Ghrelin对脑缺血再灌注大鼠脑水肿和水通道蛋白4表达的影响

 目的： 探讨ghrelin对脑缺血再灌注大鼠脑水肿、血脑屏障通透性及水通道蛋白4（AQP4）表达的影响。方法： 成年SD雄性大鼠随机分为3组:sham组、大脑中动脉阻塞（MCAO）组和ghrelin处理组。采用线栓法复制MCAO模型（缺血2 h,再灌注22 h）。Ghrelin组大鼠于再灌开始时经股静脉注射ghrelin 10 nmol/kg。TTC染色观察脑梗死体积,神经功能评分判断脑功能障碍程度,分别以体积计算和干湿重法检测脑肿胀程度和脑含水量的变化,收集脑血管外伊文思蓝(EB)来评估血脑屏障的破坏程度,免疫组化和Western blotting检测AQP4的表达变化。结果： 与MCAO组比较,ghrelin处理组的脑梗死体积较小（P<0.01）,神经功能评分较低（P<0.01）,脑组织中的EB渗出量较少（P<0.01）。Ghrelin处理组大鼠的脑肿胀体积、脑含水量和AQP4表达明显低于MCAO组（P<0.05）。结论： Ghrelin减轻大鼠脑缺血/再灌注损伤,减轻脑水肿和血脑屏障的破坏,抑制脑组织中AQP4的表达。AQP4在ghrelin的脑保护机制中可能发挥重要作用。     

脑出血后水通道蛋白4与内向整流性钾通道4.1的再分布与脑水肿形成的关系

目的:探讨水通道蛋白4(AQP4)与内向整流性钾通道4.1(Kir4.1)在出血性脑水肿形成中的作用.方法:采用胶原酶注入法建立脑出血(ICH)模型,运用干湿重法、伊文氏蓝(EB)测定法、荧光双标和RT-PCR分别检测ICH后脑水含量(BWC)、血脑屏障(BBB)通透性、AQP4与Kir4.1及两者mRNA的表达变化,并对每一时间点AQP4 mRNA、 Kir4.1 mRNA表达量做比值分析.结果:ICH后3h BWC已明显增高,至48h达到峰值;EB含量在ICH后48h内高于对照组,以6h最甚;荧光双标显示,AQP4与Kir4.1强弱不等地表达在双侧软脑膜、室管膜、脉络膜等与水代谢密切相关的界面上.ICH后6h及其以后时段,两者的mRNA均明显增高,且于48h达到峰值;比值分析显示,ICH后6h及以后时段,AQP4 mRNA的增加量明显大于Kir4.1 mRNA的增加量.结论:ICH早期的脑水肿主要由血脑屏障通透性增加所致,而ICH中后期的脑水肿主要由AQP4与Kir4.1的再分布引起.     

局灶性脑缺血再灌注致血脑屏障破坏与zileuton的保护作用

目的： 探讨局灶性脑缺血再灌注损伤（CIRI）致血脑屏障(BBB) 通透性破坏的影响因素,观察高选择性5-脂氧合酶（5-LO）抑制剂zileuton的保护作用并分析其机制。方法: 线栓法制备大鼠大脑中动脉闭塞2 h/再灌注24 h模型（MCAO2 h/R24 h）,于缺血前2 h、再灌注0、5、10 h,分别灌胃给予zileuton10、50 mg·kg-1。伊文氏蓝示踪剂检测BBB;AutoCAD图像分析软件计算脑水肿程度;RT-PCR法检测脑组织白三烯受体1mRNA（CysLTR1 mRNA）;ELISA法检测血清白三烯B4（LTB4）;免疫组化法检测脑组织水通道蛋白4（AQP4）、基质金属蛋白酶9（MMP-9）蛋白。结果: MCAO2 h/R24 h后,BBB通透性明显增高,出现脑水肿,血清LTB4含量升高,梗塞侧脑组织CysLTR1mRNA表达增强,缺血区与梗塞灶周边缺血半暗带（IP）区AQP4与MMP-9蛋白表达上调; zileuton10、50 mg·kg-1均能有效控制CIRI所致的BBB破坏,改善脑水肿,降低血清LTB4含量,下调脑组织CysLTR1mRNA、AQP4与MMP-9表达。结论: CIRI后BBB通透性明显破坏,zileuton的保护作用与抑制脑组织和循环血液中的5-LO通路活化、下调脑组织缺血区与IP区的AQP4与MMP-9蛋白表达有关。     

The cerebral endothelium during pregnancy: a potential role in the development of eclampsia.

The authors investigated the influence of pregnancy on cerebral endothelial cell permeability in response to an acute elevation in intravascular pressure that caused forced dilatation of myogenic tone. Third-order branches of the posterior cerebral artery (PCA) were dissected from nonpregnant (NP) and late-pregnant (LP, days 19 to 20) Sprague-Dawley rats and mounted on glass cannulas in an arteriograph chamber that allowed control over intravascular pressure and measurement of both diameter and permeability to fluorescent dextran (3000 Da). Permeability was determined at 75 mm Hg and after a step increase in pressure to 200 mm Hg. The extent of pinocytosis and transcellular transport in response to pressure was evaluated separately in the same groups of animals at 75 and 200 mm Hg using transmission electron microscopy. All arteries developed myogenic tone at 75 mm Hg that was lost when pressure was increased to 200 mm Hg to cause forced dilatation. The increased pressure caused a significant increase in permeability to dextran and enhanced pinocytosis in arteries from LP animals, but not in NP animals whose permeability remained constant at both pressures. These results suggest a pregnancy-specific effect on the cerebral endothelium that may promote enhanced vascular permeability during acute hypertension and may contribute to the edema formation and neurologic complications of eclampsia.     

Aquaporin-4 in brain and spinal cord oedema

Brain oedema is a major clinical problem produced by CNS diseases (e.g. stroke, brain tumour, brain abscess) and systemic diseases that secondarily affect the CNS (e.g. hyponatraemia, liver failure). The swollen brain is compressed against the surrounding dura and skull, which causes the intracranial pressure to rise, leading to brain ischaemia, herniation, and ultimately death. A water channel protein, aquaporin-4 (AQP4), is found in astrocyte foot processes (blood–brain border), the glia limitans (subarachnoid cerebrospinal fluid—brain border) and ependyma (ventricular cerebrospinal fluid—brain border). Experiments using mice lacking AQP4 or alpha syntrophin (which secondarily downregulate AQP4) showed that AQP4 facilitates oedema formation in diseases causing cytotoxic (cell swelling) oedema such as cerebral ischaemia, hyponatraemia and meningitis. In contrast, AQP4 facilitates oedema elimination in diseases causing vasogenic (vessel leak) oedema and therefore AQP4 deletion aggravates brain oedema produced by brain tumour and brain abscess. AQP4 is also important in spinal cord oedema. AQP4 deletion was associated with less cord oedema and improved outcome after compression spinal cord injury in mice. Here we consider the possible routes of oedema formation and elimination in the injured cord and speculate about the role of AQP4. Finally we discuss the role of AQP4 in neuromyelitis optica (NMO), an inflammatory demyelinating disease that produces oedema in the spinal cord and optic nerves. NMO patients have circulating AQP4 IgG autoantibody, which is now used for diagnosing NMO. We speculate how NMO-IgG might produce CNS inflammation, demyelination and oedema. Since AQP4 plays a key role in the pathogenesis of CNS oedema, we conclude that AQP4 inhibitors and activators may reduce CNS oedema in many diseases.     

5-LO通路活化对大鼠脑缺血再灌注损伤致血脑屏障破坏的影响

为了研究大鼠局灶性脑缺血再灌注损伤(CIRI)后血脑屏障(BBB)通透性的改变,观察5-脂氧酶(5-LO)、白三烯(LTs)、核因子-κB(NF-κB)、基质金属蛋白酶-9(MMP-9)的表达变化,探讨5-LO通路活化参与BBB破坏的可能机制,本实验采用线栓法制备大鼠大脑中动脉闭塞2h/再灌注24h模型。伊文氏蓝示踪剂检测BBB的通透性;RT-PCR检测损伤侧脑组织5-LO mRNA、半胱氨酰白三烯受体1(CysLTR1)mRNA的表达;ELISA检测血清LTB4的含量;免疫组织化学法检测损伤侧脑组织5-LO、NF-κB、MMP-9蛋白的表达情况。结果显示:局灶性脑缺血2h/再灌注24h后,大鼠BBB的通透性明显增高,5-LO mRNA、CysLTR1 mRNA的表达以及血清LTB4的含量均增高;5-LO、NF-κB、MMP-9蛋白在脑组织内的表达亦显著增多。本研究结果提示,CIRI后5-LO通路活化可经CysLTR1、LTB4、NF-κB、MMP-9介导BBB破坏,继而引发级联反应,加重脑损伤。     

bFGF对大鼠脑损伤后血脑屏障通透性的影响

目的：探讨碱性成纤维生长因子（bFGF）对大鼠颅脑创伤后血脑屏障通透性的影响及可能的机制。方法：在Wistar大鼠颅脑脑创伤的同时腹腔注射bFGF,伤后24小时检测创伤线和bFGF治疗组脑组织含水量,并用伊文氏兰作为示踪剂定量观察血脑屏障通透性,结果：bFGF治疗组大鼠脑组织含水量及伊文氏兰含量均明显低于颅脑创伤组。结论：在颅脑创伤早期给予bFGF可以有效地减轻血脑屏障破坏的程度。     

芍药苷对脑缺血损伤的保护作用及其对脑血管通透性的影响

目的观察芍药苷（peoniflorin,PF）注射液对脑缺血损伤的保护作用及其对脑血管通透性的影响。方法采用线栓法闭塞大脑中动脉建立大鼠局灶性脑缺血模型（MCAO）,各组分别进行行为学评分,脑组织含水量和脑梗塞面积测定及免疫组化检测脑组织中水通道蛋白-4（AQP4）的表达。此外,检测PF对脑缺血再灌注损伤小鼠脑血管通透性的影响。结果PF注射给药可显著改善脑缺血的神经损伤症状,降低脑组织的含水量,缩小脑梗死面积,降低脑血管通透性,减少AQP4阳性细胞的表达。结论芍药苷注射液对脑缺血有明显的保护作用,该作用可通过调节AQP4的表达而降低脑血管通透性来完成。     

电针预处理对MCAO大鼠模型血脑屏障和MMP-9的影响

目的:探讨电针(EA)预处理对大鼠脑缺血再灌注后血脑屏障(BBB)通透性及脑内基质金属蛋白酶-9(MMP-9)表达的影响。方法:96只成年雄性SD大鼠随机分为假手术(Sham)组、单纯电针(EA)组、缺血(MCAO)组及电针预处理(EA+MCAO)组,每组24只。使用线栓法制作大鼠大脑中动脉阻塞(MCAO)模型,缺血120 min再灌注48 h后处死取脑。分别采用干湿重法测定各组动物脑水含量,伊文斯蓝(EB)法检测血脑屏障通透性,Western Blot检测紧密连接蛋白(TJP)及MMP-9表达水平,同时明胶酶谱法检测MMP-9活性。结果:与Sham组相比,MCAO组大鼠脑水含量及EB含量增多(P0.05),缺血侧脑组织TJP水平下降(P0.05),MMP-9表达及活性明显升高(P0.05);与MCAO组大鼠比较,EA+MCAO组脑水含量及EB含量减少(P0.05),缺血侧脑组织TJP水平升高(P0.05),同时MMP-9表达及活性显著降低(P0.05)。结论:电针预处理通过抑制缺血后脑内MMP-9的表达及活性,维持BBB完整性,有效改善脑缺血后的脑水肿症状。     

Aggravated chronic brain injury after focal cerebral ischemia in aquaporin-4-deficient mice

The water channel aquaporin-4 (AQP4) is important in brain water homeostasis, and is also involved in astrocyte growth and glial scar formation. It has been reported that AQP4 deficiency attenuates acute ischemic brain injury as a result of reducing cytotoxic edema. Here, we determined whether AQP4 deficiency influences chronic brain injury after focal cerebral ischemia induced by 30 min of middle cerebral artery occlusion (MCAO). AQP4^−/− mice exhibited a lower survival rate and less body weight gain than wild-type mice, but their neurological deficits were similar to wild-type mice during 35 days after MCAO. At 35 days after MCAO, AQP4^−/− mice showed more severe brain atrophy and cavity formation in the ischemic hemisphere as well as more neuronal loss in the hippocampus. Furthermore, astrocyte proliferation and glial scar formation were impaired in AQP4^−/− mice. Therefore, AQP4 deficiency complicated by astrocyte dysfunction aggravates chronic brain injury after focal cerebral ischemia, suggesting that AQP4 may be important in the chronic phase of the post-ischemic recovery process.     

高压氧对脑缺血再灌注小鼠明胶酶、一氧化氮合酶及血脑屏障的影响

目的:通过检测脑缺血再灌注小鼠明胶酶A(MMP－2)、明胶酶B(MMP－9)及一氧化氮合酶(NOS)活性,探讨高压氧(HBO)对脑缺血再灌注小鼠明胶酶、NOS及血脑屏障(BBB)通透性的影响。方法:复制脑缺血再灌注模型,并于再灌注期间经0.25MPaHBO治疗5次,采用明胶酶谱分析法及比色法,检测脑组织海马区明胶酶及NOS的活性,同时经尾静脉注射2%伊文思兰(EB),检测脑组织EB含量。结果:脑缺血再灌注后明胶酶(A、B)活性增加,HBO+脑缺血再灌注组明胶酶B(MMP－9)活性明显低于脑缺血再灌注组;而HBO对明胶酶A(MMP－2)作用不显著。脑缺血再灌注后NOS活性增加,HBO+脑缺血再灌注组NOS含量显著低于脑缺血再灌注组(P＜0.01)。脑组织EB含量以再灌注4h最高,11h、23h、48h、72h脑组织EB含量逐渐减少。高压氧+脑缺血再灌注组脑组织EB含量明显低于脑缺血再灌注组(P＜0.05,P＜0.01)。结论:高压氧具有降低脑缺血再灌注小鼠明胶酶B及NOS活性,降低血脑屏障的通透性的作用。     

缓激肽对大鼠缺血区血脑屏障的影响

目的研究缓激肽对局部脑缺血区超微结构、血脑屏障的通透性及继发性脑水肿的影响。方法制备大鼠大脑中动脉缺血模型,在大脑中动脉缺血2hr再灌注1hr末,颈内动脉灌注小剂量缓激肽(10μg/kg/min),应用电镜观察血脑屏障超微结构的改变;测定脑组织伊文思蓝含量来判断血脑屏障的通透性;应用干湿法测定脑含水量的变化。结果缓激肽灌注大鼠脑毛细血管紧密连接开放,对照组大鼠紧密连接完整;与对照组相比,缓激肽灌注组缺血侧脑组织伊文思蓝含量明显高于缺血对照组(P<0.01),但再灌注24hr后脑含水量并没有增加(P>0.05)。结论小剂量缓激肽通过开放紧密连接来增加缺血区血脑屏障的通透性,但并不会增加继发性脑水肿的程度。     

Potentials of magnesium treatment in subarachnoid haemorrhage.

Subarachnoid hemorrhage from a ruptured aneurysm is a subset of stroke. The young age (median 55 years) and poor outcome (50% of patients die; 30% of survivors remain dependent) explain why in the population the loss of productive life years from aneurysmal subarachnoid hemorrhage (SAH) is as large as that from brain infarcts, the most common type of stroke. Ischemia plays an important role in the pathophysiological process after SAH. A period of global cerebral ischemia firstly occurs in the acute phase, immediately after rupture of the aneurysm, due to acute vasoconstriction and elevated intracranial pressure, which leads to a drop in perfusion pressure. This is quite distinct from the secondly, delayed cerebral ischemia (DCI), which is focal or multi-focal. DCI usually occurs between 4 and 10 days after the initial bleeding, has a gradual onset and is multi-focal, and is an important cause of death and dependency after SAH. The interval between the bleeding and the onset of ischemia provides an opportunity for preventive treatment. Magnesium is readily available, inexpensive and has a well-established clinical profile in obstetrical and cardiovascular practice. It is beneficial in the treatment of eclampsia, a disease with a pathophysiology comparable to DCI after subarachnoid hemorrhage. Neuroprotective mechanisms of magnesium include inhibition of the release of excitatory amino-acids and blockade of the NMDA-glutamate receptor. Magnesium is also a non-competitive antagonist of voltage dependent calcium channels, has cerebrovascular dilatory activity and is an important co-factor of cellular ATPases, including the Na/K-ATPase. Magnesium can reverse delayed cerebral vasospasm and reduces the extent of acute ischemic cerebral lesions after experimental subarachnoid hemorrhage in rats. In this article we discuss the neuroprotective potency of magnesium in SAH by describing the pathophysiology of ischaemia after SAH and the many ways magnesium may interfere with this.     

氧自由基在高原暴露下血脑屏障通透性改变中的作用及其与高原脑水肿的关系

目的观察高原环境暴露下脑内氧自由基与脑含水量的变化,探讨氧自由基在高原脑水肿血脑屏障改变中的作用。方法取不同海拔梯度下小鼠脑组织匀浆化学法测定脑内SOD、MDA、GSH和GSH-PX活性,比色法测定脑组织内伊文思蓝(EB)含量,湿干比值法测定脑含水量。结果高原暴露下,小鼠脑内SOD、MDA、GSH活性是随着海拔增高而逐渐增高,随着时间延长而逐渐增高,以暴露于5000m的高海拔区第7~9d增高最明显,而GSH-PX则相反。与此同时,脑内EB含量和脑内含水量逐渐增高。脑内氧自由基活性与脑内EB含量和脑含水量之间有明显的正相关关系。结论氧自由基在高原脑水肿形成中起了重要作用,是高原环境下血脑屏障通透性增高的重要因素。     

Rapamycin alleviates brain edema after focal cerebral ischemia reperfusion in rats

Brain edema is a major consequence of cerebral ischemia reperfusion. However, few effective therapeutic options are available for retarding the brain edema progression after cerebral ischemia. Recently, rapamycin has been shown to produce neuroprotective effects in rats after cerebral ischemia reperfusion. Whether rapamycin could alleviate this brain edema injury is still unclear. In this study, the rat stroke model was induced by a 1-h left transient middle cerebral artery occlusion using an intraluminal filament, followed by 48?h of reperfusion. The effects of rapamycin (250?μg/kg body weight, intraperitoneal; i.p.) on brain edema progression were evaluated. The results showed that rapamycin treatment significantly reduced the infarct volume, the water content of the brain tissue and the Evans blue extravasation through the blood–brain barrier (BBB). Rapamycin treatment could improve histological appearance of the brain tissue, increased the capillary lumen space and maintain the integrity of BBB. Rapamycin also inhibited matrix metalloproteinase 9 (MMP9) and aquaporin 4 (AQP4) expression. These data imply that rapamycin could improve brain edema progression after reperfusion injury through maintaining BBB integrity and inhibiting MMP9 and AQP4 expression. The data of this study provide a new possible approach for improving brain edema after cerebral ischemia reperfusion by administration of rapamycin.     

The role of aquaporin-4 in the blood-brain barrier development and integrity: studies in animal and cell culture models

Aquaporin-4 (AQP4) is the major water channel expressed in brain perivascular astrocyte processes. Although the role of AQP4 in brain edema has been extensively investigated, little information exists regarding its functional role at the blood-brain barrier (BBB). The purpose of this work is to integrate previous and recent data regarding AQP4 expression during BBB formation and depending on BBB integrity, using several experimental models. Results from studies on the chick optic tectum, a well-established model of BBB development, and the effect of lipopolysaccharide on the BBB integrity and on perivascular AQP4 expression have been analyzed and discussed. Moreover, data on the BBB structure and AQP4 expression in murine models of Duchenne muscular dystrophy are reviewed. In particular, published results obtained from mdx(3cv) mice have been analyzed together with new data obtained from mdx mice in which all the dystrophin isoforms including DP71 are strongly reduced. Finally, the role of the endothelial component on AQP4 cellular expression and distribution has been investigated using rat primary astrocytes and brain capillary endothelial cell co-cultures as an in vitro model of BBB.     

SIRT1对早期脑缺血大鼠水通道蛋白4表达的影响

目的:检测水通道蛋白4(AQP4)及沉默信息调节因子1(SIRT1)在脑缺血大鼠脑组织中的表达变化,探究SIRT1对AQP4的调节作用,明确二者在脑缺血及脑水肿发生发展中的作用。方法:雄性SD大鼠随机分成假手术组(sham组)和脑缺血模型组(MCAO组),其中MCAO组又分为6 h、12 h、24 h和48 h 4个时点组别。采用线栓法阻塞大脑中动脉建立局灶性脑缺血模型,于相应时点进行神经症状评分,Morris水迷宫检测大鼠学习认知功能,TTC染色观察脑梗死体积,干湿重法检测脑含水量的变化,HE染色观察大脑皮层周围组织神经细胞形态学变化,Western blot检测AQP4、SIRT1和基质金属蛋白酶9(MMP-9)的表达情况。结果:与sham组相比较,随着再灌注时间增加,MCAO组大鼠神经功能评分、脑梗死体积、脑组织通透性和脑组织含水量均持续增加,而大鼠学习认知功能则降低显著,HE染色显示脑缺血大脑皮层周围组织神经元细胞形态不规则,数目减少;Western blot实验结果显示AQP4表达水平呈增高趋势,SIRT1表达降低,MMP-9表达增高,MCAO-48 h组与sham组比较差异最明显(P0.01)。结论:脑缺血后,伴随脑组织损伤的加剧,SIRT1和MMP-9信号通路的表达激活影响了AQP4的表达活化,共同参与了脑水肿的形成。     

黄芩茎叶总黄酮对大鼠大脑海马区微血管和血脑屏障缺血再灌注损伤的预防作用

目的 探讨黄芩茎叶总黄酮（SSTF）对脑缺血再灌注海马区微血管、血脑屏障（BBB）损伤的预防性保护作用。 方法 SD大鼠90只,随机分为假手术组（sham组）、模型组（IR组）和SSTF预处理组,造模前1周SSTF各组灌胃给药,低、中、高剂量组分别给50、100、200 mg/(kg·d),共7d。IR组和SSTF各组制作脑缺血再灌注模型,术后评价神经功能缺损变化,干湿重法和伊文思蓝法检测脑组织含水量和微血管通透性,单宁酸 氯化铁媒染（TA-Fe）法显示并观测大鼠微血管密度(MVD)和微血管面积比(MVA),Real-time PCR法检测水通道蛋白4（AQP4） mRNA的表达水平,电镜观察血脑屏障完整性。 结果 SSTF各组与IR组比,神经功能缺损评分、脑组织含水量、微血管通透性明显降低（P＜0.01,P＜0.05）,MVD、MVA增加（P＜0.01）, AQP4 mRNA表达增强(P＜0.01),BBB损伤不同程度减轻,内皮细胞肿胀渐消退,紧密连接松解好转,基膜渐连续、清晰,胶质细胞足板胞质溶解减轻,渐接近正常;SSTF 中、高组上述表现较SSTF 低组好转的更明显（P<0.01）,SSTF 中组与SSTF 高组比较差异无统计学意义（P＞0.05）。 结论 SSTF干预对海马区微血管、血脑屏障和神经损伤有预防性保护作用,其作用机制可能是通过增加有效微血管再通数量,维持血脑屏障完整和功能,减轻脑水肿实现的。SSTF的有效预防剂量为100mg/(kg·d)。     

两种脑出血动物模型的AQP4表达与磁共振成像的比较研究

目的比较两种脑出血(ICH)动物模型磁共振成像(MRI)的差异,并对其分子机制进行探讨。方法将胶原酶和自体血注入大鼠尾状核建立脑出血模型,分别于术后6h、12h、1d、2d、3d和7d进行磁共振成像扫描,观察两组脑出血模型血肿体积的大小;运用干湿重法、伊文思蓝(EB)测定法和免疫印迹分别检测两组脑出血模型的脑含水量(BWC)、血脑屏障(BBB)通透性和AQP4的表达变化。结果胶原酶模型组的血肿体积在脑出血后1d达到最大并持续至3d,自体血组的血肿体积在12h达到最大;胶原酶模型组的BWC在1d达到高峰并持续至3d,而自体血组BWC在2d逐渐降低;胶原酶模型组的EB含量在12h达到高峰并持续至2d,而自体血组EB含量在1d逐渐下降;两组模型的AQP4表达量在6h开始升高,1d达到高峰,2d逐渐降低。两组模型比较具有统计学差异(P<0.05)。结论胶原酶对BBB和细胞外基质的破坏以及AQP4的表达变化是两组脑出血模型血肿体积出现差异的重要原因。     

Blood-brain barrier breakdown in septic encephalopathy and brain tumours

Septic encephalopathy is associated with breakdown of the blood-brain barrier and cerebral oedema. These features are also common properties of brain tumours. Perimicrovessel oedema, disruption of associated astrocyte end feet and neuronal injury occur in a porcine model of acute septic encephalopathy. The adrenergic system has been implicated in the inflammatory response to sepsis and may play a role in controlling blood-brain barrier permeability, since the beta2-adrenoceptor agonist dopexamine inhibits perimicrovessel oedema formation whereas the alpha1-adrenoceptor agonist methoxamine provokes it. Electron microscopy revealed tight junction opening in high-grade astrocytoma microvessels. Expression of the tight junction protein occludin is reduced in these microvessels and this reduction is inversely correlated with the degree of cerebral oedema. Normal astrocytes secrete factors that induce barrier properties in endothelial cells, whereas high-grade astrocytomas secrete vascular endothelial growth factor, which stimulates angiogenesis, down regulates occludin and increases endothelial cell permeability. The water channel protein aquaporin-4 is normally expressed in astrocyte foot processes around cerebral microvessels. Its expression is massively up-regulated in high-grade astrocytoma and around metastatic adenocarcinoma. There is a significant correlation between aquaporin-4 expression and the degree of cerebral oedema, but it is not clear whether increased aquaporin-4 expression enhances oedema formation or clearance. These results suggest that the pathophysiology of brain oedema is multifactorial, but that there may be common processes operating regardless of the aetiology.