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Review Article Neuroinvasion and Inflammation in Viral Central Nervous System Infections

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Review Article Neuroinvasion and Inflammation in Viral Central Nervous System Infections Hindawi Publishing Corporation Mediators of Inflammation Volume 2016, Article ID 8562805, 16 pages http://dx.doi.org/10.1155/2016/8562805 Review Article Neuroinvasion and Inflammation in Viral Central Nervous System Infections Tobias Dahm, Henriette Rudolph, Christian Schwerk, Horst Schroten, and Tobias Tenenbaum Pediatric Infectious Diseases, Department of Pediatrics, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany Correspondence should be addressed to Tobias Tenenbaum; [email protected] Received 17 December 2015; Revised 16 March 2016; Accepted 12 April 2016 Academic Editor: Mukesh Kumar Copyright © 2016 Tobias Dahm et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Neurotropic viruses can cause devastating central nervous system (CNS) infections, especially in young children and the elderly. The blood-brain barrier (BBB) and the blood-cerebrospinal fluid barrier (BCSFB) have been described as relevant sites ofentry for specific viruses as well as for leukocytes, which are recruited during the proinflammatory response in the course ofCNS infection. In this review, we illustrate examples of established brain barrier models, in which the specific reaction patterns of different viral families can be analyzed. Furthermore, we highlight the pathogen specific array of cytokines and chemokines involved in immunological responses in viral CNS infections. We discuss in detail the link between specific cytokines and chemokines and leukocyte migration profiles. The thorough understanding of the complex and interrelated inflammatory mechanisms aswell identifying universal mediators promoting CNS inflammation is essential for the development of new diagnostic and treatment strategies. 1. Introduction killer (NK) cells, dendritic cells (DCs), and perivascular andmeningealmastcellsaswellasmonocytesandpoly- Viral central nervous system (CNS) infections can be clas- morphonuclear granulocytes (PMN) are only present in low sified depending on the anatomical site of the inflammation numbers [6–8]. However, the composition of inflammatory andtheentrysiteofviralpathogens.Aninfectionofthe cells in the CNS and especially in the CSF, which can be meninges is referred to as meningitis, of the brain as encepha- clinically monitored by lumbar puncture, undergoes constant litis, and of the spinal cord as myelitis. When a combination changes throughout a CNS infection. of regions is affected, the terms meningoencephalitis or An increase in the number of leukocytes within the CSF encephalomyelitis are applied [1]. Viral CNS infections are can especially be noted in patients with viral meningitis, almost threefold as frequent as bacterial infections with an whereas during encephalitis, patients rarely exhibit elevated incidence of 20–30/100.000 per year [2, 3]. Despite an often cell counts in the CSF. During encephalitis, immune cells mildacutephase,fataloutcomesarepossible,whilethelong migrate into the brain parenchyma [9]. The cascade of events term impact of viral CNS infections has not been elucidated following viral CNS infection includes the recruitment of T- in detail yet [4]. lymphocytes, macrophages, and to some extent PMN. An + + In healthy individuals various immune cells, which increase in CD4 T-cells, CD8 T-cells, and NK cells has been enhance the protection against invading pathogens, are found recorded in the context of viral meningitis. The dominant in small numbers in the CNS. The majority (70–80%) of these PMN population seen in early stages of the enteroviral CNS immune cells in the cerebrospinal fluid (CSF) are phenotypic infection, for example, may pave the way for monocytes and + + + CD3 memory T-cells; both CD4 and CD8 subsets are lymphocytes [10]. present with around 40–50% and 20–30%, respectively [5]. In In this review we highlight the role and probable causes of + contrast, B-cells (dominantly CD27 memory cells), natural leukocyte migration via the BBB and the BCSFB into the CNS 2 Mediators of Inflammation Endothelial cells CSF CSF Parenchyma Epithelial cell Parenchyma Basal lamina Blood Choroid Blood Tight junction plexus Basal lamina stroma Parenchyma Pericyte Tight junction Astrocyte Fenestrated end feet endothelial cell CSF CSF (a) (b) Figure 1: Barriers of the brain. (a) The BBB found between the lumen of the cerebral blood vessels and the brain parenchyma is composed of capillary endothelial cells, astrocytes, and pericytes and obtains its characteristic physical barrier function via linking the endothelial cells through luminal tight junctions. (b) The BCSFB located between the CSFnd a the fenestrated blood vessels of the choroid plexus. This selective barrier contains polar choroid plexus epithelial cells joined to one another through tight junctions found on the apical side. following viral infection. In this context we further describe fenestration is important for the main function of the CP, the associated mediators and their influence on the migration which is the synthesis of CSF [18]. patterns. The paracellular permeability of the BBB and the BCSFB is mainly regulated by two junctional complexes: TJs and 2. Involvement of the Brain Barriers in adherens junctions (AJs) [19]. The TJs are built and reinforced CNS Infection through a number of junctional proteins such as occludin, claudins, coxsackie adenovirus receptor (CAR), and also To cause CNS infections pathogens must first successfully junctional adhesion molecules (JAMs), whereas the AJs cross the protective barriers of the brain. The CNS is an largely consist of transmembrane cadherins closely linked by immune-specialized site, which maintains a homogenous alpha, beta, and gamma catenin to the cytoskeleton [19–22]. environment by regulation of entrance and exit of substances The primary (direct) or secondary (via host cell signaling through the major brain barriers: the blood-brain barrier events) disruption of those junctional molecules by CNS (BBB) and the blood-cerebrospinal fluid barrier (BCSFB) pathogens can facilitate crossing of virus particles, leukocytes, [11]. The BBB and BCSFB form metabolic (enzymatic activity and inflammatory mediators into the CNS [15]. on passing molecules), physical (minimizing the paracellular flux), and transport (controlling molecular flux through spe- 3. Pathogen Entry into the CNS cialized membrane transporters) barriers [12, 13] (Figure 1). The BBB, which has the largest surface area available for The brain capillaries and the CP are relevant sites of entry for communication between the brain and the blood, creates a pathogens such as bacteria, viruses, fungi, and parasites into barrier through a functional unit consisting of endothelial the CNS. For entry the pathogens must first cross the respec- cells, which are joined and stabilized through tight junc- tive barriers, which are the BBB and the BSCFB. The BBB tions (TJs), astrocyte end feet, and pericytes. This highly has been described as an entrance site for bacterial pathogens selective barrier between the peripheral blood and the brain such as Neisseria meningitidis (N. meningitidis) [23, 24] and parenchyma of the CNS consists of specialized cells which in Streptococcus pneumoniae (S. pneumoniae) [25, 26], for fungi cooperation create a homeostatic environment for cells of the such as Candida albicans (C. albicans) [27, 28], and also for CNS [14, 15] (Figure 2). viruseslikeWestNilevirus(WNV)[29,30],humanimmun- The BCSFB is found in the choroid plexus (CP) located odeficiency virus (HIV) [31, 32], or herpes simplex virus in the ventricles of the brain. The epithelium of the CP is (HSV) [15, 33]. In contrast, the BCSFB has not received the mainly responsible for the barrier function of the BCSFB. same amount of attention, due to the lack of adequate in vivo Apart from maintaining the physical barrier of the CP, the and in vitro models for this barrier. To date, a range of bacteria BCSFB, with its array of specific transport channels and a as well as viruses were shown to use the BCSFB as an entry low pinocytotic activity, is involved in para- and transcellular site into the CNS, which include Streptococcus suis (S. suis) transport of molecules and immune cells between the brain [34–36], N. meningitidis [37, 38], Haemophilus influenzae (H. andthecerebrospinalfluid[16].Theendothelialcellswithin influenzae) [39–41], and Listeria monocytogenes [42–44] as the choroid plexus parenchyma are fenestrated and hardly well as coxsackievirus B3 (CVB3) [45, 46], chikungunya virus limit flux of molecules across the endothelial cells [17]. This (CHIKV) [47], and Echovirus 30 (EV30) [48]. The role of the Mediators of Inflammation 3 BBB models BBB models BBB models Monoculture Monoculture Coculture (a) (b) (c) BBB models BBB models BBB models Coculture Coculture Coculture (d) (e) (f) BCSFB models BCSFB models Monoculture Coculture (g) (h) Endothelial cells Pericytes Epithelial cells Astrocytes Figure 2: Schematic representation of various in vitro BBB and BCSFB models. The BBB models areuilt b up around endothelial cells, whereas the BCSFB models rely on epithelial cell culture. The setup can be a monoculture: endothelial or epithelial cells only (a, b, and g); coculture: endothelial cells with epithelial cells (h) or endothelial cells with pericytes or astrocytes (c and d); and triple-culture: endothelialin combination with astrocytes and pericytes (e and f). These
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