Jiancong Chen

and 10 more

Background Brain injury is the main cause of high mortality and disability after successful cardiopulmonary resuscitation (CPR) from sudden cardiac arrest (CA). Transient receptor potential M4 (TRPM4) channel is a novel target for ameliorating blood-brain barrier (BBB) disruption and neuroinflammation. Herein, we tested whether flufenamic acid (FFA), which is reported to block TRPM4 with high potency, confers neuroprotection against brain injury secondary to CA/CPR and whether the action is exerted by blocking the TRPM4 channel. Methods Wild-type (WT) and Trpm4 knockout (Trpm4−/−) mice subjected to 10-min CA/CPR were randomized to receive FFA or vehicle once daily. Post-CA/CPR brain injuries including neurological deficits, survival rate, histological damages, edema formation, BBB destabilization and neuroinflammation were assessed. Results In WT mice subjected to CA/CPR, FFA was effective in improving survival and neurologic outcome, reducing neuropathological injuries, attenuating brain edema, lessening leakage of IgG, restoring tight junction protein expression as well as promoting microglia/macrophages from the pro-inflammatory subtype towards the anti-inflammatory one. In comparison to WT mice, Trpm4−/− mice exhibited less neurologic deficiency, lighter histological impairment, more integrity of BBB and more anti-inflammatory microglia/macrophages polarization. As expected, FFA did not provide a benefit of superposition compared with vehicle in the Trpm4−/− mice after CA/CPR. Conclusions FFA mitigates BBB breach and modifies the functional status of microglia/macrophages, thereby improving survival and neurological deficits following CA/CPR. The neuroprotective effects are at least partially through interfering with the TRPM4 channel. These results provide significant clinical potentials to improve the prognosis for CA victims with successful resuscitation.