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首页> 外文期刊>neurosurgical focus >The mechanobiological theory: a unifying hypothesis on the pathogenesis of moyamoya disease based on a systematic review
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The mechanobiological theory: a unifying hypothesis on the pathogenesis of moyamoya disease based on a systematic review

机译：机械生物学理论：基于系统评价的烟雾病发病机制的统一假说

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OBJECTIVE Moyamoya angiopathy (MMA) affects the distal internal carotid artery and is designated as moyamoya disease (MMD) when predisposing conditions are absent, or moyamoya syndrome (MMS) when it occurs secondary to other causes. The authors aimed to investigate the reason for this anatomical site predilection of MMA. There is compelling evidence to suggest that MMA is a phenomenon that occurs due to stereotyped mechanobiological processes. Literature regarding MMD and MMS was systematically reviewed to decipher a common pattern relating to the development of MMA. METHODS A systematic review was conducted to understand the pathogenesis of MMA in accordance with PRISMA guidelines. PubMed MEDLINE and Scopus were searched using “moyamoya” and “pathogenesis” as common keywords and specific keywords related to six identified key factors. Additionally, a literature search was performed for MMS using “moyamoya” and “pathogenesis” combined with reported associations. A progressive search of the literature was also performed using the keywords “matrix metalloprotease,” “tissue inhibitor of matrix metalloprotease,” “endothelial cell,” “smooth muscle cell,” “cytokines,” “endothelin,” and “transforming growth factor” to infer the missing links in molecular pathogenesis of MMA. Studies conforming to the inclusion criteria were reviewed. RESULTS The literature search yielded 44 published articles on MMD by using keywords classified under the six key factors, namely arterial tortuosity, vascular angles, wall shear stress, molecular factors, blood rheology/viscosity, and blood vessel wall strength, and 477 published articles on MMS associations. Information obtained from 51 articles that matched the inclusion criteria and additional information derived from the progressive search mentioned above were used to connect the key factors to derive a network pattern of pathogenesis. CONCLUSIONS Based on the available literature, the authors have proposed a unifying theory for the pathogenesis of MMA. The moyamoya phenomenon appears to be the culmination of an interplay of vascular anatomy, hemodynamics, rheology, blood vessel wall strength, and a plethora of intricately linked mechanobiological molecular mediators that ultimately results in the mechanical process of occlusion of the blood vessel, stimulating angiogenesis and collateral blood supply in an attempt to perfuse the compromised brain.
机译：目的 烟雾病（MMA）累及颈内动脉远端，无诱发因素时称为烟雾病（MMD），继发于其他原因时称为烟雾病（MMS）。作者旨在调查MMA这种解剖部位偏爱的原因。有令人信服的证据表明，MMA是一种由于刻板的机械生物学过程而发生的现象。系统地回顾了有关MMD和MMS的文献，以破译与MMA发展相关的常见模式。方法 根据PRISMA指南进行系统评价，了解MMA的发病机制。检索PubMed、MEDLINE和Scopus，使用“烟雾病”和“发病机制”作为常用关键词，以及与6个已确定的关键因素相关的特定关键词。此外，使用“烟雾病”和“发病机制”结合报告的关联对MMS进行了文献检索。使用关键词“基质金属蛋白酶”、“基质金属蛋白酶组织抑制剂”、“内皮细胞”、“平滑肌细胞”、“细胞因子”、“内皮素”和“转化生长因子”对文献进行渐进检索，以推断MMA分子发病机制中缺失的环节。对符合纳入标准的研究进行了评价。结果 文献检索得到44篇关于MMD的发表文章，关键词分为动脉迂曲度、血管角度、壁剪切应力、分子因素、血液流变/黏度和血管壁强度，发表MMS关联文献477篇。从符合纳入标准的 51 篇文章中获得的信息以及从上述渐进式检索中获得的其他信息用于连接关键因素以得出发病机制的网络模式。结论 基于现有文献，作者提出了MMA发病机制的统一理论。烟雾现象似乎是血管解剖学、血流动力学、流变学、血管壁强度和大量错综复杂的机械生物学分子介质相互作用的高潮，最终导致血管闭塞的机械过程，刺激血管生成和侧支血液供应，试图灌注受损的大脑。

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