objective： Mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes （MELAS） is a progressive, multisystem affected mitochondrial disease associated with a number of disease-related defective genes. M ELAS has unpredictable presentations and clinical course, and it can be commonly misdiagnosed as encephalitis, cerebral infarction, or brain neoplasms. This review aimed to update the diagnosis progress in MELAS, which may provide better understanding of the disease nature and help make the right diagnosis as well. Data Sources： The data used in this review came fi-om published peer review articles from October 1984 to October 2014, which were obtained fiom PubMed. The search term is ＂MELAS＂, Study Selection： lnfornmtion selected from those reported studies is mainly based on the progress on clinical tkatures, blood biochemistry, neuroimaging, muscle biopsy, and genetics in diagnosing MELAS. Results： MELAS has a wide heterogeneity in genetics and clinical manifestations. The relationship between mutations and phenotypes remains unclear. Advanced serial functional magnetic resonance imaging （MRI） can provide directional information on this disease. Muscle biopsy has meaningflil value in diagnosing MELAS, which shows the presence of ragged red fibers and mosaic appearance of cytochrome oxidase negative fibers. Genetic studies have reported that approximately 80% of MELAS cases are caused by the lnutation in.3243A〉G of the mitochondrial transfer RNA （Leu （UU R）） gene （MT-TLI）. Conclusions： MELAS involves multiple systems with variable clinical symptoms and recurrent episodes. The prognosis of MELAS patients depends on timely diagnosis. Therefore, overall diagnosis of MELAS should be based on the maternal inheritance family history, clinical manifestation, and findings from serial MR1, muscle biopsy, and genetics.
文摘Objective：To summarize the clinical presentation,pathogenesis,neuroimaging,treatment,and outcome of stroke-like migraine attacks after radiation therapy （SMART） syndrome,and to propose diagnostic criteria for this disorder.Data Sources：We searched the PubMed database for articles in English published from 1995 to 2015 using the terms of ＂stroke-like AND migraine AND radiation.＂ Reference lists of the identified articles and reviews were used to retrieve additional articles.Study Selection：Data and articles related to late-onset effects of cerebral radiation were selected and reviewed.Results：SMART is a rare condition that involves complex migraines with focal neurologic deficits following cranial irradiation for central nervous system malignancies.The recovery,which ranges from hours to days to weeks,can be partial or complete.We propose the following diagnostic criteria for SMART：（1） Remote history of therapeutic external beam cranial irradiation for malignancy;（2） prolonged,reversible clinical manifestations mostly years after irradiation,which may include migraine,seizures,hemiparesis,hemisensory deficits,visuospatial defect,aphasia,confusion and so on;（3） reversible,transient,unilateral cortical gadolinium enhancement correlative abnormal T2 and fluid-attenuated inversion recovery signal of the affected cerebral region;（4） eventual complete or partial recovery,the length of duration of recovery ranging from hours to days to weeks;（5） no evidence of residual or recurrent tumor;（6） not attributable to another disease.To date,no specific treatment has been identified for this syndrome.Conclusions：SMART is an extremely rare delayed complication of brain irradiation.However,improvements in cancer survival rates have resulted in a rise in its frequency.Hence,awareness and recognition of the syndrome is important to make a rapid diagnosis and avoid aggressive interventions such as brain biopsy and cerebral angiography.
基金ThisworkwassupportedbythegrantsfromtheGuangdongNaturalScienceFoundationProgram (No 31694 )andtheGuangdongNaturalScienceFoundationKeyProgram (No21894)
文摘The first description of a syndrome including stroke-like episodes, lactic acidaemia, and ragged red fibres, was reported by Shapira et al in 1975. 1 Pavlakis et al 2 described further cases, introduced the acronym MELAS (mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes), and suggested that this represented a distinct mitochondrial disease phenotype. In 1990, Goto et al 3 identified A3243G mutation in the transfer RNA (tRNA) leucine (UUR) gene in some patients with MELAS. Although this mutation has now been established to be the commonest mtDNA defect it is often misdiagnosed. Here we report a kindred of MELAS including a mother and a son. Clinical, pathological and genetic studies are proceeding.
文摘目的基于核苷酸结合寡聚化结构域样受体3/半胱氨酸蛋白酶-1(NLRP3/caspase-1)信号通路探究二甲双胍对2型糖尿病(T2DM)合并脑卒中患者认知功能的改善作用。方法选取2021年2月至2022年5月就诊于邯郸市中心医院的63例T2DM,按照随机数字表法将其分为对照组(n=32)与试验组(n=31),对照组给予钠-葡萄糖共转运蛋白2抑制剂(SGLT-2i)类药物治疗,试验组在对照组基础上给予二甲双胍治疗,两组患者均连续治疗12周。收集患者临床资料,对比治疗前后两组简易精神量表(MMSE)得分、蒙特利尔认知评估量表(MoCA)得分、空腹血糖(FBG)、糖化血红蛋白(HbA1c)、餐后2小时血糖(2 hPBG)、外周单核细胞中NLRP3炎性小体蛋白表达水平、caspase-1蛋白表达水平及血清IL-8、IL-1β水平;采用Pearson线性相关分析治疗后NLRP3、caspase-1、IL-18、IL-1β与FBG的相关性。结果治疗后,试验组MMSE、MoCA得分均增高,且明显高于对照组(P<0.05),试验组FBG、HbA1c、2 h PBG水平低于对照组(P<0.05),试验组NLRP3、caspase-1蛋白水平和IL-18、IL-1β水平较对照组明显更低(P<0.05);经Pearson线性相关分析显示,治疗后NLRP3、caspase-1、IL-18、IL-1β与FBG呈正相关(P<0.05)。结论二甲双胍治疗能够改善T2DM合并脑卒中患者的认知功能,降低血糖水平和炎症反应,这可能与其对NLRP3/caspase-1信号通路的调节作用有关。
文摘脑卒中是全球主要致残致死性疾病之一,其中急性缺血性脑卒中(acute ischemic stroke,AIS)最为常见。AIS的病理机制错综复杂,涉及多种因素,而炎症反应在其发生和发展过程中发挥至关重要作用。中枢神经系统的免疫细胞——小胶质细胞在AIS中具有双重作用,一方面M1型小胶质细胞主导的促炎反应会加剧脑损伤,另一方面M2型小胶质细胞主导的抗炎反应可促进脑组织的修复。NOD样受体热蛋白结构域相关蛋白3(NOD-like receptor thermal protein domain associated protein 3,NLRP3)炎性小体的激活是导致小胶质细胞焦亡的主要机制,该过程受到多种因素的影响,包括离子迁移、活性氧的产生以及线粒体功能障碍。针对NLRP3炎性小体通路的抑制作为一种有潜力的治疗策略,已经显示出减轻脑损伤、降低神经炎症以及改善神经功能恢复的效果。本研究综合讨论了小胶质细胞NLRP3炎性小体介导的细胞焦亡在AIS中的作用,以及通过药物开发、干细胞治疗和综合治疗策略来抑制NLRP3炎性小体的可能性。同时,本研究也探讨了未来研究的方向,旨在为AIS的治疗提供新的思路。
