Integrative multi-omics analysis reveals inflammation-related molecular networks in acute mountain sickness

High-altitude cerebral edema (HACE) is a life-threatening condition following rapid ascent to high altitude, with acute mountain sickness (AMS) as a key precursor. Increasing evidence implicates inflammation in its pathogenesis, yet the molecular regulatory networks remain unclear.

We integrated bulk RNA-seq (GSE75665), non-coding RNA-seq (GSE90500), and single-cell RNA-seq datasets to explore inflammation-related mechanisms in AMS. Differentially expressed genes (DEGs) were identified and analyzed using Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG), and Gene Set Enrichment Analysis (GSEA). Protein-protein interaction, miRNA-mRNA, transcription factor, and drug-gene networks were constructed. Single-cell and deconvolution analyses determined cell-type-specific expression and immune composition. A hypobaric hypoxia-induced HACE mouse model was established for experimental validation to assess heparin-binding EGF-like growth factor (HBEGF) expression and associated neuroinflammatory and pathological changes.

We identified 323 DEGs, including five 5 inflammation-related genes, all downregulated in AMS and enriched in epithelial cell growth, migration, and the ErbB signaling pathway. hsa-miR-375 was predicted to regulate multiple key genes, and drug gene analysis highlighted HBEGF as a potential therapeutic target. Single-cell data revealed monocytes as the major source of key gene expression and increased CD4⁺ monocytes in AMS. In vivo, HBEGF expression was significantly reduced in HACE mice, while Adeno-associated virus (AAV)-mediated HBEGF overexpression mitigated cerebral edema, blood-brain barrier disruption, neuronal injury, and proinflammatory cytokine release.

This integrative multi-omics study identifies monocyte-mediated inflammation and the ErbB pathway as critical mechanisms in HACE. HBEGF emerges as a promising therapeutic target for preventing neuroinflammation and cerebral injury in high-altitude conditions.