Effects of propranolol and clonidine on brain edema, blood-brain barrier permeability, and endothelial glycocalyx disruption after fluid percussion brain injury in the rat.

Abstract

BACKGROUND:

Traumatic brain injury causes a disruption of the vascular endothelial glycocalyx layer that is associated with an overactivation of the sympathoadrenal system. We hypothesized that early and unselective beta-blockade with propranolol alone or in combination with the alfa2-agonist clonidine would decrease brain edema, blood-brain barrier permeability, and glycocalyx disruption at 24 hours after trauma.

METHODS:

We subjected 53 adult male Sprague-Dawley rats to lateral fluid percussion brain injury and randomized infusion with propranolol (n = 16), propranolol + clonidine (n = 16), vehicle (n = 16), or sham (n = 5) for 24 hours. Primary outcome was brain water content at 24 hours. Secondary outcomes were blood-brain barrier permeability and plasma levels of syndecan-1 (glycocalyx disruption), cell damage (histone-complexed DNA fragments), epinephrine, norepinephrine, and animal motor function.

RESULTS:

We found no difference in brain water content (mean ± SD) between propranolol (80.8 ± 0.3%; 95% confidence interval [CI], 80.7-81.0) and vehicle (81.1 ± 0.6%; 95% CI, 80.8-81.4) (p = 0.668) or between propranolol/clonidine (80.8 ± 0.3%; 95% CI, 80.7-81.0) and vehicle (p = 0.555). We found no effect of propranolol and propranolol/clonidine on blood-brain barrier permeability and animal motor scores. Unexpectedly, propranolol and propranolol/clonidine caused an increase in epinephrine and syndecan-1 levels.

CONCLUSION:

This study does not provide any support for unselective beta-blockade with propranolol or the combination of propranolol and the alfa2-agonist clonidine on brain water content. The novel finding of an increase in plasma concentrations of epinephrine and syndecan-1 after propranolol treatment in traumatic brain injury is of unclear significance and should be investigated further.

• Authors: Gustav Folmer Genét, Peter Bentzer, Morten Bagge Hansen, Sisse Rye Ostrowski, Pär Ingemar Johansson
• Journal: The journal of trauma and acute care surgery (J Trauma Acute Care Surg) Vol. 84 Issue 1 Pg. 89-96 (01 2018) ISSN: 2163-0763 [Electronic] United States
• PMID: 28930945 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Adrenergic alpha-2 Receptor Agonists
• Adrenergic beta-Antagonists
• Propranolol
• Clonidine

Topics

• Adrenergic alpha-2 Receptor Agonists (pharmacology)
• Adrenergic beta-Antagonists (pharmacology)
• Animals
• Blood-Brain Barrier (drug effects)
• Brain Edema (etiology, metabolism, pathology)
• Brain Injuries, Traumatic (complications, metabolism, pathology)
• Capillary Permeability (drug effects)
• Clonidine (pharmacology)
• Disease Models, Animal
• Glycocalyx (drug effects, metabolism, pathology)
• Male
• Propranolol (pharmacology)
• Rats
• Rats, Sprague-Dawley