Various studies have shown the detrimental effects on AD patients’ CNS of proinflammatory cytokines, which are predominantly elicited from microglial cells with chronic exposure to Aβ. The injurious effects of proinflammatory cytokines can lead to neuronal dysfunction and death through mechanisms including the induction of nitric oxide (NO) production (
21,
22); long-term potentiation (LTP) of synaptic transmission inhibition, which plays a key role in the formation of memory (
23,
24); and reduced hippocampal neurogenesis (
25).
Immunotherapy is a newly developed strategy that can help to slow cognitive impairment and reduce the AD-associated lesions (
26). Since anti-inflammatory cytokines can protect the CNS from lesions caused by proinflammatory cytokines (
27-
29), IL-4, as the most prominent anti-inflammatory cytokine, has a wide range of implications for treating AD (
4,
26,
27,
30,
31). This cytokine can polarize T-cells and macrophages to Type 2 morphology (Th2 and M2) and accelerate amyloidosis (
32). Kiyota et al. showed that AAV-mediated IL-4 can reduce the burden of Aβ (1-42) in vivo (
4). Zhao et al. demonstrated that IL-4 can protect the microglia by inhibiting production of free radicals (
33). In addition, several other mechanisms of the inhibitory effects of IL-4 have been noted, including its inhibition of formyl peptide receptor (FPR) (
34).
This study established that AAV encoding IL-4 the same as rIL-4 protein against Aβ (1-42)-induced IL1-β, IL-6, TNF-α, and IL-18 proinflammatory cytokines in rat primary microglia and in the B92 rat microglia cell line (
28). The AAV vector used has a complex library of hybrid capsids from eight different wild-type viruses and has high transduction efficacies, especially in vitro, compared to other wild type serotypes.
Several studies have shown that Aβ (1-42) induces the production of proinflammatory cytokines in vitro (
28,
31), in animal labs (
4), and in AD patients (
26,
35-
37), and evidence has shown the contribution of proinflammatory cytokine in the AD development process.
Many studies have shown an elevated level of TNF-α in the serum and cerebrospinal fluid (CSF) of AD patients and have confirmed the potential involvement of this prominent proinflammatory cytokine in AD pathophysiology (
31,
35). Tobinick et al. demonstrated that consumption of a TNF-α inhibitor (Etanercept) by AD patients leads to a significant improvement (
38). Szczepanik et al. (
28) reported that TNF-α was secreted from Aβ (1-42)-induced primary microglia and the THP-1 cell line (
39). The current study used quantitative PCR assay to confirm acceleration of the mRNA level of TNF-α in Aβ (1-42)-induced primary and continuous rat microglia cells.
Elevated levels of IL-6 (
40,
41) and its contribution to pathophysiology in AD patients has been shown by Cojocaru et al. (
41). As shown in
Figure 3, the mRNA of this cytokine increased markedly against Aβ (1-42) induction.
Bossu et al. (
42) demonstrated an increased IL-18 cytokine level in AD patients and a positive correlation between IL-18 expression and AD-related cognitive impairment (
43,
44). The present study demonstrated that Aβ (1-42), like other assessed proinflammatory cytokines (
45), can induce IL18 mRNA expression, while its expression can be inhibited by the anti-inflammatory cytokines, either rIL-4 or rAAV-IL4.
In AD-affected patients, the expression of Aβ (1-42)-induced proinflammatory cytokines can cause progressive dementia because of negative neurodegenerative effects. IL-4 not only protects neurons from further injury, but also revives the impaired neurodegenerative lesions (
46) by inhibiting IFN-λ priming of microglia through cAMP signaling, with later reduction in impairing proinflammatory cytokines such as TNF-α, IL-1β, and nitric oxide (
47).
In conclusion, this study has shown that anti-inflammatory gene delivery by AAV vector plays a significant role in modulating immune response in Aβ (1-42)-induced processes. In addition, it seems that this newly suggested treatment could have implications in other allergic disorders, autoimmune diseases, and transplant rejection.