transmedТрансляционная медицинаTranslational Medicine2311-44952410-5155Almazov National Medical Research Centre, Saint Petersburg, Russia10.18705/2311-4495-2023-10-6-566-5NYMEXYtransmed-818Research ArticleНЕВРОЛОГИЯ И НЕЙРОХИРУРГИЯNEUROLOGY AND NEUROSURGERYРоль нейровоспаления в патогенезе отека головного мозга и геморрагической трансформации при ишемическом инсульте: механизмы и терапевтические мишени.The role of neuro-inflammatory in the pathogenesis of brain edema and hemorrhagic transformation in ischemic stroke: mechanisms and therapeutic targetШиленкоЛ. А.ShilenkoL. A.

Шиленко Леонид Алексеевич, лаборант-исследователь НИЛ патологии малого круга кровообращения; студент

ул. Аккуратова, д. 2, Санкт-Петербург, 197341

Leonid A. Shilenko, Laboratory Assistant of Laboratory of Pulmonary Vascular Disease; Student

Akkuratova str., 2, Saint Petersburg, 197341

shilenko.leo@yandex.ruКарповА. А.KarpovA. A.

Карпов Андрей Александрович, к.м.н., заведующий НИЛ патологии малого круга кровообращения, доцент кафедры патологии Института медицинского образования; ведущий научный сотрудник отдела «Технологии сильного искусственного интеллекта в физиологии и медицине»

Andrei A. Karpov, PhD, Head of Laboratory of Pulmonary Vascular Disease, Associate Professor of the Department of Pathology; Leading Researcher of the Department of “Strong Artificial Intelligence Technologies in Physiology and Medicine”

ВеретенниковаЕ. И.VeretennikovaE. I.

Веретенникова Елизавета Ивановна, клинический ординатор 2-го года кафедры факультетской терапии им. профессора В. А. Вальдмана

Elizaveta I. Veretennikova, 2nd year Resident Physician at the Department of Faculty Therapy named after Professor V. A. Valdman

ГалагудзаМ. М.GalagudzaM. M.

Галагудза Михаил Михайлович, дд.м.н., профессор и член-корреспондент РАН, директор Института экспериментальной медицины, заведующий кафедрой патологии Института медицинского образования; профессор кафедры патофизиологии с курсом клинической патофизиологии

Michael M. Galagudza, MD, DSc, Director of Institute of Experimental Medicine, Head of the Department of Pathology, Institute of Medical Education; Professor and Corresponding Member of the Russian Academy of Science; Professor at the Department of Pathophysiology

Федеральное государственное бюджетное учреждение «Национальный медицинский исследовательский центр имени В. А. Алмазова» Министерства здравоохранения Российской Федерации; Федеральное государственное бюджетное образовательное учреждение высшего образования «Первый Санкт-Петербургский государственный медицинский университет имени академика И. П. Павлова» Министерства здравоохранения Российской ФедерацииРоссияAlmazov National Medical Research Centre; Academician I. P. Pavlov First Saint Petersburg State Medical UniversityRussian FederationФедеральное государственное бюджетное учреждение «Национальный медицинский исследовательский центр имени В. А. Алмазова» Министерства здравоохранения Российской Федерации; Федеральное государственное автономное образовательное учреждение высшего образования «Санкт-Петербургский государственный электротехнический университет «ЛЭТИ» им. В. И. Ульянова (Ленина)»РоссияAlmazov National Medical Research Centre; Saint Petersburg Electrotechnical University “LETI”Russian FederationФедеральное государственное бюджетное образовательное учреждение высшего образования «Санкт-Петербургский государственный педиатрический медицинский университет» Министерства здравоохранения Российской ФедерацииРоссияSaint Petersburg State Pediatric Medical UniversityRussian FederationФедеральное государственное бюджетное учреждение «Национальный медицинский исследовательский центр имени В. А. Алмазова» Министерства здравоохранения Российской Федерации; Федеральное государственное бюджетное образовательное учреждение высшего образования «Первый Санкт-Петербургский государственный медицинский университет имени академика И. П. Павлова» Министерства здравоохранения Российской ФедерацииРоссияAlmazov National Medical Research Centre; Academician I. P. Pavlov First Saint Petersburg State Medical UniversityRussian Federation202320122023106566580Copyright © Шиленко Л.А., Карпов А.А., Веретенникова Е.И., Галагудза М.М., 20242024Шиленко Л.А., Карпов А.А., Веретенникова Е.И., Галагудза М.М.Shilenko L.A., Karpov A.A., Veretennikova E.I., Galagudza M.M.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://transmed.almazovcentre.ru/jour/article/view/818

Острое нарушение мозгового кровообращения является одной из ведущих причин инвалидизации и смертности во всем мире. Учитывая значительное увеличение продолжительности жизни населения, инсульт в ближайшие несколько десятилетий будет оставаться серьезной медико-социальной проблемой. Среди различных причин инсульта преобладает ишемическое повреждение головного мозга. В основе ишемического инсульта лежит снижение интенсивности кровоснабжения тканей головного мозга, в результате которого уменьшается доставка к нейронам необходимого количества глюкозы и кислорода, которые требуются для обеспечения нормальной функции этого органа. В то же время во многих случаях спонтанное либо медикаментозное восстановление кровотока после периода ишемии сопровождается парадоксальным нарастанием повреждения, в связи с чем процесс повреждения ткани головного мозга при нарушениях кровообращения целесообразно рассматривать в контексте ишемического-реперфузионного повреждения (ИРП). Одним из ключевых механизмов ИРП головного мозга является воспалительная реакция. В процессе вторичного иммунного повреждения головного мозга принимают участие как механизмы врожденного иммунитета, проявляющиеся лейкоцитарной инфильтрацией поврежденного участка головного мозга, так и антиген-зависимые реакции адаптивного иммунитета. Одним из важнейших проявлений нейровоспаления при ИРП головного мозга является повышение транси парацеллюлярной проницаемости гематоэнцефалического барьера, которое лежит в основе развития вазогенного отека головного мозга и геморрагической трансформации очага. В настоящем обзоре рассмотрены современные представления о молекулярных механизмах, связывающих асептическое воспаление, отек и геморрагическую трансформацию.

Acute cerebrovascular accident is one of the leading causes of disability and death worldwide. Given the significant increase in life expectancy of the population, stroke will remain a serious medical and social problem in the next few decades. Among the various causes of stroke, ischemic brain damage predominates. Ischemic stroke is based on a decrease in the intensity of blood supply to the brain tissues, as a result of which there is a decrease in the delivery to neurons of the required amount of glucose and oxygen, which are required to ensure the normal function of this organ. At the same time, in many cases, spontaneous or medical restoration of blood flow after a period of ischemia is accompanied by a paradoxical increase in damage, and therefore it is advisable to consider the process of damage to brain tissue during circulatory disorders in the context of ischemic-reperfusion injury (IRI). One of the key mechanisms of brain IRP is the inflammatory response. In the process of secondary immune damage to the brain, both mechanisms of innate immunity, manifested by leukocyte infiltration of the damaged brain area, and antigen-dependent reactions of adaptive immunity are involved. One of the most important manifestations of neuroinflammation in cerebral IRI is an increase in transand paracellular permeability of the blood-brain barrier, which underlies the development of vasogenic cerebral edema and hemorrhagic transformation of the focus. This review considers current ideas about the molecular mechanisms that link aseptic inflammation, edema, and hemorrhagic transformation.

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The authors declare that there are no conflicts of interest present.