Abstract

Post-traumatic anxiety notably involves inflammation, but its causes and functional significance are yet unclear. Here, we report that failure of the innate immune system Toll-like receptor 9 (TLR9) to limit inflammation is causally involved with anxiety-associated inflammation and that peripheral administration of specific oligonucleotide activators of TLR9 may prevent post-traumatic consequences in stressed mice. Suggesting involvement of NFκB-mediated enhancement of inflammatory reactions in the post-traumatic phenotype, we found association of serum interleukin-1β increases with symptoms severity and volumetric brain changes in post-traumatic stress disorder patients. In predator scent-stressed mice, the moderate NFκB-activating oligonucleotides mEN101 and its human ortholog BL-7040, but not the canonic NFκB activator oligonucleotide ODN1826, induced anxiolytic effects. In stressed mice, peripherally administered mEN101 prevented delayed stress-inducible serum interleukin-1β increases while limiting stress-characteristic hippocampal transcript modifications and the anxiety-induced EGR1-mediated neuronal activation. Attesting to the TLR9 specificity of this response, BL-7040 suppressed NFκB-mediated luciferase in transfected cells co-expressing TLR9, but not other TLRs. Furthermore, TLR9−/− mice were mEN101 and BL-7040 resistant and presented unprovoked anxiety-like behavior and anxiety-characteristic hippocampal transcripts. Our findings demonstrate functional relevance of TLR9 in protecting stressed mammals from overreacting to traumatic experiences and suggest using oligonucleotide-mediated peripheral TLR9 activation to potentiate the innate immune system and prevent post-traumatic inflammation and anxiety.

Highlights

  • Post-traumatic stress disorder (PTSD) is a severe and longlasting anxiety disorder with recently increasing abundance and social and economic significance.[1]

  • Given the reports on the increase in PTSD of both IL-1 and IL-6, we used the summated serum IL1b and IL6 levels (designated ‘inflammatory load’, (Figure 1a)) to challenge the possibility that peripheral inflammation is correlated with PTSD symptoms severity

  • When divided into high and low inflammatory load by splitting the group in the median (Figure 1a), patients with high inflammatory load (n 1⁄4 9) showed increased re-experiencing (Po0.014, Figure 1b), arousal (Po0.022), overall Clinician-Administered PTSD Scale (Po0.05) and Montgomery-Asberg Depression Rating Scale (MADRS) (Po0.02) scores compared with PTSD patients with low inflammatory load (n 1⁄4 10)

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Summary

Introduction

Post-traumatic stress disorder (PTSD) is a severe and longlasting anxiety disorder with recently increasing abundance and social and economic significance.[1] Apart from their central nervous system impairments, PTSD patients suffer multiple peripheral pathologies,[2] including persistent inflammation. Hormones released during stress prepare the immune system to cope with physical injuries.[5] anxiety patients and rodents exposed to acute stressors both show elevated serum levels of pro-inflammatory cytokines (for example, interleukin (IL) -1b and IL-6).[6,7] apart from their protective immune functions, such peripheral cytokines access the brain and stimulate specific receptors.[8,9,10]

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