Acute effects of ferumoxytol on regulation of renal hemodynamics and oxygenation

The superparamagnetic iron oxide nanoparticle ferumoxytol is increasingly used as intravascular contrast agent in magnetic resonance imaging (MRI). This study details the impact of ferumoxytol on regulation of renal hemodynamics and oxygenation. In 10 anesthetized rats, a single intravenous injection of isotonic saline (used as volume control) was followed by three consecutive injections of ferumoxytol to achieve cumulative doses of 6, 10, and 41 mg Fe/kg body mass. Arterial blood pressure, renal blood flow, renal cortical and medullary perfusion and oxygen tension were continuously measured. Regulation of renal hemodynamics and oxygenation was characterized by dedicated interventions: brief periods of suprarenal aortic occlusion, hypoxia, and hyperoxia. None of the three doses of ferumoxytol resulted in significant changes in any of the measured parameters as compared to saline. Ferumoxytol did not significantly alter regulation of renal hemodynamics and oxygenation as studied by aortic occlusion and hypoxia. The only significant effect of ferumoxytol at the highest dose was a blunting of the hyperoxia-induced increase in arterial pressure. Taken together, ferumoxytol has only marginal effects on the regulation of renal hemodynamics and oxygenation. This makes ferumoxytol a prime candidate as contrast agent for renal MRI including the assessment of renal blood volume fraction

MR Elastography-Based Assessment of Matrix Remodeling at Lesion Sites Associated With Clinical Severity in a Model of Multiple Sclerosis

Magnetic resonance imaging (MRI) with gadolinium based contrast agents (GBCA) is routinely used in the clinic to visualize lesions in multiple sclerosis (MS). Although GBCA reveal endothelial permeability, they fail to expose other aspects of lesion formation such as the magnitude of inflammation or tissue changes occurring at sites of blood-brain barrier (BBB) disruption. Moreover, evidence pointing to potential side effects of GBCA has been increasing. Thus, there is an urgent need to develop GBCA-independent imaging tools to monitor pathology in MS. Using MR-elastography (MRE), we previously demonstrated in both MS and the animal model experimental autoimmune encephalomyelitis (EAE) that inflammation was associated with a reduction of brain stiffness. Now, using the relapsing-remitting EAE model, we show that the cerebellum-a region with predominant inflammation in this model-is especially prone to loss of stiffness. We also demonstrate that, contrary to GBCA-MRI, reduction of brain stiffness correlates with clinical disability and is associated with enhanced expression of the extracellular matrix protein fibronectin (FN). Further, we show that FN is largely expressed by activated astrocytes at acute lesions, and reflects the magnitude of tissue remodeling at sites of BBB breakdown. Therefore, MRE could emerge as a safe tool suitable to monitor disease activity in MS

Technical Developments and Ex Vivo Demonstration in a Mouse Model of Neuroinflammation

Neuroinflammation can be monitored using fluorine-19 (19F)-containing nanoparticles and 19F MRI. Previously we studied neuroinflammation in experimental autoimmune encephalomyelitis (EAE) using room temperature (RT) 19F radiofrequency (RF) coils and low spatial resolution 19F MRI to overcome constraints in signal-to-noise ratio (SNR). This yielded an approximate localization of inflammatory lesions. Here we used a new 19F transceive cryogenic quadrature RF probe (19F-CRP) that provides the SNR necessary to acquire superior spatially-resolved 19F MRI. First we characterized the signal-transmission profile of the 19F-CRP. The 19F-CRP was then benchmarked against a RT 19F/1H RF coil. For SNR comparison we used reference compounds including 19F-nanoparticles and ex vivo brains from EAE mice administered with 19F-nanoparticles. The transmit/receive profile of the 19F-CRP diminished with increasing distance from the surface. This was counterbalanced by a substantial SNR gain compared to the RT coil. Intraparenchymal inflammation in the ex vivo EAE brains was more sharply defined when using 150 μm isotropic resolution with the 19F-CRP, and reflected the known distribution of EAE histopathology. At this spatial resolution, most 19F signals were undetectable using the RT coil. The 19F-CRP is a valuable tool that will allow us to study neuroinflammation with greater detail in future in vivo studies

Stonin1 mediates endocytosis of the proteoglycan NG2 and regulates focal adhesion dynamics and cell motility

Cellular functions, ranging from focal adhesion (FA) dynamics and cell motility to tumour growth, are orchestrated by signals cells receive from outside via cell surface receptors. Signalling is fine-tuned by the exo-endocytic cycling of these receptors to control cellular responses such as FA dynamics, which determine cell motility. How precisely endocytosis regulates turnover of the various cell surface receptors remains unclear. Here we identify Stonin1, an endocytic adaptor of unknown function, as a regulator of FA dynamics and cell motility, and demonstrate that it facilitates the internalization of the oncogenic proteoglycan NG2, a co-receptor of integrins and platelet-derived growth factor receptor. Embryonic fibroblasts obtained from Stonin1-deficient mice display a marked surface accumulation of NG2, increased cellular signalling and defective FA disassembly as well as altered cellular motility. These data establish Stonin1 as a specific adaptor for the endocytosis of NG2 and as an important factor for FA dynamics and cell migration

Treatment of Relapsing Paralysis in Experimental Encephalomyelitis by Targeting Th1 Cells through Atorvastatin

Statins, known as inhibitors of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase, exhibit numerous functions related to inflammation, such as MHC class II down-regulation, interference with T cell adhesion, and induction of apoptosis. Here we demonstrate that both subcutaneous and oral administration of atorvastatin inhibit the development of actively induced chronic experimental autoimmune encephalomyelitis in SJL/J mice and significantly reduce the inflammatory infiltration into the central nervous system (CNS). When treatment was started after disease onset, atorvastatin reduced the incidence of relapses and protected from the development of further disability. Both the reduced autoreactive T cell response measured by proliferation toward the encephalitogenic peptide PLP139–151 and the cytokine profile indicate a potent blockade of T helper cell type 1 immune response. In in vitro assays atorvastatin not only inhibited antigen-specific responses, but also decreased T cell proliferation mediated by direct TCR engagement independently of MHC class II and LFA-1. Inhibition of proliferation was not due to apoptosis induction, but linked to a negative regulation on cell cycle progression. However, early T cell activation was unaffected, as reflected by unaltered calcium fluxes. Thus, our results provide evidence for a beneficial role of statins in the treatment of autoimmune attack on the CNS

Stonin1 mediates endocytosis of the proteoglycan NG2 and regulates focal adhesion dynamics and cell motility

Cellular functions, ranging from focal adhesion (FA) dynamics and cell motility to tumour growth, are orchestrated by signals cells receive from outside via cell surface receptors. Signalling is fine-tuned by the exo-endocytic cycling of these receptors to control cellular responses such as FA dynamics, which determine cell motility. How precisely endocytosis regulates turnover of the various cell surface receptors remains unclear. Here we identify Stonin1, an endocytic adaptor of unknown function, as a regulator of FA dynamics and cell motility, and demonstrate that it facilitates the internalization of the oncogenic proteoglycan NG2, a co-receptor of integrins and platelet-derived growth factor receptor. Embryonic fibroblasts obtained from Stonin1-deficient mice display a marked surface accumulation of NG2, increased cellular signalling and defective FA disassembly as well as altered cellular motility. These data establish Stonin1 as a specific adaptor for the endocytosis of NG2 and as an important factor for FA dynamics and cell migration

Oral High-Dose Atorvastatin Treatment in Relapsing-Remitting Multiple Sclerosis

BACKGROUND:Recent data from animal models of multiple sclerosis (MS) and from a pilot study indicated a possible beneficial impact of statins on MS. METHODOLOGY/PRINCIPAL FINDINGS:Safety, tolerability and effects on disease activity of atorvastatin given alone or in combination with interferon-beta (IFN-beta) were assessed in a phase II open-label baseline-to-treatment trial in relapsing-remitting MS (RRMS). Patients with at least one gadolinium-enhancing lesion (CEL) at screening by magnetic resonance imaging (MRI) were eligible for the study. After a baseline period of 3 monthly MRI scans (months -2 to 0), patients followed a 9-month treatment period on 80 mg atorvastatin daily. The number of CEL in treatment months 6 to 9 compared to baseline served as the primary endpoint. Other MRI-based parameters as well as changes in clinical scores and immune responses served as secondary endpoints. Of 80 RRMS patients screened, 41 were included, among them 16 with IFN-beta comedication. The high dose of 80 mg atorvastatin was well tolerated in the majority of patients, regardless of IFN-beta comedication. Atorvastatin treatment led to a substantial reduction in the number and volume of CEL in two-sided multivariate analysis (p = 0.003 and p = 0.008). A trend towards a significant decrease in number and volume of CEL was also detected in patients with IFN-beta comedication (p = 0.060 and p = 0.062), in contrast to patients without IFN-beta comedication (p = 0.170 and p = 0.140). Immunological investigations showed no suppression in T cell response but a significant increase in IL-10 production. CONCLUSIONS/SIGNIFICANCE:Our data suggest that high-dose atorvastatin treatment in RRMS is safe and well tolerated. Moreover, MRI analysis indicates a possible beneficial effect of atorvastatin, alone or in combination with IFN-beta, on the development of new CEL. Thus, our findings provide a rationale for phase II/III trials, including combination of atorvastatin with already approved immunomodulatory therapy regimens. TRIAL REGISTRATION:ClinicalTrials.gov NCT00616187

Perfluorocarbon Particle Size Influences Magnetic Resonance Signal and Immunological Properties of Dendritic Cells

The development of cellular tracking by fluorine (19F) magnetic resonance imaging (MRI) has introduced a number of advantages for following immune cell therapies in vivo. These include improved signal selectivity and a possibility to correlate cells labeled with fluorine-rich particles with conventional anatomic proton (1H) imaging. While the optimization of the cellular labeling method is clearly important, the impact of labeling on cellular dynamics should be kept in mind. We show by 19F MR spectroscopy (MRS) that the efficiency in labeling cells of the murine immune system (dendritic cells) by perfluoro-15-crown-5-ether (PFCE) particles increases with increasing particle size (560>365>245>130 nm). Dendritic cells (DC) are professional antigen presenting cells and with respect to impact of PFCE particles on DC function, we observed that markers of maturation for these cells (CD80, CD86) were also significantly elevated following labeling with larger PFCE particles (560 nm). When labeled with these larger particles that also gave an optimal signal in MRS, DC presented whole antigen more robustly to CD8+ T cells than control cells. Our data suggest that increasing particle size is one important feature for optimizing cell labeling by PFCE particles, but may also present possible pitfalls such as alteration of the immunological status of these cells. Therefore depending on the clinical scenario in which the 19F-labeled cellular vaccines will be applied (cancer, autoimmune disease, transplantation), it will be interesting to monitor the fate of these cells in vivo in the relevant preclinical mouse models

Identification of Cellular Infiltrates during Early Stages of Brain Inflammation with Magnetic Resonance Microscopy

A comprehensive view of brain inflammation during the pathogenesis of autoimmune encephalomyelitis can be achieved with the aid of high resolution non-invasive imaging techniques such as microscopic magnetic resonance imaging (μMRI). In this study we demonstrate the benefits of cryogenically-cooled RF coils to produce μMRI in vivo, with sufficient detail to reveal brain pathology in the experimental autoimmune encephalomyelitis (EAE) model. We could visualize inflammatory infiltrates in detail within various regions of the brain, already at an early phase of EAE. Importantly, this pathology could be seen clearly even without the use of contrast agents, and showed excellent correspondence with conventional histology. The cryogenically-cooled coil enabled the acquisition of high resolution images within short scan times: an important practical consideration in conducting animal experiments. The detail of the cellular infiltrates visualized by in vivo μMRI allows the opportunity to follow neuroinflammatory processes even during the early stages of disease progression. Thus μMRI will not only complement conventional histological examination but will also enable longitudinal studies on the kinetics and dynamics of immune cell infiltration

Modulation of human antigen-specific T cell response - therapeutic implications for multiple sclerosis

Multiple Sklerose (MS) ist eine heterogene Krankheit des Zentralnervensystems, deren pathologische Mechanismen noch nicht vollständig aufgeklärt sind. Die gegenwärtige Hypothese ist, daß pro-inflammatorische T-Zellen entscheidend an der Pathogenese der MS beteiligt sind. Man geht davon aus, daß eine Fehlregulation der T-Zell-Kontrolle, möglicherweise bedingt durch ein Ungleichgewicht an Apoptose-regulierenden Molekülen, dabei eine Rolle spielt. Tatsächlich zielen therapeutische Strategien darauf ab, T-Zell-Aktivierung, Proliferation und Produktion von Zytokinen zu verringern, oder T-Zell-Eliminierung zu fördern. Diese Arbeit sollte zum einen die Bedeutung regulatorischer Faktoren klären, die für das überleben der T-Zellen von MS-Patienten verantwortlich sind. Zum anderen sollten die antiproliferative oder Apoptose-fördende Wirkung potentiell therapeutisch wirksamer Moleküle untersucht werden. Eine eingeschränkte Regulation der autoreaktiven T-Zellen durch Apoptose in der Peripherie und im ZNS trägt möglicherweise zur Pathophysiologie der MS bei. Als Schlüsselfaktoren der Regulation von Apoptose wurden Mitglieder der Bcl-2-Familie in MS-Patienten und Probanden untersucht. Diese Faktoren wurden in Relation zu der Suszeptibilität der T-Zellen gegenüber aktivierungsinduziertem Zelltod (sog. Activation-induced cell death oder AICD) überprüft. Um die in-vivo-Elimination der Antigen-reaktiven T-Zellen nachzuahmen, wurde ein in-vitro-Modell des AICD mit repetitiver T-Zell-Stimulation verwendet. Tatsächlich zeigten polyklonale T-Zellen von MS-Patienten eine verringerte Suszeptibilität für AICD, nachgewiesen sowohl durch verminderte Caspaseaktivtät (p=0.013) als auch durch DNA-Fragmentierung (p=0.0071). Weiter wurden höhere Spiegel des Proteins Bcl-XL in den Immunzellen von MS-Patienten mit Immunoblotting gemessen (p=0.014). Eine inverse Korrelation zwischen der Expression an Bcl-XL und der Empfindlichkeit der T-Zellen gegenüber AICD steht in Übereinstimmung mit vorhergehenden Daten bezüglich der Bedeutung dieses Proteins für die Apoptose-Resistenz von T-Zellen. Es wurde bereits gezeigt, daß dieses Molekül die Ausprägung der experimentell-autoimmun Enzephalomyelitis, des Tiermodells der MS, verstärkt. Zusammen mit den erhöhten Bcl-XL-Werten bei MS-Patienten, ergeben sich nun Perspektiven für einen therapeutischen Ansatz. Abgesehen von dem Konzept die apoptotische Eliminierung von T-Zellen zu unterstützen, streben gegenwärtige therapeutische Strategien an, die Aktivierung und weitere Proliferation der schädlichen T-Zellen zu hemmen. Basierend auf klinischer Erfahrung mit eher unselektiven Therapien, ist es ein therapeutisches Ziel, neue immunomodulatorische Substanzen mit besserer Selektivität zu finden, um das Nutzen/Risiko-Verhältnis zu maximieren. Aus diesem Grund wurden zwei unterschiedliche Substanzen untersucht die beide den Zellzyklus beeinflussen. Als erster Kandidat wurde der kürzlich entdeckte Todesligand TRAIL (engl.: TNF-related apoptosis inducing ligand) aus der TNF/NGF-Familie untersucht, da diesem bereits T-Zell-regulatorische Funktionen zugeschrieben worden waren, humane Antigen-spezifische T-Zellen jedoch resistent gegenüber TRAIL-induzierter Apoptose sind. Der zweite Kandidat mit potenziell therapeutischer Wirkung bei MS ist Atorvastatin, ein HMG-CoA-Reduktase-Hemmer, der bereits als Lipidsenker bei Patienten eingesetzt wird. Um die Hypothese zu überprüfen, daß diese Substanzen T-Zell-Rezeptor-Signale beeinflussen können, wurden humane Antigen-spezifische T-Zell-Linien von MS-Patienten und gesunden Probanden eingesetzt. Diese wurden hinsichtlich T-Helfer-Phänotyp und Peptid-Spezifität charakterisiert. Eine Behandlung mit TRAIL führte zur Hemmung der Proliferation in unterschiedlichem Ausmaß (6.2% - 63.8%). Atorvastatin hemmte in Abhängigkeit von der Dosis ebenso die Proliferation Antigen-spezifischer T-Zellen. Beide Substanzen wirkten antiproliferativ unabhängig von der Antigenpräsentation, aufgrund ihrer Fähigkeit, die Proliferation in Abwesenheit von professionellen Antigen-präsentierenden Zellen zu vermindern. Diese Eigenschaft weißt auf einen direkten Einfluß auf die T-Zell-Funktion hin. Die TRAIL-induzierte Hypoproliferation war assoziiert mit einer Herunterregulation der Zyklin-abhängigen Kinase CDK4 (engl.: cyclin dependent kinase 4), einem Schlüsselenzym für die nach T-Zell-Rezeptor-Stimulation einsetzende Transition von der G1- zur S-Phase des Zellzyklus. Inkubation mit Atorvastatin induzierte ebenso eine Verminderung von CDK4, begleitet von einer Erhöhung von p27Kip1. Die Atorvastatin-vermittelte Proliferations- und Zellzyklus-Blockade konnte durch Mevalonat rückgängig gemacht werden. Mevalonat ist ein Zwischenprodukt des HMG-CoA-Reduktaseweges. Atorvastatin scheint demnach einen direkten Einfluß auf diese Enzymkaskade zu haben, der wichtig für die Isoprenylierung von GTPase-Proteinen der Rho-Familie ist. T-Zell-Rezeptor-Stimulation führt zur Freisetzung von Kalzium aus intrazellulären Speichern und nachfolgend zur Öffnung transmembranöser Kalzium-Kanäle (sog. calcium release-activated calcium oder CRAC-Kanäle), die eine für die T-Zellaktivierung notwendige und anhaltende Erhöhung der intrazellulären Kalzium-Konzentration hervorruft. Nach Behandlung mit TRAIL wurde eine konzentrationsabhängige Inhibition des Einstroms extrazellulärer Kalzium-Ionen durch die CRAC-Kanäle beobachtet. Dies wurde mit löslichem TRAIL-Rezeptor-Fusionsprotein, einem TRAIL-Antagonisten, rückgängig gemacht. Die Blockade von Kalzium-abhängigen Aktivierungssignalen stellt damit möglicherweise einen primären immunregulatorischen Mechanismus für diese Todesliganden dar. Jedoch wurde keine Auswirkung von Atorvastatin auf die T-Zellaktivierung beobachtet, da der Einstrom von extrazellulärem Kalzium nicht beeinflußt wurde. Während Studien zum TRAIL-vermittelten Einfluß auf die T-Zell-Aktivierung und dem Zellzyklus erst in der präklinischen Phase sind, werden Statine, die ebenfalls den Zellzyklus beeinflussen, bereits in der Therapie anderer Erkrankungen angewand. Darüber hinaus werden derzeit bereits klinische Studien mit Statinen zur MS-Therapie durchgeführt. Weitere Untersuchungen zu den detaillierten Mechanismen antiproliferativer Substanzen mit potenziellem therapeutischen Effekt in der MS ermöglichen die Entwicklung von selektiveren immunomodulatorischen Therapien mit höherem therapeutischen Nutzen für MS-Patienten.Multiple sclerosis (MS) is a heterogeneous disease of the central nervous system whose pathological mechanisms are far from completely understood. The current hypothesis is that pro-inflammatory T cells are orchestrating the pathogenesis of this condition. It is considered that a dysregulation in T cell control to be involved, with an imbalance in apoptosis-regulating molecules possibly playing a role. In fact, therapeutic strategies aim to reduce T cell activation, proliferation and cytokine production or to promote T cell elimination. The focus of this thesis was to identify the role of regulatory molecules for T cell survival in the immune pathogenesis of MS, and to investigate antiproliferative or apoptosis-promoting effects on T cells by potential therapeutic molecules. A limitation in the apoptotic regulation of autoreactive T cells in the periphery and in the CNS may contribute to the pathophysiology of MS. As key regulators of apoptosis, members of the Bcl-2 family were investigated in both MS patients and controls. These factors were examined in relation to the susceptibility of T cells, from both groups, towards activation-induced cell death (AICD). To mimic the in vivo elimination of antigen-reactive T cells, an in vitro model of AICD involving repetitive T cell receptor mediated stimulation was utilized. In fact, polyclonal T cells from MS patients showed a decreased susceptibility to undergo AICD as shown by both caspase activity (p=0.013) and DNA fragmentation (p=0.0071) assays. Furthermore, Bcl-XL protein levels, as measured by immunoblotting, were increased in the peripheral immune cells of MS patients (p=0.014). An inverse correlation observed between Bcl-XL levels and susceptibility of T cells to undergo AICD is in line with previous data on the significance of this anti-apoptotic protein in T cell resistance. Since this molecule has already been shown to aggravate the outcome of experimental autoimmune encephalitis, the animal model for MS, the observation of elevated Bcl-XL levels in patients offers perspectives towards therapeutic manipulation in MS. Apart from promoting apoptotic elimination, current therapeutic strategies aim at inhibiting activation and further proliferation of potentially harmful T cells. Based on clinical experience with rather non-selective therapies that promote T cell elimination, a therapeutic goal is to identify newer immunomodulatory substances with better selectivity in order to maximize the therapy's benefit to risk ratio. Thus, two different substances, both interfering with cell cycle regulation, were investigated. The first candidate was the recently discovered member of the TNF/NGF family of death ligands, TNF-related apoptosis inducing ligand (TRAIL) since it has been reported to have immunoregulatory functions and since human antigen-specific T cells were shown to be resistant towards apoptosis induction by this ligand. The second candidate drug with potential in MS therapy is atorvastatin, a 3-hydroxy-3-methylglutaryl coenzyme (HMG-CoA) reductase inhibitor and lipid-lowering drug, already indicated for anomalies in lipid metabolism. In order to prove the hypothesis that these substances interfere with T cell receptor signaling, human antigen-specific T cell lines from both MS patients and controls, characterized with regards to T helper differentiation and peptide specificity, were employed. Exogenous treatment of TRAIL resulted in an inhibition in proliferation, albeit to varying degrees (6.2% - 63.8% inhibition). Atorvastatin also inhibited proliferation of antigen-specific T cell lines in a dose-dependent manner. Both compounds induced hypoproliferation independently of antigen presentation, as shown by their ability to block T cell proliferation in response to direct T cell receptor engagement, thus indicating a direct influence on T cell function. The growth inhibition by TRAIL was associated with a downregulation of the cell cycle regulator CDK4, indicative of an inhibition of cell cycle progression at the G1/S transition. Incubating T cells with atorvastatin also induced a downregulation of CDK4 expression, which was accompanied by an upregulation of p27Kip1 expression. The atorvastatin-mediated inhibition in proliferation and cell cycle progression could be reversed by mevalonate, an intermediate product of the HMG-CoA reductase pathway, suggesting a direct involvement of atorvastatin in this pathway, necessary for the isoprenylation of small GTPase proteins of the Rho family. Utilizing a thapsigargin model of calcium influx to activate the same calcium-release activated calcium (CRAC) channels as T cell receptor-stimulation by antigen, an inhibition in calcium influx could be observed on pre-incubating T cells with TRAIL. Co-incubating with human recombinant TRAIL receptor 2 fusion protein, a competitive antagonist for TRAIL, reversed this inhibition. A direct influence on calcium influx is indicative of an influence of TRAIL on the activation status of human T cells. Therefore, TRAIL directly inhibits activation of these cells via blockade of calcium influx. However, no impact of atorvastatin on early T cell activation was observed, since calcium influx was unaffected. While TRAIL-mediated interference with T cell activation and further cell cycle progression is still in the pre-clinical phase, statins, which have also been shown here to interfere with the T cell cycle, are already employed in the clinic for other ailments. In fact, clinical trials are currently being undertaken with this group of drugs for MS. Further studies on detailed mechanisms of antiproliferative substances effective in MS will allow the development of highly selective immunomodulatory agents with increased beneficial profile as MS therapy