The present study demonstrates that an uncontrolled, prolonged inflammatory process may be a driving force for the progressive degeneration of DA neurons in PD. Microglia were indispensable for the chronic DA neurodegeneration induced by neurotoxins (MPP+ and rotenone) or inflammogen LPS. Through a vicious cycle formed between injured neurons and unregulated neuroinflammation, the neurodegeneration continued to progress even after the initial toxic triggers (LPS and MPP+) were withdrawn. Sustained release of reactive free radicals from activated microglia and HMGB1 from dying/dead neurons and activated microglia was critical for the formation and the maintenance of this vicious cycle. Further mechanistic studies indicate that interactions between HMGB1 and microglial Mac1 bridged persistent neuroinflammation and progressive neurodegeneration in chronic PD progression. This study not only furthers our understanding of the mechanism underlying the progressive nature of PD, but also pinpoints major mediators linking persistent inflammation and chronic neurodegeneration.
The involvement of neuroinflammation in PD and other neurodegenerative diseases has long been recognized (
Kreutzberg, 1996). The pioneer work of Dr. McGeer and his colleagues reveals reactive microglia in the SN of Parkinson's and Alzheimer's disease brains (
McGeer et al., 1988). Since then, numerous studies have reported elevated levels of inflammatory mediators in the brain of various neurodegenerative diseases (
Yamada et al., 1992;
Mogi et al., 1994;
Liu et al., 2003). Nevertheless, these observations left the question open whether the observed neuroinflammation is beneficial, detrimental, or inconsequential to neuronal loss. The initial experimental evidence confirmed the participation of microglial activation in a variety of models of neurodegeneration (
Streit and Kreutzberg, 1988;
Akiyama and McGeer, 1989;
Banati et al., 1993). Recently, neuroinflammation is increasingly accepted as a double-edged sword (
Nguyen et al., 2002;
Wyss-Coray and Mucke, 2002). Microglia have been reported to remove toxic proteins (e.g. amyloid plaques), clear cell debris, secret neurotrophic factors, and prevent neurodegeneration (
Schwartz, 2002;
Simard et al., 2006). On the other hand, ample evidence points to detrimental roles of neuroinflammation in neurodegenerative diseases (
Liberatore et al., 1999;
Du et al., 2001;
Gayle et al., 2002;
Glass et al., 2010;
Przedborski, 2010).
Here, we provided direct experimental evidence implicating persistent microglial activation as the major driving cause of PD progressive neurodegeneration. This conclusion is supported by the following experimental findings: first, dopaminergic neurodegeneration progressed markedly over time in neuron-glia cultures treated with MPP
+, rotenone, or LPS, but not in neuron-enriched cultures treated with the same toxins (); second, withdrawal of activated microglia and released inflammatory mediators prevented DA neurons from LPS-induced progressive degeneration (); third, the continued presence of initial triggers (e.g. LPS and MPP
+) was not required for persistent microglial activation and progressive neurodegeneration (); forth, continuing release of superoxide and NO from activated microglia in neuron-glia cultures treated with LPS () or MPTP/MPP
+ (
Gao et al., 2003a) as well as prolonged upregulations of inflammatory enzymes (NADPH oxidase and iNOS) in LPS-treated neuron-glia cultures () pointed to a critical role of inflammation-elicited oxidative insults in chronic neurodegeneration; fifth, post-treatment with inhibitors against NADPH oxidase and iNOS significantly attenuated LPS-mediated progressive neurodegeneration (); finally, microglial activation induced by chronic infusion of LPS into the SN or by a single systemic LPS injection mediated delayed and progressive degeneration of nigral DA neurons in rodents (
Gao et al., 2002b;
Ling et al., 2006;
Qin et al., 2007). Taken together, these results lend strong credence to the concept that uncontrolled microglial activation, either as an initiator or as a secondary contributor, could drive a chronic, progressive neurodegenerative process.
The positive feedback between activated microglia and damaged neurons is crucial for both chronic neuroinflammation and progressive neurodegeneration. Acute insults to the CNS such as environmental neurotoxins can directly trigger immediate neuronal lesions. Injured neurons activate microglia through generating a spectrum of noxious endogenous substances in the extracellular milieu. Once activated, microglia secret various inflammatory and neurotoxic factors (e.g. cytokines, reactive free radicals and proteases) and exacerbate ongoing neurodegeneration (
Kreutzberg, 1996;
Liu et al., 2003;
Block et al., 2007). Thus, no matter which comes first, neurodegeneration and neuroinflammation, once reaching a certain threshold, propagate to form a vicious cycle (
Gao and Hong, 2008). This cycle not only further augments the ongoing pathology, but also makes neurodegeneration become a chronic, progressive process. Therefore, it is the activation of microglia that enables an initial acute neuronal injury to transform into chronic and progressive neurodegeneration.
DAMPs (e.g. ATP, heat-shock proteins, S100 proteins and HMGB1), naturally are nuclear or cytosolic molecules with defined intracellular function. When released extracellularly, DAMPs can activate microglia. HMGB1 is reported to link acute neuron necrosis and delayed neuroinflammation in ischemic brain damage (
Kim et al., 2006;
Muhammad et al., 2008). Additionally, diffuse deposits of HMGB1 are found around dying neurons in rat models of Alzheimer's disease (
Takata et al., 2004). In the present study, we found that HMGB1 not only stimulated microglia to release inflammatory factors, including TNFα, IL-1β, and NO (), but also caused chronic dopaminergic neurodegeneration in the presence of microglia (). More importantly, the long-term release of HMGB1 in neuron-glia cultures treated with MPP
+/LPS/rotenone, but not in LPS-treated mixed-glia cultures, along with the neuroprotective effect of the neutralization of HMGB1 () suggests that HMGB1 from degenerating neurons may be an important mediator linking sustained neuroinflammation to progressive PD neurodegeneration.
The involvement of multiple separate receptors (e.g. TLR2, TLR4 and RAGE) in HMGB1-mediated cellular and biological responses has been well described (
Scaffidi et al., 2002;
Lotze and Tracey, 2005). Interestingly, although recent findings bring more attention to the HMGB1–TLR4 pathway (
Maroso et al., 2010;
Mittal et al., 2010), HMGB1 has also been reported to cause lethality in TLR4-defective C3H/HeJ mice, which points to a TLR4-independent pathway for HMGB1 (
Sims et al., 2010). There is a great deal of interest in defining novel receptors and binding partners for HMGB1 and in elucidating the signal transduction mechanisms underlying the HMGB1 receptor–ligand interactions. Here, we identified microglial Mac1 as a receptor of HMGB1. Mac1 (also known as complement receptor 3, CD11b/CD18 or α
Mβ
2) is an adhesion molecule and also functions as a PRR (
Wright and Jong, 1986;
Ross and Vetvicka, 1993;
Ross, 2000;
Andres-Mateos et al., 2007;
Pei et al., 2007). PRRs including Mac1 expressed broadly on microglia can react to DAMPs and other aberrant endogenous ligands in neuronal tissues (
Floden et al., 2005;
Block et al., 2007;
Gao et al., 2008). In the brain, Mac1 is involved in microglial adhesion, chemotaxis, phagocytosis, and activation (
Mayadas and Cullere, 2005). The expression of Mac1 is elevated in PD brains (
Liberatore et al., 1999). Mac1 deficiency in microglia greatly attenuated chronic impairment of DA neurons induced by LPS, rotenone (), or MPTP (
Hu et al., 2008). Because neither MPTP nor MPP
+ can directly activate microglia (
Gao et al., 2003a), Mac1 seems to be a target for some of the noxious endogenous compounds generated following neuronal injuries. In support of this notion, Mac1 was found to be required for the microglia-mediated enhanced neurotoxicity induced by α-synuclein in neuron-glia cultures (
Andres-Mateos et al., 2007). α-synuclein is predominantly an intracellular neuronal protein, but it has also been recovered from human blood and cerebrospinal fluid (
El-Agnaf et al., 2003). Similarly,
β-amyloid (
β25–35) has been reported to bind to Mac1 and to mediate microglial release of NO (
Goodwin et al., 1997).
We demonstrated in the present study that HMGB1 interacted with microglial Mac1 and this interaction mediated persistent neuroinflammation and consequent progressive neurodegeneration. Specifically, the co-immunoprecipitation and the binding analysis revealed the physical interaction between HMGB1 and Mac1 (). Consistent with this physical interaction, functional assays indicated that the binding of HMGB1 to microglial Mac1 activated microglia NF-κB pathway and NADPH oxidase. The activation of both NF-κB and NADPH oxidase was blunted in Mac1-/- microglia ( and ). As a result, Mac1-/- microglia released less inflammatory factors and superoxide upon HMGB1 stimulation and the deficiency of microglial Mac1 and NADPH oxidase attenuated HMGB1-mediated neurodegeneration (, & ). The HMGB1 was able to induce membrane translocation of p47phox in microglia, which required the presence of Mac1 (). Thus, the coupling between Mac1 and NADPH oxidase might be an important mechanism by which HMGB1 mediated chronic microglial activation and induced progressive neurodegeneration.
The deleterious effects of excessive microglial activation are not limited to PD. More recent evidence suggests that an inflammatory mechanism is commonly shared by a large group of neurodegenerative disorders (
Gao and Hong, 2008). Moreover, a critical role of microglial activation in the progression, rather than the onset of amyotrophic lateral sclerosis, a progressive paralytic neurodegenerative disorder, has been elegantly demonstrated. Lowering expression of mutant superoxide dismutase (SOD1) within microglia in a transgenic mouse model expressing LoxSOD1
G37R has little effect on the early disease phase but sharply slows later disease progression and extends the survival of the mice (
Boillee et al., 2006). With awareness of a driving role of over-activation of microglia in neurodegenerative diseases, pharmacological targeting of secondary neurodegeneration mediated by uncontrolled microglial activation could be of therapeutic value for slowing down the disease progression. In conclusion, our data together provide direct experimental evidence indicating that uncontrolled, prolonged inflammation may be a driving force of progressive PD neurodegeneration. Interactions between HMGB1 (derived from degenerating neurons and activated microglia) and microglial Mac1 sustained chronic inflammation and mediated chronic PD neurodegeneration. Mac1 might become a promising target for the development of therapeutic agents halting the vicious cycle between uncontrolled neuroinflammation and degenerating neurons and thereby retarding the progression of PD.