AQP4 | |||||||||||||||||||||||||||||||||||||||||||||||||||
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Aliases | AQP4 , aquaporin 4, HMIWC2, MIWC, WCH4, hAQP4 | ||||||||||||||||||||||||||||||||||||||||||||||||||
External IDs | OMIM: 600308; MGI: 107387; HomoloGene: 37507; GeneCards: AQP4; OMA:AQP4 - orthologs | ||||||||||||||||||||||||||||||||||||||||||||||||||
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Aquaporin-4, also known as AQP-4, is a water channel protein encoded by the AQP4 gene in humans. [5] AQP-4 belongs to the aquaporin family of integral membrane proteins that conduct water through the cell membrane. A limited number of aquaporins are found within the central nervous system (CNS): AQP1, 3, 4, 5, 8, 9, and 11, but more exclusive representation of AQP1, 4, and 9 are found in the brain and spinal cord. [6] AQP4 shows the largest presence in the cerebellum and spinal cord grey matter. [7] In the CNS, AQP4 is the most prevalent aquaporin channel, specifically located at the perimicrovessel astrocyte foot processes, glia limitans, and ependyma. [8] In addition, this channel is commonly found facilitating water movement near cerebrospinal fluid and vasculature. [9]
Aquaporin-4 was first identified in 1986. It was the first evidence of the existence of water transport channels. [10] The method that was used to discover the existence of the transport channels was through knockout experiments. With this technique they were able to show the significant role of AQP4 in CNS injuries and brain water imbalances. [6] In 1994 the channel was successfully cloned and initially named Mercury-Insensitive Water Channel. [11]
The structure of AQP4 consists of six-transmembrane domains and five connecting loops to form the channel. Through x-ray crystallography, it was found that “each AQP4 monomer consists of six helical, membrane-spanning domains and two short helical segments surrounding a narrow aqueous pore.” [12] At the narrowest point the aqueous pore measures 2.8 angstroms, just large enough for the single-file passage of water molecules. While each monomer is individually capable of water transport, the quaternary structure of the channel is a tetramer. [7] The assembly of AQP4 monomers into tetramers is similar to other aquaporin channels. [13] In addition, AQP4 has two distinct structural isoforms located in the CNS: M1 and M23. [6] Both form homo- and hetero-tetramers that are permeable to water. [6] M23 isoforms are larger square arrays in the endfoot membranes of astrocytes compared to M1 isoforms, which are smaller and more unstable. The aquaporin-4 tetramers accumulate to transform into orthogonal arrays of particle (OAPs) in the cell plasma membrane. [12]
Aquaporin-4 is the most common aquaporin in the brain, spinal cord, and optic nerve. [11] It is highly expressed in the human body primarily at the end-feet of astrocytes. [12] Additionally, AQP4 can also be located in epithelial cells of many organs throughout the human body, such as the kidney, intestine, salivary glands, sensory organs, and skeletal muscles. [10] In these specific cases of epithelial cell expression, AQP4 is concentrated within the basolateral membrane layer of these locations. [13]
Furthermore, AQP4 also plays a role in the supportive cells of sensory organs, such as the retina, inner ear, and olfactory epithelium. [12] Within the retina, AQP4 is highly concentrated where the processes of Müller cells have a basal lamina around blood vessels and inner limiting membrane [10] and to a lesser degree in the inner and outer plexiform layers. [14]
AQP4 is also expressed in astrocytes and is upregulated by direct insult to the central nervous system. [15] Specifically within the central nervous system (CNS), AQP4 can be found along the spinal cord and serves as the main water channel. [6] The AQP4 channels are highly concentrated in the blood-brain barrier (BBB), as well as in other cerebrospinal fluid barriers. [16]
In the kidneys, AQP4 is primarily found in the inner medulla, and shows little to no presence in the outer medulla and cortex. [17] It is constitutively expressed in the basolateral cell membrane of principal collecting duct cells and provide a pathway for water to exit these cells. [18]
Aquaporin-4's overall function is to provide fast water transportation as well as maintain homeostatic balance within the central nervous system. This channel can transport water up to speeds of 3E9 molecules per second. [7] It is the primary water channel protein that reconciles the homeostasis of water in the CNS. [6] AQP4 may be involved in a variety of physiological processes such as waste removal (glymphatic system) and fine-tuning of potassium homeostasis. [16] Water flowing into and out of the brain or spinal cord is assisted by AQP4. [6] Here, AQP4 channels respond passively to osmotic gradients. In addition, they play a role in brain water transport, cell migration, brain edema, metabolism and cell homeostasis. [19]
Other systems are also regulated by AQP4. Within the inner ear, the main role is to provide osmotic balance in supporting epithelium cells within the organ of Corti by recycling K+. [10] Another specific role AQP4 plays is to help odorant molecules bind to target receptors and binding proteins within olfactory epithelium. [10] Within the retina, the role of AQP-4 is to maintain homeostasis. [10] Aquaporin-4 is essential in the formation of memory as well as synaptic plasticity. [16] Other performances that aquaporin-4 is involved in are synaptic plasticity, astrocyte migration, regulation of extracellular space volume, and the homeostasis of potassium. [16]
The condition known as neuromyelitis optica, NMO, is a rare demyelinating, inflammatory disorder of the CNS that primarily affects the optic nerves and spinal cord of individuals. [20] Aquaporin-4 is the predominant autoimmune target in 2/3 neuromyelitis optica and higher AQP4 autoantibody levels are associated with the occurrence of optic neuritis (ON), [21] however serum AQP4-IgG titer only moderately reflects disease activity, severity, or neurological prognosis. [22] Specific AQP4 IgG autoantibody, or NMO-IgG, binds to the extracellular surface of AQP4. [12] This binding provides an opening for the development of targeted therapeutics in NMO. [12] Therapy options are immunosuppression, such as corticosteroids and azathioprine immunosuppressive drugs, immunomodulation, and plasma exchange. [12] A recent serum antibody (anti-AQP4) has been detected for patients with NMO, which is currently used to diagnose this condition. [8]
Other clinical significant implications of AQP4 in the human body is the role in the regulation of cerebrospinal fluid (CSF) in the ventricles. Within the ventricles of the brain, AQP4 can be utilized in the removal of excess CSF in conditions such as hydrocephaly. [19] The primary treatment for individuals with hydrocephaly is through the implementation of mechanical shunts into the ventricles to drain the excess fluid. With further research into the role of AQP4, it may be possible to modify the human body's system of upregulation of these channels to help in the reabsorption of CSF without the need to use physically invasive treatments. [19]
Based on work in animal models, aquaporin-4 may have a role in several other diseases including Alzheimer's disease, amyotrophic lateral sclerosis, Parkinson's disease, multiple sclerosis, and epilepsy, and appears to have a role in pathological response to traumatic brain injury and stroke. [16]
In rodent models, AQP4 appears plays a role in both the development and resolution of the cerebral edema that occurs following an injury like TBI or stroke and around brain tumors. [8] [13] In comparison with wild-type mice, double knockout mice exhibited different diseases course post brain injury. [16] It indicated reduced intracranial pressure, cell death, water accumulation, astrogliosis, and lesion volume. [16] The expression of aquaporin 4 is reliant on the disease stage of TBI. [16] In an acute stage of TBI, the lack of aquaporin 4 causes an decrease of excess water removal while for later stage TBI results in prevention of severe damage and swelling. [16]
In people who suffer from Alzheimer's disease, amyloid plaques sometimes develop in brain arteries—a condition is referred to as cerebral amyloid angiopathy, or CAA. Animal studies have found that the severity of CAA increases or decreases depending on aquaporin-4 expression. When there is an decrease in AQP4, CAA severity increases and vice versa; it is not known what causes changes in AQP4 expression levels, nor whether this is part of the disease process or an effort of the brain to adapt. [16] In animal models of amyotrophic lateral sclerosis, AQP4 is overexpressed in the brainstem, cortex, and gray matter of the spinal cord which results in swollen astrocytes; the reason for this is not understood. [16]
Knockout mice display cognition problems; there is disruption in memory consolidation as well as disruption between memory acquisition, spatial recognition, and memory of where an object was after it has been moved. [16]
Transverse myelitis (TM) is a rare neurological condition wherein the spinal cord is inflamed. The adjective transverse implies that the spinal inflammation (myelitis) extends horizontally throughout the cross section of the spinal cord; the terms partial transverse myelitis and partial myelitis are sometimes used to specify inflammation that affects only part of the width of the spinal cord. TM is characterized by weakness and numbness of the limbs, deficits in sensation and motor skills, dysfunctional urethral and anal sphincter activities, and dysfunction of the autonomic nervous system that can lead to episodes of high blood pressure. Signs and symptoms vary according to the affected level of the spinal cord. The underlying cause of TM is unknown. The spinal cord inflammation seen in TM has been associated with various infections, immune system disorders, or damage to nerve fibers, by loss of myelin. As opposed to leukomyelitis which affects only the white matter, it affects the entire cross-section of the spinal cord. Decreased electrical conductivity in the nervous system can result.
Astrogliosis is an abnormal increase in the number of astrocytes due to the destruction of nearby neurons from central nervous system (CNS) trauma, infection, ischemia, stroke, autoimmune responses or neurodegenerative disease. In healthy neural tissue, astrocytes play critical roles in energy provision, regulation of blood flow, homeostasis of extracellular fluid, homeostasis of ions and transmitters, regulation of synapse function and synaptic remodeling. Astrogliosis changes the molecular expression and morphology of astrocytes, in response to infection for example, in severe cases causing glial scar formation that may inhibit axon regeneration.
Neuromyelitis optica spectrum disorders (NMOSD) are a spectrum of autoimmune diseases characterized by acute inflammation of the optic nerve and the spinal cord (myelitis). Episodes of ON and myelitis can be simultaneous or successive. A relapsing disease course is common, especially in untreated patients.
Glial fibrillary acidic protein (GFAP) is a protein that is encoded by the GFAP gene in humans. It is a type III intermediate filament (IF) protein that is expressed by numerous cell types of the central nervous system (CNS), including astrocytes and ependymal cells during development. GFAP has also been found to be expressed in glomeruli and peritubular fibroblasts taken from rat kidneys, Leydig cells of the testis in both hamsters and humans, human keratinocytes, human osteocytes and chondrocytes and stellate cells of the pancreas and liver in rats.
Myelin oligodendrocyte glycoprotein (MOG) is a glycoprotein believed to be important in the myelination of nerves in the central nervous system (CNS). In humans this protein is encoded by the MOG gene. It is speculated to serve as a necessary "adhesion molecule" to provide structural integrity to the myelin sheath and is known to develop late on the oligodendrocyte.
Multiple sclerosis is an inflammatory demyelinating disease of the CNS in which activated immune cells invade the central nervous system and cause inflammation, neurodegeneration, and tissue damage. The underlying cause is currently unknown. Current research in neuropathology, neuroimmunology, neurobiology, and neuroimaging, together with clinical neurology, provide support for the notion that MS is not a single disease but rather a spectrum.
Multiple sclerosis and other demyelinating diseases of the central nervous system (CNS) produce lesions and glial scars or scleroses. They present different shapes and histological findings according to the underlying condition that produces them.
Inflammatory demyelinating diseases (IDDs), sometimes called Idiopathic (IIDDs) due to the unknown etiology of some of them, are a heterogenous group of demyelinating diseases - conditions that cause damage to myelin, the protective sheath of nerve fibers - that occur against the background of an acute or chronic inflammatory process. IDDs share characteristics with and are often grouped together under Multiple Sclerosis. They are sometimes considered different diseases from Multiple Sclerosis, but considered by others to form a spectrum differing only in terms of chronicity, severity, and clinical course.
Baló's concentric sclerosis is a disease in which the white matter of the brain appears damaged in concentric layers, leaving the axis cylinder intact. It was described by József Mátyás Baló who initially named it "leuko-encephalitis periaxialis concentrica" from the previous definition, and it is currently considered one of the borderline forms of multiple sclerosis.
Research in multiple sclerosis may find new pathways to interact with the disease, improve function, curtail attacks, or limit the progression of the underlying disease. Many treatments already in clinical trials involve drugs that are used in other diseases or medications that have not been designed specifically for multiple sclerosis. There are also trials involving the combination of drugs that are already in use for multiple sclerosis. Finally, there are also many basic investigations that try to understand the disease better and in the future may help to find new treatments.
A glial scar formation (gliosis) is a reactive cellular process involving astrogliosis that occurs after injury to the central nervous system. As with scarring in other organs and tissues, the glial scar is the body's mechanism to protect and begin the healing process in the nervous system.
Tumefactive multiple sclerosis is a condition in which the central nervous system of a person has multiple demyelinating lesions with atypical characteristics for those of standard multiple sclerosis (MS). It is called tumefactive as the lesions are "tumor-like" and they mimic tumors clinically, radiologically and sometimes pathologically.
The glymphatic system is a system for waste clearance in the central nervous system (CNS) of vertebrates. According to this model, cerebrospinal fluid (CSF) flows into the paravascular space around cerebral arteries, combining with interstitial fluid (ISF) and parenchymal solutes, and exiting down venous paravascular spaces. The pathway consists of a para-arterial influx route for CSF to enter the brain parenchyma, coupled to a clearance mechanism for the removal of interstitial fluid (ISF) and extracellular solutes from the interstitial compartments of the brain and spinal cord. Exchange of solutes between CSF and ISF is driven primarily by arterial pulsation and regulated during sleep by the expansion and contraction of brain extracellular space. Clearance of soluble proteins, waste products, and excess extracellular fluid is accomplished through convective bulk flow of ISF, facilitated by astrocytic aquaporin 4 (AQP4) water channels.
Neuroinflammation is inflammation of the nervous tissue. It may be initiated in response to a variety of cues, including infection, traumatic brain injury, toxic metabolites, or autoimmunity. In the central nervous system (CNS), including the brain and spinal cord, microglia are the resident innate immune cells that are activated in response to these cues. The CNS is typically an immunologically privileged site because peripheral immune cells are generally blocked by the blood–brain barrier (BBB), a specialized structure composed of astrocytes and endothelial cells. However, circulating peripheral immune cells may surpass a compromised BBB and encounter neurons and glial cells expressing major histocompatibility complex molecules, perpetuating the immune response. Although the response is initiated to protect the central nervous system from the infectious agent, the effect may be toxic and widespread inflammation as well as further migration of leukocytes through the blood–brain barrier may occur.
Multiple sclerosis (MS) can be pathologically defined as the presence of distributed glial scars (scleroses) in the central nervous system that must show dissemination in time (DIT) and in space (DIS) to be considered MS lesions.
MOG antibody disease (MOGAD) or MOG antibody-associated encephalomyelitis (MOG-EM) is an inflammatory demyelinating disease of the central nervous system. Serum anti-myelin oligodendrocyte glycoprotein antibodies are present in up to half of patients with an acquired demyelinating syndrome and have been described in association with a range of phenotypic presentations, including acute disseminated encephalomyelitis, optic neuritis, transverse myelitis, and neuromyelitis optica.
Inebilizumab, sold under the brand name Uplizna, is a medication for the treatment of neuromyelitis optica spectrum disorder (NMOSD) in adults. Inebilizumab is a humanized mAb that binds to and depletes CD19+ B cells including plasmablasts and plasma cells.
Satralizumab, sold under the brand name Enspryng, is a humanized monoclonal antibody medication that is used for the treatment of neuromyelitis optica spectrum disorder (NMOSD), a rare autoimmune disease. The drug is being developed by Chugai Pharmaceutical, a subsidiary of Roche.
Anti-AQP4 diseases, are a group of diseases characterized by auto-antibodies against aquaporin 4.
Foot processes are specialized protrusive cellular extensions that may exhibit a pyramidal or finger-like morphology. They are most evident in mural cells, that are associated with and ensheath walls of blood capillaries, such as pericytes, podocytes and astrocytes.