Endothelial dysfunction on cerebral small vessel disease

Abstract

Globally, Stroke represents the second leading cause of death and the third leading cause of disability and stroke incidence in low- and middle-income countries has more than doubled in the last decades [[2]Johnson W. Onuma O. Owolabi M. et al.Stroke: a global response is needed.Bull World Health Organ. 2016 Sep 1; 94 (634–634A)Google Scholar, [4]Rodríguez-Salinas L.C. Medina M.T. Stroke in developing countries.in: Bogousslvasky Stroke; Selected Topics. World Federation of Neurology (WFN) Seminars in Clinical Neurology, Demos, New York2006: 49-62Google Scholar] and is responsible for 85% of the deaths due to neurological disorders. Cerebral small vessel disease causes 25% of strokes [[1]Cannistraro R.J. Badi M. Eidelman B.H. et al.CNS small vessel disease: a clinical review.Neurology. 2019 Jun 11; 92: 1146-1156Google Scholar]. Cerebral Small vessel disease (CSVD), is a heterogeneous vascular entity, that includes lacunar cerebral infarctions which are small deep infarcts in the territory of small penetrating arteries (Deep perforator arteriopathy) or cerebral amyloid angiopathy among others, due to a local disease of these vessels which cause ischaemic stroke, intracebral haemorrhage, vascular cognitive impairment, abnormal movement disorders, focal neurologic syndromes, etc (Norrving et al. 2013; Sacco et al. 2013; Fisher 1982). CSVD is associated with blood-brain barrier disruption and endothelial dysfunction [[5]Schreiber S. Wilisch-Neumann A. Schreiber F. et al.The spectrum of age-related small vessel diseases: potential overlap and interactions of amyloid and non-amyloid vasculopathies.Neuropathol Appl Neurobiol. 2019 Aug; : 6Google Scholar]. Endothelial dysfunction represents a reduction on the nitric oxide-dependent-vascular dilatation and can be described as an imbalance between vasodilatation and vasoconstriction produced by the endothelium( [[3]Moncada S. Higgs E.A. The discovery of nitric oxide and its role in vascular biology.Br J Pharmacol. 2006; 147: S193-S201Google Scholar]). CSVD can be evaluated using Neuroimaging. Recent small subcortical infarcts, lacunes, white matter hyperintensities, perivascular spaces and microbleeds are usually the most frequent findings [[6]Wardlaw J.M. Smith E.E. Biessels G.J. et al.Standards for reporting vascular changes on neuroimaging (STRIVE v1). Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegeneration.Lancet Neurol. 2013; 12: 822-838Google Scholar]. Several risk factors are strongly associated with CSVD and endothelial dysfunction such as : High blood pressure, metabolic syndrome, hyper homocysteine, low plasma levels of vitamin B12, abnormal endothelium-dependent vasodilation among others. These factors associated with genetics factors and lifestyle changes in low- and middle-income countries can explain the increased stroke incidence mainly in CSVD patients from these countries.