Elevated Plasma BDNF Levels Are Correlated with NK Cell Activation in Patients with Traumatic Spinal Cord Injury T
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International Immunopharmacology 74 (2019) 105722 Contents lists available at ScienceDirect International Immunopharmacology journal homepage: www.elsevier.com/locate/intimp Elevated plasma BDNF levels are correlated with NK cell activation in patients with traumatic spinal cord injury T Long Xua,1,2, Yong Zhangb,1,3, Renjie Zhangb, Huaqing Zhangb, Peiwen Songb, Tai Maa, Yue Lia, ⁎ ⁎⁎ Xian Wanga, Xin Houa, Qun Lia, Jiegou Xua, Xiaoping Gaoc, ,4, Cailiang Shenb, ,4 a School of Basic Medical Science, Anhui Medical University, Hefei, Anhui, China b Department of Orthopedics & Spine Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China c Department of Rehabilitation Medicine, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China ARTICLE INFO ABSTRACT Keywords: Background: The precise role of innate immune responses in the early stage of traumatic spinal cord injury (SCI), Spinal cord injury especially those mediated by natural killer (NK) cells, is poorly understood. BDNF Methods: The frequency and phenotype of NK cells from traumatic SCI patients and healthy controls were as- NK cells sessed by flow cytometry. ELISA assay was used to detect the production of a series of cytokines, neurotrophins, Activation and neurohormones in plasma samples. In vitro cell culture was performed to observe brain-derived neurotrophic factor (BDNF)-induced NK cell activation. Results: A significant increase in the NK cell frequency and the presence of NK cells with the activated phenotype was observed, as reflected by the enhanced expression of CD69, HLA-DR, NKG2D, and NKp30 on the NK cells, in traumatic SCI patients within 24 h of injury, compared to case for the healthy controls. Meanwhile, a higher level of BDNF, a member of the neurotrophin family, was observed in the plasma samples of the SCI patients; the elevated level of BDNF was strongly and positively correlated with the percentage of NK cells during the early stage of traumatic SCI. Furthermore, the expression of CD69 and NKp30 on the NK cells increased following stimulation with BDNF for 24 h in vitro, which is consistent with the in vivo observation in SCI patients. Conclusion: Collectively, our findings demonstrate the activation of NK cells within 24 h after traumatic SCI, and reveal a novel role of BDNF in regulating NK cell activation. 1. Introduction response, partly characterized by the synthesis of cytokines and che- mokines, as well as the synergistic infiltration of the injured area with Spinal cord injury (SCI), which usually results from vehicular acci- peripheral immune cells including both innate and adaptive immune dents and accidental falls particularly in elderly people, is a life-altering cells, such as macrophages, natural killer (NK) cells, neutrophils, B illness leading to disorders in motor, sensory, and autonomic function. cells, and T cells [6,7]. NK cells not only play an important regulatory The annual incidence of SCI varies worldwide [1,2]. While the precise role by secreting cytokines [7], but also display altered cytotoxic ac- immunological events involved in the pathophysiology of SCI remain tivity in central nervous system (CNS) diseases [8,9]. However, the unclear, it has become increasingly clear that the inflammation caused relationship between NK cells and SCI-induced inflammation has not by immune cells plays an important role in the progression of this been thoroughly studied. Particularly, there are few researches on the disease [3–5]. alteration of the phenotype and activation of NK cells in the early Previous studies have shown that SCI initiates a potent immune period (< 24 h) of traumatic SCI. Although their vital natural killing ⁎ Correspondence to: X. Gao, Department of Rehabilitation Medicine, the First Affiliated Hospital of Anhui Medical University, 218#Ji Xi Road, Hefei, Anhui 230022, PR China. ⁎⁎ Correspondence to: C. Shen, Department of Orthopedics & Spine Surgery, the First Affiliated Hospital of Anhui Medical University, 218#Ji Xi Road, Hefei, Anhui 230022, PR China. E-mail addresses: [email protected] (L. Xu), [email protected] (X. Gao), [email protected] (C. Shen). 1 These authors contributed equally to this work. 2 Department of Immunology, School of Basic Medical Science, Anhui Medical University, 81#Mei Shan Road, Hefei, Anhui, China 230032 3 Department of Orthopedics & Spine Surgery, the First Affiliated Hospital of Anhui Medical University, 218#Ji Xi Road, Hefei, Anhui, PR China 230022 4 These authors are co-responding authors. https://doi.org/10.1016/j.intimp.2019.105722 Received 29 April 2019; Received in revised form 24 June 2019; Accepted 24 June 2019 Available online 28 June 2019 1567-5769/ © 2019 Elsevier B.V. All rights reserved. L. Xu, et al. International Immunopharmacology 74 (2019) 105722 activity towards certain infected or transformed cells and modulatory Table 1 functions, especially via the release of pro-inflammatory cytokines [6], Subjects characteristics (age, gender, BMI, SCI injury levels, ASIA impairment are well known, how NK cells exert inflammatory functions in trau- Scale, Etiology and Associated injuries). matic SCI is still unclear. Characteristics HC SCI p-Value t-Value NK cells can be divided into two major phenotypic and functional (n = 20) (n = 21) subsets based on their CD56 expression levels [10,11]. NK cells from the CD56bright subset are relatively dominant in secondary lymphoid Age (mean ± SEM) 53.45 ± 2.113 55.62 ± 2.153 0.4769 0.7182 Gender 0.275 tissues (e.g., tonsils) and have limited cytotoxicity, but produce large Male 11 15 amounts of cytokines [12,13]. Whereas, the majority of circulating NK Female 9 6 cells belong to the CD56dim subset; they exhibit a notably higher cy- BMI (mean ± SEM) 21.4 ± 0.4387 21.73 ± 0.368 0.562 0.5849 tolytic capacity against infected or stressed target cells [14,15]. It is Spinal cord Injury levels C2–C4 NA 7 well known that NK cells express a multitude of activating and in- C5–C7 14 hibitory receptors that interact with ligands expressed on the surface of ASIA impairment scale target cells; the activation of NK cells is determined by the balance A06 between these receptors [16,17]. B05 In this study, we first characterized the NK cells in patients with C010 D00 traumatic SCI. We analyzed the frequency and phenotype of circulating E200 NK cells and found that traumatic SCI patients showed a significant Etiology increase in the frequency of NK cells and the presence of NK cells with Traffic014 the activated phenotype. We also found that the level of BDNF was Fall 0 6 fi Other 0 1 elevated signi cantly in the plasma of SCI patients, and that BDNF Associated injuries NA 0 promotes the activation of NK cells ex vivo by upregulating the ex- pression of CD69 and NKp30. Date shown as mean ± SEM. NA, not applicable. 2. Materials and methods Table 2 Monoclonal antibodies. 2.1. Patients and samples Antibody specificity Clone Conjugate Cat.NO. Manufacturer Peripheral blood samples were obtained from the inpatients at the CD3 SK7 APC-cy7 557832 BD Pharmingen™ First Affiliated Hospital of the Anhui Medical University. This study was CD4 RPA-T4 BV 510 300545 Biolegend ™ approved by the Institutional Review Board for human experimenta- CD8 RPA-T8 Percp-cy5.5 560662 BD Pharmingen CD19 H1B19 V 500 561125 BD Pharmingen™ tion, and all participants or their guardians signed informed consent CD56 NCAM16.2 BV 421 562751 BD Horizon™ forms before the experiments. All the enrolled patients met the criteria CD69 FN50 PE 310906 Biolegend for the diagnosis of traumatic SCI (as defined by the American Spinal CD81 JS-81 FITC 561956 BD Pharmingen™ ™ Injury Association, Atlanta, GA, USA), which was confirmed by two CD226 DX11 FITC 559788 BD Pharmingen CD244 2-69 PE 550816 BD Pharmingen™ independent experienced spine surgeons. None of the SCI patients in- HLA-DR L243 BV 510 307646 Biolegend cluded as the experimental subjects in this study had comorbid neu- NKG2D 1D11 Percp-cy5-5 562364 BD Pharmingen™ rodegenerative diseases. NKp30 P30-15 Alexa-647 325212 Biolegend In all SCI patients, neurological level of injury was present at or NKp44 44.189 APC 336942 eBioscience above the seventh cervical vertebra (C7). The distribution of age and sex among the SCI patients, as well as the healthy controls (HCs) is Ashland, OR). shown in Table 1. All blood samples were collected within 24 h after the SCI. The following patients, without limitations, were excluded: SCI patients with infections, SCI patients taking medicine in the short term 2.3. Cytokine quantification or receiving intravenous antibiotic injections, and SCI patients that underwent other invasive operations. In short, patients that underwent Quantification of the cytokine levels in plasma obtained from the any treatment that may possibly interfere with the immune response HCs and SCI patients was performed using a quantitative sandwich were excluded. ELISA kit (Dakewe Bio-engineering, Shenzhen, China), according to the For comparison, HCs were recruited from the local community in manufacturer's recommendations. Plasma levels of the following cyto- the Hefei area at the same time. The HCs also had a similar socio- kines were analyzed: IL-6, TNF-α, IFN-γ, IL-12p70, IL-17A, IL-12/ economic status and dietary patterns as the SCI patients. Furthermore, 23p40, IL-10, and TGF-β1. The detection limit for the measurement of we collected the comprehensive medical history of all the subjects, and all cytokines was 5 pg/ml; for TGF-β1, it was 15 pg/ml. they all underwent physical examinations. Then, subjects with blood- transmissible infections, medical abnormalities including CNS dis- orders, and traumatic or serious medical illnesses were excluded. 2.4. Neurotrophin and neurohormone quantification Additionally, any pathology or treatment that could interfere with leukocyte parameters, such as immunosuppressive or im- Brain-derived neurotrophic factor (BDNF), neurotrophin-3 (NT-3), munomodulatory therapy, or the administration of a vaccine < 3 Melatonin, and β-endorphin (β-EP) levels were determined using spe- months ago was an additional exclusion criterion.