Simka Marian, Latacz Paweł, Czaja Joanna
1 Department of Anatomy, University of Opole, Opole, Poland.
2 Department of Neurology, Jagiellonian University Collegium Medicum, Krakow, Poland.
High Alt Med Biol. 2018 Dec;19(4):394-397. doi: 10.1089/ham.2018.0066. Epub 2018 Sep 21.
In this article, we suggest that the glymphatic system of the brain can play an important role in the pathogenesis of high-altitude cerebral edema (HACE). Water enters the intercellular space of the brain primarily through aquaporin-4 (AQP-4) water channels, the main component of the glymphatic system, whereas acetazolamide, pharmacological agent used in the prevention of HACE, is the blocker of the AQP-4 molecule. In animal experiments, cerebral edema caused by hypobaric hypoxia was associated with an increased expression of AQP-4 by astrocytes. Also, the glymphatic system is primarily active during sleep, although sleep at high altitude is a well-known risk factor of developing HACE. All these findings support our hypothesis. We suggest that future research on the prevention and treatment of HACE should involve factors that are already known to modify activity of the glymphatic system, such as angiotensin-converting enzyme inhibitors or other pharmaceutical agents affecting noradrenergic system of the brain, body posture during sleep, anatomy of the veins draining the cranial cavity, and the influence of physical activity before and during exposure to high altitude, especially in relation to sleep.
在本文中，我们认为大脑的类淋巴系统在高原脑水肿（HACE）的发病机制中可能起重要作用。水主要通过类淋巴系统的主要成分水通道蛋白4（AQP - 4）水通道进入大脑的细胞间隙，而用于预防HACE的药物乙酰唑胺是AQP - 4分子的阻滞剂。在动物实验中，低压缺氧引起的脑水肿与星形胶质细胞中AQP - 4表达增加有关。此外，类淋巴系统主要在睡眠期间活跃，尽管高原睡眠是发生HACE的一个众所周知的危险因素。所有这些发现都支持我们的假设。我们建议，未来关于HACE预防和治疗的研究应涉及已知可改变类淋巴系统活性的因素，如血管紧张素转换酶抑制剂或其他影响大脑去甲肾上腺素能系统的药物、睡眠期间的身体姿势、引流颅腔的静脉解剖结构以及在暴露于高原之前和期间体育活动的影响，特别是与睡眠相关的影响。
