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  • Updated 02.15.2021
  • Expires For CME 02.15.2024

Role of neuroinflammation in the pathogenesis of neurologic disorders and principles of management

Introduction

Overview

Neuroinflammation is defined as an inflammatory response within the CNS leading to activation of the innate immune system and is characterized by cellular and molecular changes within the CNS that include activation of the microglia and release of inflammatory mediators, such as cytokines. Neuroinflammation is a part of the pathology of several neurodegenerative disorders, CNS trauma, epilepsy, stroke, infections, and psychiatric disorders. Biomarkers of neuroinflammation, in body fluids as well as with brain imaging, are useful for diagnosis and as a basis for targeting therapeutics. Several strategies, both pharmacological (anti-inflammatory drugs) and nonpharmacological, are available or under investigation for managing neuroinflammation.

Key points

• Neuroinflammation is a pathological feature of several neurologic disorders.

• Neuroinflammation is a driver as well as consequence of CNS diseases.

• Biomarkers of neuroinflammation can be used as diagnostics, to assess disease progression, as targets for therapeutics, and to monitor clinical trials.

• Several strategies are available for managing neuroinflammation, and it is possible to choose one that is best suited for an individual patient.

Historical note and terminology

Inflammation (Latin: inflammatio) is part of the complex biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or irritants, and is a protective response involving immune cells, blood vessels, and molecular mediators. Neuroinflammation is defined as an inflammatory response within the central nervous system (CNS) leading to activation of the brain's innate immune system. It is characterized by a host of cellular and molecular changes within the CNS, including activation of glia; release of inflammatory mediators, such as cytokines; and generation of reactive oxygen species. Neuroinflammation can be acute or chronic. Acute inflammation usually follows injury to the CNS immediately and is characterized by inflammatory molecules, endothelial cell activation, platelet deposition, and tissue edema, whereas chronic inflammation is the sustained activation of microglia and recruitment of other immune cells into the brain. Chronic inflammation is typically associated with neurodegenerative diseases. Neuroinflammation is a driver as well as consequence of CNS diseases.

Neuroinflammation is not isolated from general inflammation because of the connection between the circulatory system and inflammation; several biomarkers of neuroinflammation are found in the blood. Moreover, some inflammatory processes involve more than 1 organ, eg, COVID-19 infection can lead to inflammation of the brain as well as the lungs.

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