Prevention of protein extravasation in the brain by an anion transport inhibitor in acute experimental hypertension in rats

Activation of protein kinase C does not participate in disruption of the blood-brain barrier to albumin during acute hypertension

The blood-brain barrier minimizes the entry of macromolecules into brain tissue. During acute increases in arterial blood pressure, disruption of the blood-brain barrier occurs primarily in cerebral venules and veins. Mechanisms by which increases in cerebral venous pressure produce disruption of the blood-brain barrier during acute hypertension are not clear. The goal of this study was to determine the role of activation of protein kinase C in disruption of the blood-brain barrier during acute hypertension. We examined the microcirculation of the cerebrum in vivo. Permeability of the blood-brain barrier was quantitated by the formation of venular leaky sites and clearance of fluorescent-labeled albumin (FITC-albumin) before and during phenylephrine-induced acute hypertension. In addition, we examined changes in pial arteriolar and pial venular pressure before and during phenylephrine-induced acute hypertension. We compared responses of the blood-brain barrier to acute hypertension in control (untreated) rats and in rats treated with inhibitors of protein kinase C; calphostin C (0.1 microM) or sphingosine (1.0 microM). Under control conditions, no venular leaky sites were visible and clearance of FITC-albumin was minimal in all groups. Phenylephrine infusion increased systemic arterial, pial arteriolar and pial venular pressures, and increased the formation of venular leaky sites and clearance of FITC-albumin by a similar magnitude in all groups. The findings of the present study suggest that inhibition of protein kinase C does not significantly alter the formation of venular leaky sites and/or clearance of FITC-albumin during acute hypertension. Thus, disruption of the blood-brain barrier during acute hypertension does not appear to be influenced by activation of protein kinase C.

Angiotensin peptide regulation of fluid-phase endocytosis in brain microvessel endothelial cell monolayers

An in vitro model comprised of primary cultures of brain microvessel endothelial cells was used to investigate angiotensin II (Ang II) effects on blood-brain barrier fluid-phase endocytosis. The effects of Ang II, saralasin, sarathrin, bradykinin (BK), and phorbol myristate acetate (PMA) on brain microvessel endothelial cell fluid-phase endocytosis were determined using the fluorescent marker, Lucifer yellow. Nanomolar concentrations of saralasin (a partial Ang II agonist) stimulated brain microvessel endothelial cell endocytosis by 30% whereas Ang II treatment enhanced Lucifer yellow uptake by 20%. Sarathrin (an Ang II antagonist) had no effect on Lucifer yellow uptake. Nanomolar concentrations of BK and PMA also stimulated Lucifer yellow uptake by the brain microvessel endothelial cell by 40 and 95%, respectively. Stimulatory effects of Ang II and saralasin on Lucifer yellow uptake by brain microvessel endothelial cells could be completely blocked by pretreatment with either sarathrin or indomethacin (an inhibitor of prostaglandin synthesis). In contrast, the effects of neither BK nor PMA on brain microvessel endothelial cell uptake of Lucifer yellow ere altered by indomethacin pretreatment. Results indicated that Ang II, saralasin, BK, and PMA produce similar stimulatory effects on brain microvessel endothelial cell fluid-phase endocytosis with only Ang II and saralasin, producing increases in brain microvessel endothelial cell fluid-phase endocytosis that appeared to be mediated by prostaglandins.

Pial venous pressure and acute hypertensive disruption of the blood-brain barrier in spontaneous and renal hypertension

The purpose of this study was to determine whether changes in pial venous pressure during acute hypertension account for altered acute hypertensive disruption of the blood-brain barrier in chronic hypertension. We studied 13 normotensive WKY rats, 7 spontaneously hypertensive rats (SHR), and 9 two-kidney, one-clip renal hypertensive rats of the same age. Pial venous pressure (servonull technique) and clearance of fluorescein-labeled dextran from pial vessels (as an estimate of permeability of the blood-brain barrier) were measured before and during acute hypertension produced by i.v. infusion of phenylephrine. Experiments were performed in anesthetized rats (50 mg/kg sodium pentobarbital i.p.). Blood and artificial cerebrospinal fluid pO2, pCO2 and pH were within normal ranges throughout the experiment. The change, time to peak and peak pial venous pressures were the same in all groups. The peak arterial pressure after phenylephrine was greater in the hypertensive rats compared to WKY rats. The time to peak mean arterial pressure was the same in all groups of rats. Clearance of FITC dextran was the same in WKY versus renal hypertensive rats, but less in SHR versus WKY rats (P less than 0.05 by analysis of variance). We conclude that something other than an attenuation of the increase in pial venous pressure protects the blood-brain barrier of SHR against acute hypertensive disruption.

Regional alterations in blood-to-brain transfer of alpha-aminoisobutyric acid and sucrose, after chronic administration and withdrawal of dexamethasone

The effect of dexamethasone administration and withdrawal was studied with respect to blood-brain barrier function. The tracers alpha-[3H]aminoisobutyric acid (AIB) (MW 104) and [14C]sucrose (MW 342), which have a low permeability across the intact endothelium, were simultaneously injected intravenously in rats treated with dexamethasone and placebo-treated control animals or in rats in which dexamethasone treatment was discontinued 3 days before the experiment. Unidirectional transfer constants (Ki) were determined in discrete brain regions. Steroid administration reduced the rate of influx of AIB and sucrose, whereas discontinuation of drug resulted in an increased permeability. These findings suggest that when exposure to glucocorticoids is prolonged, the efficiency of medical treatment of CNS diseases may decrease due to reduction of drug delivery to CNS. Thus, these experimental findings may have particular importance in the clinical setting of drug administration when considering the combination of steroids with other drugs, and may aid in understanding better the pathogenesis of some types of brain edema seen in patients from whom corticosteroid therapy has been withdrawn.

A brief episode of severe arterial hypertension induces delayed deterioration of brain function and worsens blood flow after transient multifocal cerebral ischemia

Transient arterial hypertension occurs sporadically following cerebral air embolism and may occur during the acute phase of stroke. This study used an animal model of multifocal cerebral ischemia induced by air embolism and reversed by recompression to assess the effect of induced hypertension on the evoked response recovery, local cerebral blood flow, intracranial pressure, and brain water in 19 anesthetized dogs (Canis familiaris). Six received 0.4 ml of air via the internal carotid artery, 8 received intracarotid air and 10 micrograms/kg norepinephrine to produce transient hypertension, and 5 received intracarotid saline and norepinephrine. The average evoked response recovery in the air-only group was 58.3 +/- 7.7% (mean +/- SEM) of control after 4 hours of recompression; the air plus hypertension group recovery was 15.4 +/- 2.7% (p less than 0.01). The final evoked response in the dogs receiving hypertension alone did not differ from control values. Seven of 8 dogs in the air plus hypertension group had very low blood flows; only 1 of 4 in the air-only group had very low flows. The amount of brain water and the intracranial pressure were not detectably different at the end of treatment among all 3 groups. These results support a role for endothelial damage produced by air and hypertension in potentiating the process of postischemic hypoperfusion.

Effects of 'DIDS', an anion transport blocker, on CSF [HCO3-] in respiratory acidosis

During acute respiratory acidosis increments in cisternal cerebrospinal fluid (CSF) [HCO3-] approximate decrements in CSF [Cl-] with CSF [Na+] remaining unchanged; the mechanisms mediating this reciprocal anionic relationship are unclear. In the present study we investigated the effects of DIDS (4,4'-diisothiocyano-disulfonic stilbene), a known inorganic anion exchange blocker, on CSF ionic regulation in acute respiratory acidosis. In two groups of anesthetized paralyzed dogs we injected either mock CSF (group I, n = 8) or mock CSF containing DIDS (group II, n = 9) into the lateral cerebral ventricles. After 45 min, acute respiratory acidosis was induced for 6 h. During acute respiratory acidosis, CSF PCO2 rose in average by 38 mm Hg in both groups; increments in CSF [HCO3-], however, were significantly lower by about 2 mEq/L in DIDS-treated animals than in controls throughout the experimental period. Such differences were not due to changes in CSF lactate concentration which were similar in both groups. Furthermore, CSF [Na+] remained unchanged in both groups. Since disulfonic stilbene derivatives combine selectively with the carrier involved in anion transport and inhibit inorganic anion exchange, the data in the present study suggest that in the central nervous system a DIDS-inhibitable carrier is involved in the rise of CSF [HCO3-] observed during acute respiratory acidosis.

Effect of radiologic contrast media and local anaesthetics on the blood-brain barrier and on the leptomeninges

The leptomeninges of cats were exposed to lidocaine, metrizamide and methiodal sodium and compared with control brains exposed to Ringer's solution. As a sign of blood-brain barrier damage, an increased extravasation of albumin into the cerebral cortex was recorded after exposure to methiodal sodium; lidocaine or metrizamide did not produce such damage. Scanning electron microscopy revealed minor cellular reactions in the mesothelial cells of the leptomeninges after application of metrizamide, lidocaine and Ringer's solution. Methiodal sodium produced an extensive cellular damage of the leptomeningeal cells. The importance of testing the leptomeningeal reactions and the reactions of the blood-brain barrier to all liquid media used on the brain surface is emphasized.

Calcium antagonists: effects on cerebral blood flow and blood-brain barrier permeability in the rat

1 Because they affect isolated cerebral arteries, some calcium antagonists have been studied on the intact cerebral circulation of the rat.2 Global cerebral blood flow ((133)Xe clearance technique) was measured in anaesthetized rats. Neither perhexiline (0.1 mug/kg to 1.0 mg/kg, i.v.) nor diltiazem (0.06-0.6 mg/kg, i.v.) had any significant effect on resting cerebral blood flow when measured 5 min after each dose. A high dose of nifedipine (1.0 mg/kg, i.v.) was administered during induced hypocapnia. Nifedipine failed to modify the hypocapnic vasoconstriction of the cerebral vasculature when compared to vehicle-treated rats.3 The possibility of discrete changes in regional cerebral blood flow was investigated. Local cerebral blood flow was measured in a number of brain regions by the [(14)C]-ethanol technique 15 min after the administration of nifedipine (20 or 100 mug/kg, i.v.). Nifedipine had no apparent effect on regional blood flow in the rat brain.4 Acute arterial hypertension increases protein leakage into the brain, a phenomenon susceptible to drugs that act on endothelial pinocytosis which is known to be calcium-dependent. The increase in protein extravasation, induced by the intravenous administration of either angiotensin II or adrenaline, was unchanged in rats previously treated with either nimodipine (20 mug/kg, i.v.) or nifedipine (50 mug/kg, i.v.) when dissolved in ethanol alone. However, nifedipine (20 mug/kg, i.v.) when dissolved in a solution of polyethylene glycol and ethanol further enhanced the hypertension-induced increase in brain albumin permeability.5 In conclusion, we have been unable to demonstrate any apparent effects of various calcium antagonists on the intact cerebral circulation of the rat, despite the number of different experimental models used.

The blood-brain barrier following experimental subarachnoid hemorrhage. Part 2: Response to mercuric chloride infusion

Under controlled physiological conditions, fresh blood was injected into the cisterna magna of 10 adult cats to produce subarachnoid hemorrhage (SAH). Damage to the blood-brain barrier (BBB) was induced 30 minutes after SAH by the intracarotid injection of a 6 x 10(-5)M solution of mercuric chloride (HgCl2). A control series of five cats received the same injection of HgCl2. Intravenously injected Evans blue dye was used to indicate areas of BBB damage. The lesions were confirmed by fluorescence microscopy. All control animals showed BBB damage in the hemisphere injected with HgCl2. Of the animals in the test group with SAH, 90% were free from lesions. When lesions were present, the distribution differed from that in the control group. These results bear a similarity to the reported absence of HgCl2 lesions during the acute stages after total cerebral ischemia. This suggests that the cellular components of the BBB participate in a general metabolic inhibition following SAH.

Therapeutic considerations in blood-brain barrier disturbances

Current methods of treatment of brain damage, as e.g. edema by steroids and barbiturates, have components which benefit the blood-brain barrier. Protection of the blood-brain barrier may result from: (a) prevention of endothelial lesions, perhaps pinocytosis (b) reduction of secondary necrosis formation, (c) interference with release, or activation of mediator compounds causing endothelial lesions such as: biogenic amines, free fatty acids, prostaglandins, free radicals, or kinins, (d) stabilization of lysosomal membranes, and (e) prevention of microcirculatory disturbances. Other methods, or compounds aiming at mechanisms of barrier damage have a therapeutic potential as shown with regard to indomethacin, free radical scavengers, or phenothiazines. However, further studies appear necessary to demonstrate the benefit of these compounds under clinical circumstances. Reversible opening of the blood-brain barrier may be considered as a therapeutic approach to provide access of drugs to brain tissue which are normally excluded by the barrier.

Phenothiazine-mediated protection of the blood-brain barrier during acute hypertension

The phenothiazine dixyrazine (5 mg . kg-1 i.v.) had minimal, transient hypotensive effects but significantly reduced the leakage of 125I labelled serum albumin in conscious rats subjected to acute hypertension provoked by i.v. adrenaline or bicuculline. By contrast, dixyrazine did not protect the blood-brain barrier during osmotic stress induced by intracarotid infusion of 2 M urea. The diameters of pial arteries and veins were continuously measured with a multichannel videoangiometer through a closed cranial window in anesthetized rats before and after i.v. injection of dixyrazine (5 mg . kg-1). No change in vessel diameter was observed except for a transient autoregulatory dilatation of arteries in response to a slight transitory decrease in the blood pressure. It is concluded that dixyrazine probably protects the blood-brain barrier during mechanical stress by modifying the endothelial cell membrane.

Cerebral air embolism and the blood-brain barrier in the rat

Cerebral air embolism can have hemodynamic effects such as increases in blood pressure and cerebral blood flow. It has been suggested that these factors play a role for the induction of the blood-brain barrier (BBB) dysfunction. In the present study, 5 microliters air was injected into the right internal carotid artery from a catheter in the external carotid artery after ligation of the extracerebral branches. No consistent change in blood pressure was observed with this small amount of air. Hypercapnia, which increases protein leakage in the brain under conditions of high intraluminal pressure, significantly reduced the extravasation in air embolism. Lidocaine and SITS (4 acetamido-4-isothiocyano-stilbene-2,2-disulfonic acid disodium), two drugs that effectively reduce the albumin leakage in acute hypertension, had no prophylactic effect in cerebral air embolism. Spontaneously hypertensive rats are less vulnerable than normotensive rats to pressure-induced BBB dysfunction but did not significantly differ from controls regarding albumin leakage in the present study. It is concluded that the increased cerebrovascular permeability in air embolism is not related to hemodynamic factors.

Effect of an anion transport inhibitor on blood-brain barrier lesions during acute hypertension. Possible prevention of transendothelial vesicular transport

Opening of the blood-brain barrier (BBB) by a hypertensive insult comprises the formation of endothelial micropinocytosis. Constricted vessels are less vulnerable to the insult. In the present study SITS (4-acetamido-4'-isothiocyano-stilbene-2,2'-disulfonic acid disodium) was shown to prevent leakage across the BBB into the brain parenchyma following a hypertensive insult induced by a local increase of the intraluminal pressure in anesthetized rats and by i.v. administration of adrenaline or bicuculline in conscious unrestrained animals. Since SITS induced an increase in cerebral blood flow the protection cannot be explained by a constrictory action on the cerebral vessels. SITS is a drug with complex action on the cell membrane including an inhibitory effect on anion transport mechanisms and on some c-AMP mediated processes. It is possible that the protection of BBB observed in the present study is connected to a reduction of c-AMP but membrane stabilizing effect can at present not be excluded.