Inflammatory processes play both regenerative and destructive roles in multiple sclerosis, stroke, CNS trauma, amyotrophic lateral sclerosis and aging-related neurodegenerative diseases such as Alzheimer's, Parkinson's and Huntington's. Endogenous defence mechanisms against these pathologies include those that are directly neuroprotective, and those that modulate the expression of inflammatory mediators in microglia, astrocytes, and invading inflammatory cells. While a number of mechanisms and molecules have been identified that can directly promote neuronal survival, less is known about how the brain protects itself from harmful inflammation, and further, how it co-opts the healing function of the immune system to promote CNS repair. The two closely related neuroprotective peptides, vasoactive intestinal peptide (VIP) and pituitary adenylyl cyclase-activating peptide (PACAP), which are up-regulated in neurons and immune cells after injury and/or inflammation, are known to protect neurons, but also exert powerful in vivo immunomodulatory actions, which are primarily anti-inflammatory. These peptide actions are mediated by high-affinity receptors expressed not only on neurons, but also astrocytes, microglia and peripheral inflammatory cells. Well-established immunomodulatory actions of these peptides are to inhibit macrophage and microglia production and release of inflammatory mediators such as TNF-a and IFN-g, and polarization of T-cell responses away from Th1 and Th17, and towards a Th2 phenotype. More recent studies have revealed that these peptides can also promote the production of both natural and inducible subsets of regulatory T-cells. The neuroprotective and immunomodulatory actions of VIP and PACAP suggest that receptors for these peptides may be therapeutic targets for neurodegenerative and neuroinflammatory diseases and other forms of CNS injury.
AbbreviationsAPE1, apurinic/apyrimidinic endonuclease; IL-1Ra, IL-1 receptor antagonist; IML, intermediolateral; KO, knockout; MOG35-55, myelin oligodendrocyte glycoprotein, amino acids 35-55; MS, multiple sclerosis; MF, macrophage; NA, noradrenaline; PACAP, pituitary adenylyl cyclase-activating peptide; PGC1a, peroxisome proliferator-activated receptor g co-activator 1a; SCG, superior cervical ganglia; SNS, sympathetic nervous system; Treg, regulatory T-cell; VIP, vasoactive intestinal peptide
IntroductionThe brain was once thought to be excluded from immune surveillance and other inflammatory processes except under a few specific pathological conditions such as CNS infection and multiple sclerosis (MS). Indeed foreign antigens are quite limited in their ability to elicit robust T-cell or humoral responses in the CNS due to a relative lack of lymphoid drainage and limited expression of major histocompatibility complex molecules. Moreover, neither strong innate nor amplified adaptive inflammatory responses are generally observed in the brain due to the presence of tight endothelial junctions and astrocyte endfeet that provide a barrier against influx of infl...