The pathophysiological process of brain HI is extremely complex and involves the imbalance of intracellular and extracellular ion homeostasis, abnormal electrical activity in the cells, excessive release of excitatory amino acids, and excessive production of free radicals. Loss of ion steady state occurs at the early stages of HI, triggering a series of cascade reactions.
In this study, using a model of HIBI established in neonatal pigs, we found that pH decreases after HI, reaching a minimum at 0–2 h, and that Hv1 expression increases. This is attributed to anaerobic fermentation in cells after HIBI, which produces a large amount of Lac. Hydrolysis of ATP leads to the release of a large amount of H+, which acidifies the intracellular environment, and in turn, leads to increased Hv1 expression. When the intracellular H+ concentration exceeds the inherent buffering capacity of the cell, H+ flows out of the cell through the expressed Hv1 channels and aggregates outside the cell, decreasing the extracellular pH to 6.5 or lower [20]. After HI, the highly expressed Hv1 transports the excess H+ from the cell to the extracellular space. The increase in extracellular H+ activates acid-sensitive ion channels, Na+ and Ca2+ influx [21], and cell depolarization, subsequently activating voltage-gated Ca2+ channels and glutamate (Glu)-activated N-methyl-D-aspartic acid (NMDA) receptors to cause a large amount of intracellular Ca2+ overload and secondary neuronal damage [22, 23]. In addition, HI reperfusion leads to injury and necrosis of some neurons, in turn leading to decreased Hv1 expression.
Hv1 transports H+ out of the cell, reduces intracellular acidosis, and stabilizes the intracellular environment, a mechanism that protects the body. With the restoration of aerobic metabolism and blood flow, the H+ generated from anaerobic metabolism is excreted, restoring the pH to normal levels, and the expression of Hv1 decreases.
The pH of brain cells after HI has a major impact on cell survival and outcome. Mild acidosis has a protective effect on nerves against excitotoxicity and ischemia reperfusion [24–27]. This is because a small decrease in intracellular pH uncouples the activation of neuronal nicotinamide adenine dinucleotide phosphate oxidase (NOX) from that of NMDA receptors, thereby preventing neuronal death [28]. After the brain tissue experiences a short-term decrease in pH, the pH rebounds, causing “alkalosis,” and the increased Glu level in this alkaline environment aggravates excitotoxicity of neurons [28–31].
The immune response in acute HI is the pathological basis of neonatal brain injury [32]. Cerebral HI triggers a cascade of inflammation processes in blood vessels, further enhancing damage to brain parenchymal cells by activating innate and peripheral immune cells, which can lead to secondary damage to brain tissue [33]. Hypoxic-ischemic white matter injury, in which the white matter of the brain becomes sparse or even softens, is the principal pathological change in disorders of myelin production. The damage to OPCs caused by the activation of microglia is considered the principal pathophysiological feature of periventricular leukomalacia [34].
MBP expression is specific to the CNS, particularly in OLs [35, 36]. MBP is located in the innermost layer of the myelin sheath and maintains close contact with the axonal membrane to keep the structure and function of the myelin sheath, promote rapid nerve conduction, and maintain insulation for nerve conduction [37]. A decreased MBP level is a sign of CNS injury. MBP is expressed at high levels in infants and young children, and its decreased expression indicates some degree of damage to myelin [38, 39]. In vitro studies have shown that hypoxia can cause neural stem cells to differentiate into OLs and astrocytes and can inhibit their differentiation into neurons [4]. In the present study, MBP expression after HI decreased compared to that in the control group, reaching a minimum at 6–12 h, which indicates that myelin damage occurred after HI. Moreover, MBP expression increased at 12 h after HI, indicating that myelin damage was accompanied by OL proliferation. Increased MBP expression indicates that HI-caused damage to the myelin sheath, which over time was accompanied by myelin sheath repair.
MOG is expressed on the outer surface of the myelin sheath and on the surface of OLs in the CNS, making it a good marker for mature OLs [40]. Compared to other major myelin-related proteins, the expression of MOG is delayed for 24–48 h. MOG can inhibit the growth of axons [41]. The results of the present study show that MOG expression initially decreased after HI, reaching a minimum at 2–6 h. Decreased MOG expression can temporarily inhibit the growth of axons and provide an opportunity for axonal regeneration. With time, the number of mature OLs gradually increases, which in turn increases MOG expression. Increased MOG expression inhibits axonal overgrowth and may also interfere with the repair of damaged nerves.
MAG is located on the cell membrane of Schwann cells and OLs [42] and plays a role in glial cell-axons. It enhances long-term axon–myelin stability and regulates the axon cytoskeleton. MAG has a dual function, as it either inhibits or promotes the growth of nerve fibers, depending on the developmental stage of the animal and type of neuron. MAG is not only an axonal growth factor but can also inhibit axon regeneration. Furthermore, it acts as an activator during fetal development but becomes an inhibitor after myelination is completed. In addition, MAG inhibits axon regeneration after injury [43, 44]. Studies have shown that MAG maintains the myelin–axon spacing by interacting with specific neuronal glycolipids (gangliosides), inhibits axon regeneration, and controls myelin formation [45, 46]. In the present study, MAG expression initially decreased after HI. This is because myelin was affected by HI and the OLs were damaged, which in turn reduced MAG expression. Over time, as neural stem cells differentiated into OLs, the latter began to proliferate, and then MAG expression increased, promoting axon regeneration after injury.
We also determined that pH in the brain after HIBI is correlated with Hv1, MBP, and MOG expression. After HI, pH decreases, Hv1 expression increases, and myelin-related protein expression decreases. Over time, pH is restored and Hv1 expression decreases, while that of myelin-associated proteins increases. This can be explained by the fact that Hv1 is required for production of NOX-dependent reactive oxygen species (ROS) in the brain. Microglia injury and demyelination require the involvement of the Hv1 proton channel. In Hv1−/− mice, ROS production is reduced, microglia activation is improved, OL progenitor cell (NG2) proliferation is increased, and the number of mature OLs is increased [47]. The Hv1 proton channel is a unique target for NOX-dependent ROS production in the mechanism that controls the pathogenesis of myelin injury. As Hv1 expression is affected by pH, we infer that pH has some effect on myelin damage and repair.
Furthermore, this study demonstrates that after HIBI, the expression of myelin-related proteins in the model group was slightly lower than that in the control group. This may be due to changes in the microenvironment of the damaged brain regions after HI. Although endogenous neural stem cells have strong proliferation and migration capabilities, their ability to ultimately promote the differentiation and maturation of new cells and form a complete neural network with other neurons in the colonized site remains limited. This shows that the microenvironment of neural stem cells contains major factors that affect their survival, regeneration, and differentiation.
After HIBI in newborn pigs, pH and Hv1 expression in the brain are negatively correlated. Both pH and myelin-associated protein expression initially decrease and then increase, suggesting that myelin in the brain is damaged by acidosis following HI. As the pH gradually recovers, the repair of damaged myelin begins.