Endothelium and Oxidative Stress: The Pandora's Box of Cerebral (and Non-Only) Small Vessel Disease?

Area of Science:

• Neurology
• Vascular Medicine
• Geriatrics

Background:

• Cerebral small vessel disease (cSVD) is a common finding in older adults, leading to disability and reduced quality of life.
• cSVD is associated with age, hypertension, diabetes, dyslipoproteinemia, smoking, low vitamin B12, and hyperhomocysteinemia.
• The precise etiopathogenetic mechanisms underlying cSVD remain unclear despite epidemiological associations.

Purpose of the Study:

• To review the potential role of endothelial dysfunction and oxidative stress in the pathogenic cascade of cSVD.
• To highlight the importance of quantifying endothelial and oxidative stress burden in determining vascular risk.
• To explore how understanding these mechanisms can help slow cSVD progression and prevent disability.

Main Methods:

• Literature review focusing on endothelial dysfunction and oxidative stress in cSVD.
• Analysis of epidemiological associations and proposed pathogenic pathways.
• Discussion of potential clinical applications for risk assessment and management.

Main Results:

• Endothelial dysfunction and oxidative stress are proposed as central pathways in cSVD pathogenesis.
• Quantifying "endotheliopathic and oxidative load" may improve vascular risk assessment.
• These pathways offer potential targets for interventions to slow disease progression.

Conclusions:

• Endothelial dysfunction and oxidative stress are critical contributors to cSVD.
• Assessing the "endotheliopathic and oxidative load" could refine clinical risk stratification.
• Targeting these mechanisms may offer a strategy to prevent disability from microvascular damage.