Abstract

BackgroundCognitive impairment is one of common complications of acute respiratory distress syndrome (ARDS). Increasing evidence suggests that interleukin-1 beta (IL-1β) plays a role in inducing neuronal apoptosis in cognitive dysfunction. The lung protective ventilatory strategies, which serve to reduce pulmonary morbidity for ARDS patients, almost always lead to hypercapnia. Some studies have reported that hypercapnia contributes to the risk of cognitive impairment and IL-1β secretion outside the central nervous system (CNS). However, the underlying mechanism of hypercapnia aggravating cognitive impairment under hypoxia has remained uncertain. This study was aimed to explore whether hypercapnia would partake in increasing IL-1β secretion via activating the NLRP3 (NLR family, pyrin domain-containing 3) inflammasome in the hypoxic CNS and in aggravating cognitive impairment.MethodsThe Sprague-Dawley (SD) rats that underwent hypercapnia/hypoxemia were used for assessment of NLRP3, caspase-1, IL-1β, Bcl-2, Bax, and caspase-3 expression by Western blotting or double immunofluorescence, and the model was also used for Morris water maze test. In addition, Z-YVAD-FMK, a caspase-1 inhibitor, was used to treat BV-2 microglia to determine whether activation of NLRP3 inflammasome was required for the enhancing effect of hypercapnia on expressing IL-1β by Western blotting or double immunofluorescence. The interaction effects were analyzed by factorial ANOVA. Simple effects analyses were performed when an interaction was observed.ResultsThere were interaction effects on cognitive impairment, apoptosis of hippocampal neurons, activation of NLRP3 inflammasome, and upregulation of IL-1β between hypercapnia treatment and hypoxia treatment. Hypercapnia + hypoxia treatment caused more serious damage to the learning and memory of rats than those subjected to hypoxia treatment alone. Expression levels of Bcl-2 were reduced, while that of Bax and caspase-3 were increased by hypercapnia in hypoxic hippocampus. Hypercapnia markedly increased the expression of NLRP3, caspase-1, and IL-1β in hypoxia-activated microglia both in vivo and in vitro. Pharmacological inhibition of NLRP3 inflammasome activation and release of IL-1β might ameliorate apoptosis of neurons.ConclusionsThe present results suggest that hypercapnia-induced IL-1β overproduction via activating the NLRP3 inflammasome by hypoxia-activated microglia may augment neuroinflammation, increase neuronal cell death, and contribute to the pathogenesis of cognitive impairments.

Highlights

  • Cognitive impairment is one of common complications of acute respiratory distress syndrome (ARDS)

  • Physiological data of rats The Partial pressure of carbon dioxide (PaCO2) levels were maintained at 35–45 mmHg in the S and hypoxemia group, and hypercapnia treatment significantly increased the PaCO2 to 60–69 mmHg, with pH at 7.20–7.25 in the hypercapnia and HH group

  • We show here that hypercapnia alone is not sufficient to induce Interleukin-1 beta (IL-1β) production, but NLR family (NLRP3) inflammasome in hypoxic rat hippocampus microglia can be activated by hypercapnia, as evidenced by the upregulation of caspase-1 and IL-1β

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Summary

Introduction

Cognitive impairment is one of common complications of acute respiratory distress syndrome (ARDS). Permissive hypercapnia is a ventilation strategy to allow for an unphysiologically high-partial pressure of carbon dioxide (PaCO2) included by reducing tidal volume, which serves to reduce pulmonary morbidity for acute respiratory distress syndrome (ARDS) patients [1]. The benefits gained from the ventilation strategy are apparent; on the other hand, hypercapnia may present a risk to CNS It has been reported in various studies that hypercapnia contributes to the risk of cognitive impairment [3, 4]; half of all ARDS survivors develop cognitive impairments [5]. Some studies have found that a longer duration of hypoxemia was associated with cognitive impairment in ARDS survivors [7, 8] It remains to be ascertained whether hypercapnia would aggravate cognitive impairment in ARDS patients with persistent hypoxemia

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