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Increased Levels of Sphingosine-1-Phosphate In Kułakowska et al. Journal of Neuroinflammation 2014, 11:193 JOURNAL OF http://www.jneuroinflammation.com/content/11/1/193 NEUROINFLAMMATION RESEARCH Open Access Increased levels of sphingosine-1-phosphate in cerebrospinal fluid of patients diagnosed with tick-borne encephalitis Alina Kułakowska1, Fitzroy J Byfield2,Małgorzata Żendzian-Piotrowska3, Joanna M Zajkowska4, Wiesław Drozdowski1, Barbara Mroczko5, Paul A Janmey2 and Robert Bucki2,6,7* Abstract Background: Tick-borne encephalitis (TBE) is a serious acute central nervous system infection that can result in death or long-term neurological dysfunctions. We hypothesize that changes in sphingosine-1-phosphate (S1P) concentration occur during TBE development. Methods: S1P and interleukin-6 (IL-6) concentrations in blood plasma and cerebrospinal fluid (CSF) were measured using HPLC and ELISA, respectively. The effects of S1P on cytoskeletal structure and IL-6 production were assessed using rat astrocyte primary cultures with and without addition of plasma gelsolin and the S1P receptor antagonist fingolimod phosphate (FTY720P). Results: We report that acute inflammation due to TBE virus infection is associated with elevated levels of S1P and IL-6 in the CSF of infected patients. This elevated concentration is observed even at the earliest neurologic stage of disease, and may be controlled by glucocorticosteroid anti-inflammatory treatment, administered to patients unresponsive to antipyretic drugs and who suffer from a fever above 39°C. In vitro, treatment of confluent rat astrocyte monolayers with a high concentration of S1P (5 μM) results in cytoskeletal actin remodeling that can be prevented by the addition of recombinant plasma gelsolin, FTY720P, or their combination. Additionally, gelsolin and FTY720P significantly decreased S1P-induced release of IL-6. Conclusions: TBE is associated with increased concentration of S1P and IL-6 in CSF, and this increase might promote development of inflammation. The consequences of increased extracellular S1P can be modulated by gelsolin and FTY720P. Therefore, blocking the inflammatory response at sites of infection by agents modulating S1P pathways might aid in developing new strategies for TBE treatment. Keywords: Cerebrospinal fluid, Tick-borne encephalitis, Sphingosine-1-phosphate, IL-6, Gelsolin, FTY720P Background has multiple physiological effects [2]. In the immune Sphingosine-1-phosphate (S1P) is a product of sphingo- system, cell surface S1P(1) receptors transduce the myelin (SM) metabolism. It is present in most eukaryotic rapid, transient effects of extracellular S1P on T- and organisms. S1P regulates cell function both intracellu- B-lymphocyte trafficking, promote early T-cell migration larly and by binding to extracellular receptors [1]. As to tissue sites of immune responses, and regulate T-cell an extracellular mediator, S1P binds to a family of proliferation and secretion of numerous cytokines [1,3]. G-protein-coupled receptors named S1P(1)-S1P(5) and S1P receptors are also found on all cell types in the CNS, and the effects of S1P on neurons [4], astrocytes [5,6], oli- * Correspondence: [email protected] godendrocytes [7], and microglia [8,9] are highly cell-type 2Institute for Medicine and Engineering, University of Pennsylvania, 1010 specific. For example, S1P is a chemoattractant for neural Vagelos Research Laboratories, 3340 Smith Walk, Philadelphia, PA 19104, USA precursor cells and is proposed to direct migration of 6Department of Physiology, Pathophysiology and Microbiology of Infections, The Faculty of Health Sciences of the Jan Kochanowski University in Kielce, neurons to sites of injury [10]. Additionally, S1P [7] or Kielce, Al. IX Wieków Kielc 19, Kielce 25-317, Poland Full list of author information is available at the end of the article © 2014 Kułakowska et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Kułakowska et al. Journal of Neuroinflammation 2014, 11:193 Page 2 of 9 http://www.jneuroinflammation.com/content/11/1/193 synthetic ligands of S1P receptors [11,12] interact with heparinized syringes and centrifuged at 1,500 g for 5 mi- neurotrophin-3 to promote survival of oligodendrocytes. nutes at 4°C. The protocol for this study was approved by S1P is abundant in plasma where it is bound to high- the Ethics Committee for Research on Humans, Medical density lipoproteins and albumin [13]. Recently we have University of Białystok (approval number: R-I-002/382/ shown that plasma gelsolin, an actin-binding PIP2-regulated 2012). At the time of patient recruitment, written consent protein, can also act as a universal carrier or scavenger of was obtained from all subjects. All individuals were under- S1P, and its function may include interference with S1P going lumbar puncture for diagnostic purposes, and most actions [14]. Such an interaction may be of importance in of the TBE patients received a second lumbar puncture settings where the concentrations of both substances 10 to 12 days later to monitor the course of the disease. change over their homeostatic ranges. Multiple sclerosis Following lumbar punctures, CSF cells were counted, (MS), a chronic immune-mediated inflammatory disease and the rest of the material (after centrifugation: 2,000 g of the CNS, seems to be one example of such a condition for 10 minutes), along with plasma samples, were frozen [15]. In the CSF of patients with MS, S1P and gelso- and kept at −80°C. lin concentrations showed a tendency to increase and Clinical and laboratory characteristics of the patient decrease, respectively, when compared to other non- groups are given in Table 1. Briefly, all TBE patients inflammatory neurological disorders [15]. An inflamma- were divided into the following groups: without and tory reaction accompanied by central nervous system with glucocorticosteroids (GCs) treatment (+G), from (CNS) infections such as tick-borne encephalitis (TBE) or whom the CSF and plasma were collected at admission Lyme neuroborreliosis (LNB), also results in blood and (TBE-I/TBE + G-I; patients at time of admission and cerebrospinal fluid (CSF) alterations in plasma gelsolin first lumbar puncture without or with GCs treatment [15]. TBE, a systemic infection with RNA virus leads to respectively) and patients from whom the CSF and the development of an acute meningitis and encephalitis, plasma samples were collected after 10 to 12 days of characterized by swelling of the brain due to inflammation treatment (TBE-II/TBE + G-II; patients after 10 to 12 days [16]. Even though TBE can be prevented by active of hospitalization, non-treated or treated with GCs, re- immunization, it is still very common in some regions spectively). Diagnosis of TBE was confirmed by detection of the world, such as Central Europe, and currently no of anti-TBE virus antibodies in the serum and CSF by specific treatment is known [17,18]. We hypothesize that ELISA (Virion-SERION kit, SERION ELISA classic TBE TBE may result in an alteration of S1P concentration in Virus IgG/IgM,Würzburg, Germany). All TBE patients the blood and CSF of patients, and in such a case modula- were given symptomatic treatment (analgesics, antipy- tion of S1P cellular effects may be used to develop new retics, and intravenous rehydration). Additionally, patients treatment strategies. FTY720P, a S1P receptor modulator, in poor general condition (fever above 39°C and seizures was found to be highly effective in the treatment of MS or disturbances of consciousness (Glasgow Coma Scale [19], and its immunomodulatory activity may be poten- score <12 points)) were treated with glucocorticosteroid tially beneficial in other CNS inflammatory conditions. (dexamethasone 12 to 16 mg daily), which was given intravenously during a period of four to six days. Materials and methods LNB was diagnosed according to the European Feder- Materials ation of Neurological Societies criteria [21]. In all our LNB S1P (S9666) was purchased from Sigma Aldrich (St Louis, patients the diagnosis was ‘definite neuroborreliosis’ and Missouri, United States). (S)- fingolimod phosphate all of them suffered from meningitis, which is a typical (FTY720P; B-0721) was purchased from Echelon Biosci- clinical manifestation of early LNB. The ELISA method ences Inc. (Salt Lake City, Utah, United States). Recombin- (Borrelia recombinant IgG/IgM ELISA, Vienna, Austria) and ant human plasma gelsolin (rhGSN) was obtained from immunoblotting (LINE Virotech, Rüsselsheim, Germany) Biogen-Idec Inc (Cambridge, Massachusetts, United States). were used to detect antibodies against Borrelia burgdorferi Stock solutions of S1P were prepared in 0.3 M NaOH, since in serum and CSF of LNB patients. MS patients included pH strongly affects the aggregation behavior of S1P [20]. in the study were in the process of MS diagnosis, and Various concentrations of S1P were prepared by mixing its their EDSS (Expanded Disability Status Scale) scores sonicated stock solution; 10 minutes, at room temperature were between 0.5 and 4.0 (1.7 ± 0.9). Finally, they were (RT) with buffer required for a particular experiment. diagnosed according to McDonald’s criteria
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