血脑屏障功能障碍与精神疾病关系的研究进展
Research Progress on the Relationship between Dysfunction of the Blood Brain Barrier and Psychiatric Diseases
DOI: 10.12677/ijpn.2026.151002, PDF,    国家自然科学基金支持
作者: 王 馨, 胡凌霄, 蒋文高*:重庆医科大学药学院分子生物学与生化药理学重点实验室,重庆
关键词: 血脑屏障精神分裂症抑郁症双相情感障碍Blood Brain Barrier Schizophrenia Major Depressive Disorder Bipolar Disorder
摘要: 血脑屏障(BBB)是外周血液和脑实质之间的动态界面,控制物质进出脑的转运,保护大脑免受血源性病原体和各种神经毒素的侵害。近年的研究提示BBB功能障碍与多种精神疾病的病理生理机制相关。本文综述了精神分裂、抑郁症和双相情感障碍等精神疾病发生发展过程中BBB功能障碍的临床和实验室研究证据,探讨了在精神疾病中BBB破坏的不同分子机制及其对疾病的影响。
Abstract: The blood brain barrier (BBB) represents the dynamic interface between the peripheral blood circulation and the central nervous system (CNS). It controls the substance transportation across the brain, protects the brain from external pathogens as well as inert neurotoxic substances from entering the CNS. Recent research has revealed the relevance of BBB dysfunction to the pathophysiology of several psychiatric diseases. The review describes the clinical and experimental evidence, possible mechanisms and effects of the BBB dysfunction on schizophrenia, major depressive disorder and bipolar disorder.
文章引用:王馨, 胡凌霄, 蒋文高. 血脑屏障功能障碍与精神疾病关系的研究进展[J]. 国际神经精神科学杂志, 2026, 15(1): 10-18. https://doi.org/10.12677/ijpn.2026.151002

参考文献

[1] Iadecola, C. (2017) The Neurovascular Unit Coming of Age: A Journey through Neurovascular Coupling in Health and Disease. Neuron, 96, 17-42. [Google Scholar] [CrossRef] [PubMed]
[2] Harrison, P.J., Geddes, J.R. and Tunbridge, E.M. (2018) The Emerging Neurobiology of Bipolar Disorder. Trends in Neurosciences, 41, 18-30. [Google Scholar] [CrossRef] [PubMed]
[3] Simpson, J.E. (2023) Potential Mechanisms Underlying the Dysfunction of the Blood-Brain Barrier. International Journal of Molecular Sciences, 24, Article No. 8184. [Google Scholar] [CrossRef] [PubMed]
[4] Bora, E. (2014) Neurodevelopmental Origin of Cognitive Impairment in Schizophrenia. Psychological Medicine, 45, 1-9. [Google Scholar] [CrossRef] [PubMed]
[5] Hjorthøj, C., Stürup, A.E., McGrath, J.J. and Nordentoft, M. (2017) Years of Potential Life Lost and Life Expectancy in Schizophrenia: A Systematic Review and Meta-Analysis. The Lancet Psychiatry, 4, 295-301. [Google Scholar] [CrossRef] [PubMed]
[6] Puvogel, S., Palma, V. and Sommer, I.E.C. (2022) Brain Vasculature Disturbance in Schizophrenia. Current Opinion in Psychiatry, 35, 146-156. [Google Scholar] [CrossRef] [PubMed]
[7] Najjar, S., Pahlajani, S., De Sanctis, V., Stern, J.N.H., Najjar, A. and Chong, D. (2017) Neurovascular Unit Dysfunction and Blood-Brain Barrier Hyperpermeability Contribute to Schizophrenia Neurobiology: A Theoretical Integration of Clinical and Experimental Evidence. Frontiers in Psychiatry, 8, Article No. 83. [Google Scholar] [CrossRef] [PubMed]
[8] Stanca, S., Rossetti, M., Bokulic Panichi, L. and Bongioanni, P. (2024) The Cellular Dysfunction of the Brain-Blood Barrier from Endothelial Cells to Astrocytes: The Pathway towards Neurotransmitter Impairment in Schizophrenia. International Journal of Molecular Sciences, 25, Article No. 1250. [Google Scholar] [CrossRef] [PubMed]
[9] Cheng, Y., Wang, T., Zhang, T., Yi, S., Zhao, S., Li, N., et al. (2022) Increased Blood-Brain Barrier Permeability of the Thalamus Correlated with Symptom Severity and Brain Volume Alterations in Patients with Schizophrenia. Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, 7, 1025-1034. [Google Scholar] [CrossRef] [PubMed]
[10] Futtrup, J., Margolinsky, R., Benros, M.E., Moos, T., Routhe, L.J., Rungby, J., et al. (2020) Blood-Brain Barrier Pathology in Patients with Severe Mental Disorders: A Systematic Review and Meta-Analysis of Biomarkers in Case-Control Studies. Brain, Behavior, & ImmunityHealth, 6, Article ID: 100102. [Google Scholar] [CrossRef] [PubMed]
[11] Uranova, N.A., Zimina, I.S., Vikhreva, O.V., Krukov, N.O., Rachmanova, V.I. and Orlovskaya, D.D. (2010) Ultrastructural Damage of Capillaries in the Neocortex in Schizophrenia. The World Journal of Biological Psychiatry, 11, 567-578. [Google Scholar] [CrossRef] [PubMed]
[12] Katsel, P., Roussos, P., Pletnikov, M. and Haroutunian, V. (2017) Microvascular Anomaly Conditions in Psychiatric Disease. Schizophrenia—Angiogenesis Connection. Neuroscience & Biobehavioral Reviews, 77, 327-339. [Google Scholar] [CrossRef] [PubMed]
[13] Enwright III, J.F., Huo, Z., Arion, D., Corradi, J.P., Tseng, G. and Lewis, D.A. (2017) Transcriptome Alterations of Prefrontal Cortical Parvalbumin Neurons in Schizophrenia. Molecular Psychiatry, 23, 1606-1613. [Google Scholar] [CrossRef] [PubMed]
[14] Argaw, A.T., Gurfein, B.T., Zhang, Y., Zameer, A. and John, G.R. (2009) Vegf-Mediated Disruption of Endothelial CLN-5 Promotes Blood-Brain Barrier Breakdown. Proceedings of the National Academy of Sciences, 106, 1977-1982. [Google Scholar] [CrossRef] [PubMed]
[15] Fulzele, S. and Pillai, A. (2009) Decreased VEGF mRNA Expression in the Dorsolateral Prefrontal Cortex of Schizophrenia Subjects. Schizophrenia Research, 115, 372-373. [Google Scholar] [CrossRef] [PubMed]
[16] Pillai, A., Howell, K.R., Ahmed, A.O., Weinberg, D., Allen, K.M., Bruggemann, J., et al. (2015) Association of Serum VEGF Levels with Prefrontal Cortex Volume in Schizophrenia. Molecular Psychiatry, 21, 686-692. [Google Scholar] [CrossRef] [PubMed]
[17] Meixensberger, S., Kuzior, H., Fiebich, B.L., Süß, P., Runge, K., Berger, B., et al. (2021) Upregulation of sICAM-1 and sVCAM-1 Levels in the Cerebrospinal Fluid of Patients with Schizophrenia Spectrum Disorders. Diagnostics, 11, Article No. 1134. [Google Scholar] [CrossRef] [PubMed]
[18] Yamamori, H., Hashimoto, R., Ishima, T., Kishi, F., Yasuda, Y., Ohi, K., et al. (2013) Plasma Levels of Mature Brain-Derived Neurotrophic Factor (BDNF) and Matrix Metalloproteinase-9 (MMP-9) in Treatment-Resistant Schizophrenia Treated with Clozapine. Neuroscience Letters, 556, 37-41. [Google Scholar] [CrossRef] [PubMed]
[19] Nie, F., Jin, R., Wu, S., Yuan, W., Wu, Y., Xue, S., et al. (2024) AQP4 Is Upregulated in Schizophrenia and Its Inhibition Attenuates Mk-801-Induced Schizophrenia-Like Behaviors in Mice. Behavioural Brain Research, 475, Article ID: 115220. [Google Scholar] [CrossRef] [PubMed]
[20] Gur, R.E., Bassett, A.S., McDonald-McGinn, D.M., Bearden, C.E., Chow, E., Emanuel, B.S., et al. (2017) A Neurogenetic Model for the Study of Schizophrenia Spectrum Disorders: The International 22q11.2 Deletion Syndrome Brain Behavior Consortium. Molecular Psychiatry, 22, 1664-1672. [Google Scholar] [CrossRef] [PubMed]
[21] Crockett, A.M., Ryan, S.K., Vásquez, A.H., Canning, C., Kanyuch, N., Kebir, H., et al. (2021) Disruption of the Blood-brain Barrier in 22q11.2 Deletion Syndrome. Brain, 144, 1351-1360. [Google Scholar] [CrossRef] [PubMed]
[22] Greene, C., Kealy, J., Humphries, M.M., Gong, Y., Hou, J., Hudson, N., et al. (2017) Dose-Dependent Expression of Claudin-5 Is a Modifying Factor in Schizophrenia. Molecular Psychiatry, 23, 2156-2166. [Google Scholar] [CrossRef] [PubMed]
[23] Nishiura, K., Ichikawa-Tomikawa, N., Sugimoto, K., Kunii, Y., Kashiwagi, K., Tanaka, M., et al. (2017) PKA Activation and Endothelial Claudin-5 Breakdown in the Schizophrenic Prefrontal Cortex. Oncotarget, 8, 93382-93391. [Google Scholar] [CrossRef] [PubMed]
[24] Sugimoto, K., Ichikawa-Tomikawa, N., Nishiura, K., Kunii, Y., Sano, Y., Shimizu, F., et al. (2020) Serotonin/5-HT1A Signaling in the Neurovascular Unit Regulates Endothelial CLDN5 Expression. International Journal of Molecular Sciences, 22, Article No. 254. [Google Scholar] [CrossRef] [PubMed]
[25] Koblan, K.S., Kent, J., Hopkins, S.C., Krystal, J.H., Cheng, H., Goldman, R., et al. (2020) A Non-D2-Receptor-Binding Drug for the Treatment of Schizophrenia. New England Journal of Medicine, 382, 1497-1506. [Google Scholar] [CrossRef] [PubMed]
[26] Alexopoulos, G.S. (2005) Depression in the Elderly. The Lancet, 365, 1961-1970. [Google Scholar] [CrossRef] [PubMed]
[27] Ménard, C., Pfau, M.L., Hodes, G.E. and Russo, S.J. (2016) Immune and Neuroendocrine Mechanisms of Stress Vulnerability and Resilience. Neuropsychopharmacology, 42, 62-80. [Google Scholar] [CrossRef] [PubMed]
[28] Greene, C., Hanley, N. and Campbell, M. (2020) Blood-Brain Barrier Associated Tight Junction Disruption Is a Hallmark Feature of Major Psychiatric Disorders. Translational Psychiatry, 10, Article No. 373. [Google Scholar] [CrossRef] [PubMed]
[29] Menard, C., Pfau, M.L., Hodes, G.E., Kana, V., Wang, V.X., Bouchard, S., et al. (2017) Social Stress Induces Neurovascular Pathology Promoting Depression. Nature Neuroscience, 20, 1752-1760. [Google Scholar] [CrossRef] [PubMed]
[30] Dudek, K.A., Dion-Albert, L., Lebel, M., LeClair, K., Labrecque, S., Tuck, E., et al. (2020) Molecular Adaptations of the Blood-Brain Barrier Promote Stress Resilience vs. Depression. Proceedings of the National Academy of Sciences, 117, 3326-3336. [Google Scholar] [CrossRef] [PubMed]
[31] Zheng, P., Romme, E., Spek, P.J.v.d., Dirven, C.M.F., Willemsen, R. and Kros, J.M. (2010) Glut1/SLC2A1 Is Crucial for the Development of the Blood‐Brain Barrier in Vivo. Annals of Neurology, 68, 835-844. [Google Scholar] [CrossRef] [PubMed]
[32] Kahl, K.G., Georgi, K., Bleich, S., Muschler, M., Hillemacher, T., Hilfiker-Kleinert, D., et al. (2016) Altered DNA Methylation of Glucose Transporter 1 and Glucose Transporter 4 in Patients with Major Depressive Disorder. Journal of Psychiatric Research, 76, 66-73. [Google Scholar] [CrossRef] [PubMed]
[33] Cobb, J.A., O’Neill, K., Milner, J., Mahajan, G.J., Lawrence, T.J., May, W.L., et al. (2016) Density of GFAP-Immunoreactive Astrocytes Is Decreased in Left Hippocampi in Major Depressive Disorder. Neuroscience, 316, 209-220. [Google Scholar] [CrossRef] [PubMed]
[34] Rajkowska, G., Hughes, J., Stockmeier, C.A., Javier Miguel-Hidalgo, J. and Maciag, D. (2013) Coverage of Blood Vessels by Astrocytic Endfeet Is Reduced in Major Depressive Disorder. Biological Psychiatry, 73, 613-621. [Google Scholar] [CrossRef] [PubMed]
[35] van Agtmaal, M.J.M., Houben, A.J.H.M., Pouwer, F., Stehouwer, C.D.A. and Schram, M.T. (2017) Association of Microvascular Dysfunction with Late-Life Depression: A Systematic Review and Meta-Analysis. JAMA Psychiatry, 74, 729-739. [Google Scholar] [CrossRef] [PubMed]
[36] Shi, W., Zhang, S., Yao, K., Meng, Q., Lu, Y., Ren, Y., et al. (2024) Breakdown of the Blood-Brain Barrier in Depressed Mice Induced by Chronic Unpredictable Mild Stress. Journal of Psychiatric Research, 180, 138-146. [Google Scholar] [CrossRef] [PubMed]
[37] Sántha, P., Veszelka, S., Hoyk, Z., Mészáros, M., Walter, F.R., Tóth, A.E., et al. (2016) Restraint Stress-Induced Morphological Changes at the Blood-Brain Barrier in Adult Rats. Frontiers in Molecular Neuroscience, 8, Article No. 88. [Google Scholar] [CrossRef] [PubMed]
[38] Xu, G., Li, Y., Ma, C., Wang, C., Sun, Z., Shen, Y., et al. (2019) Restraint Stress Induced Hyperpermeability and Damage of the Blood-Brain Barrier in the Amygdala of Adult Rats. Frontiers in Molecular Neuroscience, 12, Article No. 32. [Google Scholar] [CrossRef] [PubMed]
[39] Matsuno, H., Tsuchimine, S., O’Hashi, K., Sakai, K., Hattori, K., Hidese, S., et al. (2022) Association between Vascular Endothelial Growth Factor-Mediated Blood-Brain Barrier Dysfunction and Stress-Induced Depression. Molecular Psychiatry, 27, 3822-3832. [Google Scholar] [CrossRef] [PubMed]
[40] Treccani, G., Schlegelmilch, A., Schultz, N., Herzog, D.P., Bessa, J.M., Sotiropoulos, I., et al. (2020) Hippocampal NG2+ Pericytes in Chronically Stressed Rats and Depressed Patients: A Quantitative Study. Stress, 24, 353-358. [Google Scholar] [CrossRef] [PubMed]
[41] Almeida, P.G.C., Nani, J.V., Oses, J.P., Brietzke, E. and Hayashi, M.A.F. (2020) Neuroinflammation and Glial Cell Activation in Mental Disorders. Brain, Behavior, & ImmunityHealth, 2, Article ID: 100034. [Google Scholar] [CrossRef] [PubMed]
[42] Zhao, D., Wu, Y., Zhao, H., Zhang, F., Wang, J., Liu, Y., et al. (2024) Midbrain FA Initiates Neuroinflammation and Depression Onset in both Acute and Chronic LPS-Induced Depressive Model Mice. Brain, Behavior, and Immunity, 117, 356-375. [Google Scholar] [CrossRef] [PubMed]
[43] Li, T., Zheng, L. and Han, X. (2020) Fenretinide Attenuates Lipopolysaccharide (LPS)-Induced Blood-Brain Barrier (BBB) and Depressive-Like Behavior in Mice by Targeting Nrf-2 Signaling. Biomedicine & Pharmacotherapy, 125, Article ID: 109680. [Google Scholar] [CrossRef] [PubMed]
[44] Liu, X., Liu, H., Wu, X., Zhao, Z., Wang, S., Wang, H., et al. (2024) Xiaoyaosan against Depression through Suppressing LPS Mediated TLR4/NLRP3 Signaling Pathway in “Microbiota-Gut-Brain” Axis. Journal of Ethnopharmacology, 335, Article ID: 118683. [Google Scholar] [CrossRef] [PubMed]
[45] Kessler, R. (1993) Sex and Depression in the National Comorbidity Survey I: Lifetime Prevalence, Chronicity and Recurrence. Journal of Affective Disorders, 29, 85-96. [Google Scholar] [CrossRef] [PubMed]
[46] Dion-Albert, L., Cadoret, A., Doney, E., Kaufmann, F.N., Dudek, K.A., Daigle, B., et al. (2022) Vascular and Blood-brain Barrier-Related Changes Underlie Stress Responses and Resilience in Female Mice and Depression in Human Tissue. Nature Communications, 13, Article No. 164.
[47] Carvalho, A.F., Firth, J. and Vieta, E. (2020) Bipolar Disorder. New England Journal of Medicine, 383, 58-66. [Google Scholar] [CrossRef] [PubMed]
[48] Kessing, L.V., Ziersen, S.C., Andersen, P.K. and Vinberg, M. (2021) A Nation-Wide Population-Based Longitudinal Study on Life Expectancy and Cause Specific Mortality in Patients with Bipolar Disorder and Their Siblings. Journal of Affective Disorders, 294, 472-476. [Google Scholar] [CrossRef] [PubMed]
[49] Fries, G.R., Walss-Bass, C., Bauer, M.E. and Teixeira, A.L. (2019) Revisiting Inflammation in Bipolar Disorder. Pharmacology Biochemistry and Behavior, 177, 12-19. [Google Scholar] [CrossRef] [PubMed]
[50] Barbosa, I.G., Bauer, M.E., Machado-Vieira, R. and Teixeira, A.L. (2014) Cytokines in Bipolar Disorder: Paving the Way for Neuroprogression. Neural Plasticity, 2014, Article ID: 360481. [Google Scholar] [CrossRef] [PubMed]
[51] Calkin, C., McClelland, C., Cairns, K., Kamintsky, L. and Friedman, A. (2021) Insulin Resistance and Blood-Brain Barrier Dysfunction Underlie Neuroprogression in Bipolar Disorder. Frontiers in Psychiatry, 12, Article ID: 636174. [Google Scholar] [CrossRef] [PubMed]
[52] Zhu, Y., Webster, M.J., Mendez Victoriano, G., Middleton, F.A., Massa, P.T. and Weickert, C.S. (2024) Molecular Evidence for Altered Angiogenesis in Neuroinflammation-Associated Schizophrenia and Bipolar Disorder Implicate an Abnormal Midbrain Blood-Brain Barrier. Schizophrenia Bulletin, 51, 1146-1161. [Google Scholar] [CrossRef] [PubMed]
[53] Kamintsky, L., Cairns, K.A., Veksler, R., Bowen, C., Beyea, S.D., Friedman, A., et al. (2020) Blood-Brain Barrier Imaging as a Potential Biomarker for Bipolar Disorder Progression. NeuroImage: Clinical, 26, Article ID: 102049. [Google Scholar] [CrossRef] [PubMed]
[54] Schroeter, M.L., Abdul-Khaliq, H., Krebs, M., Diefenbacher, A. and Blasig, I.E. (2008) Serum Markers Support Disease-Specific Glial Pathology in Major Depression. Journal of Affective Disorders, 111, 271-280. [Google Scholar] [CrossRef] [PubMed]
[55] Fiedorowicz, J.G., Coryell, W.H., Rice, J.P., Warren, L.L. and Haynes, W.G. (2012) Vasculopathy Related to Manic/Hypomanic Symptom Burden and First-Generation Antipsychotics in a Sub-Sample from the Collaborative Depression Study. Psychotherapy and Psychosomatics, 81, 235-243. [Google Scholar] [CrossRef] [PubMed]
[56] Fiedorowicz, J.G., Solomon, D.A., Endicott, J., Leon, A.C., Li, C., Rice, J.P., et al. (2009) Manic/Hypomanic Symptom Burden and Cardiovascular Mortality in Bipolar Disorder. Psychosomatic Medicine, 71, 598-606. [Google Scholar] [CrossRef] [PubMed]
[57] Zetterberg, H., Jakobsson, J., Redsäter, M., Andreasson, U., Pålsson, E., Ekman, C.J., et al. (2014) Blood-Cerebrospinal Fluid Barrier Dysfunction in Patients with Bipolar Disorder in Relation to Antipsychotic Treatment. Psychiatry Research, 217, 143-146. [Google Scholar] [CrossRef] [PubMed]
[58] Wakonigg Alonso, C., McElhatton, F., O’Mahony, B., Campbell, M., Pollak, T.A. and Stokes, P.R.A. (2024) The Blood-Brain Barrier in Bipolar Disorders: A Systematic Review. Journal of Affective Disorders, 361, 434-444. [Google Scholar] [CrossRef] [PubMed]
[59] Lizano, P., Pong, S., Santarriaga, S., Bannai, D. and Karmacharya, R. (2023) Brain Microvascular Endothelial Cells and Blood-Brain Barrier Dysfunction in Psychotic Disorders. Molecular Psychiatry, 28, 3698-3708. [Google Scholar] [CrossRef] [PubMed]
[60] Kılıç, F., Işık, Ü., Demirdaş, A., Doğuç, D.K. and Bozkurt, M. (2020) Serum Zonulin and Claudin-5 Levels in Patients with Bipolar Disorder. Journal of Affective Disorders, 266, 37-42. [Google Scholar] [CrossRef] [PubMed]
[61] Turan, Ç., Kesebir, S. and Süner, Ö. (2014) Are ICAM, VCAM and E-Selectin Levels Different in First Manic Episode and Subsequent Remission? Journal of Affective Disorders, 163, 76-80. [Google Scholar] [CrossRef] [PubMed]
[62] Hochman, E., Taler, M., Flug, R., Gur, S., Dar, S., Bormant, G., et al. (2023) Serum Claudin-5 Levels among Patients with Unipolar and Bipolar Depression in Relation to the Pro-Inflammatory Cytokine Tumor Necrosis Factor-Alpha Levels. Brain, Behavior, and Immunity, 109, 162-167. [Google Scholar] [CrossRef] [PubMed]