Immunometabolic Regulation of Myeloid-Lymphoid Interactions Following Traumatic Brain Injury

Abstract

Traumatic brain injury (TBI) is a major public health issue, producing significant patient mortality and poor long-term outcomes. Increasing evidence suggests an important, yet poorly defined, role for the immune system in the development of progressive secondary injury. Herein, we tested the hypothesis that peripheral macrophage infiltration initiates long-lasting adaptive immune responses after TBI. Using a murine controlled cortical impact model, we found increased infiltration and pro-inflammatory (M1) polarization of macrophages for up to three weeks post-TBI. Monocytes purified from the injured brain stimulated the proliferation of naïve T lymphocytes, enhanced the polarization of T effector cells (Teff: TH1/TH17), and decreased the production of regulatory T cells (TREG) in a mixed lymphocyte reaction. Similarly, elevated Teff polarization within both blood and brain tissue was attenuated by myeloid cell depletion after TBI. Functionally, C3H/HeJ (TLR4 mutant) mice reversed both M1 macrophage and TH1/TH17 polarization after TBI, as compared to C3H/OuJ (wild-type) mice. Moreover, brain monocytes isolated from C3H/HeJ mice were less potent stimulators of T lymphocyte proliferation and TH1/TH17 polarization, as compared to C3H/OuJ monocytes. To further elucidate the mechanism underlying this myeloid TLR4-mediated Teff activation, we examined the metabolic regulator, 5’-adenosine monophosphate-activated protein kinase (AMPK), within infiltrating macrophages following TBI. We determined that reduced activation of myeloid AMPK induced the generation of pro-inflammatory, myelin reactive T-cells. Similarly, we detected myelin-laden macrophages within the cerebrospinal fluid of severe TBI patients. Administration of the AMPK activator, metformin, attenuated pro-inflammatory Teff cell generation and enhanced counter-inflammatory TREGs in wild-type mice; however, these effects were lost in myeloid-specific AMPKα1 knockout mice. Activation of AMPK restored myeloid expression and activity of Ten-eleven translocase 2 (TET2), a demethylase that regulated the expression of myeloid PD-L1 after TBI. Moreover, TET2-/- mice exhibited exaggerated T-cell activation in response to TBI. In line with these data, activation of myeloid AMPK reduced the loss of white matter and improved neurobehavioral outcomes after TBI. Our studies identify that immunometabolic dysfunction drives epigenetic regulation of the myeloid-lymphoid transition after TBI; suggesting targeted interventions during the early stage of injury may prevent progressive neurodegeneration.