水通道蛋白4与脑水肿研究进展

水通道蛋白4(AQP4)是膜水通道蛋白家族的一员,在脑组织中高表达,是控制水进出脑组织的通道。近年来发现,AQP4的功能和表达与脑水肿密切相关。同时脑水肿又是和脑疾病治疗密切相关的病理过程,对两者的研究或许可以为我们带来更多的临床治疗新思路。本文综述了AQP4的结构、表达、调控与功能以及AQP4与脑水肿关系的研究进展。     

大鼠脑缺血再灌注时水通道蛋白4表达与血脑屏障通透性变化

目的:研究大鼠脑缺血/再灌注时脑组织中水通道蛋4(AQP4)表达与脑水肿、血脑屏障通透性间关系。方法:采用大鼠大脑中动脉线栓缺血模型,免疫组化法、蛋白印迹法测定AQP4表达,干湿重法测定脑水含量以评价脑水肿,伊文氏蓝(EB)法测定血脑屏障通透性。结果:脑缺血后再灌注4～6h,AQP4表达上调,至12h上调显著,48～72h达高峰。脑水含量、EB含量均与此趋势相一致,且AQP4表达与脑水含量、EB含量呈显著正相关(P0.05)。结论:AQP4表达参与了缺血性脑水肿的产生,且与BBB通透性改变呈正相关。     

水通道蛋白与脑部疾病

水通道蛋白是参与跨细胞水转运的膜通道蛋白家族成员,广泛存在于机体组织细胞中,参与水的分泌与吸收。近年来脑部的水通道蛋白成为研究热点。水通道蛋白在脑中的主要生理功能是参与调节脑内渗透压及电解质的平衡,维持脑脊液的分泌及平衡,并与各种脑部疾病的病理过程及其所造成的水肿密切相关。调控水通道蛋白的表达可以减轻各种脑部疾病造成的病理损伤和阻止脑水肿的形成,这为临床治疗脑部疾病提供了新的思路和方法。本文就水通道蛋白与脑部疾病的关系的研究进展作一综述。     

高血压脑出血大鼠脑组织TLR4、AQP-4、NO表达的变化及与脑水肿的关系分析

摘要 目的：探讨高血压脑出血（HICH）大鼠脑组织中Toll样受体4（TLR4）、水通道蛋白-4（AQP-4）、一氧化氮（NO）表达变化情况及与脑水肿的关系。方法：选取48只SHR大鼠,随机分为假手术组、HICH 12 h组、HICH 24 h组、HICH 48 h组、HICH 72 h组、HICH 7 d组,采用细菌胶原酶0.4 U配成2 μL,立体定向下注射至大鼠脑右侧尾状核建立HICH大鼠模型,假手术组注入等量生理盐水。观察相应时间点大鼠脑组织TLR4、AQP-4、NO表达变化情况及脑组织含水量变化情况,Pearson检验分析HICH大鼠脑组织含水量与脑组织中TLR4、AQP-4、NO表达情况的相关性。结果：各时间点HICH大鼠TLR4表达水平较假手术组均明显升高,其他时间点HICH大鼠TLR4表达水平较HICH 12 h组均明显升高（P＜0.05）;各时间点HICH大鼠AQP-4表达水平均较假手术组明显升高（P＜0.05）;各时间点HICH大鼠NO表达水平较假手术组均明显降低（P＜0.05）。各时间点HICH大鼠脑组织含水量均较假手术组明显升高（P＜0.05）,且各组大鼠脑组织含水量呈升高后降低趋势（P＜0.05）。Pearson检验结果显示HICH大鼠脑组织含水量与TLR4、AQP-4表达水平均呈正相关,与NO表达水平呈负相关（P＜0.05）。结论：HICH大鼠脑组织TLR4、AQP-4、NO的动态变化与脑组织含水量具有相关性,提示三者参与了脑水肿的形成与消退,为后续临床针对HICH的诊疗方案制定提供新思路和方向,具备一定参考价值。     

水通道蛋白4在脑缺血后脑水肿中的作用

脑缺血是由于动脉阻塞或灌注不足导致大脑局部血流减少无法满足代谢需求产生的功能障碍。脑水肿是脑组织间或细胞内液体过度积聚的病理现象,是脑缺血后较为严重的并发症,将会导致颅内压升高,脑组织受压而神经功能受损,甚至死亡。水通道蛋白(aquaporin)是一类分布在细胞膜上的蛋白质家族,目前已发现有13种亚型,主要调节细胞内外水平衡且参与细胞迁移和信号传导等多个生理病理过程。水通道蛋白4(aquaporin-4,AQP4)主要分布在中枢神经系统中星形胶质细胞的终足上,在细胞毒性水肿和血管源性水肿的形成和消除中起双重作用,与脑缺血后脑水肿有密切关系。机体通过转录过程及翻译后修饰等多个水平调节AQP4的表达协调其功能。本文回顾了目前AQP4在脑缺血后作用的最新进展,力图为治疗脑卒中后脑水肿提供新的研究方向。     

水通道蛋白-4在突触可塑性及学习记忆中的作用

水通道蛋白-4(aquaporin-4,AQP-4)作为水通道蛋白家族之一,在中枢神经系统具有广泛的分布,且在星形胶质细胞终足上高表达。研究表明,AQP-4可通过调节星形胶质细胞的功能在维持脑内水稳态、脑体积和神经元兴奋性等方面发挥重要的作用。但是AQP-4在突触可塑性、学习记忆及认知等方面所发挥的作用还不明了。突触功能可塑性的变化按其性质的不同可分为长时程增强(long term potentiation,LTP)和长时程抑制(long term depression,LTD),两者被公认为是学习记忆的神经生物学基础。海马区是调节学习记忆过程的核心脑区,其突触可塑性与学习记忆有密切的关系。本文旨在综述AQP-4与海马区突触可塑性及相关学习记忆的关系研究进展,并展望AQP-4作为新的靶点在认知功能障碍中的可能作用,为临床治疗相关神经系统疾病提供新的思路与方向。     

脑水肿时紧密连接蛋白occludin及AQP4的表达变化

目的:采用枕大池内注入脂多糖(lipopolysaccharides,LPS)的方法建立大鼠脑水肿模型,观察脑组织病理形态学变化,脑组织含水量(brain water content,BWC),血脑屏障(blood brain barrier,BBB)的紧密连接蛋白Occludin和水通道蛋白-4(aquaporin 4,AQP4)表达水平的动态变化,研究AQP4及Occludin与脑水肿形成的关系,及其可能的作用机制,为临床脑水肿的治疗提供理论依据。方法:选用Wistar健康成年大鼠,随机分为正常对照组,生理盐水组和脂多糖组,后两组的观察时间点选定于造模后3 h、6h、12 h、24 h、72 h。采用经皮穿刺枕大池内注入脂多糖的方法制备脑水肿动物模型,正常对照组、生理盐水组及脂多糖组分别于各时间点进行开颅取脑,测定脑组织含水量,通过HE染色法观察脑组织的病理形态学变化,应用Western blot方法检测occludin的表达变化。应用RT-PCR技术测定脑组织内AQP4mRNA的表达变化。结果:生理盐水组各时间点中有少量AQP4mRNA及occludin蛋白的表达,与正常对照组之间无显著性差异;脂多糖组在造模后3 hAQP4的mRNA表达开始增加,6-12 h达高峰,此后明显下降,随后表达开始减弱,24-72 h表达显著低于生理盐水组;occludin蛋白表达下降出现于造模后3 h,12-24 h下降更明显,72 h表达开始升高。结论:枕大池内注入脂多糖(LPS)所建立脑水肿模型中,脑组织含水量及血脑屏障通透性增加,病理学特点是血管源性脑水肿出现早且持久,后期伴有细胞毒性脑水肿的改变。AQP4早期表达增强是胶质细胞的适应性反应,与血脑屏障的破坏有关,促进了血管源性脑水肿的发生。后期AQP4表达减弱是机体内在防御机制的表现,同时又促进细胞毒性脑水肿的形成。occludin在脑组织中表达量随脑水肿的加重而降低,即与脑水肿的程度呈负相关,目前认为这与脑水肿时内皮细胞通透性增加,血脑屏障的通透性改变,导致occludin的表达下调有关,促进了血管源性脑水肿的发生。针对以上特点,我们可以进一步研究调控AQP4及occludin表达的药物,从而减轻脑损伤后脑水肿的程度,为脑水肿的治疗提供新的临床策略。     

早期糖尿病大鼠晶状体和视网膜水通道蛋白4表达的研究

目的观察早期糖尿病大鼠晶状体、视网膜水通道蛋白4(aquaporin 4,AQP-4)表达的变化,探讨糖尿病大鼠眼组织水代谢改变的机制。方法 SD大鼠分为正常对照组和糖尿病组。制作糖尿病大鼠模型,于第4、8周取材,用免疫组化法和计算机图像分析系统半定量分析各组大鼠晶状体、视网膜AQP-4表达的变化。结果正常及糖尿病大鼠AQP-4在晶状体上皮均无表达。AQP-4在视网膜上有表达,正常大鼠主要表达于视网膜视杆视锥层、节细胞层和神经纤维层,糖尿病大鼠从内界膜延伸至视细胞层整个视网膜厚度均可见AQP-4阳性表达,特别是在神经节细胞层毛细血管内皮和神经纤维层阳性表达更明显。糖尿病大鼠视网膜组织AQP-4阳性表达标随周龄的延长而增强。结论糖尿病大鼠视网膜AQP-4的表达较正常组增强,提示水通道蛋白的表达增加是糖尿病早期发生视网膜水肿的机制之一。     

颅内压参数联合血清caveolin-1、AQP-4对高血压脑出血患者术后预后不良的预测价值

摘要 目的：探讨颅内压参数联合血清小窝蛋白-1（caveolin-1）、水通道蛋白4（AQP-4）对高血压脑出血（HICH）患者术后预后不良的预测价值。方法：选择2020年1月至2022年1月河北省胸科医院收治的106例HICH患者,术后随访3个月,根据格拉斯哥预后（GOS）评分将患者分为预后良好组（55例）,预后不良组（51例）。术后监测颅内压参数[压力反应指数（PRx）、平均颅内压波幅（MWA）、20 mmHg阈值下颅内压剂量（Dicp20）],检测血清caveolin-1、AQP-4水平。多因素Logistic回归分析HICH患者术后预后不良的因素。受试者工作特征曲线（ROC）分析颅内压参数联合血清caveolin-1、AQP-4预测HICH患者术后预后不良的价值。结果：预后不良组PRx、MWA、Dicp20以及血清caveolin-1、AQP-4水平高于预后良好组（P＜0.05）。低术前格拉斯哥昏迷评分（GCS）评分、高PRx、高Dicp20、高caveolin-1、高AQP-4是HICH患者术后预后不良的危险因素（P＜0.05）。联合PRx、Dicp20、caveolin-1和AQP-4预测HICH患者术后3个月预后不良的的曲线下面积为0.823,大于PRx、Dicp20、caveolin-1和AQP-4单独预测。结论：高PRx、Dicp20、caveolin-1、AQP4是HICH患者术后预后不良的危险因素,联合颅内压参数PRx、Dicp20及血清caveolin-1、AQP4预测HICH患者术后预后不良具有较高的价值。     

不同浓度中药怀牛膝加黄芪煎液对重型颅脑损伤大鼠脑组织含水量及AQP4表达的影响

目的观察低、中、高不同浓度中药怀牛膝加黄芪煎液对重型颅脑损伤大鼠脑组织含水量及水通道蛋白4(AQP4)表达的影响,探讨其治疗重型脑损伤性脑水肿最佳用药浓度及机制。方法将SD大鼠65只随机分为假手术组(5只),模型组(15只),低浓度怀牛膝加黄芪组(A组)15只,中浓度怀牛膝加黄芪组(B组)15只,高浓度怀牛膝加黄芪组(C组)15只,采用改良后Feency’s方法建立大鼠重型颅脑损伤模型。分别在1、3、7天3个时间点每组各取5只大鼠测定脑组织含水量,HE染色观察脑组织变化情况,并采用免疫组化方法检测脑组织AQP4的表达。结果模型组大鼠重型颅脑损伤后各时间点脑组织含水量、损伤灶周围AQP4的表达均高于假手术组(P0.05),HE染色观察发现模型组的脑组织肿胀水肿明显;A、B组各时间点脑组织含水量、AQP4表达水平与模型组相比较无明显降低(P0.05),HE染色观察发现与模型组基本一致;C组各时间点脑组织含水量、AQP4表达水平均较模型组降低(P0.05),HE染色观察发现与模型组比较,脑组织水肿情况有所改善。结论 C组改善重型颅脑损伤后引起的脑水肿效果最明显,其作用机制可能与减少AQP4在损伤脑组织中的表达、减轻脑细胞损害有关。     

Role of aquaporins in cell migration and edema formation in human brain tumors

The aquaporins (AQPs) are a family of transmembrane water channel proteins widely distributed and play a major role in transcellular and transepithelial water movement. Moreover, recent evidence indicates that AQPs may be involved in cell migration, angiogenesis, and tumor growth. This review article summarizes literature data concerning the involvement of AQP-1 and -4 in human brain tumor growth and edema formation and suggests a potential therapeutic approach by antagonizing their biological activity.     

Propofol Administration Modulates AQP-4 Expression and Brain Edema After Traumatic Brain Injury

The increased intracranial pressure caused by brain edema following traumatic brain injury (TBI) always leads to poor patient prognosis. Aquaporin-4 (AQP-4) plays an important role in edema formation and resolution, which may provide a novel therapeutic target for edema treatment. In this present study, we found that propofol treatment, within a short time, after TBI significantly reduced brain edema in a controlled cortical injury rat model and suppressed in vivo expression of AQP-4. The ameliorating effect of propofol was associated with attenuated expression of interleukin-1β (IL-1β) and tumor necrosis factor-α (TNF-α). In addition, the regulatory effect of propofol on AQP-4 expression was investigated in cultured astrocytes. Results showed that propofol could block the stimulatory effect of IL-1β and TNF-α on AQP-4 expression in cultured astrocytes. We also found that both NFκB and p38/MAPK pathways were involved in IL-1β and TNF-α-induced AQP-4 expression and that propofol functions as a dual inhibitor of NFκB and p38/MAPK pathways. In conclusion, treatment with propofol, within a short time, after TBI attenuates cerebral edema and reduces the expression of AQP-4. Propofol modulates acute AQP-4 expression by attenuating IL-1β and TNF-α expression and inhibiting IL-1β and TNF-α induced AQP-4 expression.     

MicroRNA 320a Functions as a Novel Endogenous Modulator of Aquaporins 1 and 4 as Well as a Potential Therapeutic Target in Cerebral Ischemia

Aquaporins facilitate efficient diffusion of water across cellular membranes, and water homeostasis is critically important in conditions such as cerebral edema. Changes in aquaporin 1 and 4 expression in the brain are associated with cerebral edema, and the lack of water channel modulators is often highlighted. Here we present evidence of an endogenous modulator of aquaporin 1 and 4. We identify miR-320a as a potential modulator of aquaporin 1 and 4 and explore the possibility of using miR-320a to alter the expression of aquaporin 1 and 4 in normal and ischemic conditions. We show that precursor miR-320a can function as an inhibitor, whereas anti-miR-320a can act as an activator of aquaporin 1 and 4 expressions. We have also shown that anti-miR-320a could bring about a reduction of infarct volume in cerebral ischemia with a concomitant increase in aquaporins 1 and 4 mRNA and protein expression.     

Different Aquaporin-4 Expression in Glioblastoma Multiforme Patients with and without Seizures

Aquaporin-4 (AQP-4), the most important water channel in the brain, is expressed by astrocyte end feet abutting microvessels. Altered expression levels of AQP-4 and redistribution of the protein throughout the membranes of cells found in glioblastoma multiforme (GBM) lead to development of the edema often found surrounding the tumor mass. Dysregulation of AQP-4 also occurs in hippocampal sclerosis and cortical dysplasia in patients with refractory partial epilepsy. This work reports on analysis of the relationship between AQP-4 expression and the incidence of epileptic seizures in patients with GBM. Immunohistochemical and polymerase chain reaction techniques were used to evaluate AQP-4 in biopsy specimens from 19 patients with GBM, 10 of who had a history of seizures before surgery. AQP-4 mRNA levels were identical in the two groups of patients, but AQP-4 expression was more frequently detected on the GBM membranes from specimens of patients with seizures than from individuals without (10 versus 2, P < 0.001). We conclude that reduced expression of cell surface AQP-4 is characteristic of GBM patients without seizures, likely attributable to a posttranslational mechanism.     

Effect of Propofol Post-treatment on Blood–Brain Barrier Integrity and Cerebral Edema After Transient Cerebral Ischemia in Rats

Although propofol has been reported to offer neuroprotection against cerebral ischemia injury, its impact on cerebral edema following ischemia is not clear. The objective of this investigation is to evaluate the effects of propofol post-treatment on blood–brain barrier (BBB) integrity and cerebral edema after transient cerebral ischemia and its mechanism of action, focusing on modulation of aquaporins (AQPs), matrix metalloproteinases (MMPs), and hypoxia inducible factor (HIF)-1α. Cerebral ischemia was induced in male Sprague–Dawley rats (n = 78) by occlusion of the right middle cerebral artery for 1 h. For post-treatment with propofol, 1 mg kg^?1 min^?1 of propofol was administered for 1 h from the start of reperfusion. Nineteen rats undergoing sham surgery were also included in the investigation. Edema and BBB integrity were assessed by quantification of cerebral water content and extravasation of Evans blue, respectively, following 24 h of reperfusion. In addition, the expression of AQP-1, AQP-4, MMP-2, and MMP-9 was determined 24 h after reperfusion and the expression of HIF-1α was determined 8 h after reperfusion. Propofol post-treatment significantly reduced cerebral edema (P < 0.05) and BBB disruption (P < 0.05) compared with the saline-treated control. The expression of AQP-1, AQP-4, MMP-2, and MMP-9 at 24 h and of HIF-1α at 8 h following ischemia/reperfusion was significantly suppressed in the propofol post-treatment group (P < 0.05). Propofol post-treatment attenuated cerebral edema after transient cerebral ischemia, in association with reduced expression of AQP-1, AQP-4, MMP-2, and MMP-9. The decreased expression of AQPs and MMPs after propofol post-treatment might result from suppression of HIF-1α expression.     

Probenecid Protects Against Transient Focal Cerebral Ischemic Injury by Inhibiting HMGB1 Release and Attenuating AQP4 Expression in Mice

Stroke results in inflammation, brain edema, and neuronal death. However, effective neuroprotectants are not available. Recent studies have shown that high mobility group box-1 (HMGB1), a proinflammatory cytokine, contributes to ischemic brain injury. Aquaporin 4 (AQP4), a water channel protein, is considered to play a pivotal role in ischemia-induced brain edema. More recently, studies have shown that pannexin 1 channels are involved in cerebral ischemic injury and the cellular inflammatory response. Here, we examined whether the pannexin 1 channel inhibitor probenecid could reduce focal ischemic brain injury by inhibiting cerebral inflammation and edema. Transient focal ischemia was induced in C57BL/6J mice by middle cerebral artery occlusion (MCAO) for 1 h. Infarct volume, neurological score and cerebral water content were evaluated 48 h after MCAO. Immunostaining, western blot analysis and ELISA were used to assess the effects of probenecid on the cellular inflammatory response, HMGB1 release and AQP4 expression. Administration of probenecid reduced infarct size, decreased cerebral water content, inhibited neuronal death, and reduced inflammation in the brain 48 h after stroke. In addition, HMGB1 release from neurons was significantly diminished and serum HMGB1 levels were substantially reduced following probenecid treatment. Moreover, AQP4 protein expression was downregulated in the cortical penumbra following post-stroke treatment with probenecid. These results suggest that probenecid, a powerful pannexin 1 channel inhibitor, protects against ischemic brain injury by inhibiting cerebral inflammation and edema.     

Modulation of TRPV4 and BKCa for treatment of brain diseases

As a member of transient receptor potential family, the transient receptor potential vanilloid 4 (TRPV4) is a kind of nonselective calcium-permeable cation channel, which belongs to non-voltage gated Ca²⁺ channel. Large-conductance Ca²⁺-activated K⁺ channel (BKCa) represents a unique superfamily of Ca²⁺-activated K⁺ channel (KCa) that is both voltage and intracellular Ca²⁺ dependent. Not surprisingly, aberrant function of either TRPV4 or BKCa in neurons has been associated with brain disorders, such as Alzheimer’s disease, cerebral ischemia, brain tumor, epilepsy, as well as headache. In these diseases, vascular dysfunction is a common characteristic. Notably, endothelial and smooth muscle TRPV4 can mediate BKCa to regulate cerebral blood flow and pressure. Therefore, in this review, we not only discuss the diverse functions of TRPV4 and BKCa in neurons to integrate relative signaling pathways in the context of cerebral physiological and pathological situations respectively, but also reveal the relationship between TRPV4 and BKCa in regulation of cerebral vascular tone as an etiologic factor. Based on these analyses, this review demonstrates the effective mechanisms of compounds targeting these two channels, which may be potential therapeutic strategies for diseases in the brain.     

Aquaporin-4 deletion in mice reduces brain edema after acute water intoxication and ischemic stroke

Cerebral edema contributes significantly to morbidity and death associated with many common neurological disorders. However, current treatment options are limited to hyperosmolar agents and surgical decompression, therapies introduced more than 70 years ago. Here we show that mice deficient in aquaporin-4 (AQP4), a glial membrane water channel, have much better survival than wild-type mice in a model of brain edema caused by acute water intoxication. Brain tissue water content and swelling of pericapillary astrocytic foot processes in AQP4-deficient mice were significantly reduced. In another model of brain edema, focal ischemic stroke produced by middle cerebral artery occlusion, AQP4-deficient mice had improved neurological outcome. Cerebral edema, as measured by percentage of hemispheric enlargement at 24 h, was decreased by 35% in AQP4-deficient mice. These results implicate a key role for AQP4 in modulating brain water transport, and suggest that AQP4 inhibition may provide a new therapeutic option for reducing brain edema in a wide variety of cerebral disorders.