Cytokines and Brain
Cytokines and Brain
Cytokines and Brain
Abstract
Cytokines are molecules secreted by peripheral immune cells, microglia, astrocytes and neurons in
the central nervous system. Peripheral or central inflammation is characterized by an upregulation
of cytokines and their receptors in the brain. Emerging evidence indicates that pro-inflammatory
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cytokines modulate brain excitability. Findings from both the clinical literature and from in vivo
and in vitro laboratory studies suggest that cytokines can increase seizure susceptibility and may
be involved in epileptogenesis. Cellular mechanisms that underlie these effects include
upregulation of excitatory glutamatergic transmission and downregulation of inhibitory
GABAergic transmission.
Keywords
Cytokine; Inflammation; Seizure; Epilepsy; Synapse; Interleukin; Tumor necrosis factor α;
Chemokine; Lipopolysaccharide; Febrile convulsion
1. Introduction to cytokines
Cytokines are signaling proteins secreted primarily by cells of the immune system, including
monocytes, macrophages (e.g. Kupffer cells, microglia), lymphocytes (B and T cells), and
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vascular endothelial cells that signal the detection of pathogens and activate cellular
networks to initiate the appropriate immunological responses. There are many classes of
cytokines including numerous interleukins, lymphokines, chemokines, hematopoietins,
interferons, as well as members of the platelet derived growth factor (PDGF), transforming
growth factor (TGF) and tumor necrosis factor (TNF) families. In this review we will focus
on the interleukins and TNFα, as they have been most extensively investigated in the context
of brain function and excitability.
Cytokines play a role in several aspects of normal central nervous system (CNS) function.
For example they participate in the regulation of sleep [84] and a variety of neuroendocrine
functions [132], plus play important roles in neuronal development [17,56,57] and possibly
in normal ageing [94]. However, there is increasing attention directed towards understanding
*
Corresponding author at: Hotchkiss Brain Institute, Department of Physiology and Pharmacology, Faculty of Medicine, University of
Calgary, Calgary, Alberta, Canada. Fax: +1 403 283 2700. [email protected] (Q.J. Pittman).
Galic et al. Page 2
cytokines as common mediators of altered CNS function during inflammatory states from
bacterial and viral infections of either the brain [71,88], or the periphery [78,82], and disease
processes with strong inflammatory components such as colitis, multiple sclerosis, acute
liver failure, amyotrophic lateral sclerosis, and Alzheimer’s Disease (reviewed in
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[20,25,108,128]). It is also well established that brain trauma including that caused by
stroke, results in massive increases in cytokine synthesis that are associated with important
effects upon recovery [3,146]. In many of these inflammatory CNS pathologies, a common
feature is the appearance of other CNS behavioral co-morbidities [170] and an increase in
excitability of the brain, sometimes manifested in the form of seizures or of acquired
epilepsy [153]. It is possible that the increased excitability leading to increased seizure
susceptibility may also be a mechanism underlying neuronal changes in brain areas
associated with behavior, but this has received little investigation to date. Thus, while
referring to important studies of cytokine participation in several inflammatory states, we
will focus this review primarily on cytokine mediation of a number of experimental models
of seizures along with reference to clinical data.
responses, signaling at the BBB appears to be the dominant means by which the brain
responds to peripheral signals; endothelial and perivascular cells synthesize prostaglandin E2
[59,138,144] which diffuses into the parenchyma to stimulate heat conservation and
production pathways in the hypothalamus and cause fever [90,134]. In addition, neurons
controlling endocrine function also respond to prostaglandins, most notably the
corticotrophin releasing factor neurons in the paraventricular nucleus that stimulate
adrenocorticotrophic hormone release from the pituitary and adrenal secretion of
corticosteroids [79].
In addition, there is now good evidence for movement of leukocytes through a largely intact
BBB during peripheral inflammation. This is thought to occur through the activation of the
cerebral endothelium in the presence of pro-inflammatory messengers [120]. This increases
endothelial cell expression of adhesion factors that are critical for cellular recruitment into
tissues. These adhesion molecules include selectins and integrins that facilitate the
extravasation of leukocytes through the endothelium and into the brain. Recent evidence
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Peripheral inflammation is but one example of a process that initiates cytokine production.
As the brain possess TLRs of various subtypes, direct inflammation of the brain, for
example during encephalitis will also upregulate cytokine production [55,76]. In fact, almost
any pathological process in the brain appears to be accompanied by, and exacerbated by
cytokine generation; these include traumatic brain injury [77], epileptic seizures [162],
ischemia [36,33], multiple sclerosis [25] and neurodegenerative diseases such as
Alzheimer’s Disease [41]. While each of these conditions has unique pathologies and
behavioral correlates, a common feature of all of them is the higher prevalence of seizures or
reduced threshold for induction of seizures. Thus we will now focus upon the evidence
implicating cytokines in seizures.
tissue or cerebral spinal fluid (CSF) from patients with chronic seizure disorders (rev. in [4]).
For example, some types of medically intractable epilepsy arising from focal cortical
malformations are associated with both increased gene expression [15] and elevated levels of
pro-inflammatory cytokines in the CNS [16,29,74,121]. Moreover, in surgical tissue samples
from patients with temporal lobe epilepsy where there are pathological features of
hippocampal sclerosis (a condition of gliosis and neuronal loss), Vezzani and colleagues
[122] have reported both activated microglial cells and increased cytokines. Cytokine levels
in the CSF of patients with seizures correlate with both seizure occurrence and duration
[91,92,111]. A number of studies have also explored the involvement of cytokines in febrile
convulsions in children but there is still no consensus regarding the risk that febrile seizures
pose on the development of adult epilepsy (rev in [39,125]).
Experimental studies in rodents have also reported a strong association between elevated
CNS levels of cytokines or of increased expression of cytokine mRNA and increased seizure
susceptibility [9,32,35,166]. Seizures elicited by convulsants in either mature [103,157,161]
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or immature [145] rats showed increases in CNS cytokine levels or cytokine expression (Fig.
1). With the use of other immature rodent models of febrile seizures, some groups have
shown temporary increases in cytokine levels after febrile seizures that return to control
levels within 48 h [40,65] (Fig. 2). Similarly, rats subjected to status epilepticus (a state of
persistent seizure) by electrical stimulation of the hippocampus [32] or those that had been
kindled (condition whereby seizures appear after repeated subthreshold stimulation of the
brain) by amygdala stimulation [115] also showed increased expression of both pro- and
anti-inflammatory cytokines. Most recently, it was reported that a rat model of absence
seizures, the Genetic Absence Epilepsy Rat, has elevated IL-1β in the cortex [1].
In addition to the persuasive evidence that seizure activity itself causes cytokine synthesis in
the brain (rev in [162]), seizures also upregulate IL-1β receptor type 1 [124], in part via
release of the molecule High Mobility Group Box 1 (HMGB1) that activates brain TLR-4
and TLR-2 (with consequent activation of cytokine synthesis) and potentiates the activity of
pro-inflammatory cytokines [99,110]. However, the findings that cytokines and cytokine
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receptors are elevated in association with seizure activity is not necessarily evidence that
they are players in terms of initiating or augmenting the enhanced excitability. To partially
address this criticism, investigators have carefully examined the time course of cytokine
generation; the observations that cytokines are already elevated at the onset of seizures raises
the likelihood that they may be causal [65,162]. The direct evidence came from studies
looking at over-expression of cytokines in transgenic animals where overt seizures were seen
in the absence of precipitating toxins [22,116].
inflammation that is known to induce central cytokines, or direct inflammation of the brain
via targeting of either TLR-4 or other TLRs also enhances seizures or reduces the threshold
to seizurogenic stimuli [5,6,63,63,95,99,127,131,139]. Even more importantly, blockade of
cytokine action in the brain, for example with exogenous application of IL-1ra (the natural
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Inflammation and cytokine release has been suspected also to participate in the very process
of epileptogenesis [40,64,122]. In different models of febrile seizures, cytokines are elevated
acutely [40,65] or chronically [40] and cause either augmented brain excitability [66], or
frank spontaneous seizures to occur [37]. Subsequently, it was shown that inflammation in
the postnatal period, whether caused by peripheral LPS alone [54], hyperthermic seizures
[40], a combination of the two [7] or direct activation of brain TLR-3 [55] caused brain
cytokines to increase and a long lasting state of increased brain excitability in adult rats.
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reviews should be consulted for detailed information. In the following section we will focus
in particular upon actions of pro-inflammatory cytokines that may help to understand their
role in increasing neuronal excitability.
IL-1β activity has been most extensively investigated in the context of its pro-convulsive
effects, with most studies focused on the acutely prepared hippocampal slice taken from
juvenile, post-weaning rodents. In this regard, it is an important, but usually overlooked fact,
that slicing the brain itself constitutes a major trauma. Given that trauma is a well known
inducer of cytokine production [3], it is not surprising that, of 17 cytokine mRNAs examined
within 3 h of slicing and maintained in vitro under standard slice conditions, 3 were
upregulated (including IL-1α and IL-1β) and 4 were downregulated (including IL-1ra). Thus
it is likely that many of the cellular changes reported are in the context of background
cytokine ‘tone’. However, an alternate approach is to examine cytokine actions in cultured
neurons that are normally harvested from late gestation fetuses (day 18–19) and incubated
for 10–20 days, where one would suspect the traumatic effects of the culturing procedure
would be mitigated during that time. Nonetheless, as cytokines play important roles in the
development of the nervous system [83], this approach also has limitations, as the rodent
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brain at this time is still very immature and developmental trajectories involving cytokine
action will undoubtedly be altered in these cultures.
Acute IL-1β application appears to have little if any effect upon resting membrane potential,
although active, regenerative currents have been reported to be altered. In hippocampal CA1
neurons, IL-1β at low doses (≤1 ng/mL) reversibly inhibited voltage dependent calcium
currents via a protein kinase C mediated action [114]. If similar effects were to take place at
the synapse, this could cause a reduction in transmitter release. Support for this possibility
comes from reports that low levels of IL-1β decrease intracellular calcium in cortical
synaptosomes [23]. In this regard, in vitro studies have examined IL-1β modulation of
gamma-amino butyric acid (GABA) and glutamate release from hippocampal slices, but the
predominant effect was a dose-dependent (1–35 ng/mL) increase in calcium-dependent
glutamate and GABA release [175]. Thus it is possible that the effects of IL-1β on
neurotransmitter release are dependent on concentration whereby higher levels are
associated with increased transmitter release. Such dichotomy in function also helps explain
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why low levels of cytokines that are released during fever appear to be associated with
sickness behaviors characterized by lethargy and decreased activity [14,83], while higher
levels may enhance neuronal excitability. In addition, whatever the cellular mechanism, it is
important to note that an identical cellular action on an inhibitory interneuron and an
excitatory output neuron will have very different effects on the circuit output, depending
upon the site of action.
In terms of mechanism of action, one potentially interesting hypothesis is that IL-1β could
affect a depolarizing, hyperpolarization-activated cationic current known as Ih. As
previously discussed, IL-1β has been shown to be important in epileptogenesis after neonatal
seizures [40]. These same investigators have also reported that there are profound alterations
in the properties of Ih after the neonatal seizures [19]. To the best of our knowledge, no one
to date as specifically addressed the question of whether or not cytokines regulate the
properties of this current.
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The most promising studies on cellular actions of IL-1β have examined its effects on
synaptic signaling. With respect to glutamate receptors, it is the alpha-amnio-3-hydroxy-5-
methyl-4-isoxazole-propionic acid (AMPA) receptor that mediates the majority of excitatory
transmission. Incubation of cultured hippocampal neurons for 1 h with 10–50 ng/mL of
IL-1β decreased surface expression of AMPA receptors. This effect was receptor mediated,
independent of synaptic transmitter release and associated with a calcium-dependent
reduction of thephosphorylationoftheGluR1 subunit of the AMPAreceptor [87]. This action
could account for the previously observed small reduction in synaptic strength seen at the
Schaffer collateral-CA1 excitatory synapse of hippocampal slices [12].
A more likely target for the excitatory effects of IL-1β is its action at the N-methyl-D-
aspartate (NMDA) receptor. This receptor is normally activated under conditions of intense
activity when the voltage dependent block is relieved by depolarization of the cell. This is
the state that would exist in a cell in the presence of depolarizations caused by convulsants
or by high frequency activity and it is the condition where IL-1β has been shown to be
effective in vivo.
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These interactions with NMDA mediated transmission are the most likely mechanism for the
IL-1β augmentation of seizures. However a number of other actions of IL-1β could also be
important. For example, glutamate uptake by astrocytes is impaired by cytokines, an effect
that would increase excitatory transmission [72,173]. In addition, acutely applied IL-1β dose
dependently decreases GABAA mediated potentials in cultured hippocampal neurons [167].
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TNFα has also been shown to affect neuronal excitability. In cultured hippocampal neurons,
long term incubation with TNFα causes increases in L-type calcium currents [51] but the
same authors reported that it decreased intracellular calcium elevations elicited by
application of glutamate agonists. To the best of our knowledge, the mechanisms underlying
these disparate responses have not been elucidated. Other in vitro studies have shown that
TNFα augments glutamatergic transmission both in the hippocampal slice and in cultures
[60,152]. Recent work from our lab indicates that elevation within the brain of TNFα due to
peripheral inflammation also increases excitability in a TNFα dependent manner. This was
observed both in vivo and in hippocampal slices obtained from animals with a peripheral
inflammation, experimentally-induced colitis [127]. Intracerebroventricular injection of
TNFα alone into the brain is capable of increasing seizure susceptibility in normal animals
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(Fig. 3). This work is in keeping with a large body of data that indicates that TNFα
augments glutamatergic transmission throughout the CNS (rev in [68,112]). The likely
mechanism for this is an action of TNFα to increase the surface expression of AMPA
receptors [10,150]. Furthermore it is a particular subtype of AMPA receptors that is inserted,
namely that which lacks the GluR2 subunit [93,109,149] (Fig. 5). This is important as
AMPA receptors lacking this subunit allow calcium entry when activated, and this can lead
to changes in gene expression as well as cytotoxicity [11]. While this action to increase
AMPA receptor expression will result in augmented excitatory transmission under
inflammatory conditions, there is also evidence that TNFα secreted by glial cells may
function to modify synapses under non-inflammatory conditions. In a process known as
synaptic scaling, neurons subjected to reduced levels of excitatory inputs can upregulate (or
scale up) specific synapses to maintain a constant level of network activity [150,155]. In a
still unknown manner (but likely involving sampling of extracellular glutamate), glial cells
somehow detect low levels of neuronal activity and after about 24 h begin to release TNFα.
The ability of neurons to alter their level of excitatory synaptic inputs is dependent upon this
glial derived TNFα, as blockade of TNFα signaling prevented or reversed this effect [148].
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Although earlier studies using fluorescent microscopy did not detect interactions between
TNFα and NMDA receptor localization [10], more recent studies using both anatomical and
electrophysiological approaches reported a ceramide-dependent effect of TNFα to cause
phosphorylation of the NR1 subunit of the NMDA receptor and an increase in its surface
expression [168]. In addition to the actions of TNFα to cause increased surface expression
of glutamate receptors, it also induces endocytosis of GABAA receptors and thus reduces
inhibitory drive [149]. As TNFα can directly affect glutamate uptake and release from glial
cells [49,137], one can readily appreciate that its actions on glial cells and on synaptic
glutamate and GABA receptors can cause profound changes in excitability and possibly long
term transcriptional changes.
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Among the long term changes that are affected by cytokines is a profound action on long
term cellular plasticity, including both long term potentiation and long term depression. In
general, both TNFα (reviewed in [2,112] and IL-1β (reviewed in [113]) inhibit these
changes that occur in hippocampal slices after stimulation of glutamate synapses at
particular frequencies. As both long term potentiation and long term depression are thought
to be cellular correlates of learning, the inhibitory action of cytokines on these phenomena
could have relevance for some of the co-morbid cognitive changes associated with seizures
and inflammation in general [58,153].
Compared to the body of work on TNFα and IL-1β, there has been much less attention
directed to other pro-inflammatory cytokines. Whereas chronic IL-6 has been shown to alter
electro-physiological and synaptic properties in the cerebellum [61], little is known of its
actions in areas implicated in seizure generation, although chronic exposure of hippocampal
cultures to IL-6 was reported to reduce both Group-II metabotropic glutamate receptors and
L-type calcium channels [160].
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Another subclass of cytokines, called chemokines, may also be important in the increased
cellular excitability associated with inflammation, as they are upregulated under
inflammatory conditions and they have chemoattractant properties to promote movement of
immune cells into the brain. There is considerable evidence that they play a physiological
role in neuroendocrine function [132] and may thus be a new class of neuromodulator
[43,133]. In this context, it appears that they can also augment neuronal transmission in the
hippocampus. The chemokine CXCL10 elicits elevations in intracellular calcium and
enhanced synaptic activity [107] as well as increased levels of ERK1/2, CREB and NFκB
[8] in hippocampal cultures. Another chemokine, CCL2 (also known as monocyte
chemotactic protein-1) causes enhanced excitatory post synaptic currents in the Schaffer
collateral pathway of the hippocampus in vitro [174], possibly via a p38 MAP kinase
pathway [28]. With chronic exposure to the chemokine, CCL3, changes in NMDA-evoked
calcium currents and increased NMDA receptors have been observed in culture [85]. It is
interesting that despite these profound cellular, synaptic and electrophysiological effects,
possible roles for chemokines in seizure generation have been primarily limited to
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Acknowledgments
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This work was supported by the Canadian Institutes of Health Research, the Crohn’s and Colitis Foundation of
Canada Chair in IBD Research and the Natural Sciences and Engineering Research Council of Canada and by
personnel support grants from the Alberta Heritage Foundation for Medical Research and the Savoy Foundation.
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Fig. 1.
Cytokine induction and microglial activation in the hippocampus after local injection of
kainic acid. Left panels show IL-1β immunoreactivity; right panels show microglia revealed
by B4-isolectin immunoreactivity. (A and B) Control saline injection in the CA1 area of the
hippocampus. (C and D) Kainic acid injection in the same area. (E and F) Control saline
injection in the CA3 area of the hippocampus. (G and H) kainic acid injection in the same
area (from [161] with permission).
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Fig. 2.
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A seizure in a neonatal rat results in transient elevation of IL-1β in the hippocampus. (A)
Representative Western blots showing increasing IL-1β protein following a febrile seizure.
(B) Quantitative analysis of IL-1β protein levels 24, 48 and 72 h following seizure induction
(from [40] with permission).
Fig. 3.
Peripheral inflammation induces hippocampal cytokine synthesis and increases seizure
susceptibility in a TNFα dependent manner. (A) At the peak (day 4) of experimental colitis
induced by intracolonic infusion of TNBS (black bars) TNFα levels are elevated. (B)
Seizure susceptibility is enhanced in colitic rats and intracerebroventricular (ICV) infusion
of IL-1ra does not interfere with this. (C) In contrast, ICV TNFα antibody administration
blocks the increased seizure susceptibility. (D) ICV TNFα alone increases seizure
susceptibility in naïve rats (from [127] copyright © 2008 by the National Academy of
Sciences of the USA).
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Fig. 4.
IL-1β augments NMDA effects in cultured hippocampal neurons. (A) Peak calcium
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Representative data showing increased calcium levels after NMDA in the presence of IL-1β.
(C) The effect of IL-1β on NMDA induced calcium increases was via an action at the
NMDA receptor as it was blocked by the NMDA receptor antagonist MK 801 (from [165]
with permission).
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Fig. 5.
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TNFα induces a transient increase in surface expression of GluR2 lacking AMPA receptors
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GluR1 receptors in response to application of TNFα in culture. (B) A similar experiment
shows that GluR2 containing AMPA receptors do not move to the membrane in response to
TNFα. (C) Compiled data indicating rapid and reversible surface expression of GluR2
lacking AMPA receptors after TNFα (from [93] with permission).