White Matter Injury of Prematurity: Its Mechanisms and Clinical Features

Abstract

A developing central nervous system is vulnerable to various insults such as infection and ischemia. While increased understanding of the dynamic nature of brain development allows a deeper insight into the pathophysiology of perinatal brain injury, the precise nature of specific fetal and neonatal brain injuries and their short- and long-term clinical consequences need special attention and further elucidation. The current review will describe the pathophysiological aspects and clinical significance of white matter injury of prematurity, a main form of perinatal brain injury in premature newborns, with a particular emphasis on its potential antenatal components.

The Potential of Stem Cell Therapy to Repair White Matter Injury in Preterm Infants: Lessons Learned From Experimental Models

“…In addition, disruptions of the oxygen supply leads to oxidative stress through various pathways, ultimately causing production and accumulation of reactive oxygen species within developing OLs (van Tilborg et al, 2016). For example, activation of nitric oxide synthase causes pre-OL injury by nitric oxide production (Gluckman et al, 1992; Khwaja and Volpe, 2008; Lee, 2017; Singh et al, 2018). Further, OPCs are extremely sensitive to oxidative damage, as they lack particular anti-oxidant enzymes (Perrone et al, 2015).…”

“…In recent years, identification of biomarkers to predict neonatal brain injury has received increasing attention. In these studies multiple biomarkers in the blood, such as S100B, GFAP and metabolites as well as non-invasive monitoring such as EEG and NIRS have been shown to predict HIE, IVH, PHVD, and PVL (Douglas-Escobar and Weiss, 2012; Stewart et al, 2013; Jin et al, 2015; Lee, 2017). However, biomarkers for early identification of dWMI are still lacking.…”

“…PVL can be subdivided based on severity of necrosis and cyst formation. Punctate white matter lesions, sometimes recognized as a separate entity, are believed to result from small necrotic lesions and can be categorized in the PVL spectrum (Volpe et al, 2011; Back, 2017; Lee, 2017; Volpe, 2017; Zaghloul and Ahmed, 2017). dWMI is characterized by diffuse, subtle alterations in the white matter microenvironment without focal necrosis.…”

Intranasal mesenchymal stem cell therapy to boost myelination after encephalopathy of prematurity

“…Diffuse white matter injury (dWMI), characterized by global hypomyelination in absence of cystic lesions, is a prominent hallmark of EoP (Back, 2017;Volpe, 2009bVolpe, , 2017. Peri-and postnatal insults associated with preterm birth, such as inflammation and respiratory problems, are thought to negatively impact oligodendrocyte (OL) lineage development, resulting in insufficient myelination and subsequently dWMI (Lee, 2017;van Tilborg et al, 2016;Volpe, Kinney, Jensen, & Rosenberg, 2011). Despite the significant morbidity associated with dWMI, at present only supportive treatment is available for preterm infants.…”

White Matter Injury in Early Brain Injury after Subarachnoid Hemorrhage

“…The human brain is comprised of both gray matter and white matter; white matter constitutes over 50% of the total brain volume 18 . Gray matter mainly consists of neuronal cell bodies, glial cells, and blood vessels, whereas white matter mainly consists of myelinated and unmyelinated axons, white matter fiber tracts and supporting glial cells including oligodendrocytes [19][20][21] . White matter is named for its relatively lighter appearance resulting from the lipid content of myelin and fewer capillaries than the gray matter.…”