Brain HealthHow Microglia Control Brain Rewiring After Chronic Low Blood Flow
As the global population ages, chronic cerebral hypoperfusion — persistently reduced blood flow to the brain — has emerged as a major driver of white matter damage and vascular cognitive impairment. This review examines the cellular and molecular mechanisms behind failed myelin repair in this condition, with a spotlight on microglia. These brain-resident immune cells can either worsen injury through pro-inflammatory signaling or promote repair by clearing myelin debris and secreting neurotrophic factors. The review also maps how microglia interact with astrocytes, endothelial cells, and peripheral immune cells to regulate the brain's repair environment. Therapeutic strategies targeting microglial polarization, phagocytic activity, and inflammatory tone are discussed as promising avenues for restoring white matter integrity and preserving cognition in aging adults.
