by Frank M. Faraci, PhD - University of Iowa College of Medicine
The brain has a constant need for oxygen, glucose and other essential nutrients. To provide adequate spatial and temporal delivery of these molecules, a complex circulation is present, one that exceeds many other organs in relation to its level of regulation and cell-to-cell integration. In The Cerebral Circulation (second edition), Dr. Marilyn Cipolla presents an update to her successful and well-cited monograph dealing with this fascinating and clinically essential topic.
The text for the second edition is organized into five major sections, supported by over 20 figures and almost 250 references. Many of these have been updated since the first edition. Thus, the presentation provides an up-to-date synthesis of work in this area. Major sections include vascular anatomy (large blood vessels and the microcirculation), including the venous system. There is considerable discussion on the role of neurons and their impact on the vasculature via both extrinsic and intrinsic innervation. Other fundamental aspects of regulation of cerebral vascular resistance and thus blood flow – myogenic tone, myogenic responses, and endothelial based mechanisms are highlighted. The discussion considers how these various mechanisms are then integrated to impact segmental vascular resistance and cerebral blood flow through major underlying processes that include autoregulation, neurovascular coupling (known to some as functional hyperemia), and chemoregulation (responses to oxygen, carbon dioxide, and pH). The presentation ends with sections on essential barriers within the brain, the blood-brain barrier and the blood-cerebrospinal fluid barrier. This portion of the text highlights new insight into the role of various tight and junctional proteins, molecular transporters, and issues related to brain and cellular edema. Along the way, new topics of interest have been integrated including the potential impact of pericytes in the distal microcirculation and the importance of collateral vessels.
This edition of The Cerebral Circulation will be on interest to both basic and clinical researchers interested in the regulation of cerebral blood flow as well as large and small vessel disease and their implications for brain health and disease. The presentation is mechanistic and up-to-date. With so many specialized reviews appearing in the literature these days, a summary like this that gives a broad, but still fairly detailed overview of the cerebral circulation can be a valuable resource.