Each year, traumatic Brain Injury (TBI) impacts millions of people
worldwide. Despite the increased resources dedicated to understanding
the complex series of physiological events that follow a TBI, effective
diagnostic and treatment options are lacking. Following a TBI, there is a
rapid, innate neuroinflammatory and inflammatory response. This re-
sponse includes activation of astrocytes and microglial cells in the
central nervous system (CNS), as well as expansion, activation and
infiltration of peripheral immune cells into the CNS. Our recent data, as
well as data from a few select other groups, have demonstrated that
following a TBI, there is evidence for a transition from an innate to an
adaptive immune response. This response appears to involve both the
liver and the spleen. This evidence for an adaptive immune response to
a TBI will be presented, as will our data highlighting the innate immune
response to TBI. In addition, data will be shown to illustrate that tar-
geting the transition from an innate to an adaptive immune response
provides neuroprotection following a TBI. The broad impact of such
findings will be further contextualized to allow for a discussion of the
potential impact on the short- and long-term consequences of targeting
the switch to an adaptive immune response for the treatment of TBI.
Keywords: Peripheral immune system, Liver, Spleen, CD74, MHC,
Invariant Chain
S13-02
NEUROGENIC IMMUNE DEFICIENCY AFTER SPINAL
CORD INJURY: MECHANISMS OF ACTION AND THER-
APEUTIC OPPORTUNITIES
Phillip Popovich
1
, Yan Wang
1
, Zhen Guan
1
, Jan Schwab
1
, Masaki
Ueno
2
, Yutaka Yoshida
2
1
Ohio State Univ., Dept. of Neuroscience, Columbus, USA
2
Cincinnati Children’s Hospital Medical Center, Division of Devel-
opmental Biology, Cincinnati, USA
Most who suffer a traumatic spinal cord injury (SCI) above spinal level
T5 develop autonomic dysreflexia (AD), a pathological condition char-
acterized by severe episodic paroxysmal hypertension. Untreated, AD
can cause pulmonary embolism, stroke or even death. Data from our lab
indicate that maladaptive plasticity in the spinal cord circuitry respon-
sible for causing AD also causes chronic immune suppression. In SCI
mice, the onset and frequency of AD correlates with the magnitude of
immune suppression. We predicted that as large segments of spinal cord
lose supraspinal input, the periodic activation of viscera-sympathetic
reflexes (e.g., due to bladder/bowel filling) will cause uncontrolled ac-
tivation of sympathetic motor neurons with heightened release of cate-
cholamines and glucocorticoids (GCs) into blood and lymphoid tissues.
Data indicate that GC and catecholamine-dependent signaling synergizes
to elicit apoptosis in leukocytes and that remaining immune cells are
functionally impaired. Retrograde trans-synaptic labeling from the
spleen of SCI mice reveals the formation of new and complex intraspinal
circuitry, presumably due to ongoing plasticity and synaptogenesis be-
tween primary sensory afferents, interneurons and sympathetic pregan-
glionic neurons. Moreover, the receptive field for activating this new
circuitry expands beyond the thoracic spinal segment that controls sec-
ondary lymphoid tissues in naı¨ve/uninjured mice. Thus, after SCI, an
uncontrolled ‘‘supercharged’’ autonomic circuit develops that recapitu-
lates convulsive neuropathology (‘‘autonomic spinal epilepsy’’) and
causes immune suppression. New preliminary data indicate that this
aberrant circuitry can be ‘‘silenced’’ and immune cell ablation reversed
by injecting inhibitory Designer Receptors Exclusively Activated by
Designer Drugs (DREADDs) into the spinal cord. Neurogenic immune
ablation may explain why people with high-level SCI are more suscep-
tible to infection – a leading cause of morbidity and mortality in this
patient population. Overcoming this deficit will reduce mortality, sig-
nificantly improve quality of life and also recovery of neurological
function after SCI. Supported in part by NIH-NINDS R01NS083942
(PGP), Dept. of Defense (W81XWH-13-1-0356).
Keywords: Autonomic Dysreflexia, hypertension, maladaptive
plasticity, Spinal Cord Injury, immune Suppression
S13-03
INTESTINAL BARRIER DYSFUNCTION AFTER TRAU-
MATIC BRAIN INJURY
Vishal Bansal
UCSD, Dept. of Surgery, San Diego, USA
The physio-logic connection be-tween the brain and the gut has recently
been coined the ‘‘neuro-enteric axis.’’ In this regard, in-ves-tigators have
established the unique in-ter-play and com-mu-nication be-tween parts of
the brain, namely the dorsal motor nucleus of the vagus nerve, the vagus
nerve and the in-testine itself. Our laboratory has demon-strated that
severe TBI causes sig-nifi-cant in-testinal dysfunc-tion. Inter-estingly, by
electrically stimulating the vagus nerve, we have shown post-TBI in-
testinal injury to be sig-nifi-cantly mitigated. When the para-digm was
reversed, vagus nerve stimulation actually impro-ved blood brain barrier
leakage and neu-ronal degene-ration fol-lowing severe TBI. How vagus
nerve stimulation may affect the neuro-enteric axis in unknown. It is
likely not purely secondary to the known anti-in-flam-matory effects of
the vagus nerve. These modulators and signals may very well be from gut
derived neuro-endo-crine hormones.
Keywords: intestinal barrier dysfunction, neuroendocrine hormone,
vagus nerve
S14 Purines - Forgotten Mediators in CNS Injury
S14-01
ROLE OF THE 2
¢
,3
¢
-CAMP-ADENOSINE PATHWAY IN
TRAUMATIC BRAIN INJURY
Edwin Jackson
1
, Patrick Kochanek
2
1
University of Pittsburgh, Pharmacology and Chemical Biology,
Pittsburgh, USA
2
University of Pittsburgh, Critical Care Medicine, Pittsburgh, USA
Using mass spectrometry, we recently discovered that some tissues
generate a positional isomer of 3
¢
,5
¢
-cAMP, namely 2
¢
,3
¢
-cAMP. Ad-
ditionally, we established that: 1) the biosynthesis of 2
¢
,3
¢
-cAMP is
stimulated by cellular injury; 2) 2
¢
,3
¢
-cAMP derives from the breakdown
of mRNA; 3) 2
¢
,3
¢
-cAMP is exported to the extracellular compartment;
and 4) extracellular 2
¢
,3
¢
-cAMP is metabolized to 2
¢
-AMP and 3
¢
-AMP,
which are subsequently metabolized to extracellular adenosine. We call
this biochemical sequence (intracellular 2
¢
,3
¢
-cAMP
0
extracellular
2
¢
,3
¢
-cAMP
0
2
¢
-AMP/3
¢
-AMP
0
adenosine) the ‘‘2
¢
,3
¢
-cAMP-adeno-
sine pathway.’’ Emerging evidence suggests that intracellular 2
¢
,3
¢
-
cAMP promotes opening of brain mitochondrial permeability transition
pores and that extracellular adenosine is a key neuroprotective autacoid.
Thus we hypothesize that the 2
¢
,3
¢
-cAMP-adenosine pathway may be an
important mechanism for protection against neurotrauma. In support of
this concept, we find that neurons, oligodendrocytes, astrocytes, and
microglia convert 2
¢
,3
¢
-cAMP mostly to 2
¢
-AMP (with oligodendrocytes
being most efficient) and 2
¢
-AMP to adenosine (with microglia being
most efficient), and knockout of 2
¢
,3
¢
-cyclic nucleotide 3
¢
-phosphodies-
terase (CNPase) attenuates the ability of oligodendrocytes to metabolize
2
¢
,3
¢
-cAMP to 2
¢
-AMP. Microdialysis experiments in mice demonstrate
that traumatic brain injury (TBI; controlled cortical impact) activates the
A-149