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Pathophysiology of the blood-brain barrier

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Conclusion

The BBB constitutes a highly specialized feature of the CNS. This specialization is manifested at the morphological and functional level. BBB morphology has been extensively studied during recent decades and, although there are still some unclear points, like the site of BBB crossing by invading inflammatory cells, a general consensus has been achieved on its anatomical and histological components. More recent research has been focused on BBB function in normal and pathological conditions. In this regard, it has been demonstrated that the BBB is not a passive protective barrier isolating the brain,but actually plays an active role in pathophysiological processes occurring within the CNS. A good example is the role of the BBB in antigen presentation. The cells of the BBB can express unique molecules of the immune system, can respond to immune mediators and can even be induced to produce these mediators by themselves. As a result, the BBB may participate in the presentation of neuronal antigens to blood-derived immune cells. Since the BBB separates the brain from the rest of the body, it also plays a crucial role in controlling access of blood-borne compounds and cells to the CNS. One of the most important challenges for the future of BBB research, is the characterization of the molecular mechanisms involved in the homing of blood cell to the brain. In the era of molecular immunology, the emphasis of BBB research has moved towards investigations of adhesion receptors on BBB cells and their interaction with counter receptors on blood-borne cells. Several adhesion events have already been discovered, but undoubtedly more will appear in the near future. The exciting possibility exists that an adhesion molecule, an addressin, specific for the BBB will be discovered. This should allow for selective intervention in immune cell homing into the brain. In that context, new therapeutic approaches for inflammatory and autoimmune conditions of the CNS would be possible.

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    Krzysztof Selmaj

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Selmaj, K. Pathophysiology of the blood-brain barrier. Springer Semin Immunopathol 18, 57–73 (1996). https://doi.org/10.1007/BF00792609

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