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Hyperglycemia exacerbates edema formation and worsens neurological outcome in ischemic stroke. Edema formation in the early hours of stroke involves transport of ions and water across an intact blood-brain barrier (BBB), and swelling of astrocytes. We showed previously that high glucose (HG) exposures of 24 hours to 7 days increase abundance and activity of BBB Na+-K+-2Cl− cotransport (NKCC) and Na+/H+ exchange 1 (NHE1). Further, bumetanide and HOE-642 inhibition of these transporters significantly reduces edema and infarct following middle cerebral artery occlusion in hyperglycemic rats, suggesting that NKCC and NHE1 are effective therapeutic targets for reducing edema in hyperglycemic stroke. The mechanisms underlying hyperglycemia effects on BBB NKCC and NHE1 are not known. In the present study we investigated whether serum-glucocorticoid regulated kinase 1 (SGK1) and protein kinase C beta II (PKCβII) are involved in HG effects on BBB NKCC and NHE1. We found transient increases in phosphorylated SGK1 and PKCβII within the first hour of HG exposure, after 5-60 min for SGK1 and 5 min for PKCβII. However, no changes were observed in cerebral microvascular endothelial cell SGK1 or PKCβII abundance or phosphorylation (activity) after 24 or 48 h HG exposures. Further, we found that HG-induced increases in NKCC and NHE1 abundance were abolished by inhibition of SGK1 but not PKCβII, whereas the increases in NKCC and NHE activity were abolished by inhibition of either kinase. Finally, we found evidence that STE20/SPS1-related proline/alanine-rich kinase and oxidative stress-responsive kinase-1 (SPAK/OSR1) participate in the HG-induced effects on BBB NKCC.

Extracorporeal circulation provides critical life support in the face of cardiopulmonary or renal failure, but it also introduces a host of unique morbidities characterized by edema formation, cardiac insufficiency, autonomic dysfunction, and altered vasomotor function. We tested the hypothesis that cyclohexanone (CHX), a solvent used in production of extracorporeal circuits and intravenous (IV) bags, leaches into the contained fluids and can replicate these clinical morbidities. Crystalloid fluid samples from circuits and IV bags were analyzed by gas chromatography-mass spectrometry to provide a range of clinical CHX exposure levels, revealing CHX contamination of sampled fluids (9.63–3,694 μg/l). In vivo rat studies were conducted ( n = 49) to investigate the effects of a bolus IV infusion of CHX vs. saline alone on cardiovascular function, baroreflex responsiveness, and edema formation. Cardiovascular function was evaluated by cardiac output, heart rate, stroke volume, vascular resistance, arterial pressure, and ventricular contractility. Baroreflex function was assessed by mean femoral arterial pressure responses to bilateral carotid occlusion. Edema formation was assessed by the ratio of wet to dry organ weights for lungs, liver, kidneys, and skin. CHX infusion led to systemic hypotension; pulmonary hypertension; depressed contractility, heart rate, stroke volume, and cardiac output; and elevated vascular resistance ( P < 0.05). Mean arterial pressure responsiveness to carotid occlusion was dampened after CHX infusion (from +17.25 ± 1.8 to +5.61 ± 3.2 mmHg; P < 0.05). CHX infusion led to significantly higher wet-to-dry weight ratios vs. saline only (3.8 ± 0.06 vs. 3.5 ± 0.05; P < 0.05). CHX can reproduce clinical cardiovascular, neurological, and edema morbidities associated with extracorporeal circulatory treatment.

External application of static magnetic fields (SMF), used specifically for the treatment of inflammatory conditions such as soft tissue injuries, has recently become popular as a complementary and/or alternative therapy with minimal investigation into efficacy or mechanism. Localized inflammation was induced via injection of inflammatory agents λ-carrageenan (CA) or histamine into rat hindpaws, alone or in conjunction with pharmacological agents, resulting in a spatially and temporally defined inflammatory reaction. Application of a 10- or 70-mT, but not a 400-mT, SMF for 15 or 30 min immediately following histamine-induced edema resulted in a significant, 20–50% reduction in edema formation. In addition, a 2-h, 70-mT field application to CA-induced edema also resulted in significant (33–37%) edema reduction. Field application before injection or at the time of maximal edema did not influence edema formation or resolution, respectively. Together, these results suggest the existence of a therapeutic threshold of SMF strength (below 400 mT) and a temporal dependence of efficacy. Administration of pharmacological agents directed at nitric oxide signaling and L-type Ca2+ channel dynamics in conjunction with SMF treatment and histamine-induced edema revealed that the potential mechanism of SMF action may be via modulation of vascular tone through effects on L-type Ca2+ channels in vascular smooth muscle cells.

Once viewed as physiologically insignificant by no less an authority than Homer Smith, the renal nerves have emerged as a physiologically important regulator of renal tubular sodium reabsorption. Increased renal sympathetic nerve activity contributes significantly to the renal sodium retention in edema-forming states.

In isolated perfused organs, vascular protein reflection coefficients (sigma) can be calculated from the changes in hematocrit and perfusate protein concentration (CP) that occur during edema formation. This technique requires the assumption that transvascular protein flux by diffusion is negligible. To assess diffusion-induced errors in calculations of sigma, we derived an expression for CP that includes determinants of diffusive protein flux: protein permeability-surface area product (PS), transvascular fluid flux (J), true sigma, and transvascular protein concentration. We used this expression to obtain values of CP under various experimental conditions and then calculated values of sigma (measured sigma) for those conditions. Diffusion causes measured sigma to be lower than true sigma. The diffusion-induced error is larger and potentially substantial when J/PS is low and when true sigma is high. Diffusion-induced error is also larger when the amount of edema formation is greater. In recent isolated canine lung experiments where J/PS was approximately 2.7, diffusion-induced errors in measured sigma for albumin would have been approximately 0.06 (at true sigma = 0.5) and approximately 0.18 (at true sigma = 0.9). When J/PS was higher, the potential for diffusion-induced errors was much smaller. We conclude that diffusion causes underestimation of true sigma and that the error in measured sigma may be substantial when J/PS is < 5 and when true sigma is > 0.5.

The purpose of this project was to study mechanisms responsible for edema formation in fetuses with hydrops. We produced hydrops fetalis in 28 fetal sheep [gestational age of 125 +/- 5 days (mean +/- SD)] by pacing their atria at 300-320 beats/min for 68 +/- 40 (SD) h. All fetuses developed peripheral edema and ascites [volume of ascitic fluid was 134 +/- 75 (SD) ml; total protein concentration was 3.10 +/- 0.6 (SD) g/dl, and total albumin concentration was 1.68 +/- 0.3 (SD) g/dl]. Pacing did not affect aortic pressure but increased venous pressure from 4 +/- 1 to 8 +/- 1 (SE) Torr. Pacing did not affect pH, arterial partial pressure of O2 (PaO2), or Na+ but increased PaCO2 from 53 +/- 1 to 55 +/- 1 (SE) Torr and K+ from 3.9 +/- 0.1 to 4.3 +/- 0.1 (SE) meq/l. Hematocrit increased from 29 +/- 1 to 32 +/- 1 (SE)% acutely with pacing but returned to base line by the last day of the experiment. Plasma protein concentration decreased slightly from 3.7 +/- 0.1 to 3.5 +/- 0.1 (SE) g/dl by the last day of the experiment; plasma albumin concentration did not change. Plasma volume decreased acutely from 271 +/- 19 to 238 +/- 16 (SE) ml and then remained decreased throughout the experiment. Red blood cell mass and the turnover time for albumin were not affected by pacing. We found no consistent relationship between edema formation and changes in arterial blood gas tensions, plasma protein concentrations, or the turnover time for albumin.2

one of the perks of teachingrespiratory physiology to graduate and medical students is the frequent opportunity to discuss the pathogenic mechanisms underlying acute lung injury and edema formation with a relatively unbiased audience. The available textbooks designed for these students do an

Edema formation was studied using in situ rabbit lungs perfused with normal 5.0 g/dl) and low (0.1 g/dl) albumin solutions. Measurements were made of the ratio of wet weight to dry weight of the lungs corrected for the residual vascular volume, [(W/D)ev] and the ratio of extravascular 22Na+ to extravascular water volume. Edema formation in the 5 g/dl lungs was insignificant during a 60-min perfusion interval. A moderate amount of edema was found in 0.1 g/dl lungs: (W/D)ev = 5.30 +/- 0.12 (SE) compared with 4.66 +/- 0.11 in the 5 g/dl lungs. Much greater rates of edema formation were found in the 0.1 g/dl lungs when left atrial pressures were increased from 0 to 10 Torr; (W/D)ev reached 7.89 +/- 0.50 in 60 min compared with 5.66 +/- 0.23 in the 5 g/dl lungs. No additional edema formation occurred when albumin concentrations were decreased from 0.1 g/dl to below 0.01 g/dl. Albumin concentration gradients across the capillary wall appear to increase with elevations in capillary pressure.

The effect of lung volume history and prior accumulation of interstitial fluid on rate of edema formation in isolated canine lobes was investigated. Mean pulmonary artery pressure and mean pulmonary venous pressure were kept constant at 40 and 30 cmH2O, respectively. Transpulmonary pressure (Ptp) was varied among 5, 15, and 25 cmH2O by progressive stepwise inflation and deflation. Rate of fluid accumulation was estimated by changes in slow weight gain after a change in Ptp. Although there is continuous interstitial fluid accumulation over the course of the experiment the results indicate that interstitial hydrostatic pressure around leaky vessels at Ptp of 15 cmH2O is reduced by prior lung inflation to Ptp of 25 cmH2O and increased by prior deflation to Ptp of 5 cmH2O. These results suggest that the distribution of interstitial fluid may vary as a function of lung volume history.

The effects of raising tidal volume and positive end-expiratory pressure (PEEP) on rate of edema formation were studied in in situ canine left upper lobe preparations. Edema was induced by increasing blood flow to the left upper lobe (4–8 times normal). In the same animal, at equivalent flows and microvascular hydrostatic pressures, rate of edema formation observed with larger tidal volumes was significantly higher than that observed with smaller tidal volumes (0.73 +/- 0.29 vs. 0.58 +/- 0.30, P less than 0.001). Edema was also induced under static conditions (i.e., flow = 0) over a wide range of vascular pressures. Rate of edema formation was plotted against pressure and the best-fit linear regression was obtained. The slopes (g.min-1.mmHg-1.100 g-1) of the regression lines were significantly higher with larger tidal volumes compared with smaller tidal volumes [0.106 +/- 0.010 (SE) vs. 0.081 +/- 0.009, P less than 0.01]. The pressure intercepts were not different (16.1 +/- 1.6 vs. 15.7 +/- 1.8). When mean airway pressures were increased to levels equivalent to those obtained with larger tidal volumes, but by raising end-expiratory pressures, rate of edema formation dropped to levels below base line. We conclude that increasing the amplitude of cyclic changes in lung volume increases edema formation through mechanisms that are independent of changes in operating (i.e., mean) lung volume.

The severity and time of edema formation is characteristically influenced by doses of dextran if injected intravenously into rats. The dose-response curve revealed that small doses of dextrans (0.1–0.8 mg/100 gm) provoke maximal edema formation within 10 minutes, while increasing doses produce less severe edema and delay in its appearance, until a critical dose is arrived at, which provokes no hyperemia and no edema at all. Further increase in dose provokes edema again. The critical dose is relatively sharp and characteristic for each type of dextrans. If antihistamines are injected simultaneously with the critical dose, edema appears with full intensity. Experiments suggest that dextrans contain two fractions with opposite effects, one which provokes the edema formation and another which inhibits the response.