The question as to whether peripherally (i.v. or intra-arterially) administered PGE
2 causes fever remains controversial. Although there are reports of peripherally injected PGE
1 and PGE
2 being pyrogenic in several species of laboratory animals [
24,
27], there are at least as many documented failures to induce fever by peripheral administration of PGE [
24,
28,
29]. The latter, negative results can be explained, at least partially, as due to self-aggregation of PGE in aqueous solutions and the subsequent loss of biological activity. Indeed, PGE
2 was found to be highly pyrogenic in rabbits when infused in an albumin-bound (monomeric), but not in a free (aggregated) form [
21]. Albumin is the principal carrier of PGE
2 in the circulation, and up to 99% of circulating PGE
2 is albumin-bound [
30].
In the present study, a 2:1 (molar ratio) PGE
2–albumin complex was prepared by adding PGE
2 (all reagents are from Sigma-Aldrich, St. Louis, Missouri, United States, unless specified otherwise) and bovine serum albumin (BSA) to pyrogen-free saline, and then sonicating this mixture for 3 min and incubating it at 37 °C for 1 h. In a thermoneutral environment, the rats were infused i.v. with BSA-bound PGE
2 (280 or 560 μg/kg, 100 μl/kg/min, 10 min). Based on the assumptions that PGE
2 is evenly distributed in the extracellular compartment (20% of the body mass) and that its half-life is 1 min [
31], it can be estimated that the protocol used elevates the plasma concentration of PGE
2 by 350 pg/ml (low dose) or 700 pg/ml (high dose) at 12 min after the beginning of infusion. These concentrations are within the physiological range [
24,
32]. Whereas BSA had no thermoregulatory effect, the PGE
2–BSA complex caused a dose-dependent rise in deep body (colonic) temperature (T
c; A). This fever response was brought about, at least in part, by tail skin vasoconstriction, as evident from a decrease in the heat loss index (the quotient of two temperature gradients: skin-ambient/colonic-ambient [
33]). Hence, when administered in its most relevant form (albumin complex) and at physiologically relevant doses, peripheral PGE
2 is pyrogenic in rats.
How circulating, albumin-bound PGE
2 causes fever remains speculative. Activation of vagal afferents by PGE
2 has been proposed [
34], but the fact that vagotomy does not affect the first febrile phase (for discussion, see [
35,
36]) makes this mechanism unlikely. An alternative scenario seems more plausible. Binding to albumin prevents the rapid enzymatic inactivation of PGE
2 [
37,
38], thus allowing it to reach a distant site. A good candidate for such a site is the preoptic hypothalamus, which is highly sensitive to the pyrogenic effect of PGE
2 [
39]. Once dissociated from albumin at the target site, PGE
2 may be carried into the brain tissue by transporters expressed at the blood–brain barrier (BBB) [
6,
26,
40]. It should be noted, however, that this scenario is speculative and needs to be tested experimentally.
Having shown that peripheral PGE
2 is pyrogenic in rats, we asked whether blood levels of PGE
2 are elevated at the onset of the first phase of LPS fever. Fever was induced by administering 0111:B4
Escherichia coli LPS (10 μg/kg) nonstressfully via the extension of a preimplanted venous (jugular) catheter to rats kept in a thermoneutral environment (see
Materials and Methods for details). The first febrile phase started at approximately 30-min post-LPS and was brought about, at least partially, by tail skin vasoconstriction (B). At 40 min (the time corresponding both to the maximal rate of rise in body temperature and to the maximal thermoeffector activity that underlies this rise), samples of venous and arterial blood were collected from LPS-treated (febrile) and saline-treated (afebrile) rats, and the concentration of PGE
2 in the venous and arterial blood was measured by enzyme immunoassay. The venous blood gathers PGE
2 synthesized in the tissues, and the arterial blood delivers it to the brain, the presumptive site of the febrigenic action of circulating PGE
2 [
39]. Consistent with the marked catabolism of PGE
2 in the lungs [
41], the level of PGE
2 was lower in the arterial than in the venous blood plasma in both afebrile and febrile rats (C). However, both the venous and arterial concentrations of PGE
2 were substantially (~2.5 times) higher in the febrile rats as compared to the afebrile controls. These data show that the level of circulating PGE
2, most importantly in the arterial blood, is increased at the onset of the first febrile phase.
Several studies aimed at determining the source of febrigenic PGE
2 have compared the antipyretic effects of nonsteroidal anti-inflammatory drugs administered peripherally (i.v. or intraperitoneally) and centrally (intracerebroventricularly [i.c.v.]). The drugs used included indomethacin [
25], nimesulide [
32], and keterolac (present study; unpublished data). All these studies faced multiple methodological problems, including acute thermoregulatory effects of the drug administered i.c.v. (present study), the ability of drugs to cross the BBB, and consequently, their tendency to be distributed evenly between the peripheral compartment and the brain [
32]. We proposed [
6] that selective neutralization of circulating PGE
2 using an antibody is a better approach to test the hypothesis that peripherally produced PGE
2 initiates fever. Being large proteins (160 kDa), antibodies cannot cross the BBB; this eliminates uncertainty common in experiments involving nonsteroidal anti-inflammatory drugs. The antibody used in the present study was raised against a PGE
2–BSA complex in rabbits. It displayed a high affinity to PGE
2 (association constant of 6.3 × 10
10 M
−1, as determined by Scatchard plot) and a low cross-reactivity with other prostanoids (<15% for PGF
1α and PGB
2, and <9% for PGA
2, PGF
2α, and PGB
1). The rats were pretreated i.v. with the anti-PGE
2 antibody (neat antiserum; 100 μl/kg/min, 120 min) or with normal rabbit serum, and LPS was injected 18 h later, i.e., at the time when the injected antibody is expected to achieve a steady-state level in the circulation [
42]. The results of this experiment are shown in A–C. The antibody (but not normal serum) suppressed the first phase of LPS fever: both the rise in T
c and the associated decrease in the heat loss index were delayed and significantly attenuated (A). Immediately after the temperature response was recorded, a sample of venous blood and the whole brain (cleared of blood) were collected for immunoenzymatic determination of the anti-PGE
2 antibody. The antibody was found at a high concentration in the blood plasma, but was below the detection limit in the brain tissue (C). To rule out the possibility that a minute, undetectable amount of antibody in the brain might have accounted for the suppression of fever, we administered a low dose (2.7 μl/min, 15 min) of the anti-PGE
2 antibody or normal serum i.c.v., and injected the rats with LPS 18 h later. The rats injected with the anti-PGE
2 antibody i.c.v. had a detectable level of the antibody in the brain (C), but their febrile response to LPS was unaffected (B). A large fraction of the antibody given i.c.v. leaked into the blood, presumably reflecting the asymmetric nature of the BBB (its major role is to limit transport in the blood-to-brain direction, but not in the opposite direction) or possibly because the BBB was breached in this experimental group by the implanted i.c.v. cannula. Importantly, however, the plasma antibody concentration in the rats treated with the i.c.v. antibody was approximately 60 times lower than that in the rats treated with the i.v. antibody (C). It is concluded that minute amounts of the anti-PGE
2 antibody in the brain (even when detectable) are not sufficient to suppress the initiation of fever, and that the cause of the delayed and attenuated first febrile phase observed in the rats pretreated with i.v. antibody was neutralization of PGE
2 outside the BBB.
Having demonstrated that circulating PGE
2 is indeed responsible, at least partially, for triggering LPS-induced fever, we investigated which step of the PGE
2 biosynthetic pathway is activated at the onset of the febrile response. Previously, we reported that the onset of the first phase of LPS fever is associated with large increases of COX-2 and mPGES-1 mRNAs in the lung and liver and with a moderate increase of COX-2 (but not mPGES-1) mRNA in the hypothalamus [
22]. However, it remained to be determined whether the observed transcriptional changes translate into changes in the corresponding protein contents at such an early time point (40 min) after LPS administration. We had also shown [
22] that neither cytosolic PLA
2-α (cPLA
2-α) nor either of the two secretory PLA
2 studied (II and V) is transcriptionally up-regulated at the onset of fever. This finding, however, does not exclude the possibility that cPLA
2 is activated posttranscriptionally by phosphorylation, the principal mechanism of activation for this enzyme [
43]. In the present study, we determined the contents of phosphorylated cPLA
2 (p-cPLA
2), COX-2, and mPGES-1 proteins by Western blot in the lung, liver, and hypothalamus at 40 min after injection of LPS or saline, a time that corresponds to the onset of the first febrile phase in LPS-treated rats (B). COX-2–positive cells were also studied in all three tissues by immunohistochemistry using two different protocols of sample preparation (see
Material and Methods). None of the enzymes studied was increased at the protein level in the hypothalamus of the LPS-treated rats as compared to the saline-treated controls (). Neither did the immunohistochemical analysis reveal any increase in the number of COX-2–positive hypothalamic cells at the onset of fever, although the same antibody readily detected a surge in the number of COX-2–positive endotheliocytes in the hypothalamic microvasculature at later stages of LPS fever, in both the present study (positive controls; unpublished data) and previous studies [
11,
12]. In the lung, LPS increased the contents of p-cPLA
2 and COX-2 (), and augmented the number of cells containing COX-2 (), but did not alter the protein level of constitutively expressed mPGES-1 (). In the liver, the immunohistochemical analysis (which is more sensitive) revealed a surge in the number of COX-2–positive cells at the onset of fever (), whereas the Western blot analysis (less sensitive) found a tendency for an increase in the overall content of COX-2 and no changes in the content of either p-cPLA
2 or mPGES-1 (). We also found that inflammatory signaling (assessed by a decrease in the content of the nuclear factor-κB inhibitor, IκB-α [
44]) was activated in the lung and liver, but not in the hypothalamus, at the onset of LPS fever ().
These results show that the onset of the first febrile phase is associated with activation of inflammatory signaling and increased PGE
2 synthesis in the periphery. The early activation of PGE
2 synthesis involves phosphorylation of cPLA
2 (lung) and transcriptional up-regulation of COX-2 (lung and liver). Transcriptional up-regulation is the main (although not the only [
45,
46]) mechanism of activation for this enzyme [
6,
7]. Hence, the increased circulating level of PGE
2 at the onset of the first febrile phase may be explained by the following enzymatic events in the lung and liver: production of arachidonic acid by activated (phosphorylated) cPLA
2 → conversion of arachidonic acid to PGH
2 by up-regulated COX-2 → isomerization of PGH
2 into PGE
2 by constitutively expressed mPGES-1. Whereas the physiological importance of cPLA
2 and mPGES-1 in the first febrile phase remains to be confirmed in studies with pharmacological or genetic blockade of these enzymes, the indispensable role of COX-2 (and the uninvolvement of COX-1) in the first phase of LPS fever have been demonstrated in our recent study in knockout mice [
47].
Preferential location of the synthesis of febrigenic PGE
2 in the liver and lungs (but not in the brain) deserves special discussion. The fact that the i.v. antibody attenuated the first febrile phase but did not abolish it completely (A) may be due to incomplete neutralization of circulating PGE
2. However, it may also reflect a contribution of centrally produced PGE
2 (e.g., by a small number of hypothalamic cells that express COX-2 constitutively) to the development of the first phase of LPS fever. Although we cannot rule out such a contribution, it is noteworthy that multiple methods used in our present and previous [
22] studies () found a profound activation of PGE
2 synthesis in the periphery, but hardly any signs (none at the protein level) of activation of hypothalamic PGE
2 synthesis.
| Table 1Inflammatory Signaling and PGE2 Synthesis Are Selectively Activated at the Onset of the First Phase of LPS Fever in the Periphery (Lung and Liver) but Not in the Brain (Hypothalamus) |
To identify the pulmonary and hepatic producers of PGE
2, we first determined how the cells that become COX-2 positive at the onset of LPS fever relate to the histological elements revealed by eosin staining; this analysis was performed in freshly frozen samples. In the lung, COX-2–positive cells were found to cluster around alveoli, often forming what looked like cell chains (unpublished data). In the liver, the parenchyma did not stain for COX-2, and the vast majority of COX-2–positive cells were located in the stromal compartment, often in close proximity to sinusoids. Some COX-2–positive cells were also found around the central vein (a small vein that gathers the blood from sinusoids) and in the visceral peritoneum covering the liver (unpublished data). We then double-stained lung and liver for COX-2 and either the macrophage marker ED2 [
48] or the endothelial marker RECA1 [
49]; this analysis was performed in paraformaldehyde-fixed samples (). In the lung, 89 ± 6% (mean ± standard error [SE] of five samples) of COX-2–positive cells were macrophages (ED2 positive), and 11% were unidentified (ED2 and RECA1 negative). In the liver, 83 ± 2% of the COX-2–positive cells were macrophages (ED2 positive), 9 ± 1% were endotheliocytes (RECA1 positive), and 8% remained unidentified. The key role of macrophages in the initiation of fever agrees with our recent finding that the first febrile phase depends entirely on the recognition of LPS (via the Toll-like receptor-4) by bone marrow-derived cells [
50].
In summary, the present study shows that the first phase of LPS fever is initiated (at least partially) by PGE2 that originated in peripheral tissues. Activation of PGE2 synthesis at the onset of the first phase of LPS fever involves phosphorylation of cPLA2, transcriptional up-regulation of COX-2, and possibly other mechanisms. The vast majority of the PGE2-producing cells are macrophages. These findings challenge the predominant view that fever is initiated exclusively by inflammatory mediators produced at the level of the BBB. These findings, however, do not contradict the principal role of the centrally produced PGE2 in the second and subsequent febrile phases.