Thromboinflammation beim ischämischen Schlaganfall – pathophysiologisches Konzept und translationale Relevanz

Zusammenfassung

Noch vor wenigen Jahren galt der ischämische Schlaganfall pathophysiologisch gesehen als Prototyp einer rein thrombotischen Erkrankung. Dies veränderte sich sukzessive, da klar wurde, dass Immunzellen im ischämischen Hirngewebe nicht nur vorhanden sind, sondern überraschenderweise sogar eine maßgebliche pathophysiologische Rolle spielen. Mittlerweile weiß man, dass viele Bestandteile des Immunsystems an der Entwicklung eines ischämischen Schlaganfalls beteiligt sind. Von größtem Interesse ist die Beobachtung, dass sich thrombotische und inflammatorische Vorgänge bei der Schlaganfallentstehung gegenseitig beeinflussen. Ein Phänomen, das unter dem Begriff Thromboinflammation Einzug in die Literatur gefunden hat. Die vorhandene Datenlage basiert im Wesentlichen auf tierexperimentellen Studien. Erste klinische Studien deuten jedoch darauf hin, dass thromboinflammatorische Vorgänge auch beim humanen ischämischen Schlaganfall eine große pathophysiologische Relevanz haben könnten, sodass sich daraus innovative Therapiestrategien entwickeln könnten. Die vorliegende Übersichtsarbeit skizziert die wichtigsten Mechanismen der Thromboinflammation im Kontext des ischämischen Schlaganfalls und geht auf erste translationale Ansätze ein.

Abstract

Only a few years ago ischemic stroke has been pathophysiologically classified as a prototype of a merely thrombotic disease. This assumption changed step-wise after the surprising finding that immune cells do not only infiltrate ischemic brain parenchyma but even play a fundamental pathophysiologic role. Meanwhile it is widely accepted that various components of the immune system contribute to ischemic stroke development. Of utmost importance, thrombotic and inflammatory processes influence each other, a phenomenon in recent literature called thrombo-inflammation. Data regarding thrombo-inflammation in ischemic stroke mainly derive from experimental rodent studies but according to the results of first clinical trials a pathophysiological relevance of thrombo-inflammatory mechanisms can be assumed also in human stroke. Therefore, anti-thrombo-inflammatory strategies could become novel treatment approaches in the future. This review aims to address the most important mechanisms of thrombo-inflammation in ischemic stroke. In addition, the first translational results, i. e. clinical trials, will be outlined.

Schlüsselwörter

ischämischer Schlaganfall - Thromboinflammation - Thrombozyten - Immunzellen

Keywords

ischemic stroke - thrombo-inflammation - platelets - immune cells

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