O processo inflamatório, a resposta imune "in situ" e a morte neuronal em sistema nervoso central de pacientes com raiva transmitida por morcegos / Inflammatory process, in situ immune response and neuronal death in central nervous system of patients with rabies transmitted by bats

AUTOR(ES)
DATA DE PUBLICAÇÃO

2009

RESUMO

Viral disease of central nervous system almost invariable fatal, rabies causes about 60.000 deaths yearly, and still remain a neglected disease in most countries, specially in developing ones. We study the meningeal, perivascular and parenquimal environment in central nervous system from patients who dies after bat transmitted rabies, looking for the inflammatory process, host immune response and neuronal death. We show that human rabies transmitted by bats is a meningoencephalomyelitis. Immunohistochemistry allows the in situ quantification of viral antigen distribution, inflammatory cellular phenotype, expression of cytokines representing both Th1 and Th2 profile and pro-inflammatory and cell apoptosis. Viral antigen was found disseminatted in cerebral parenquima, more abundant in neurons, without cerebral area preference. Glial cells, specially astrocytes, were immunostained with rabies antigen, as well as endothelial and vascular mononuclear cells. These findings contributed for an alternative hypothesis of the occurrence of hematogenic viral dissemination, through viral infection or passage by endothelial cells, followed by astrocyte infection, and finally reaching neurons. IL-12 significant expression in central nervous system from rabies patients probably reflect preservation of immunity. The lack of effective NK cells could compromise adaptive immune response, demonstred by TCD4+ lymphocytes depletion in cerebral parenquima, ineffective TCD8+ cytotoxic activity with low granzyme expression and low expression of IFN-g and IL-2r. This situation reflects viral effect on host innate and adaptive immune response leading to an ineffective response for viral clearance. High pro-inflammatory cytokine expression, IL- 1b, IL-6 and TNF-a, contribute for neuronal damage, with predominant Th2 cytokine profile in central nervous system in rabies patients, with high expression of IL-4 and IL-10. Increased TGF-b expression also shows an immune suppressor environment, which maintains the neuronal network intact, but also contributes for viral permanence. The low degree of apoptotic neurons opposed with expressive apoptosis of TCD4+ and TCD8+ lymphocytes, could indicate viral mechanisms anti-apoptotic for neurons preservation and favour viral dissemination, or pro-apoptotic, destroying lymphocytes and attenuating the inflammatory process. In synthesis, the involvement of central nervous system in rabies is consequence of inflammatory process with TCD8+ lymphocytes predominance, Th2 profile cytokines expression, affecting all brain compartments and areas, especially the medulla oblongata.

ASSUNTO(S)

sistema nervoso central inflammation rabies imunoistoquímica immunohistochemistry quirópteros central nervous system raiva inflamação chiroptera

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