title: Progress in Drug Treatment of Cerebral Edema.
abstract: Cerebral edema causes intracranial hypertension (ICH) which leads to severe outcome of patients in the clinical setting. Effective anti-edema therapy may significantly decrease the mortality in a variety of neurological conditions. At present drug treatment is a cornerstone in the management of cerebral edema. Osmotherapy has been the mainstay of pharmacologic therapy. Mannitol and hypertonic saline (HS) are the most commonly used osmotic agents. The relative safety and efficacy of HS and mannitol in the treatment of cerebral edema and reduction of enhanced ICP have been demonstrated in the past decades. Apart from its osmotic force, HS exerts anti-edema effects partly through inhibition of Na(+)-K(+)-2Cl(-) Cotransporter-1 (NKCC1) and aquaporin 4 (AQP4) expression in astrocytes. Melatonin may also reduce brain edema and exert neuroprotective effect on several central nervous system diseases through inhibition of inflammatory response. The inhibitors of Na/H exchanger, NKCC and AQP4 may attenuate brain edema formation through inhibition of excessive transportation of ion and water from blood into the cerebral tissue. In this review we survey some of the most recent findings in the drug treatment of brain edema focusing on the use of osmotherapy, melatonin and inhibitors of ion cotransporters and water channels. A better understanding of the molecular mechanism of these agents would help to improve in the clinical management of patients with brain edema.
authors.affiliation: Department of Emergency and Critical Care Medicine, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, P.R. China. yiyudeng666@163.com.
authors.forename: Y Y
authors.initials: YY
authors.lastname: Deng
authors.forename: F C
authors.initials: FC
authors.lastname: Shen
authors.forename: D
authors.initials: D
authors.lastname: Xie
authors.forename: Q P
authors.initials: QP
authors.lastname: Han
authors.forename: M
authors.initials: M
authors.lastname: Fang
authors.forename: C B
authors.initials: CB
authors.lastname: Chen
authors.forename: H K
authors.initials: HK
authors.lastname: Zeng
mesh_terms: D000818:Animals; D051401:Aquaporin 4 / Q000037:antagonists & inhibitors / Q000378:metabolism; D001921:Brain / Q000187:drug effects* / Q000378:metabolism / Q000473:pathology; D001929:Brain Edema / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology; D005440:Fluid Therapy / Q000379:methods; D006801:Humans; D008353:Mannitol / Q000494:pharmacology / Q000627:therapeutic use; D008550:Melatonin / Q000494:pharmacology / Q000627:therapeutic use; D018696:Neuroprotective Agents / Q000494:pharmacology / Q000627:therapeutic use; D012462:Saline Solution, Hypertonic / Q000494:pharmacology / Q000627:therapeutic use; D064506:Solute Carrier Family 12, Member 2 / Q000378:metabolism; D027981:Symporters / Q000037:antagonists & inhibitors
chemical_list: D051401:Aquaporin 4; D018696:Neuroprotective Agents; D012462:Saline Solution, Hypertonic; D064506:Solute Carrier Family 12, Member 2; D027981:Symporters; D008353:Mannitol; D008550:Melatonin