microcirculationРегионарное кровообращение и микроциркуляцияRegional blood circulation and microcirculation1682-66552712-9756Academician I.P. Pavlov First St. Petersburg State Medical University10.24884/1682-6655-2021-20-2-5-19microcirculation-942Research ArticleОБЗОРЫREVIEWSМеханизмы развития острого ишемического повреждения головного мозга: клинические и экспериментальные возможности его коррекцииBrain acute ischemia mechanisms: implications to experimental and clinical treatmentИвановЕ. В.IvanovE. V.

Иванов Евгений Викторович – канд. мед. наук, преподаватель кафедры физиологии и общей патологии факультета фундаментальной медицины 

119991, Москва, Ленинские горы, д. 1

Ivanov Evgenii V. – PhD, MD, department of Physiology and general Pathology teacher 

1, Leninskie Gory, Moscow, 119991

ivanovev101@gmail.comГавриловаС. А.GavrilovaS. A.

Гаврилова Светлана Анатольевна – д-р биол. наук, доцент, доцент кафедры физиологии и общей патологии факультета фундаментальной медицины 

119991, Москва, Ленинские горы, д. 1

Gavrilova Svetlana A. – Sc. D., department of Physiology and general Pathology assistant professor 

1, Leninskie Gory, Moscow, 119991

sgavrilova@mail.ruКошелевВ. Б.KoshelevV. B.

Кошелев Владимир Борисович – д-р биол. наук, профессор, зав. кафедрой физиологии и общей патологии факультета фундаментальной медицины 

119991, Москва, Ленинские горы, д. 1

Koshelev Vladimir B. – Sc. D., department of Physiology and general Pathology assistant professor 

1, Leninskie Gory, Moscow, 119991

koshelevvladimir1953@yandex.ruФедеральное государственное бюджетное образовательное учреждение высшего образования «Московский государственный университет имени М. В. Ломоносова»РоссияM. V. Lomonosov Moscow State UniversityRussian Federation202110062021202519Copyright © Иванов Е.В., Гаврилова С.А., Кошелев В.Б., 20212021Иванов Е.В., Гаврилова С.А., Кошелев В.Б.Ivanov E.V., Gavrilova S.A., Koshelev V.B.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.microcirc.ru/jour/article/view/942

В обзоре рассмотрены современные представления о развитии ишемического повреждения головного мозга и основные терапевтические подходы. В настоящее время очерчен круг патологических факторов, влияющих на выживание нейронов и глиальных клеток в очаге ишемии: деполяризация, цитотоксический и вазогенный отек, кальциевая перегрузка, эксайтотоксичность, воспаление, повреждение свободными радикалами. Эффективная и быстрая реперфузия существенно улучшает состояние пациентов, но другие подходы к лечению инфаркта не вошли в клиническую практику. Исследуются десятки препаратов, направленных на компенсацию отдельных патогенетических звеньев инфаркта (нейропротекторы), но они оказываются неэффективны в крупных клинических исследованиях.Причиной неэффективности нейропротекторных препаратов может быть недостаточное понимание значения мишени лекарственного средства. Многие эффективные в доклинических исследованиях препараты не были изучены в крупных клинических исследованиях. Дополнительные патогенетические механизмы, описанные в последнее десятилетие, расширяют наши знания о природе инфаркта головного мозга и могут служить перспективными направлениями для разработки новых терапевтических подходов.

We have reviewed current understanding of ischemic brain damage and the main therapeutic approaches. Pathological factors affecting the survival of neurons and glial cells in the focus of ischemia are outlined: depolarization, cytotoxic and vasogenic edema, calcium overload, excitotoxicity, inflammation, free radical damage. Effective and rapid reperfusion significantly improves patient’s survival and functional outcomes, but other approaches to brain infarction treatment did not approve their effectiveness in large clinical trials. Dozens of drugs (neuroprotectors) are being studied in order to compensate isolated pathological brain ischemia pathways and to increase cellular survival, but they were ineffective in large clinical trials.The reason for the ineffectiveness of neuroprotective drugs may be a lack of understanding of the drug targets real importance. Many drugs that have shown promising results in preclinical studies have not been studied in large clinical trials until now. Additional pathogenetic mechanisms revealed in the last decade expand our knowledge about the brain infarction and may become promising directions for the development of new therapeutic approaches.

острое нарушение мозгового кровообращения (OHMK)инфаркт головного мозганейропротекцияишемияишемия/реперфузиянейроиммунитетсвободные радикалыотек головного мозгаэксайтотоксичностькальциевая перегрузкаACE (Acute Cerebrovascular Event)brain infarctionneuroprotectionischemiaischemia/reperfusionneuroimmunityfree radicalsbrain edemaexcitotoxicitycalcium overloadReferencesLindsay MP, Norrving B, Sacco RL, Brainin M, Hacke W, Martins S. et al. World Stroke Organization (WSO): Global Stroke Fact Sheet 2019. Int J Stroke. 2021;14(8):806–817. Doi: 10.1177/1747493019881353.Lindsay MP, Norrving B, Sacco RL, Brainin M, Hacke W, Martins S. et al. World Stroke Organization (WSO): Global Stroke Fact Sheet 2019. Int J Stroke. 2021;14(8):806–817. Doi: 10.1177/1747493019881353.Hu S, Cui B, Mlynash M, Zhang X, Mehta KM, Lansberg MG. Stroke epidemiology and stroke policies in China from 1980 to 2017: A systematic review and meta-analysis. Vol. 15, International Journal of Stroke. 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The authors declare that there are no conflicts of interest present.