Brain Advance Access originally published online on May 6, 2004
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Brain, Vol. 127, No. 6, 1313-1331, 2004
© 2004 Guarantors of Brain
doi: 10.1093/brain/awh156
Simultaneous neuroprotection and blockade of inflammation reverses autoimmune encephalomyelitis
Department of Molecular Medicine & Pathology, Faculty of Medicine and Health Science, University of Auckland, Auckland, New Zealand
Correspondence to: Associate Professor Geoffrey Krissansen, Department of Molecular Medicine & Pathology, Faculty of Medicine and Health Science, University of Auckland, 85 Park Road, Grafton, Auckland, New Zealand. E-mail: gw.krissansen{at}auckland.ac.nz
In multiple sclerosis, the immune system attacks the white matter of the brain and spinal cord, leading to disability and/or paralysis. Myelin, oligodendrocytes and neurons are lost due to the release by immune cells of cytotoxic cytokines, autoantibodies and toxic amounts of the excitatory neurotransmitter glutamate. Experimental autoimmune encephalomyelitis (EAE) is an animal model that exhibits the clinical and pathological features of multiple sclerosis. Current therapies that suppress either the inflammation or glutamate excitotoxicity are partially effective when administered at an early stage of EAE, but cannot block advanced disease. In a multi-faceted approach to combat EAE, we blocked inflammation with an anti-MAdCAM-1 (mucosal addressin cell adhesion molecule-1) monoclonal antibody and simultaneously protected oligodendrocytes and neurons against glutamate-mediated damage with the 
-amino-3-hydroxy-5-methyl-4-isoxazolepropionate (AMPA)/kainate antagonist 2,3-dihydroxy-6-nitro-7- sulfamoylbenzo(f)quinoxaline (NBQX) and the neuroprotector glycine–proline–glutamic acid (GPE; N-terminal tripeptide of insulin-like growth factor). Remarkably, administration at an advanced stage of unremitting EAE of either a combination of NBQX and GPE, or preferably all three latter reagents, resulted in amelioration of disease and repair of the CNS, as assessed by increased oligodendrocyte survival and remyelination, and corresponding decreased paralysis, inflammation, CNS apoptosis and axonal damage. Each treatment reduced the expression of nitric oxide and a large panel of proinflammatory and immunoregulatory cytokines, in particular IL-6 which plays a critical role in mediating EAE. Mice displayed discernible improvements in all physical features examined. Disease was suppressed for 5 weeks, but relapsed when treatment was suspended, suggesting treatment must be maintained to be effective. The above approaches, which allow CNS repair by inhibiting inflammation and/or simultaneously protect neurons and oligodendrocytes from damage, could thus be effective therapies for multiple sclerosis.
Key Words: glutamate receptor antagonist; MAdCAM-1 antibody; encephalomyelitis; cell adhesion
Abbreviations:
AMPA= -amino-3-hydroxy-5-methyl-4-isoxazolepropionate; CNPase = 2'3'-cyclic nucleotide 3'-phosphodiesterase; DAB = diaminobenzidine; EAE = experimental autoimmune encephalomyelitis; ELISA = enzyme-linked immunosorbent assay; GFAP = glial fibrillary acidic protein; GluR = glutamate receptor; GPE = glycine–proline–glutamic acid; Ig = immunoglobulin; IGF-1 = insulin-like growth factor-1; IL = interleukin; IFN = interferon; mAb = monoclonal antibody; MAdCAM-1 = mucosal addressin cell adhesion molecule-1; MOG = myelin oligodendrocyte glycoprotein; MBP = myelin basic protein; NBQX = 2,3-dihydroxy-6-nitro-7-sulfamoylbenzo(f)quinoxaline; NMDA = N-methyl-D-aspartate; PBS = phosphate-buffered saline; RPAs = RNase protection assays; SDF = stromal cell derived factor; TGF = transforming growth factor; TNF = tumour necrosis factor; TUNEL = terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate-digoxigenin nick end labelling.
Received November 9, 2003. Revised January 18, 2004. Accepted January 19, 2004.
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