Ureaplasma-Driven Neuroinflammation in Neonates: Assembling the Puzzle Pieces

Ureaplasma species (spp.) are commonly regarded as lowvirulence colonizers of the genitourinary tract. Intrauterine Ureaplasma infection, however, has been associated with chorioamnionitis and preterm birth. The overall impact of a neonatal Ureaplasma colonization is yet to be understood. High pathogen prevalence and frequent neurological morbidities particularly in immature preterm infants call for an assessment of the significance of Ureaplasma spp. in neonatal neuroinflammation. This narrative review summarizes clinical data, animal studies, and in vitro results to elucidate potential Ureaplasma-associated neurological morbidities as well as underlying mechanisms. Increasing evidence indicates an involvement of Ureaplasma spp. in invasive central nervous system infections, suggesting a meticulous ability of Ureaplasma spp. to interfere with immune defense mechanisms. Ultimately, Ureaplasma spp. should be considered as relevant pathogens in neonatal neuroinflammation

Ureaplasma-driven neonatal neuroinflammation: novel insights from an ovine model

Ureaplasma species (spp.) are considered commensals of the adult genitourinary tract, but have been associated with chorioamnionitis, preterm birth, and invasive infections in neonates, including meningitis. Data on mechanisms involved in Ureaplasma-driven neuroinflammation are scarce. The present study addressed brain inflammatory responses in preterm lambs exposed to Ureaplasma parvum (UP) in utero. 7 days after intra-amniotic injection of UP (n = 10) or saline (n = 11), lambs were surgically delivered at gestational day 128–129. Expression of inflammatory markers was assessed in different brain regions using qRT-PCR and in cerebrospinal fluid (CSF) by multiplex immunoassay. CSF was analyzed for UP presence using ureB-based real-time PCR, and MRI scans documented cerebral white matter area and cortical folding. Cerebral tissue levels of atypical chemokine receptor (ACKR) 3, caspases 1-like, 2, 7, and C–X–C chemokine receptor (CXCR) 4 mRNA, as well as CSF interleukin-8 protein concentrations were significantly increased in UP-exposed lambs. UP presence in CSF was confirmed in one animal. Cortical folding and white matter area did not differ among groups. The present study confirms a role of caspases and the transmembrane receptors ACKR3 and CXCR4 in Ureaplasma-driven neuroinflammation. Enhanced caspase 1-like, 2, and 7 expression may reflect cell death. Increased ACKR3 and CXCR4 expression has been associated with inflammatory central nervous system (CNS) diseases and impaired blood–brain barrier function. According to these data and previous in vitro findings from our group, we speculate that Ureaplasma-induced caspase and receptor responses affect CNS barrier properties and thus facilitate neuroinflammation

Characterization of immortalized murine brain capillary endothelial cells as an in vitro model of the blood brain barrier

Die Blut-Hirn-Schranke reguliert den Transport von Molekülen aus dem Blut in das Gehirn und aus dem Hirngewebe in das Blut. Die Grundlage dieser für den Erhalt der Homöostase im Gehirn wichtigen Schranke bilden zwischen Endothelzellen der Gehirnkapillaren (BCECs) entwickelte, besonders dichte Zonulae Occludentes (Tight Junctions). Viele Krankheiten, zum Beispiel die Multiple Sklerose, gehen mit einer Dysfunktion der BBB einher, die molekularen Grundlagen verschiedener Störungen und damit die Therapiemöglichkeiten sind bisher jedoch oftmals noch unbekannt. Ein grundlegendes Problem der Forschung an der BBB war bislang das Fehlen eines geeigneten immortalisierten in vitro-Modelles zum Verständnis der Differenzierung und Regulierung der Schrankenfunktion. Es gelang nun erstmals, aus murinen BCECs ein solches in vitro-Modell der BBB zu entwickeln, welches wichtige Charakteristika der BBB in vivo aufweist. Zu den Eigenschaften der BBB in vivo zählen allgemein ein hoher transendothelialer elektrischer Widerstand (TER) von bis zu 2000  x cm², die Expression der TJ-Proteine Occludin, Claudin-1, Claudin-3 und Claudin-5 sowie eine geringe Rate transzellulärer Transportvorgänge. Die Entwicklung einer immortalisierten Zelllinie als in vitro-Modell der BBB beinhaltete das Bereitstellen einer möglichst natürlichen Umgebung für die Endothelzellen. Durch Zugabe von Wachstums- und Differenzierungsfaktoren sowie Serumreduktion im Differenzierungsmedium konnte eine dichte Schrankenfunktion induziert werden, welche sich anhand von TER-Messungen nachweisen ließ. Mittels immuncytochemischen und molekularbiologischen Methoden wurde außerdem die Expression verschiedener TJ-Proteine in den immortalisierten BCECs gezeigt. Die Permeabilität der BBB wird durch eine Reihe von Faktoren beeinflusst. So war zu erkennen, dass Glucocorticoide und Insulin die Barrierenfunktion der BBB induzieren und die Zugabe dieser Faktoren die in vitro-Kultivierung von BCECs ermöglicht, ohne dass diese dabei für die BBB in vivo wesentliche Charakteristika verlieren. Diese Ergebnisse stimmen überein mit anderen Studien, denenzufolge für die Induktion und Aufrechterhaltung komplexer Tight Junctions bei kultivierten Endothelzellen Glucocorticoide förderlich sind. Auch klinisch wird dieser Einfluss von Glucocorticoiden bereits genutzt: so konnten im Falle der Multiplen Sklerose Therapieerfolge durch die Gabe von Corticosteroiden erzielt werden.The blood brain barrier is responsible for regulation of transport between blood and brain, thus keeping up the brain's homeostasis. Tight Junctions in between brain capillary endothelial cells are the basis for barrier properties. Many diseases are going hand in hand with or are caused by a leakage within the blood brain barrier. Research was often limited by the lack of a proper in vitro model of the blood brain barrier. Aim of this study was to establish an in vitro model of the blood brain barrier and investigate regulation mechanisms. After cell isolation from murine brains certain growth- and differentiation supplements were added, cells were afterwards investigated regarding typical blood brain barrier properties. These are certain tight junction proteins (e.g. occludine, claudins), a high transendothelial electrical resistance as well as a low rate of transcellular transport. Our results showed the isolated brain capillary endothelial cells to be displaying those properties, thus building a valid in vitro model of the blood brain barrier

Ureaplasma-Driven Neuroinflammation in Neonates: Assembling the Puzzle Pieces

Ureaplasma species (spp.) are commonly regarded as lowvirulence colonizers of the genitourinary tract. Intrauterine Ureaplasma infection, however, has been associated with chorioamnionitis and preterm birth. The overall impact of a neonatal Ureaplasma colonization is yet to be understood. High pathogen prevalence and frequent neurological morbidities particularly in immature preterm infants call for an assessment of the significance of Ureaplasma spp. in neonatal neuroinflammation. This narrative review summarizes clinical data, animal studies, and in vitro results to elucidate potential Ureaplasma-associated neurological morbidities as well as underlying mechanisms. Increasing evidence indicates an involvement of Ureaplasma spp. in invasive central nervous system infections, suggesting a meticulous ability of Ureaplasma spp. to interfere with immune defense mechanisms. Ultimately, Ureaplasma spp. should be considered as relevant pathogens in neonatal neuroinflammation

<b><i>Ureaplasma</i></b>-Driven Neuroinflammation in Neonates: Assembling the Puzzle Pieces

&lt;i&gt;Ureaplasma&lt;/i&gt; species (spp.) are commonly regarded as low-virulence colonizers of the genitourinary tract. Intrauterine &lt;i&gt;Ureaplasma&lt;/i&gt; infection, however, has been associated with chorioamnionitis and preterm birth. The overall impact of a neonatal &lt;i&gt;Ureaplasma&lt;/i&gt; colonization is yet to be understood. High pathogen prevalence and frequent neurological morbidities particularly in immature preterm infants call for an assessment of the significance of &lt;i&gt;Ureaplasma&lt;/i&gt; spp. in neonatal neuroinflammation. This narrative review summarizes clinical data, animal studies, and &lt;i&gt;in vitro&lt;/i&gt; results to elucidate potential &lt;i&gt;Ureaplasma&lt;/i&gt;-associated neurological morbidities as well as underlying mechanisms. Increasing evidence indicates an involvement of &lt;i&gt;Ureaplasma&lt;/i&gt; spp. in invasive central nervous system infections, suggesting a meticulous ability of &lt;i&gt;Ureaplasma&lt;/i&gt; spp. to interfere with immune defense mechanisms. Ultimately, &lt;i&gt;Ureaplasma&lt;/i&gt; spp. should be considered as relevant pathogens in neonatal neuroinflammation. </jats:p

Ureaplasma species modulate cytokine and chemokine responses in human brain microvascular endothelial cells

Ureaplasma species are common colonizers of the adult genitourinary tract and often considered as low-virulence commensals. Intraamniotic Ureaplasma infections, however, facilitate chorioamnionitis and preterm birth, and cases of Ureaplasma-induced neonatal sepsis, pneumonia, and meningitis raise a growing awareness of their clinical relevance. In vitro studies are scarce but demonstrate distinct Ureaplasma-driven impacts on immune mechanisms. The current study addressed cytokine and chemokine responses upon exposure of native or lipopolysaccharide (LPS) co-stimulated human brain microvascular endothelial cells (HBMEC) to Ureaplasma urealyticum or U. parvum, using qRT-PCR, RNA sequencing, multi-analyte immunoassay, and flow cytometry. Ureaplasma exposure in native HBMEC reduced monocyte chemoattractant protein (MCP)-3 mRNA expression (p < 0.01, vs. broth). In co-stimulated HBMEC, Ureaplasma spp. attenuated LPS-evoked mRNA responses for C-X-C chemokine ligand 5, MCP-1, and MCP-3 (p < 0.05, vs. LPS) and mitigated LPS-driven interleukin (IL)-1α protein secretion, as well as IL-8 mRNA and protein responses (p < 0.05). Furthermore, Ureaplasma isolates increased C-X-C chemokine receptor 4 mRNA levels in native and LPS co-stimulated HBMEC (p < 0.05). The presented results may imply immunomodulatory capacities of Ureaplasma spp. which may ultimately promote chronic colonization and long-term neuroinflammation

Regulation and release of vasoactive endoglin by brainendothelium in response to hypoxia/reoxygenation in stroke

In large vessel occlusion stroke, recanalization to restore cerebral perfusion is essential but not necessarily sufficient for a favorable outcome. Paradoxically, in some patients, reperfusion carries the risk of increased tissue damage and cerebral hemorrhage. Experimental and clinical data suggest that endothelial cells, representing the interface for detrimental platelet and leukocyte responses, likely play a crucial role in the phenomenon referred to as ischemia/reperfusion (I/R)-injury, but the mechanisms are unknown. We aimed to determine the role of endoglin in cerebral I/R-injury; endoglin is a membrane-bound protein abundantly expressed by endothelial cells that has previously been shown to be involved in the maintenance of vascular homeostasis. We investigated the expression of membranous endoglin (using Western blotting and RT-PCR) and the generation of soluble endoglin (using an enzyme-linked immunosorbent assay of cell culture supernatants) after hypoxia and subsequent reoxygenation in human non-immortalized brain endothelial cells. To validate these in vitro data, we additionally examined endoglin expression in an intraluminal monofilament model of permanent and transient middle cerebral artery occlusion in mice. Subsequently, the effects of recombinant human soluble endoglin were assessed by label-free impedance-based measurement of endothelial monolayer integrity (using the xCELLigence DP system) and immunocytochemistry. Endoglin expression is highly inducible by hypoxia in human brain endothelial monolayers in vitro, and subsequent reoxygenation induced its shedding. These findings were corroborated in mice during MCAO; an upregulation of endoglin was displayed in the infarcted hemispheres under occlusion, whereas endoglin expression was significantly diminished after transient MCAO, which is indicative of shedding. Of note is the finding that soluble endoglin induced an inflammatory phenotype in endothelial monolayers. The treatment of HBMEC with endoglin resulted in a decrease in transendothelial resistance and the downregulation of VE-cadherin. Our data establish a novel mechanism in which hypoxia triggers the initial endothelial upregulation of endoglin and subsequent reoxygenation triggers its release as a vasoactive mediator that, when rinsed into adjacent vascular beds after recanalization, can contribute to cerebral reperfusion injury

Regulation and Release of Vasoactive Endoglin by Brain Endothelium in Response to Hypoxia/Reoxygenation in Stroke

In large vessel occlusion stroke, recanalization to restore cerebral perfusion is essential but not necessarily sufficient for a favorable outcome. Paradoxically, in some patients, reperfusion carries the risk of increased tissue damage and cerebral hemorrhage. Experimental and clinical data suggest that endothelial cells, representing the interface for detrimental platelet and leukocyte responses, likely play a crucial role in the phenomenon referred to as ischemia/reperfusion (I/R)-injury, but the mechanisms are unknown. We aimed to determine the role of endoglin in cerebral I/R-injury; endoglin is a membrane-bound protein abundantly expressed by endothelial cells that has previously been shown to be involved in the maintenance of vascular homeostasis. We investigated the expression of membranous endoglin (using Western blotting and RT-PCR) and the generation of soluble endoglin (using an enzyme-linked immunosorbent assay of cell culture supernatants) after hypoxia and subsequent reoxygenation in human non-immortalized brain endothelial cells. To validate these in vitro data, we additionally examined endoglin expression in an intraluminal monofilament model of permanent and transient middle cerebral artery occlusion in mice. Subsequently, the effects of recombinant human soluble endoglin were assessed by label-free impedance-based measurement of endothelial monolayer integrity (using the xCELLigence DP system) and immunocytochemistry. Endoglin expression is highly inducible by hypoxia in human brain endothelial monolayers in vitro, and subsequent reoxygenation induced its shedding. These findings were corroborated in mice during MCAO; an upregulation of endoglin was displayed in the infarcted hemispheres under occlusion, whereas endoglin expression was significantly diminished after transient MCAO, which is indicative of shedding. Of note is the finding that soluble endoglin induced an inflammatory phenotype in endothelial monolayers. The treatment of HBMEC with endoglin resulted in a decrease in transendothelial resistance and the downregulation of VE-cadherin. Our data establish a novel mechanism in which hypoxia triggers the initial endothelial upregulation of endoglin and subsequent reoxygenation triggers its release as a vasoactive mediator that, when rinsed into adjacent vascular beds after recanalization, can contribute to cerebral reperfusion injury