Hierarchy of pathogenetic mechanisms of chronic cerebrovascular insufficiency and therapeutic strategies for neuroprotection

Abstract

Chronic cerebrovascular insufficiency (CCI) is an independent disease with complex etiopathogenetic mechanisms and a polymorphic clinical picture. The complex hierarchy of pathogenetic mechanisms and clinical manifestations forces the doctor to choose a strategy for drug therapy, taking into account the multifunctional effect on all pathogenetic mechanisms. With regard to chronic cerebrovascular insufficiency, there are still no unambiguous standards, mainly the use of preventive strategies (antihypertensive drugs, antiplatelet agents, anticoagulants, statins) is recommended. At the same time, a combination of pathological factors leads to a violation of the integrity of the homeostasis system and mitochondrial and endothelial dysfunction, atrophy of the cerebral cortex, neurodegeneration, and proliferation of glial cells. Violations of metabolic, protein-synthetic processes in the vascular wall and neurons underlie subsequent morphological damage, which is the foundation for the development or manifestation of a particular symptom. Therefore, only preventive or symptomatic therapy separately from each other is unlikely to have the expected effect. Due to the fact that there are no unified diagnostic criteria, a unified pathogenetic paradigm, there are no standards in the treatment of CNMC, neuropeptides have been actively studied in recent years. They are capable of selective binding to endogenous proteins and can form structural conformations in response to various stimuli in the biological environment, which allows for various therapeutic applications of peptide assemblies. The drugs have pronounced neurotrophic, mediator, effector and anti-inflammatory properties, are highly effective, can be used in small doses, and have no side reactions. A promising drug in this group is a polypeptide from the brain of porcine embryos6 which has a good evidence base for efficacy and safety in patients with cerebrovascular diseases. . To increase the effectiveness of therapy, it is advisable to combine neurope-tides with antioxidants and antihypoxants, choline precursor drugs.