Neuropeptides and immunity

The role of the conjunctival epithelium in ocular allergy

PURPOSE OF REVIEW

The epithelium of target organs is playing an increasing role in allergy. Several studies have shown that epithelial cells participate actively in inflammatory processes. This review will focus on recent advances in the role of conjunctival epithelium in allergy as a potential target for therapeutic interventions.

RECENT FINDINGS

Several studies have already shown the involvement of ocular surface epithelial cells in allergic inflammatory diseases, because they are able to produce and secrete cytokines and chemokines upon stimulation. They also express adhesion molecules as well as receptors for several substances implicated in inflammation. Some studies have also shown that conjunctival epithelial cells express co-stimulatory molecules when they interact with activated T cells, adding more evidence to the important role that epithelial cells play in the pathogenesis of ocular inflammatory diseases. Recent reports have also demonstrated that during inflammatory conditions, conjunctival epithelial cells show an altered expression of their neuroreceptors, suggesting that a modulation of neural regulation may be of therapeutic value.

SUMMARY

The ocular surface epithelium is not just a simple physical barrier to the entrance of foreign bodies. It participates in the allergic inflammatory process by being influenced by inflammatory molecules, and by secreting inflammatory cytokines and chemokines. Moreover, the epithelium not only actively participates in the inflammation process but can also initiate it. This relevant spectrum of actions makes epithelium an attractive target for therapeutic interventions.

Efficacy of topical nerve growth factor treatment in dogs affected by dry eye

BACKGROUND

Preliminary data show that nerve growth factor (NGF) may improve tear production in humans. We evaluated the efficacy of topical NGF treatment in dogs who developed dry eye after the excision of the third eyelid lacrimal gland.

METHODS

English Bulldogs (2- to 6-year-old males and females) that had undergone the surgical removal of the prolapsed lacrimal gland of the third eyelid in both eyes at the age of 3-6 months developed chronic keratoconjunctivitis sicca associated with a decrease of Schirmer tear test I values after at least 1 year. One eye, randomly selected, of each dog was treated twice daily with 100 microl of NGF ointment for 1 month, while the fellow eye was used as control and treated with the ointment vehicle only. At baseline and after 1 month of NGF treatment the following examinations were performed: corneal evaluation by slit lamp, fluorescein staining, Schirmer tear test I, tear ferning test, corneal esthesiometry by cotton swab and conjunctival impression cytology.

RESULTS

Topical application of NGF caused a significant improvement of all the evaluated parameters compared with baseline values. In contrast, in the control eyes there was no significant difference between the values measured before and after treatment. In particular, after NGF treatment superficial punctate keratopathy was resolved, corneal haze was reduced from stage 4 to stage 2 and Schirmer test values increased (17.2+/-1.7 mm/min vs 4.5+/-1.3 mm/min; p<0.05), as did the tear mucous component (as demonstrated by ferning test: 2.0+/-0.0 vs 4.0+/-0.0; p<0.05); conjunctival impression cytology evaluation demonstrated the presence of numerous mucous filaments and a significant increase in conjunctival goblet cell density (102.7+/-68.3 vs. 18.2+/-14.3 cell x field; p<0.05). Topical NGF treatment improved corneal sensitivity in two of three eyes.

CONCLUSIONS

This open study suggests that topical application of NGF may enhance the production and functional characteristics in tear film, with an improvement of ocular surface signs in dogs with surgically induced dry eye. These results suggest the possibility of performing further, larger, controlled studies.

Neuropeptides in skin

Neuropeptides are a heterogeneous group of more than 50 molecules that play a role in various cutaneous functions and diseases; they act as neuromodulators, neurotransmitters, neurohormones, and hormones. In the skin, neuropeptides are synthesized locally (i.e., in keratinocytes and in endothelial cells) and are transported by nerve fibers or immune cells (i.e., lymphocytes, monocytes, and polymorphonuclear cells). Specific receptors and binding sites for neuropeptides have been described in different cell lines in the skin (keratinocytes, endothelial cells, immune cells, fibroblasts). Many different biologic actions of neuropeptides have been demonstrated. Depletion of cutaneous neuropeptides (i.e., with capsaicin cream) or therapeutic use of neuropeptide agonists and/or antagonists may aid in the treatment of skin diseases.

Vascular somatostatin receptors in synovium from patients with rheumatoid arthritis

The peripheral nervous system and its neuropeptidergic pathways may play an important role in the pathogenesis and development of rheumatoid arthritis. In the present study, the role of the neuropeptide somatostatin (SRIF), which was recently shown to be implicated in inflammatory diseases of the gastrointestinal tract, was evaluated by measuring the expression of somatostatin receptors in synovium from patients with rheumatoid arthritis. Somatostatin receptors were detected using in vitro receptor autoradiography in the synovium from five patients with active disease. No receptors were found in one case, a successfully treated patient with quiescent disease. The receptors were of high affinity and specific for biologically active somatostatin analogs. Displacement by nanomolar concentrations of somatostatin-14, somatostatin-28, and octreotide was observed, suggesting that most of the receptors identified belong to the SRIF1A subtype. The somatostatin receptors were preferentially located in blood vessels, with specific labeling of the veins but not of the arteries. The whole vessel wall was homogeneously labeled including the smooth muscle cells and probably the endothelium. These data suggest that the synovium in active rheumatoid arthritis expresses a high density of somatostatin receptors. Somatostatin may act through these venous receptors to influence the inflammatory process by induction of vasoconstriction, inhibition of plasma extravasation and cell migration, or inhibition of neovascularization.

Intestinal vessels express a high density of somatostatin receptors in human inflammatory bowel disease

BACKGROUND/AIMS

The neuropeptide somatostatin exerts multiple functions in the gastrointestinal tract and may also play a regulatory role in inflammatory bowel disease, as several other neuropeptides do, e.g., substance P or calcitonin gene-related peptide. Therefore, the expression of somatostatin receptors was evaluated in tissue sections of diseased intestines and compared with controls.

METHODS

Somatostatin receptors were measured in intestinal samples of 6 patients with Crohn's disease, 3 with ulcerative colitis, and 7 controls using somatostatin receptor autoradiography with 125I-[Tyr3]-octreotide or 125I-[Leu8,D-Trp22,Tyr25]-somatostatin-28 as radioligands. Substance P receptors were measured similarly on adjacent sections.

RESULTS

Somatostatin receptors are present in high density in most intramural veins, but not in arteries, of intestines in florid Crohn's disease or ulcerative colitis. The receptors are specific and of high affinity for somatostatin-14 and -28, as well as for octreotide. Somatostatin receptors remain undetectable in the veins of noninflamed control intestine. Substance P receptors are identified in the somatostatin receptor-positive veins and also in arteries.

CONCLUSIONS

The expression of receptors for somatostatin in veins of inflamed intestines suggests an active involvement of this peptide in the pathophysiology of inflammatory bowel disease and perhaps of inflammation in general.

Expulsion of Hymenolepis nana from mice with congenital deficiencies of IgE production or of mast cell development

The roles of IgE and mast cells on expulsion of adult Hymenolepis nana from the intestine were examined in mice. IgE-dependency was determined by comparing congenitally IgE-deficient SJA/9 and IgE-producing SJL/J mice infected with 50 H. nana eggs. Anti-H. nana IgE antibody was detected at three weeks post infection (p.i.) in SJL but not in SJA mice. The number of adult worms in the intestines of SJA and of SJL mice were similar at two weeks, but significantly more were found in SJA mice at three weeks p.i. Treatment of mice with anti-epsilon antibody also resulted in an increased worm burden at three weeks, suggesting participation of IgE in expulsion of H. nana. Intestinal mastocytosis was induced by infection regardless of the IgE status of the mice. Mast cell-dependency was tested in mast cell-deficient W/Wv and in normal littermate +/+ mice infected with 100 H. nana eggs. Anti-H. nana antibody was detected in both groups of mice at three weeks p.i. Worm expulsion seemed to be mast cell dependent because expulsion was less complete in W/Wv mice at three weeks p.i. Peripheral blood eosinophilia was comparable at three weeks p.i. in both IgE and mast cell sufficient and deficient mice. These results suggest that IgE and mast cells participate in the expulsion of H. nana adults from intestine in mice.

Regulation of human T lymphoblast growth by sensory neuropeptides: augmentation of cholecystokinin-induced inhibition of Molt-4 proliferation by somatostatin and vasoactive intestinal peptide in vitro

The effects on proliferation of Molt-4 lymphoblasts of cholecystokinin (CCK-8), somatostatin-14 (SS), vasoactive intestinal peptide (VIP) and substance P (SP) were investigated using different combinations of the peptides, peptide analogs and their antagonists. In vitro proliferation of the cells was measured by a colorimetric assay for cell growth and survival. Results indicate that SP and SP (3-11) stimulated, whereas CCK-8, VIP and SS inhibited, proliferation in a dose-dependent manner (P < 0.05). Unsulfated CCK-8 had no effect on growth of Molt-4 lymphoblasts, and a specific antagonist of CCK, at a concentration 10(-6) M, diminished the inhibitory effect of CCK-8 on Molt lymphoblasts (P < 0.05). This suggests that the inhibitory action of CCK-8 was mediated by peripheral-type CCK receptors. SS and VIP, at equimolar concentrations of 10(-6) M, significantly augmented the CCK-8-induced inhibition of Molt-4 lymphoblast proliferation. However, none of the inhibiting neuropeptides suppressed stimulation of Molt-4 lymphoblast proliferation in response to SP. These data suggest a role of sensory neuropeptides including CCK in modulating human T lymphoblast proliferation during neuroendocrine interactions with the immune system.

Evidence of a neurogenic component during IgE-mediated inflammation in mouse skin

IgE-mediated inflammation was measured in mouse footpads that lacked sciatic innervation. Mice were passively sensitized with a monoclonal antibody, IgE anti-dinitrophenol, or were immunized for specific IgE production. Antigen-induced swelling in the denervated footpads was reduced 23-39% when compared to sham or untreated controls. Reduced IgE-mediated swelling responses were attributed to the loss of a mast cell-nerve interaction and not to blood vessel sensitivity to vasoamines. Furthermore, electrical stimulation of the distal segment of the sciatic nerve completely restored IgE-mediated inflammation. These data provide in vivo evidence that peripheral nerves participate in cutaneous IgE-mediated swelling reactions with the net effect of increasing inflammation.

Interactions of mast cells with the nervous system ?Recent advances

This article reviews recent advances in the understanding of mast cell-nervous system interactions. It is drawn largely from work published within the last ten years, and discusses the anatomical and biochemical evidence of a functional connection between mast cells and the nervous system, and the implications that such a relationship may have for normal and abnormal physiological functioning. Mast cells are found at varying levels of association with the nervous system; in CNS parenchyma (mainly thalamus), in connective tissue coverings (e.g. meninges, endoneurium), and in close apposition to peripheral nerve endings in a variety of tissues. There is, as yet, no clearly defined role for mast cells in nervous system function, or vice-versa, and it seems most likely that their interactions fulfil mutually modulatory roles. By extension, pathological situations where one of the partners in this relationship is overly stimulated may lead to a dysregulation of the other, and contribute to disease symptomatology.

Localisation and characterisation of substance P binding to human synovial tissue in rheumatoid arthritis

The neuropeptide substance P is found in perivascular and free unmyelinated nerve fibres in human synovial tissue. Quantitative receptor autoradiography was used to show specific, high affinity (Kd = 0.75 (0.21), nmol/l (mean (standard error of the mean)), low capacity (Bmax = 27.8 (7.9) amol/mm2) binding sites for substance P Bolton Hunter-labelled with iodine-125 localised to vascular endothelial cells in human synovial tissue. The binding could be saturated, was reversible, and was dependent on the magnesium concentration. Unlabelled substance P and neurokinin A competitively inhibited specific binding with 50% inhibition at concentrations of 1.25 (0.21) and 175 (29) nmol/l respectively. Neurokinin B (mumol/l) and calcitonin gene related peptide (1 mumol/l) did not inhibit binding. These binding sites show characteristics of the neurokinin 1 tachykinin receptor subtype. This provides further evidence that substance P may play a part in the vascular control of human synovium and may influence inflammatory processes in joints.

Modulation of the immune response by tachykinins

Neuro-immunology is becoming an increasingly important discipline of immunology. This review has examined the immunomodulatory function of one group of neuropeptides, the TK, particularly SP and NKA. These peptides are localized in primary afferent nerves which have been shown to innervate several immune organs. In addition, binding sites for the TK have been demonstrated in thymus, spleen and lymph node. Several immune cell types also express neurokinin receptors including human circulating lymphocytes with binding to the Th/i class predominating, murine T and B cells, a human T lymphoblastoid cell line, human monocytes, rabbit polymorphonuclear leucocytes and guinea-pig macrophages. The apposition of nerves with immune cells and receptors for neuropeptides thus produces an environment for interaction between the nervous and immune systems. Studies in vitro and, more recently, in vivo have examined how the TK regulate immune cell responses. The TK stimulate proliferation of T cells, enhance mitogen-induced release of cytokines including IFN-gamma, TNF-alpha, IL-1 and IL-6 from mononuclear cells and macrophages, enhance immunoglobulin secretion and affect cellular chemotaxis and phagocytosis. Studies in vivo have shown a role for TK in lymphocyte recirculation of sheep lymph nodes, reversal of stress-induced thymic involution and Ig production in both rat and mouse. Many of these effects appear to be mediated via NK-2 type receptors. To date, most of the work has involved studies in vitro, but the results from these are now being validated by studies in vivo where both the immune system and neuropeptides are able to interact at many anatomical sites. The complexities of the immune and the nervous systems mean that only a small number of potential interactions has been examined. Future studies can be expected to amplify these observations, especially with respect to the understanding of inflammatory and immune diseases in humans.

Tachykinin-mediated modulation of the primary antibody response in rats: evidence for mediation by an NK-2 receptor

Evidence for the involvement of primary afferent nerves and their associated neuropeptides in in vivo immunologic responses has been based on experiments in rats in which destruction of primary afferent nerves by the sensory neurotoxin capsaicin results in a diminished ability of the animal to mount a primary antibody response to sheep red blood cell (SRBC) antigen. This effect was shown to be reversed by substance P infusion immediately following antigenic stimulation. In this report we show that neurokinin A (NKA) is 12 times more potent than substance P in its capacity to reverse the effects of neonatal capsaicin pretreatment on the antibody response. Neurokinin A has a pD2 of 6.65 compared to 5.98 for substance P. In addition, NKA was more potent than substance P in reversing the effects of surgical lesions 2 days prior to antigenic stimulation. The effects of the D- and L-Pro9 analogues of [Glp6, Pro9]-SP6-11 on the plaque-forming cell response in capsaicin-treated rats provide further support for the hypothesis that the tachykinin receptor modulating the primary antibody response is an NK-2 receptor. These results demonstrate, for the first time, a role for NKA in in vivo immunomodulation.

Nerve growth factor promotes human hemopoietic colony growth and differentiation

Nerve growth factor (NGF) is a neurotropic polypeptide necessary for the survival and growth of some central neurons, as well as sensory afferent and sympathetic neurons. Much is now known of the structural and functional characteristics of NGF, whose gene has recently been cloned. Since it is synthesized in largest amounts by the male mouse submandibular gland, its role exclusively in nerve growth is questionable. NGF also causes histamine release from rat peritoneal mast cells in vitro, and we have shown elsewhere that it causes significant, dose-dependent, generalized mast cell proliferation in the rat in vivo when administered neonatally. Our experiments now indicate that NGF causes a significant stimulation of granulocyte colonies grown from human peripheral blood in standard hemopoietic methylcellulose assays. Further, NGF appears to act in a relatively selective fashion to induce the differentiation of eosinophils and basophils/mast cells. Depletion experiments show that the NGF effect may be T-cell dependent and that NGF augments the colony-stimulating effect of supernatants from the leukemic T-cell (Mo) line. The hemopoietic activity of NGF is blocked by polyclonal and monoclonal antibodies to NGF. We conclude that NGF may indirectly act as a local growth factor in tissues other than those of the nervous system by causing T cells to synthesize or secrete molecules with colony-stimulating activity. In view of the synthesis of NGF in tissue injury, the involvement of basophils/mast cells and eosinophils in allergic and other inflammatory processes, and the association of mast cells with fibrosis and tissue repair, we postulate that NGF plays an important biological role in a variety of repair processes.

Mechanisms of persistent synovitis

Rheumatoid arthritis is characterised by persistent and symmetrical synovitis. In this article we propose two linked hypotheses to explain these observations. A mechanism to explain symmetry of synovitis is described whereby fine afferent nerve fibres from joints become bilaterally sensitized to movement with resultant release of neuropeptides promoting an inflammatory response. Clinical and experimental evidence is reviewed and shows that movement and resulting hypoxic reperfusion injury leads to a persistent synovitis.