中国神经再生研究(英文版)

中国神经再生研究(英文版) ›› 2015, Vol. 10 ›› Issue (10): 1599-1601.doi: 10.4103/1673-5374.165286

• 观点:视神经损伤修复保护与再生 • 上一篇    下一篇

急性视神经炎：神经保护和髓鞘修复策略的临床范式？

  

  • 收稿日期:2015-07-29 出版日期:2015-10-28 发布日期:2015-10-28

Acute optic neuritis: a clinical paradigm for evaluation of neuroprotective and restorative strategies?

Sara S. Qureshi, Elliot M. Frohman*   

  1. Department of Neurology, University of Texas Southwestern School of Medicine, Dallas, TX, USA (Qureshi SS, Frohman EM)
    Department of Ophthalmology, University of Texas Southwestern School of Medicine, Dallas, TX, USA (Frohman EM)
  • Received:2015-07-29 Online:2015-10-28 Published:2015-10-28
  • Contact: Elliot M. Frohman, M.D., Ph.D.,Elliot.Frohman@UTSouthwestern.edu.

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摘要：

急性视神经炎是一种常见的，而且往往在早期就可表现症状的中枢神经系统炎性脱髓鞘疾病，如多发性硬化症和视神经脊髓炎。它会影响至少一半以上的多发性硬化症患者，其中有15-20％的患者会表现出传入视觉功能通路的几个独特特点，这使急性视神经炎模型成为研究疾病发病机制和评估潜在神经保护和髓鞘修复策略的理想系统。在过去的十年里，使用非侵入性方法技术已经取得了视觉功能通路的精确结构、功能和特性等，这些技术现在通过验证，已经证实了视觉功能通路的结构、功能和电生理相关性。此外，如通过光学相干断层分析测量研究已经建立临床和放射学非眼部疾病活动的关联，即在多发性硬化症种，视网膜神经纤维层和神经节细胞/视网膜内网状层会加速丢失，将中枢神经系统视觉功能通路作为一个整体来表现中枢神经系统炎性脱髓鞘疾病或许也是合理的。我们在文章中介绍了现代化高精度的临床前工具分析视觉功能通路的精确结构、功能和电生理，讨论了目前和潜在的新技术在未来的应用中如何研究推定神经保护和修复髓鞘的策略，并试图找出能够维护和修复组织架构的电生理替代工具。

Abstract:

Acute optic neuritis (AON) is a common, and often the earliest manifestation of central nervous system (CNS) inflammatory demyelinating disorders like multiple sclerosis (MS) and neuromyelitis optica. It affects at least half the patients with MS and is the presenting feature in 15-20% of patients Several unique features of the afferent visual pathway (AVP) make the AON model an ideal system to study disease pathogenesis and evaluate potential neuroprotective and myelin repair strategies. Over the past decade, advancements in technology have made precise structural, functional and electrophysiological characterization of the AVP possible, using sensitive and largely non-invasive methods. These techniques, now validated, have confirmed correlation of structural, functional and electrophysiological measures of the AVP. Furthermore, investigations have established association of clinical and radiologic non-ocular disease activity in MS with accelerated loss of retinal nerve fiber layer (RNFL) and ganglion cell/inner plexiform layers (GCIPL) of the retina, as measured by optical coherence tomography (OCT). Since, retinal changes in MS appear to reflect global CNS processes, it appears reasonable to generalize lessons learnt from the AVP to the CNS as a whole in CNS inflammatory demyelinating disorders. The presence of axons and glia in the absence of myelin is a feature unique to the retina in the CNS. This allows for independent monitoring of the derivative elements of CNS inflammatory injury; demyelination, axon loss and neuronal degeneration. Cases with relative axon preservation, ideal candidates for myelin repair, can be differentiated from those with axon involvement that require reconstitution of axon circuitry before myelin repair is attempted. Similarly, neuroprotective and even regenerative capabilities can be detected and monitored longitudinally using sensitive techniques to quantify RNFL and GCIPL thickness. In this article, we will describe the modern, high precision, para-clinical tools that enable precise structural, functional and electrophysiological analysis of the AVP. This is followed by a discussion of the current and potential future applications of novel technology to study putative neuroprotective and myelin repair strategies, in an attempt to identify agents that preserve and repair tissue architecture, electrophysiology, and ultimately function.