The
inflammatory cascade(Call it what is really is: the neuronal cascade of death! Which your doctors are doing nothing about, leaving millions to billions of neurons to die in the first week!) that ensues following an ischemic stroke has been
increasingly recognized(Known since the Rockefeller University report in Jan. 2009! So you're that fucking out-of-date?) as a driving force in the long-term disability
associated with the disease. This synopsis will highlight recent
preclinical studies that aimed to promote a robust Treg (T-regulatory
cell) response via interleukin-2 (IL-2) signaling following an
experimental stroke.
To elucidate the mechanism by which an
expansion in Tregs following experimental ischemic injury promotes white
matter integrity and functional recovery, Yuan et al (Regulatory T cell expansion promotes white matter repair after stroke. Neurobiol Dis. 2023;179:106063. doi: 10.1016/j.nbd.2023.106063)
demonstrated that Treg augmentation via direct intravenous transfer of
Tregs isolated from donor mice 2 hours after transient middle cerebral
artery occlusion (tMCAO) resulted in improved white matter recovery when
compared with splenocyte-treated mice poststroke. To determine whether
promoting an endogenous Treg expansion poststroke would similarly result
in a neuroprotective(Don't ever use the milquetoast word, neuroprotection. It doesn't signal urgency at all! Whereas your doctor telling you they failed to stop the neuronal cascade of death in the first week might engender a few medical malpractice suits. I suggest a payment of $1000 a dead neuron; in my case that would come to 5.571 billion dead neurons; Only 55 trillion dollars!) phenotype, wild-type mice were treated with either
a consecutive intraperitoneal administration of IL-2/IL-2 antibody
complexes (IL-2/IL-2Ab) or equal concentrations of isotype-matched
antibody (IgG) at 6 hours, 1 day, 2 days, 3 days, 10 days, 20 days, and
30 days after stroke. At 14 days after stroke, IL-2/IL-2Ab mice
displayed a significant increase in the CD25+CD4+Foxp3+
Treg cell population in the blood, spleen, and brain parenchyma when
compared with IgG-treated controls. Importantly, IL-2/IL-2Ab treatment
mitigated sensorimotor dysfunction at 35 days, but not at 7 days after
stroke. To evaluate white matter integrity, longitudinal in vivo
diffusion tensor imaging scans 14 and 28 days after tMCAO coupled with
ex vivo diffusion tensor imaging scanning of brains 35 days after stroke
were used to construct fractional anisotropy maps. Fractional
anisotropy mapping showed that IL-2/IL-2Ab–treated mice exhibited
improved white matter integrity at 28 and 35 days after stroke,
indicating that Treg expansion promotes white matter integrity in the
late phase of stroke. Delayed IL-2/IL-2Ab treatment remained protective
even when administered as late as 5 days after stroke, as Luxol fast
blue staining of coronal brain slices of treated mice showed increased
myelin in the external capsule and striatum 21 days after tMCAO in
IL-2/IL-2Ab–treated mice compared with IgG-treated mice.
To determine a precise signaling mechanism through which Tregs promote long-term tissue repair following ischemic stroke, Shi et al (Treg cell-derived osteopontin promotes microglia-mediated white matter repair after ischemic stroke. Immunity. 2021;54:1527–1542.e8. doi: 10.1016/j.immuni.2021.04.022)
utilized single-cell RNA sequencing and flow cytometry to verify that
Tregs are among the immune cell populations that infiltrate the brain
poststroke at 3, 5, 7, 14, and 35 days after stroke. To confirm their
role in improving white matter integrity after stroke, Tregs were
selectively depleted via diphtheria toxin (DT) injections in Foxp3DTR (DTR) transgenic mice that express the DT receptor under the control of the Foxp3
promoter. Treg depletion resulted in diminished functional recovery and
drastically aggravated white matter lesions following an ischemic
stroke. Comparative transcriptomic analysis of sorted CD4+CD25+Foxp3(GFP)+
Treg cells from the ischemic brain and blood of stroke and sham DTR
mice identified differentially expressed genes between
brain-infiltrating Treg cells and peripheral Treg cells; several genes
upregulated in brain-infiltrating Treg cells encoded trophic factors
known to stimulate oligodendrocyte precursor cell differentiation, such
as Igf1, IL-1a, and Osm. Additionally, brain-infiltrating Treg cells displayed higher levels of transcripts encoding cytokines such as Spp1, Il1b, Il1a, and Il10,
suggesting that Treg cell-mediated white matter repair may rely on
immunomodulatory signals and cell-cell interactions. Treg-derived
osteopontin was identified as a potential signaling molecule driving
microglial-mediated white matter repair, as protein-protein interaction
enrichment analysis via STRING (Search Tool for the Retrieval of
Interacting Genes/Proteins) identified interactions between Spp1, which encodes osteopontin, and Itgb1, Itga5, and Itgav,
which encode the integrin subunits of the osteopontin receptor on
microglia. To confirm the role of osteopontin signaling in vivo, Treg
cells derived from wild-type or Spp1−/− mice into DTR+DT mice 6 hours after tMCAO, and myelination was assessed via Luxol fast blue staining. Importantly, Spp1−/−
Treg cell-treated mice displayed a reduction in myelination when
compared with wild-type Treg cell-treated mice. Lastly, this study
showed that IL-2/IL-2Ab treatment boosted the number of osteopontin+
Treg cells in the ischemic brain 3 days after tMCAO, improved
sensorimotor function, spatial learning, and mitigated white matter
injury (fractional anisotropy mapping and dual staining for myelin basic
protein).
Observing the capacity of IL-2 to drive Treg
recruitment and infiltration into the brain following stroke resulting
in improved functional recovery and white matter repair, Yshii et al (Astrocyte-targeted
gene delivery of interleukin 2 specifically increases brain-resident
regulatory T cell numbers and protects against pathological
neuroinflammation. Nat Immunol. 2022;23:878–891. doi: 10.1038/s41590-022-01208-z)
aimed to develop and validate a central nervous system–specific
therapeutic strategy. The adeno-associated virus–based therapeutic
delivery system detailed in this study utilized the GFAP (glial
fibrillary acidic protein) promoter to drive IL-2 expression in
astrocytes specifically while simultaneously avoiding expression in both
the peripheral immune systems and astrocytes. The ability of the
delivery system to drive astrocyte-specific expression of IL-2 and
increase recruit of Tregs to the central nervous system was validated
using ELISA, flow cytometry, immunofluorescent staining, and single-cell
RNA-seq. The efficacy of the gene delivery was evaluated in various
models of central nervous system injury, such as the controlled cortical
impact model for traumatic brain injury, a distal middle cerebral
artery occlusion model, the photothrombotic model stroke, and the
experimental autoimmune encephalomyelitis model of multiple sclerosis.
Cognitive recovery was then assessed 15 days after injury using the
Morris water maze test and the novel object recognition test.
Comparative assessments of tissue injury and lesion size were conducted
using immunofluorescence staining of the cortical tissue and MRI 14 days
after injury. Importantly, PHP.GFAP-IL-2 treatment before injury
mitigated neuroinflammation and improved functional recovery in all
models of central nervous system injury, including traumatic brain
injury, stroke, and multiple sclerosis, and did not impact the
peripheral immune system.
While preclinical studies have shown
promising results in the use of IL-2 to amplify Tregs to mitigate white
matter injury following ischemic stroke, the application of this method
in clinical settings remains sparse. One major hurdle in applying
IL-2–mediated Treg expansion in clinical trials is to do so without
inadvertently activating other immune cells or causing broader side
effects that come with IL-2 treatments.