Background
Chemical warfare nerve agents (CWNA) were developed during World War II but remain a significant threat through deployment by hostile nations or by terrorist organizations [
1]. CWNA, such as soman (pinacolyl methylphosphonofluoridate, GD), rapidly and irreversibly bind to acetylcholinesterase, causing excess acetylcholine accumulation in the central and peripheral nervous systems. GD exposure can cause intense tonic-clonic convulsions, respiratory paralysis and possibly death [
2]. Following exposure, the ensuing cholinergic crisis leads to the development of status epilepticus (SE) that can continue unabated for many hours [
3]. SE induces neuroinflammatory gliosis [
4] and profound neuronal cell loss in the piriform cortex, hippocampus, amygdala and thalamus [
5,
6]. Excitotoxic neural damage following GD exposure activates a neuroinflammatory response [
7‐
10], which may contribute to the neuropathology.
The extent to which neuroinflammation contributes to cell loss following central nervous system (CNS) injury largely depends on many factors, such as local environment, concentration of the inflammatory mediators, the responding immune cell phenotype and the timing of their interaction with damaged neural cells [
11,
12]. In severe and progressive CNS injuries, increased neuroinflammatory activity appears detrimental since anti-inflammatory treatments are successful in reducing brain pathology in animal models of CNS injury [
13,
14]. Following injury, infiltrating leukocytes and activated macrophages release many inflammatory proteins, including the acute phase response (APR) inducing cytokines IL-1, IL-6 and TNF-α [
15]. Though pluripotent, cytokines such as IL-1 (α and β) and TNF-α are toxic to neural tissues
in vitro [
16‐
18] and can exacerbate experimental CNS injury
in vivo [
19‐
21].
Evidence of neuroinflammation following GD-induced SE has been shown at the level of gene transcription [
7‐
10], though data are limited on protein upregulation [
22,
23]. Therefore, the purpose of this study was to investigate the extent and maturation of the neuroinflammatory response by examining cytokine protein increases following GD exposure up to 72 hours after SE onset. Protein levels of ten cytokines were quantified using a multiplex bead immunoassay in brain tissue lysates of SE-injury susceptible regions (i.e., piriform cortex, thalamus and hippocampus). APR cytokines were markedly elevated in vulnerable brain regions and were localized to resident neural cells (i.e., neurons, astrocytes or microglia). These data are the first to show concurrent cytokine protein upregulation and cellular origin of these factors following GD-induced SE.
Discussion
Brain damage caused by CWNA induced seizure activity can cause profound behavioral changes in animals [
26,
27] and may lead to behavioral impairment and a reduced quality of life for CWNA exposure survivors [
28]. Neuroinflammation is common following many types of brain injury, including seizure activity, and may exacerbate brain pathology following GD-induced SE. Our current understanding of the neuroinflammatory process following GD exposure is limited to mRNA transcript [
7‐
10] and protein levels of a small number of factors [
23]. Neuroinflammation has been associated with brain pathology in many CNS injury models [
29‐
31] since many inflammatory mediators are toxic to neural cells [
16,
20]. This study reveals a strong induction of innate inflammatory cytokines in brain regions vulnerable to GD-induced SE.
Here, the regional and temporal protein concentration changes of 10 cytokines were quantified following GD-induced SE. We focused on three brain regions where damage is robust following GD exposure, the piriform cortex, hippocampus and thalamus [
6,
32]. The protein concentrations of four APR cytokines (IL-1α, IL-1β, IL-6 and TNF-α) significantly increase and compare favorably with previously reported mRNA data [
7,
9,
10]. Transcript work in a mouse model of GD exposure [
7] revealed results similar to those reported here for IL-1β and IL-6, though TNF-α protein peaks in the rat model precede their observed mRNA peaks in the mouse model by approximately 12 hours. These discrepancies may be due to differences in HI-6 pretreatment time (5 vs. 30 minutes prior), HI-6 concentration (50 vs. 125 mg/kg), AMN treatment (none vs. 1 minute) or species physiology (mouse vs. rat). The closest comparison to this study reported mRNA expression peaks in the piriform cortex at 2 hours for TNF-α and 6 hours for IL-1β and IL-6, between 10-18 hours before the protein peaks shown in this study [
10]. In this case, transcription of the mRNA predictably precedes translation of the protein. However, they saw no significant increases in TNF-α or IL-6 mRNA but did report a significant increase in IL-1β mRNA in the hippocampus, contrary to the protein data reported here. It is unknown why these differences occurred. However, a strong increasing trend is apparent in both the mRNA (TNF-α and IL-6) and protein data (IL-1β) that is consistent with the aforementioned transcription/translation pattern and could conceivably be resolved by more data points.
Neurons, activated microglia, and astrocytes can produce neurotoxic cytokines in the brain following CNS injury [
33]. In this study, activated microglia produce both IL-1α and β, whereas dystrophic microglia express only IL-1β. Morphologically, dystrophic microglia display characteristics that may include deramification, spheroid formation, beading along the processes and cytorrhexis [
34]. It is well established that IL-1 expression by activated microglia can lead to tissue injury following CNS damage [
35,
36], but little is known about dystrophic microglia or why they might preferentially express one IL-1 isoform over the other. Dystrophic microglia only appear in progressive neurodegenerative disease states [
34,
37] and may be indicative of the rapid progression of an acute pathological process in this model. Coupled with the observation that IL-1β is the major form of IL-1 that contributes to CNS damage following injury [
38,
39], IL-1β expression by dystrophic microglia may represent yet another signal by an injured cell to propagate the inflammatory cascade. Though unable to localize TNF-α to specific cells, expression of this pro-inflammatory cytokine can also be detrimental to neural cells in the injury area. TNF-α does not appear to be directly neurotoxic to neurons, but expression as part of neuroinflammation greatly exacerbates excitotoxic cell death in the presence of excess glutamate [
40], a condition that likely occurs following GD exposure [
24]. Overall, expression of TNF-α, IL-1α and IL-1β is neurotoxic, contributing to neuronal cell death, edema and blood brain barrier failure following CNS injury [
18,
41,
42] and likely has a similar role following GD-induced SE.
IL-6 was expressed primarily by neurons and, to a lesser extent, by hypertrophic astrocytes in this model. IL-6 expression occurs in both cell types [
43‐
45] and can be neuroprotective
in vivo [
45,
46] and
in vitro [
43]. Since neurons are particularly vulnerable to GD-induced SE damage [
6,
47], expression of a factor that promotes neuronal survival by inducing the expression of metallothionein I + II and granulocyte-macrophage colony-stimulating factor in macrophages [
48], stimulates the release of nerve growth factor from astrocytes [
49] and inhibits neutrophil infiltration [
32] to counter neurotoxic inflammatory factors such as IL-1is not surprising. Furthermore, IL-6 expression begins the synthesis of corticotrophin and glucocorticoids [
50], initiating an anti-inflammatory feedback loop. Expression of IL-6 predictably follows early expression of IL-1α, IL-1β and TNFα. Therefore, IL-6 expression by neurons and astrocytes may be a neuroprotective mechanism initiated following the neurotoxic expression of IL-1 in microglia.
Acknowledgements
The authors would like to thank Thuy Dao, Andrew Koemeter-Cox, Michelle Guignet, Claire Geddes and Jennifer Peeling for their expert technical support and Dr. Wolfgang Streit, University of Florida College of Medicine, for his assistance in identifying dystrophic microglia. This work was supported by the US Army Medical Research and Materiel Command and by the Defense Threat Reduction Agency (I10001_04_RC_C and W911NF-07-D-001). The findings contained herein are the private views of the author(s) and are not to be construed as official or as reflecting the views of the US Army or Department of Defense.
Competing interests
The authors declare that they have no competing interests.
Authors' contributions
EAJ analyzed all data, wrote the manuscript and participated in acquisition of data. EAJ and RKK both participated in developing the study concept and experimental design. Both authors read and approved the final manuscript.