Following traumatic brain injury and ischemia, the brain swells due to edema resulting in raised intracranial pressure, neurologic deterioration and in the case of severe swelling, death. At present there is no effective treatment for fulminating brain swelling. The long term goal of this project is to identify the mechanisms leading to traumatic brain swelling and to introduce novel therapies to combat the edematous process. In the previous grant period, we studied the energy crisis that accompanies trauma and found that mitochondrial impairment is a contributing factor toward rendering the brain unable to maintain ionic homeostatis leading to cellular swelling. We now believe the fluid does not enter the cell via a compromised blood brain barrier but enters the cell through the astrocytic end feet which are plastered around the microvessels and provide an entry route to the tissue. We now extend our studies in this proposal to further elucidate the pathway for water entry through aquaporin channels in the rat which serve as an alternate gateway for the edema fluid. To this purpose we base our future work on three hypotheses encompassing (1) clarifying the role of aquaporins in traumatic brain injury by identifying the pathway of sodium and water entry into brain after experimental cortical contusion injury. (2) defining the temporal course of AQP4 channel expression after cortical contusion injury during the period of edema formation and resolution and (3) pharmacologically modulating AQP4 channels to prevent water entry utilizing a selective V1a receptor antagonist which suppresses AQP4 upregulation and reduces edema. For these purposes we utilize sodium fluorescein to identify route of sodium entry. We will utilize sodium and potassium ion selective microelectrodes to measure the ionic changes in the extracellular space which play a major role in determining the amount of water entering brain. At the conclusion of the experiments, brain edema and total tissue sodium and potassium will be measured to gauge the effect of the pharmacologic suppression of the AQP4 channels. Using the well established model of cortical contusion to produce injury we will measure the change in AQP4 protein by western blot analysis;characterize the drug induced special changes by immunohistochemistry and confocal microscopy. Taken in concert, these studies will provide a more in depth understanding of the role of aquaporins in brain injury and introduce novel therapeutic approaches for treating brain edema.

Public Health Relevance

At present, there is no effective treatment for brain swelling following traumatic brain injury. Therefore, it is important to determine why the brain swells, what are the mechanisms involved and how can it be treated. This proposal will address the fundamental mechanism of brain swelling and how it can be blocked pharmacologically.

National Institute of Health (NIH)
National Institute of Neurological Disorders and Stroke (NINDS)
Research Project (R01)
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Clinical Neuroscience and Disease Study Section (CND)
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Hicks, Ramona R
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Virginia Commonwealth University
Schools of Medicine
United States
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Marmarou, Christina R; Liang, Xiuyin; Abidi, Naqeeb H et al. (2014) Selective vasopressin-1a receptor antagonist prevents brain edema, reduces astrocytic cell swelling and GFAP, V1aR and AQP4 expression after focal traumatic brain injury. Brain Res 1581:89-102
Filippidis, Aristotelis S; Liang, Xiuyin; Wang, Weili et al. (2014) Real-time monitoring of changes in brain extracellular sodium and potassium concentrations and intracranial pressure after selective vasopressin-1a receptor inhibition following focal traumatic brain injury in rats. J Neurotrauma 31:1258-67
Kleindienst, Andrea; Dunbar, Jana G; Glisson, Renee et al. (2013) The role of vasopressin V1A receptors in cytotoxic brain edema formation following brain injury. Acta Neurochir (Wien) 155:151-64
Prieto, Ruth; Tavazzi, Barbara; Taya, Keisuke et al. (2011) Brain energy depletion in a rodent model of diffuse traumatic brain injury is not prevented with administration of sodium lactate. Brain Res 1404:39-49
Fazzina, Giovanna; Amorini, Angela M; Marmarou, Christina R et al. (2010) The protein kinase C activator phorbol myristate acetate decreases brain edema by aquaporin 4 downregulation after middle cerebral artery occlusion in the rat. J Neurotrauma 27:453-61
Taya, Keisuke; Marmarou, Christina R; Okuno, Kenji et al. (2010) Effect of secondary insults upon aquaporin-4 water channels following experimental cortical contusion in rats. J Neurotrauma 27:229-39
Kleindienst, A; Dunbar, J G; Glisson, R et al. (2006) Effect of dimethyl sulfoxide on blood-brain barrier integrity following middle cerebral artery occlusion in the rat. Acta Neurochir Suppl 96:258-62
Kleindienst, A; Fazzina, G; Amorini, A M et al. (2006) Modulation of AQP4 expression by the protein kinase C activator, phorbol myristate acetate, decreases ischemia-induced brain edema. Acta Neurochir Suppl 96:393-7
Marmarou, A; Signoretti, S; Aygok, G et al. (2006) Traumatic brain edema in diffuse and focal injury: cellular or vasogenic? Acta Neurochir Suppl 96:24-9
Marmarou, Anthony; Signoretti, Stefano; Fatouros, Panos P et al. (2006) Predominance of cellular edema in traumatic brain swelling in patients with severe head injuries. J Neurosurg 104:720-30

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