Here, a murine model of CSDS-induced depression was employed to explore the potential antidepressant activity of the Smilax glabra Roxb.-derived flavonol glycoside engeletin. Ultimately these analyses revealed that engeletin is able to alleviate CSDS-related depressive-like phenotypes through its ability to suppress LCN2/CXCL10 pathway activation and thereby modulate microglial polarization.
Stress responses entail the engagement of a diverse range of physiological and behavioral responses[21]. Exposure to chronic stress over extended periods can contribute to the incidence of MDD and other adverse outcomes. The precise biological mechanisms that give rise to MDD remain incompletely understood, and therapeutic options remain limited owing to the heterogeneous nature of this disease and the pathogenic and clinical levels[22, 23]. Diagnosing MDD in a clinical setting is also highly dependent on structured interviews and subjective criteria, contributing to a greater risk of patients being misdiagnosed, thus increasing the burden of this disease.
Structural MRIs have led to the identification of several brain abnormalities in MDD patients, with these changes most commonly manifesting in gray matter areas related to decision-making, emotional procession, and reward circuitry within the limbic system and frontal lobe[24, 25]. Multiparameter MRI scans are currently regarded as the most effective approach to noninvasively analyzing the pathological basis of MDD in vivo[26]. T1WI and T2WI strategies enable the visualization of brain anatomy, whereas quantitative indices such as DTI measurements and T2 values can provide quantitative sensitivity when attempting to detect injury to the nervous system and gauge the efficacy of neuroprotective interventions[27]. The T2 hyperintensity of the bilateral prefrontal cortex is associated with increases in inflammation, vascular permeabilization, myelin turnover, water content, and the accumulation of byproducts of myelin and axonal breakdown[28, 29]. ADC and FA values are key quantitative DTI parameters that are closely correlated with the pathogenesis of depression. These quantitative DTI and T2 parameters can also be evaluated and compared with the outcomes of behavioral and histological analyses to gain more robust insight into the incidence of depression and to explore therapeutic outcomes[30, 31]. Here, ADC, FA, and T2 values for the bilateral prefrontal cortex were significantly altered in CSDS model mice, while engeletin administration reversed these changes and alleviated depressive-like behavioral phenotypes. Overall these findings conclusively demonstrate that T2 and DTI measures can offer value as biomarkers of depression that can gauge disease progression and enable the rigorous assessment of interventional strategies.
Neuroinflammation is increasingly understood to play an important role in the pathogenesis of depression[13, 32]. The use of anti-inflammatory drugs to suppress microglia-mediated inflammation has been shown to alleviate depressive symptoms, and a growing body of evidence suggests that depressive-like phenotypes can arise owing to the imbalance between pro- and anti-inflammatory cytokine production. Here, engeletin was found to promote the upregulation of anti-inflammatory IL-10 within the mPFC in CSDS model mice while suppressing the expression of pro-inflammatory IL-1β, IL-6, and TNF-α. As peripheral cytokines are generally limited in their ability to cross the blood-brain barrier, microglia serve as a main source of these inflammatory mediators within the CNS, promoting neuroinflammation that is central to the pathogenesis of CSDS-associated depressive-like behaviors.
Microglia are mesoderm-derived cells present within neurological tissues that are central to depression-related pathways and to the incidence of neuroinflammation[9]. While microglial polarization has been found to correlate with depressive behavior, the specific mechanisms underlying this correlation and their therapeutic relevance remain to be fully clarified. Microglia that exhibit M1 and M2 polarization profiles secrete differing levels of pro- and anti-inflammatory cytokines, in addition to expressing different functional and morphological markers[33]. M1 microglia, which generally express iNOS and CD86, produce high concentrations of inflammatory cytokines such as IL-6, TNF-α, IFN-γ, and IL-1β, whereas M2 microglia express Arg1 and CD206, and secrete anti-inflammatory factors including IL-10, IL-4, and TGF-β[8]. M2 microglial polarization has been demonstrated to have beneficial effects following chronic stress in the context of neurological disease[34]. Here, treatment with engeletin resulted in M2 microglia activation and the suppression of M1 polarization, in turn increasing IL-10 and TGF-β secretion while suppressing IL-1β, TNF-α, and IL-6 production within the mPFC. These results thus suggested that engeletin is capable of treating CSDS through the tuning of the microglial balance of M1/M2 polarization and the alleviation of neuroinflammation, potentially providing a novel avenue for the treatment of neurological disease.
LCN2 has increasingly been shown to play a central role in the incidence of neuroinflammatory pathology in the CNS[35]. Also referred to as NGAL or 24p3, LCN2 is a lipocalin family member that binds to a range of hydrophobic molecules, interacts with particular cell surface receptors, and controls concentrations of iron within cells, thereby influencing an array of pathways[36, 37]. While the expression of LCN2 at baseline is relatively limited, it can be rapidly upregulated whereupon it serves as a regulator of viability, migratory activity, innate immunity, and tissue morphology. Multiple studies have identified links between LCN2, depression, and behavior[38]. For example, mice exposed to a 6 h restraint model of stress exhibited a 7-fold increase in hippocampal LCN2 expression. Restraint stress also reportedly induces an increase in amygdalar LCN2 expression, with such upregulation primarily taking place within neurons and being functionally linked to increases in immature neuroplastic spines consistent with fear memory formation[39, 40]. Stress-naïve Lcn2-knockout rodents also resent with an increase in spine density in the amygdalar basolateral complex as compared to wild-type control animals[41]. Naude et al.[42]found that plasma LCN2 levels in patients with depression were significantly increased relative to non-depressed controls, and plasma LCN2 levels were also reportedly higher in patients suffering from recurrent depression as compared to first-episode depression.
Chemokines play an essential role in guiding the movement of particular cell populations to specific physiological sites. In addition to their importance in the maintenance of systemic homeostasis, these chemotactic cytokines can also contribute to pathological changes within the CNS, particularly in the context of development, injury, synaptic transmission, and disease-related neuroinflammatory activity[43]. LCN2 was recently identified as a promoter of chemokine expression within the CNS, with neurons, endothelial cells, astrocytes, and microglia all serving as potential cellular producers of chemokines[38]. CXCL10 secretion induced by LCN2 has been reported to induce microglial, astrocytic, and neuronal migration through mechanisms at least partially regulated by JAK2/STAT3 and IKK/NF-κB pathways[44]. Here, chronic stress was associated with significant LCN2/CXCL10 axis activation, whereas the administration of engeletin markedly suppressed LCN2 and CXCL10 expression within the mPFC in a manner that was reversed by LCN2 overexpression in the mPFC of these engeletin-treated CSDS model mice.
LCN2 was significantly downregulated in apoptosis-resistant microglia, and subsequent research in which LCN2 was knocked down or overexpressed revealed that it serves as a vital mediator of apoptotic sensitization and the amoeboid transformation of activated microglia[45, 46]. The precise physiological importance of LCN2 as a regulator of the M1/M2 polarization of microglia, however, remains poorly understood. Here, the antidepressant-like effects of engeletin were primarily found to be attributable to its ability to modulate LCN2/CXCL10 pathway signaling and microglial polarization. The overexpression of LCN2 was sufficient to reverse the antidepressant-like benefits of engeletin in CSDS model mice while reducing the expression of M2-associated proteins (Fig. 9). These data provide further support for the utility of LCN2 as a diagnostic biomarker of depression that can be assessed in combination with a range of other inflammatory markers, growth factors, and metabolic or endocrine changes when assessing the incidence of depressive symptoms.
Together, these data demonstrate that chronic stress is associated with LCN2 upregulation whereas engeletin treatment is capable of mitigating inflammation-associated damage and promoting the M2 polarization of M1 microglia through the suppression of LCN2/CXCL10 signaling activity.