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Review: Molecular pathogenesis of blood–brain barrier breakdown in acute brain injury
Author(s) -
Nag S.,
Kapadia A.,
Stewart D. J.
Publication year - 2011
Publication title -
neuropathology and applied neurobiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.538
H-Index - 95
eISSN - 1365-2990
pISSN - 0305-1846
DOI - 10.1111/j.1365-2990.2010.01138.x
Subject(s) - pathogenesis , blood–brain barrier , medicine , pathology , neuroscience , biology , central nervous system
S. Nag, A. Kapadia and D. J. Stewart (2011) Neuropathology and Applied Neurobiology 37, 3–23
Molecular pathogenesis of blood–brain barrier breakdown in acute brain injury Historically, the blood–brain barrier (BBB) was considered to be at the level of cerebral endothelium. Currently, the interaction of endothelium with other components of the vessel wall and with neurones and glial cells is considered to constitute a functional unit, termed the neurovascular unit that maintains cerebral homeostasis in steady states and brain injury. The emphasis of this review is on cerebral endothelium, the best‐studied component of the neurovascular unit, and its permeability mechanisms in health and acute brain injury. Major advances have been made in unravelling the molecular structure of caveolae and tight junctions, both of which are components of the structural barrier to the entry of plasma proteins into brain. Time course studies suggest that caveolar changes precede junctional changes in acute brain injury. Additional factors modulating BBB permeability in acute brain injury are matrix metalloproteinases‐2 and 9 and angiogenic factors, the most notable being vascular endothelial growth factor‐A and angiopoietins (Ang) 1 and 2. Vascular endothelial growth factor‐A and Ang2 have emerged as potent inducers of BBB breakdown while Ang1 is a potent anti‐leakage factor. These factors have the potential to modulate permeability in acute brain injury and this is an area of ongoing research. Overall, a combination of haemodynamic, structural and molecular alterations affecting brain endothelium results in BBB breakdown in acute brain injury.