Chemokine CCL5 Promotes Robust Optic Nerve Regeneration and Mediates Many of the Effects of CNTF Gene Therapy

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Chemokine CCL5 Promotes Robust Optic Nerve Regeneration and Mediates Many of the Effects of CNTF Gene Therapy Chemokine CCL5 promotes robust optic nerve regeneration and mediates many of the effects of CNTF gene therapy Lili Xiea,b,c, Yuqin Yina,b,c, and Larry Benowitza,b,c,d,e,1 aLaboratories for Neuroscience Research in Neurosurgery, Department of Neurosurgery, Boston Children’s Hospital, Boston, MA 02115; bF.M. Kirby Neurobiology Center, Boston Children’s Hospital, Boston, MA 02115; cDepartment of Neurosurgery, Harvard Medical School, Boston, MA 02115; dDepartment of Ophthalmology, Harvard Medical School, Boston, MA 02115; and eProgram in Neuroscience, Harvard Medical School, Boston, MA 02115 Edited by Keith R. Martin, University of Cambridge, Cambridge, United Kingdom, and accepted by Editorial Board Member Jeremy Nathans January 25, 2021 (received for review August 17, 2020) Ciliary neurotrophic factor (CNTF) is a leading therapeutic candidate (rCNTF) can promote optic nerve regeneration (20, 30, 31), for several ocular diseases and induces optic nerve regeneration in others find little or no effect unless SOCS3 (suppressor of cytokine animal models. Paradoxically, however, although CNTF gene ther- signaling-3), an inhibitor of the Jak-STAT pathway, is deleted in apy promotes extensive regeneration, recombinant CNTF (rCNTF) RGCs (5, 6, 32). In contrast, multiple studies show that adeno- has little effect. Because intraocular viral vectors induce inflamma- associated virus (AAV)-mediated expression of CNTF in RGCs tion, and because CNTF is an immune modulator, we investigated induces strong regeneration (33–40). The basis for the discrepant whether CNTF gene therapy acts indirectly through other immune effects of rCNTF and CNTF gene therapy is unknown but is of mediators. The beneficial effects of CNTF gene therapy remained considerable interest in view of the many promising clinical and unchanged after deleting CNTF receptor alpha (CNTFRα)inretinal preclinical outcomes obtained with CNTF to date. ganglion cells (RGCs), the projection neurons of the retina, but were Because intravitreal virus injections induce inflammation (41), diminished by depleting neutrophils or by genetically suppressing we investigated the possibility that CNTF, a known immune monocyte infiltration. CNTF gene therapy increased expression of modulator (42–44), might act by elevating expression of other C-C motif chemokine ligand 5 (CCL5) in immune cells and retinal glia, immune-derived factors. We report here that the beneficial effects NEUROSCIENCE and recombinant CCL5 induced extensive axon regeneration. Con- of CNTF gene therapy in fact require immune system activation versely, CRISPR-mediated knockdown of the cognate receptor (CCR5) and elevation of C-C motif chemokine ligand 5 (CCL5). Depletion in RGCs or treating wild-type mice with a CCR5 antagonist repressed of neutrophils, global knockout (KO) or RGC-selective deletion the effects of CNTF gene therapy. Thus, CCL5 is a previously unrec- of the CCL5 receptor CCR5, or a CCR5 antagonist all suppress ognized, potent activator of optic nerve regeneration and mediates many of the effects of CNTF gene therapy. the effects of CNTF gene therapy, whereas recombinant CCL5 (rCCL5) promotes axon regeneration and increases RGC survival. ciliary neurotrophic factor | retinal ganglion cells | regeneration | These studies point to CCL5 as a potent monotherapy for optic neuroinflammation nerve regeneration and to the possibility that other applications of CNTF and other forms of gene therapy might similarly act indi- rectly through other factors. ike most pathways in the mature central nervous system (CNS), Lthe optic nerve cannot regenerate once damaged due in part to cell-extrinsic suppressors of axon growth (1, 2) and the low intrinsic Significance growth capacity of adult retinal ganglion cells (RGCs), the projec- tion neurons of the eye (3–5). Consequently, traumatic or ischemic CNTF is a leading therapeutic candidate for glaucoma and other optic nerve injury or degenerative diseases such as glaucoma lead to ocular diseases and is widely used experimentally to promote irreversible visual losses. Experimentally, some degree of regener- axon regeneration after optic nerve injury. Paradoxically, whereas ation can be induced by intraocular inflammation or growth factors CNTF gene therapy is neuroprotective for retinal ganglion cells expressed by inflammatory cells (6–10), altering the cell-intrinsic and promotes considerable regeneration following optic nerve growth potential of RGCs (3–5), enhancing physiological activity injury, recombinant CNTF has little effect. We show that CNTF (11, 12), chelating free zinc (13, 14), and other manipulations gene therapy exacerbates the inflammatory reaction to virally (15–19). However, the extent of regeneration achieved to date re- mediated gene therapy, leading to widespread expression of mains modest, underlining the need for more effective therapies. chemokine CCL5. Blocking CCL5 signaling abrogates most neuro- Ciliary neurotrophic factor (CNTF) is a leading therapeutic protective and axon-promoting effects of CNTF gene therapy, candidate for glaucoma and other ocular diseases (20–23). Acti- whereas recombinant CCL5 largely mimics the beneficial effects of vation of the downstream signal transduction cascade requires CNTF gene therapy. Thus, this study identifies a potent, previously CNTF to bind to CNTF receptor-α (CNTFRα) (24), which leads unknown agent for optic nerve regeneration and raises general questions about interpreting results of gene therapy studies. to recruitment of glycoprotein 130 (gp130) and leukemia inhibi- tory factor receptor-β (LIFRβ) to form a tripartite receptor α Author contributions: L.X., Y.Y., and L.B. designed research; L.X. performed research; L.X. complex (25). CNTFR anchors to the plasma membrane through and Y.Y. analyzed data; and L.X. and L.B. wrote the paper. a glycosylphosphatidylinositol linkage (26) and can be released The authors declare no competing interest. and become soluble through phospholipase C-mediated cleavage This article is a PNAS Direct Submission. K.R.M. is a guest editor invited by the (27). CNTF has been reported to activate STAT3 phosphorylation Editorial Board. in retinal neurons, including RGCs, and to promote survival, but it Published under the PNAS license. is unknown whether these effects are mediated by direct action of 1To whom correspondence may be addressed. Email: larry.benowitz@childrens. CNTF on RGCs via CNTFRα (28). Our previous studies showed harvard.edu. that CNTF promotes axon outgrowth from neonate RGCs in This article contains supporting information online at https://www.pnas.org/lookup/suppl/ culture (29) but fails to do so in cultured mature RGCs (8) or doi:10.1073/pnas.2017282118/-/DCSupplemental. in vivo (6). Although some studies report that recombinant CNTF Published February 24, 2021. PNAS 2021 Vol. 118 No. 9 e2017282118 https://doi.org/10.1073/pnas.2017282118 | 1of11 Downloaded by guest on September 23, 2021 Results with GFAP vs. CNTFRα with TUJ1; Fig. 2C). Thus, in the retina, CNTF Gene Therapy Induces Optic Nerve Regeneration. Our initial as elsewhere in the mature CNS, CNTFRα is expressed primarily study tested whether virally mediated CNTF delivery does in fact in nonneuronal cells (46). This localization pattern does not appear produce a qualitatively different outcome from high doses of tobealteredbyCNTFgenetherapy(Fig.2A). Despite the absence rCNTF protein. We tested a range of rCNTF concentrations cor- of protein staining in RGCs, in situ hybridization (RNA Scope) responding to those reported to be effective (5, 30), adjusting for detects measurable CNTFRa mRNA in these cells (Fig. 2 B, Top). differences in volume between the rat and mouse eyes as needed. The accuracy of this signal was verified using an AAV2 expressing Compared to bovine serum albumin (BSA)-injected controls, a small hairpin RNA (shRNA) to knock down CNTFRα expres- rCNTF at concentrations of 0.03, 0.1, 0.3, and 0.5 μg/μLdidnot sion in RGCs (AAV2-anti-CNTFRa shRNA). Two weeks after improve regeneration (Fig. 1 A and C) nor RGC survival (Fig. 1 B AAV2-sh-CNTFR injection, in situ hybridization revealed a near- and D). To more closely approximate the continuous delivery of complete loss of CNTFRα mRNA in RGCs (P < 0.001; Fig. 2B). CNTF by gene therapy, we also tested three injections of rCNTF CNTFRα knockdown did not diminish the effects of CNTF gene (2 d before, the day of, and 3 d after optic nerve injury), which again therapy on either axon regeneration (P = 0.344; Fig. 2B)orRGC yielded little optic nerve regeneration (SI Appendix,Fig.S1A–D). survival (P = 0.538; Fig. 2 E–H). Thus, the effects of CNTF gene CNTF gene therapy was carried out using an AAV that targets therapy do not appear to require the expression of CNTFRα in RGCs (and some amacrine cells). AAV2-CNTF increased CNTF RGCs. Although it remains possible that RGCs might import bi- mRNA levels ∼30-fold above background and ∼20-fold above the ologically relevant levels of CNTFRα from another source, the control virus 2 wk after transfection (P < 0.05: AAV2-CNTF vs. near absence of CNTFRα protein detected in RGCs and results AAV2-GFP; n = 4 retinas per group; SI Appendix,Fig.S1E). CNTF reported below (in TheEffectsofCNTFGeneTherapyAre gene therapy led to both robust axon regeneration and improved Mediated Primarily via Chemokine CCL5) argue against this RGC survival (P < 0.001 and P < 0.01, respectively; Fig. 1 C and D). proposition (Fig. 2A). rCNTF has been reported to substantially elevate SOCS3 expres- sion (45) and can induce regeneration if SOCS3
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