Precipitants of hepatic encephalopathy induce rapid astrocyte swelling in an oxidative stress dependent manner.

Hepatic encephalopathy (HE) is seen as the clinical manifestation of a low grade cerebral edema with formation of reactive oxygen and nitrogen species (RNOS). Astrocyte swelling is a crucial event and in cultured astrocytes HE-relevant factors almost instantaneously induce the formation of RNOS. However, short term effects of ammonia, inflammatory cytokines and RNOS on the volume of astrocytes and other brain cells as well as the underlying mechanisms are largely unknown, although a pathogenic link between RNOS formation and swelling in HE has been proposed. This issue was addressed in the present study by means of live-cell volume microscopy of brain cells in vitro. Ammonia, diazepam and pro-inflammatory cytokines such as tumor-necrosis factor-α (TNF-α), interferon-γ, interleukin-1β induced within 20min astrocyte swelling by about 25% accompanied by nuclear swelling of similar magnitude. Astrocyte swelling in response to NH4Cl, TNF-α or diazepam was abolished by the antioxidant epigallocatechin-gallate pointing to an involvement of RNOS. NH4Cl-induced astrocyte swelling was sensitive to inhibition of glutamine synthetase, NADPH oxidase or nitric oxide synthases. In line with a NMDA receptor-, prostanoid- and Ca(2+)-dependence of NH4Cl-induced RNOS formation, Ca(2+) chelation and inhibition of NMDA receptors or cyclooxygenase suppressed NH4Cl-induced astrocyte swelling, whereas the Ca(2+)-ionophore ionomycin, NMDA, glutamate and prostanoids induced rapid astrocyte swelling. NH4Cl also induced swelling of cultured microglia in a glutamine-synthesis dependent way, but had no effect on cell volume of cultured neurons. It is concluded that the pathways which trigger RNOS formation in astrocytes also trigger astrocyte swelling, whereas conversely and as shown previously hypoosmotic astrocyte swelling can induce RNOS formation. This establishes a complex interplay with an auto-amplificatory loop between RNOS formation and astrocyte swelling as an important event in the pathogenesis of HE.