Hypercapnia Exacerbates The Disruption Of The Blood-Brain Barrier By Inducing Interleukin-1 Beta Overproduction In The Blood Of Hypoxemic Adult Rats

Refractory hypoxemia is the main symptom of acute respiratory distress syndrome (ARDS). Low tidal volume ventilation is routinely applied in clinical practice to correct hypoxemia, which aims to prevent ventilator-induced lung injury. However, this ventilation strategy inevitably leads to hypercapnia. Our previous study demonstrated that hypercapnia aggravated cognitive impairment in hypoxemic rats; however, the underlying mechanism remains unclear. The aim of the present study was to investigate whether hypercapnia exacerbates the blood-brain barrier (BBB) disruption through inducing interleukin (IL)-1 beta overproduction in the blood of hypoxemic rats. The BBB permeability in a rat model of hypercapnia/hypoxemia was evaluated. The levels of IL-1 beta in the blood of rats and human whole-blood cultures were assessed. The expression of IL-1 receptor 1 (IL-1R1), phosphorylated IL-1R1-associated kinase (p-IRAK-1) and tight junctional proteins in cerebral vascular endothelial cells was examinedin vitroandin vivo. In addition, IL-1Ra, an IL-1 receptor antagonist, was used to determine whether hypercapnia affects tight junctional protein expression in hypoxic cerebral vascular endothelial cells through inducing IL-1 beta overproduction. It was observed that hypercapnia alone did not disrupt the BBB, but aggravated the damage to the BBB integrity in hypoxemic rats. Hypercapnia increased IL-1 beta expression in the blood of hypoxemic rats as well as in hypoxic human whole-blood cultures. IL-1R1 and p-IRAK-1 expression was increased, while that of tight junctional proteins was reduced by hypercapnia in hypoxemic cerebral vascular endothelial cellsin vitroandin vivo. Additionally, the expression of tight junctional proteins was markedly increased following treatment with IL-1Ra. These results suggest that hypercapnia-induced IL-1 beta overproduction in the hypoxemic blood may decrease tight junctional protein expression in cerebrovascular endothelial cells via the IL-1R1/p-IRAK-1 pathway, further disrupting BBB integrity, and eventually resulting in increased BBB permeability.