Introduction
Microglial cells are brain-specific tissue resident macrophages that are directly derived from yolk-sac erythromyeloid precursor cells (EMP) during embryonic development [
19]. As major contributors to the immune status of the central nervous system (CNS) microglial cells scan the CNS for cellular debris by continuously protract and retract their cell processes [
26]. The microglial survey mediates the immune response, supports the homeostasis of the neurons and, in collaboration with astrocytes, maintains the integrity of the blood-brain barrier (BBB) [
23,
32,
37]. Microglial cells become activated by a large variety of pathogenic situations. Upon activation, the cells take on an amoeboid shape and initiate the paracrine recruitment of blood-derived macrophages into the altered brain parenchyma, initiating an inflammatory response [
2,
11]. Microglia serves additional, only partly known, roles in repair processes following the acute stage of tissue damage [
18,
27]. Recent studies addressing the phenotypic adaptations of peripheral macrophages in cancer have shown that tumor associated macrophages (TAMs), similar to the M1 and M2 activation states of macrophages, display particular marker profiles of pro- and anti-oncogenic action [
25,
31]. TAMs with anti-tumor action share characteristics with M1 macrophages; are capable of antigen presentation and paracrine signaling to promote inflammation, thereby hampering tumor growth and prolonging patient survival [
28,
39]. These cells are referred to as M1-like cells. In contrast, TAMs that promote tumor progression are associated with an immunosuppressive response; contribute to tumor angiogenesis and proliferation, and are associated with poor clinical outcomes [
10,
17,
33] and these cells are referred to as M2-like cells. In general, TAMs are more similar to M2 - than M1 macrophages [
36].
Recent reports have pointed to the heterogeneity of microglial cells [
10]. In glioblastoma, microglia displays a pro-oncogenic phenotype resembling that of M2-like macrophages, because the cells are in a microenvironment rich in glioma (stem) cell derived factors like TGF-β1, MCP-1, PGE-2, and soluble colony stimulating factors [
22]. There is data showing that resident microglia in glioblastomas plays a role in tumor progression and invasion by the release of cytokines and proteases [
24,
35,
38]. However, the mechanism of microglial activation and the contribution of microglia to tumor progression are largely unknown. In order to obtain insight in the specific action of residential microglial cells in gliomas, proper discrimination of these cells from TAMs is necessary. So far, specific markers for residential microglial cells that delineate these cells from other recruited cells of monocyte lineage, are lacking. As a matter of fact, TAMs share many markers with microglial cells. The microglial marker Iba-1 is co-expressed with CD45 and is therefore, not discriminative between residential microglia and monocytic cells that migrated into the brain [
13]. In the brains of patients who suffered from Alzheimer disease (AD) the markers CD45 and Iba-1 were used in combination with P2RY12 to separate macrophages from microglia [
13]. Considering the growing interest in understanding the role of microglial cells in gliomas, specific markers for the identification of resident microglia in the context of primary brain tumors are urgently needed.
Recently, the Purinergic Receptor P2Y12 (P2RY12) was proposed as a specific marker for healthy rodent CNS microglial cells, discriminating these cells from other types of tissue resident macrophages or blood-derived monocytes [
5]. P2RY12 was claimed as a specific marker for microglial cells in human brains [
1,
6,
34]. P2RY12 belongs to the family of P2 purinergic receptors, consisting of seven transmembrane G protein coupled receptors (GPCRs) that contribute to ATP-and ADP-mediated cell migration in vitro [
7]. P2RY12 is expressed in activated platelets and notoriously, in microglial cells [
20]. P2RY12 deficiency in P2RY12 knockdown mice significantly compromised microglial chemotaxis and extension of microglial foot processes in response to CNS injury [
12,
29]. In this study, we scrutinized P2RY12 as a marker for microglial cells in glial tumors. We also investigated the relation between the expression of P2RY12 and that of pro- or anti-inflammatory markers; the expression sites in the microglial cells and the relation with tumor progression.
Discussion
In the present study, we found that resident microglial cells in gliomas specifically express P2RY12 and that the expression distinguishes microglia from other monocytes and macrophages. This finding in human gliomas corroborates the data we generated from the murine gliomas represented in the GEO database. The analysis of the public glioma datasets and the multi-labeling experiments of the glioma biopsy specimens confirmed that P2RY12 mRNA and protein expression is confined to resident microglial cells. In addition, P2RY12 expression is associated with tumor grade: the expression is less in AA and GBM, as compared to A II. However, the expression of P2RY12 is not an independent prognosticator in gliomas; when strong prognostic factors as IDH mutational status or methylation status of MGMT are taken into consideration, no additional effects of the expression are found. The expression of P2RY12 appeared to be higher in the IDH mutated tumors, which is in line with the association of IDH mutation and better prognosis on the one hand, and the pro-inflammatory status on the other. Remarkably, with increasing malignancy grade there is a shift from cytoplasmic to nuclear expression, and in the high-grade tumors the nuclear expression of P2RY12 coincides with that of the M2 markers CD163 and CD204 (Fig.
1a and c, Fig.
4). We also observed that in the high-grade gliomas the P2RY12 positive microglial cells have taken an amoeboid phenotype (Fig.
1b).
Upon pathologic stimuli, resting microglia adopt a highly dynamic phenotype referred to as “ramified microglia”, with an extensive motile set of foot processes that continuously survey the local environment to recognize and eliminate pathogens [
6]. Loss of microglial expression of P2RY12 in knockout mice resulted in impaired polarization, migration and extension of microglial processes towards extracellular nucleotides released from damaged cells, indicating that P2RY12 is required to guide microglial chemotaxis [
12]. Further studies revealed that a raise of local extracellular ATP/ADP levels at the site of CNS injury activates Gi/o-coupled P2RY12, followed by PI3K and PLC signaling-mediated migration of microglial cells towards the chemotactic source [
7]. Exogenous stimuli like lipopolysaccharides (LPS) can cause a dramatic reduction of the P2RY12 expression in microglia cells in vitro accompanied by the retraction of microglial processes and metamorphosis into an amoeboid shape [
12]. These phenomena indicate a function of P2RY12 in the activation of immune regulation during inflammation.
The environmental changes taking place under various pathological conditions cause ATP/ADP leaks that are noticed by the P2RY12 receptors of microglia and lead to changes affecting the cell processes and motility of the cells [
16]. High concentrations of purinergic nucleotides and nucleosides such as adenosine and ATP were shown to work in synergy with LPS activation of microglial cells, promoting chemo repulsion away from the ATP source, a process that is associated with increased local adenosine A2A receptor signaling [
16,
30]. The expression of the adenosine A2A receptor increases significantly in response to LPS, while P2RY12 expression decreased by LPS, indicating that the shift from a ramified towards an amoeboid phenotype depends on the balance between P2RY12 and A2A receptor signaling, respectively [
16]. More studies are required to elucidate the exact regulatory mechanism of microglia immune-activation by these two significant signaling pathways.
In this study we observed nuclear localization of P2RY12 in microglial cells in the high-grade tumors, while in the lower graded astrocytomas P2RY12 was expressed in the cytoplasm. G protein-coupled receptors (GPCRs), such as P2RY12 and its family members are considered as cell surface bound mediators of intracellular signaling. From in vitro and in vivo studies, it is known that some receptors have a nuclear localization. These receptors include the receptors for apelin, angiotensin II AT1, parathyroid hormone, glutamate mGluR5, endothelin ETA and ETB, and the prostaglandins EP1, EP3, and EP4 [
21]. The mechanism and functional implications of nuclear translocation remains obscure. It has been suggested that nuclear import is programmed by the DNA sequence of the receptors. Nuclear GPCRs complex proteins such as heterotrimeric G proteins, phospholipase A2, and phospholipase C seem to remain active in intracellular signaling, similar to the activation of nuclear endothelin and prostaglandin receptors that were proven to increase nuclear Ca
2+concentrations [
21]. However, the functional implications of nuclear localization of the P2RY12 receptor and its association with advanced tumor grade needs to be further unraveled.