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Kynurenine Pathway Modulation Reverses the Experimental Autoimmune Encephalomyelitis Mouse Disease Progression Gayathri Sundaram1,2, Chai K

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Kynurenine Pathway Modulation Reverses the Experimental Autoimmune Encephalomyelitis Mouse Disease Progression Gayathri Sundaram1,2, Chai K Sundaram et al. Journal of Neuroinflammation (2020) 17:176 https://doi.org/10.1186/s12974-020-01844-y RESEARCH Open Access Kynurenine pathway modulation reverses the experimental autoimmune encephalomyelitis mouse disease progression Gayathri Sundaram1,2, Chai K. Lim3, Bruce J. Brew1,2,4* and Gilles J. Guillemin1,5* Abstract Background: Multiple sclerosis (MS) is a chronic immune-mediated disorder of the central nervous system characterized by demyelination, neuroinflammation, and neurodegeneration. Activation of the kynurenine pathway (KP) results from acute and chronic neuroinflammation leading to both immune suppression and neurotoxicity. However, the exact effects of KP metabolites and changes in neurodegenerative diseases over time are not fully understood. Studies, including those in MS models, have reported that short-term KP activation is beneficial through immune tolerance. However, the effects of long-term KP activation are poorly understood. We hypothesized that such chronic activation is responsible for the neurodegeneration in MS, and further, modulating the KP in EAE-induced mice could significantly decrease the EAE disease severity. Methods: We biochemically altered the KP at different stages of the disease in experimental allergic encephalomyelitis (EAE) mouse model of MS and at two different enzymatic levels of the KP (IDO-1 (indoleamine 2, 3 dioxygenase)) and KMO (kynurenine monooxygenase). CNS tissue and blood samples were analyzed longitudinally using GCMS, HPLC, IHC, and RT-PCR. Results: We showed that the KP was steadily upregulated correlating with disease severity and associated with a shift towards increasing concentrations of the KP metabolite quinolinic acid, a neuro- and gliotoxin. KP modulation by inhibition of IDO-1 with 1-methyl tryptophan (1-MT) was dependent on the timing of treatment at various stages of EAE. IDO-1 inhibition at EAE score 2 led to significantly higher numbers of FoxP3 cells (p < 0.001) in the spleen than earlier IDO-1 inhibition (prophylactic 1-MT treatment group (p < 0.001)), 1-MT treatment after EAE induction (EAE score 0; p < 0.001), and 1-MT treatment at EAE score of 1 (p < 0.05). Significant improvement of disease severity was observed in EAE mice treated with 1-MT at EAE score 2 compared to the untreated group (p < 0.05). KP modulation by KMO inhibition with Ro 61-8048 led to significantly greater numbers of Foxp3 cells (p < 0.05) in Ro 61-8048 treated mice and even more significant amelioration of EAE disease compared to the 1-MT treatment groups. (Continued on next page) * Correspondence: [email protected]; [email protected] Bruce J. Brew and Gilles J. Guillemin are equal last authors. 1Peter Duncan Neurosciences Research Unit, St Vincent’s Centre for Applied Medical Research, Sydney, NSW 2010, Australia Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. 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 in a credit line to the data. Sundaram et al. Journal of Neuroinflammation (2020) 17:176 Page 2 of 14 (Continued from previous page) Conclusions: These results provide a new mechanistic link between neuroinflammation and neurodegeneration and point to KP modulation at the KMO level to preserve immune tolerance and limit neurodegeneration in EAE. They provide the foundation for new clinical trials for MS. Keywords: Multiple sclerosis, Tryptophan, Kynurenine pathway, Quinolinic acid, Neuroinflammation, Neurodegeneration Background MS patients will eventually develop a secondary progres- Multiple sclerosis (MS) is a complex inflammatory and sive phase characterized by neurodegeneration without demyelinating disease of the central nervous system relapses but still associated with neuroinflammation. (CNS) characterized by the presence of plaques [1]. Presently, it is not clear whether the two processes of These are associated with immune activation, especially neuroinflammation and neurodegeneration are causally of the innate immune system [2]. Much of the evidence linked, or mostly independent. While the short-term role for MS pathogenesis and its disease modifying therapies of KP activation appears to be beneficial in suppressing comes from studies of the experimental autoimmune en- neuroinflammation, long-term KP activation is likely cephalomyelitis (EAE) mouse model. Traditionally, the detrimental due to the production of excessive neuro- CD4+ T-cell subsets, Th1 and Th17 cells, are considered toxic metabolites of the KP. This is supported by our to be the encephalitogenic T-cells in both MS and EAE earlier study on MS patients showing a shift in the KP mice. These Th1 cells have many effects, but the rele- towards more neurotoxic products that correlated with vance here is that they increase the secretion of the pro- worsening of the disease and the switch to the secondary inflammatory cytokine and interferon-γ (IFN-γ)[3]. progressive phase of MS [9]. Given the relationship be- While IFN-γ has pleiotropic effects, it is also one of the tween the KP and neuroinflammation and neurodegen- most potent activators of the kynurenine pathway (KP). eration, especially the KP derived toxin QUIN, we IFN-γ induces indoleamine 2,3-dioxygenase (IDO-1), a hypothesized that activation of the KP in MS provides a tryptophan (TRP)-catabolizing enzyme, which is the first new mechanistic link between neuroinflammation and enzyme of the KP (see Fig. 1a). IDO-1-expressing cells neurodegeneration. To test this, we used a chronic-EAE exert a profound inhibitory effect on T-cells, which in mouse model to better represent the chronic progressive turn suppress the proinflammatory processes that occur form of MS due to similarities in disease susceptibility, in response to tissue damage [4]. However, KP activation course, and histopathology. The KP was inhibited at the also leads to increasing amounts of 3-hydroxy kynure- initial step (IDO-1) and midway at the kynurenine nine (3-HK), a free radical generator, as well as quinoli- monooxygenase (KMO) step (Fig. 1a). Our hypothesis nic acid (QUIN), a neuro- and gliotoxin acting primarily was that modulating the KP in EAE-induced mice could through the N-methyl-D-aspartate (NMDA) receptor. significantly decrease the EAE disease severity. Kynurenic acid (KYNA), a neuroprotective antagonist of We injected 1-methyl-tryptophan (1-MT; IDO-1 in- NMDA receptors, is also produced. The relative hibitor) and Ro 61-8048 (KMO inhibitor) after the mice amounts of these, and their effects in the context of had developed EAE at a score of 2. This was to ensure chronic inflammation, are poorly understood. that IDO-1 induction had enough time to trigger im- There are several lines of evidence supporting the mune tolerance and to determine the therapeutic ability presence of activation of the KP in MS and its biological of KP modulators to prevent neurodegeneration (as op- significance. In MS patients, TRP levels are decreased in posed to other studies that had inhibited the KP at an both plasma and CSF [5]. This is potentially biologically earlier time point before the development of tolerance). significant as IDO-1 activation leads to decreased in- The clinical course was measured in conjunction with flammation through suppression of T-cell responses and immunohistochemistry (IHC), qRT-PCR, uHPLC, and promotion of tolerance [6]. Furthermore, there is in- GC-MS techniques to quantify the KP metabolites in- creased expression and production of the KP enzymes, volved in neuroprotection and neurotoxicity. Our results kynurenine amino transferases 1 and 2 (KAT 1 and 2), reveal a dynamic interplay between KP metabolites and in red blood cells and their resulting metabolite KYNA EAE disease development. They demonstrate that KP ac- in the plasma of MS patients [7]. Indeed, the CSF KYNA tivation is a crucial component in MS neuropathogenesis concentrations are increased during an acute relapse and and link neuroinflammation with neurodegeneration. decreased in the chronic phase [8]. Furthermore, this study demonstrates that altering the In the long term, MS is often associated with neurode- KP with specific enzyme inhibitors is likely to have generation. Approximately 50% of relapsing remitting therapeutic potential for MS. Sundaram et al. Journal of Neuroinflammation (2020) 17:176 Page 3 of 14 Fig. 1 Experimental autoimmune encephalomyelitis (EAE). a Schematic illustration of kynurenine pathway (KP). KP is depicted as metabolites in black, enzymes in blue. b Experimental procedure to induce experimental autoimmune encephalomyelitis (EAE) in C57BL/6 mice with MOG35-55 peptide (myelin oligodendroglial protein) and pertussis toxin (PTx). c Mean daily clinical score in the EAE (n = 18) and healthy mice (n = 15). d Body weight of EAE and healthy mice was determined (mean ± SD). e–i Inflammation, demyelination, and neuronal loss in EAE-induced mice spinal cord. e The inflammatory foci (mean ± SD) counted in H&E stained axonal sections of EAE and healthy control. f and g Representative histological spinal cord sections of healthy (f) and EAE mice (g) stained with H&E. h Demyelination (% area) without inflammation detected by Luxol Fast Blue (LFB)/cresyl violet staining.
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