Resveratrol Acts Anti-Inflammatory and Neuroprotective in an Infant Rat Model of Pneumococcal Meningitis by Modulating the Hippocampal miRNome.

Resveratrol (RSV) is anti-inflammatory and neuroprotective, cross the blood-brain barrier (BBB) and has a safe profile. Besides, RSV modulates the expression of some miRNAs related to neurological disorders. Thus, we hypothesized that RSV can be neuroprotective in pneumococcal meningitis by modulating the global microRNA expression profile (miRNome). Eleven-day old rats were intracysternally infected with S. pneumoniae (~ 2 × 106 c.f.u.) and were orally administered with RSV (50 mg/kg) or vehicle in pre-treatment (before infection) or post-treatment schedules (3 and 18 h p.i.). At 24 h p.i., animals were euthanized and apoptotic cells were counted in the hippocampal dentate gyrus of the right brain hemispheres. The hippocampi from left hemispheres were used for cytokines and chemokines multiplex assay and miRNome profiling with TaqMan OpenArray Rodent MicroRNA. Infected rats treated with RSV had lower apoptotic scores and IL-1ß, CCL2, and CCL3 levels when compared to the infected group receiving placebo. Seven miRNAs were down regulated, and 18 were up regulated by pneumococcal acute meningitis. Thirty-seven miRNAs were down regulated, and three were up regulated (hsa-miR-15b-5p, hsa-miR-25-3p, hsa-miR-125b-5p) by the interaction between meningitis and RSV. Pathway enriched analysis revealed that meningitis and RSV modulate the expression of miRNAs targeting critical pathways related to the pathophysiology of bacterial meningitis. Nevertheless, hsa-miR-25-3p and hsa-miR-125b-5p target the transcription factor TEF-1, for which there are binding sites in Il-1ß, Ccl2, and Ccl3 genes. RSV is anti-inflammatory and neuroprotective in an infant rat model of pneumococcal meningitis and these positive effects involve the modulation of the hippocampal miRNome.

Depression-Like Adult Behaviors may be a Long-Term Result of Experimental Pneumococcal Meningitis in Wistar Rats Infants.

Pneumococcal meningitis is a life-threatening infection of the central nervous system (CNS) with a high mortality rate. In addition to causing severe neurological sequelae infectious diseases of the CNS can play a significant role in the pathogenesis of neuropsychiatric disorders. In this study infant Wistar rats, postnatal day 11, received intracerebroventricular (i.c.v.) either artificial cerebrospinal fluid (CSF) or a Streptococcus pneumoniae suspension to a concentration of 1 × 106 colony-forming units (CFU). 18 h later animals received antibiotic treatment as usual during 7 days. On postnatal day 46, the animals received imipramine intraperitoneal (i.p.) or sterile NaCl during 14 days (postnatal days 46-60). Then, on postnatal days 59-60 we evaluated the consumption of sweet food (an index of anhedonia). On postnatal day 60 the animals were submitted to the forced swimming task. 60 min after this task the animals were decapitated and the blood was collected to evaluate adrenocorticotropic hormone (ACTH) and corticosterone. Immediately after blood collection the hippocampus was removed to evaluate brain-derived neurotropic factor (BDNF) and glial cell line-derived neurotrophic factor (GDNF). The meningitis group exhibited depressive-like behavior as evidenced by decreased sucrose intake and increased immobility time in the forced swimming task, and BDNF and GDNF decrease in the hippocampus. ACTH levels were increased in the blood. Imipramine treatment reversed depressive-like behaviors, re-established hippocampal BDNF and GDNF expression, and normalized ACTH levels in the blood. Here we demonstrate that meningitis during early life period can trigger depressive-like behavior in adult life of rats.

Role of oxidative stress in the pathophysiology of pneumococcal meningitis.

Pneumococcal meningitis is a life-threatening disease characterized by an acute purulent infection affecting the pia mater, the arachnoid, and the subarachnoid spaces. Streptococcus pneumoniae crosses the blood-brain barrier (BBB) by both transcellular traversal and disruption of the intraepithelial tight junctions to allow intercellular traversal. During multiplication, pneumococci release their bacterial products, which are highly immunogenic and may lead to an increased inflammatory response in the host. Thus, these compounds are recognized by antigen-presenting cells through the binding of toll-like receptors. These receptors induce the activation of myeloid differentiation factor 88 (MyD88), which interacts with various protein kinases, including IL-1 receptor-associated kinase-4 (IRAK4), which is phosphorylated and dissociated from MyD88. These products also interact with tumor necrosis factor receptor-associated factor 6 dependent signaling pathway (TRAF6). This cascade provides a link to NF- κ B-inducing kinase, resulting in the nuclear translocation of NF- κ B leading to the production of cytokines, chemokines, and other proinflammatory molecules in response to bacterial stimuli. Consequently, polymorphonuclear cells are attracted from the bloodstream and then activated, releasing large amounts of NO(•), O2(•), and H2O2. This formation generates oxidative and nitrosative stress, subsequently, lipid peroxidation, mitochondrial damage, and BBB breakdown, which contributes to cell injury during pneumococcal meningitis.

Cannabidiol reduces host immune response and prevents cognitive impairments in Wistar rats submitted to pneumococcal meningitis.

Pneumococcal meningitis is a life-threatening disease characterized by an acute infection affecting the pia matter, arachnoid and subarachnoid space. The intense inflammatory response is associated with a significant mortality rate and neurologic sequelae, such as, seizures, sensory-motor deficits and impairment of learning and memory. The aim of this study was to evaluate the effects of acute and extended administration of cannabidiol on pro-inflammatory cytokines and behavioral parameters in adult Wistar rats submitted to pneumococcal meningitis. Male Wistar rats underwent a cisterna magna tap and received either 10µl of sterile saline as a placebo or an equivalent volume of S. pneumoniae suspension. Rats subjected to meningitis were treated by intraperitoneal injection with cannabidiol (2.5, 5, or 10mg/kg once or daily for 9 days after meningitis induction) or a placebo. Six hours after meningitis induction, the rats that received one dose were killed and the hippocampus and frontal cortex were obtained to assess cytokines/chemokine and brain-derived neurotrophic factor levels. On the 10th day, the rats were submitted to the inhibitory avoidance task. After the task, the animals were killed and samples from the hippocampus and frontal cortex were obtained. The extended administration of cannabidiol at different doses reduced the TNF-α level in frontal cortex. Prolonged treatment with canabidiol, 10mg/kg, prevented memory impairment in rats with pneumococcal meningitis. Although descriptive, our results demonstrate that cannabidiol has anti-inflammatory effects in pneumococcal meningitis and prevents cognitive sequel.

Pathophysiology of acute meningitis caused by Streptococcus pneumoniae and adjunctive therapy approaches.

Pneumococcal meningitis is a life-threatening disease characterized by an acute purulent infection affecting piamater, arachnoid and the subarachnoid space. The intense inflammatory host's response is potentially fatal and contributes to the neurological sequelae. Streptococcus pneumoniae colonizes the nasopharynx, followed by bacteremia, microbial invasion and blood-brain barrier traversal. S. pneumoniae is recognized by antigen-presenting cells through the binding of Toll-like receptors inducing the activation of factor nuclear kappa B or mitogen-activated protein kinase pathways and subsequent up-regulation of lymphocyte populations and expression of numerous proteins involved in inflammation and immune response. Many brain cells can produce cytokines, chemokines and others pro-inflammatory molecules in response to bacteria stimuli, as consequence, polymorphonuclear are attracted, activated and released in large amounts of superoxide anion and nitric oxide, leading to the peroxynitrite formation, generating oxidative stress. This cascade leads to lipid peroxidation, mitochondrial damage, blood-brain barrier breakdown contributing to cell injury during pneumococcal meningitis.

Pathophysiology of acute meningitis caused by Streptococcus pneumoniae and adjunctive therapy approaches / Fisiopatologia da meningite ocasionada pelo Streptococcus pneumoniae e novas possibilidades terapêuticas adjuvantes

Pneumococcal meningitis is a life-threatening disease characterized by an acute purulent infection affecting piamater, arachnoid and the subarachnoid space. The intense inflammatory host's response is potentially fatal and contributes to the neurological sequelae. Streptococcus pneumoniae colonizes the nasopharynx, followed by bacteremia, microbial invasion and blood-brain barrier traversal. S. pneumoniae is recognized by antigen-presenting cells through the binding of Toll-like receptors inducing the activation of factor nuclear kappa B or mitogen-activated protein kinase pathways and subsequent up-regulation of lymphocyte populations and expression of numerous proteins involved in inflammation and immune response. Many brain cells can produce cytokines, chemokines and others pro-inflammatory molecules in response to bacteria stimuli, as consequence, polymorphonuclear are attracted, activated and released in large amounts of superoxide anion and nitric oxide, leading to the peroxynitrite formation, generating oxidative stress. This cascade leads to lipid peroxidation, mitochondrial damage, blood-brain barrier breakdown contributing to cell injury during pneumococcal meningitis.

A meningite pneumocócica é doença potencialmente fatal caracterizada por infecção aguda purulenta que afeta a pia-máter, a aracnoide e o espaço subaracnoide. A resposta inflamatória do hospedeiro é potencialmente fatal e contribui para as sequelas neurológicas. O processo inicia-se com a colonização da nasofaringe pelo Streptococcus pneumoniae, seguida de invasão, bacteremia e passagem através da barreira hematoencefálica. O S. pneumoniae é reconhecido por células apresentadoras de antígenos através da ligação aos receptores Toll-like. Isto induz a ativação do fator nuclear kappa B ou proteína quinase ativada por mitógenos. Muitas células cerebrais também podem produzir citocinas, quimiocinas e outras moléculas pró-inflamatórias em resposta aos estímulos bacterianos. Como consequência, são atraídos polimorfonucleares, ocorrendo a liberação de grandes quantidades de ânion superóxido e óxido nítrico, o que leva à formação de peroxinitrito e ocasiona o estresse oxidativo. Esta cascata pró-inflamatória leva à peroxidação lipídica, a danos mitocondriais e à ruptura da barreira hematoencefálica, contribuindo para o dano celular em meningite pneumocócica.

Dexamethasone treatment reverses cognitive impairment but increases brain oxidative stress in rats submitted to pneumococcal meningitis.

Pneumococcal meningitis is associated with a significant mortality rate and neurologic sequelae. The animals received either 10 µL of saline or a S. pneumoniae suspension and were randomized into different groups: sham: placebo with dexamethasone 0.7 mg/kg/1 day; placebo with dexamethasone 0.2 mg/kg/7 days; meningitis groups: dexamethasone 0.7 mg/kg/1 day and dexamethasone 0.2 mg/kg/7 days. Ten days after induction we evaluated memory and oxidative stress parameters in hippocampus and cortex. In the step-down inhibitory avoidance task, we observed memory impairment in the meningitis group with dexamethasone 0.2 mg/kg/7 days. The lipid peroxidation was increased in hippocampus in the meningitis groups with dexamethasone and in cortex only in the meningitis group with dexamethasone 0.2 mg/kg/7 days. The protein carbonyl was increased in hippocampus in the meningitis groups with dexamethasone and in cortex in the meningitis groups with and without dexamethasone. There was a decrease in the proteins integrity in hippocampus in all groups receiving treatment with dexamethasone and in cortex in all groups with dexamethasone (0.7 mg/kg/1 day). The mitochondrial superoxide was increased in the hippocampus and cortex in the meningitis group with dexamethasone 0.2 mg/kg/7 days. Our findings demonstrate that dexamethasone reverted cognitive impairment but increased brain oxidative stress in hippocampus and cortex in Wistar rats ten days after pneumococcal meningitis induction.

A kinetic study of the cytokine/chemokines levels and disruption of blood-brain barrier in infant rats after pneumococcal meningitis.

Bacterial meningitis is an inflammation of the meninges and subarachnoid space that occurs in response of bacteria. Young children are particularly vulnerable to bacterial meningitis, two thirds of meningitis deaths in low-income countries occur among children under the age of fifteen. The main bacterial pathogens causing meningitis beyond the neonatal period are Streptococcus pneumoniae, Haemophilus influenza type b and Neisseria meningitidis. Therefore, the aim of this study is to evaluate the kinetic and the levels of TNF-α, IL-1ß, IL-6, IL-10 and CINC-1 in different brain regions as well as the blood-brain barrier permeability after meningitis induced by S. pneumoniae in infant Wistar rats. The animals underwent a magna cistern tap receiving either 10µL sterile saline as a placebo or an equivalent volume of a S. pneumoniae suspension at the concentration 1×10(6)CFU/mL. The animals were killed at different times after induction. The brain was removed and the hippocampus and the cortex were isolated and used for the determination of cytokine/chemokine levels and blood-brain barrier permeability. The cerebrospinal fluid was obtained by puncture of the cisterna magna to TNF-α and IL-1ß analysis. In the hippocampus, the CINC-1 and IL-1ß levels were found increased at 6h, 12h and 24h after pneumococcal meningitis induction. In the cortex the levels of the CINC-1 were increased at 6h, 12h and 24h. The IL-1ß and TNF-α were increased at 12h and 24h. The level of IL-6 was increased only after 24h after pneumococcal meningitis induction. In cerebrospinal fluid, the TNF-α was increased at 12h, 24h and IL-1 was increased at 24h after S. pneumoniae induction. The blood-brain barrier breakdown in hippocampus and cortex were observed at 12h until 24h during meningitis. In conclusion, a peak of pro-inflammatory cytokine/chemokine is associated with disruption of the blood-brain barrier in infants with pneumococcal meningitis.

Evaluation of mitochondrial respiratory chain in the brain of rats after pneumococcal meningitis.

The brain is highly dependent on ATP and most cell energy is obtained through oxidative phosphorylation, a process requiring the action of various respiratory enzyme complexes located in a special structure of the inner mitochondrial membrane. Bacterial meningitis due to Streptococcus pneumoniae is associated with a significant mortality rate and persisting neurologic sequelae including sensory-motor deficits, seizures, and impairments of learning and memory. In this context, we evaluated the activities of mitochondrial respiratory chain complexes in the brain of rats submitted to meningitis by S. pneumoniae inoculation into the cisterna magna. Our results demonstrated that complex I activity was not altered in cerebral cortex after meningitis; complexes II, III and IV were increased 24 and 48h after meningitis. We have also verified that complex I was inhibited in prefrontal cortex 48h after meningitis; complexes II, III and IV were not altered. Our results also demonstrated that complex I activity was inhibited in striatum, hippocampus and cerebellum 24h after meningitis. Moreover, complex II activity was increased in hippocampus and striatum 24 and 48h after meningitis; complexes III and IV activity were increased in striatum, hippocampus and cerebellum 48h after meningitis. Taking together previous reports and our present findings, we speculate that oxidative stress and metabolism impairment might contribute, at least in part, for the pathogenesis of pneumococcal meningitis.

TNF-alpha, IL-1beta, IL-6, and cinc-1 levels in rat brain after meningitis induced by Streptococcus pneumoniae.

Bacterial meningitis caused by Streptococcus pneumoniae is associated with a significant mortality rate and persisting neurologic sequelae, including sensory-motor deficits, seizures, and impairment of learning and memory. The presence of proliferating bacteria within the subarachnoid and ventricular space compartments triggers an intense inflammatory host response at killing the invading microorganism. Proinflammatory mediators released in the process, including tumor necrosis factor alpha (TNF-alpha), interleukin (IL)-1beta, and IL-6, were shown to contribute to the development of brain injury in bacterial meningitis. Thus, the aim of this study was to verify the levels of the TNF-alpha, IL-1beta, IL-6, and CINC-1 in the rat brain after pneumococcal meningitis. The animals underwent a magna cistern tap receiving either 10 microL of sterile saline as a placebo or an equivalent volume of a S. pneumoniae suspension at the concentration of 5x10(9) cfu/mL. The placebo group was killed immediately after the induction and the meningitis group at 0, 6, 12, 24, 48, and 96h after induction. The brains were removed followed by the isolation of the hippocampus and prefrontal cortex for determining TNF-alpha, IL-1beta, IL-6, and CINC-1 levels. In the hippocampus we found increased levels of the TNF-alpha only at 6h (p<0.01; F=3.777); CINC-1 levels increased at 6 and 24h (p<0.001; p<0.05; F=15.05); and IL-6 and IL-1beta levels were not altered. In the prefrontal cortex, the TNF-alpha levels were found to be increased only at 6h (p<0.05; F=4.921); IL-6 (p<0.05; F=11.69) and IL-1beta (p<0.001; F=132.0) levels were found to be increased only at 24h after meningitis induction; and CINC-1 levels were found to be increased at 6, 12, and 24h (p<0.01; p<0.01; p<0.01; F=16.86) after meningitis induction. Our data suggest that cytokine/chemokine levels can be putative biomarkers of brain damage in the first hours of the pneumococcal meningitis.

Tumor necrosis factor alpha (TNF-alpha) levels in the brain and cerebrospinal fluid after meningitis induced by Streptococcus pneumoniae.

Bacterial meningitis due to Streptococcus pneumoniae is associated with a significant mortality rate and persisting neurologic sequelae including sensory-motor deficits, seizures, and impairments of learning and memory. The presence of proliferating bacteria within the subarachnoid and ventricular space compartments triggers an intense inflammatory host response at killing the invading microorganism. Proinflammatory mediators released in the process include tumor necrosis factor alpha (TNF-alpha), interleukin (IL)-1beta, IL-6. TNF-alpha have several effects, including cytotoxicity, antiviral activity, transcription factor activation, and immune response regulation. Thus, the aim of this study was to verify the levels of the TNF-alpha after pneumococcal meningitis in male Wistar rats. The animals underwent a magna cistern tap receiving either 10 microL sterile saline as a placebo or an equivalent volume of a S. pneumoniae suspension at the concentration 5 x 10(9)cfu/mL. The animals were killed at 0, 6, 12, 24, 48 and 96 h after induction. The brain was removed and hippocampus, cortex, prefrontal and cerebrospinal fluid (CSF) were isolated and used for the determination of TNF-alpha levels. We found an increase in TNF-alpha levels at 6h after induction of the meningitis in the hippocampus (p<0.01), frontal cortex (p<0.05), and cerebrospinal fluid (p<0.001).There was no alteration in the cortex. Our data suggest that TNF-alpha is involved in the pathophysiology of the pneumococcal meningitis and could be investigated as a putative biomarker for brain damage in the first hours.

Brain creatine kinase activity after meningitis induced by Streptococcus pneumoniae.

Bacterial meningitis due to Streptococcus pneumoniae is associated with a significant mortality rate and persisting neurologic sequelae including sensory-motor deficits, seizures, and impairments of learning and memory. Creatine kinase (CK) is an effective buffering system of cellular ATP levels in high-energy consuming tissues; a decrease in CK activity is associated with a neurodegenerative pathway that results in neuronal loss. Thus, the aim of this study was to evaluate brain CK activity after pneumococcal meningitis. The animals underwent a magna cistern tap receiving either sterile saline as a placebo or an equivalent volume of a S. pneumoniae suspension; they were killed 6, 12, 24 and 48h after that, the brain was removed and hippocampus, striatum, cerebellum, cerebral cortex and prefrontal cortex were dissected and used for the determination of CK activity. We verified that CK activity was not altered 6 and 12h after meningitis. Interestingly, 24h after the induction of the meningitis we observed a decrease in CK activity. Finally, CK activity was not altered 48h after meningitis. Although it is difficult to extrapolate our findings to the human condition, the inhibition of brain CK activity may be involved in the pathogenesis of pneumococcal meningitis.

Fístulas de LCR postraumatismo encefalocraneano grave: su detección por RM con secuencias Spin-Eco y Cine-Gre / MR findings in traumatic cerebrospinal fluid fistulae

Propósito: las fístulas de LCR representa entre el 4 y el 8 por ciento de las complicaciones postraumatismo encefalocraneano grave en la población infantil. Presentamos nuestra experiencia en su diagnóstico con RM en secuencias Spin-Eco T2 y Cine Gre. Material y método: estudiamos tres pacientes de 6, 11 y 13 años que presentaron traumatismo encéfalocraneano grave y su complicación común fue la meningitis a distancia por Diplococo Pneumoniae. Los estudios se realizaron en un equipo 0,5 T en secuencias FSE T2 multiplanares de 3 mm de espesor y Cine GRE de 3 mm en cuatro fases de 16 imágenes cada una. Resultados: encontramos fístulas múltiples de la región temporomastoidea en dos pacientes y un paciente con fístula única a través de la lámina cribosa del etmoides. Conclusión: la RM se muestra como un método no invasivo y áltamente confiable en la detección de fístulas de LCR (AU)

Fístulas de LCR postraumatismo encefalocraneano grave: su detección por RM con secuencias Spin-Eco y Cine-Gre / MR findings in traumatic cerebrospinal fluid fistulae

Propósito: las fístulas de LCR representa entre el 4 y el 8 por ciento de las complicaciones postraumatismo encefalocraneano grave en la población infantil. Presentamos nuestra experiencia en su diagnóstico con RM en secuencias Spin-Eco T2 y Cine Gre. Material y método: estudiamos tres pacientes de 6, 11 y 13 años que presentaron traumatismo encéfalocraneano grave y su complicación común fue la meningitis a distancia por Diplococo Pneumoniae. Los estudios se realizaron en un equipo 0,5 T en secuencias FSE T2 multiplanares de 3 mm de espesor y Cine GRE de 3 mm en cuatro fases de 16 imágenes cada una. Resultados: encontramos fístulas múltiples de la región temporomastoidea en dos pacientes y un paciente con fístula única a través de la lámina cribosa del etmoides. Conclusión: la RM se muestra como un método no invasivo y áltamente confiable en la detección de fístulas de LCR

Características clínico-microbiológicas de la meningitis por Streptococcus pneumoniae resistente a la penicilina / Streptococcus pneumoniae meningitis resistant to penicillin clinical and microbiological characteristics

Objetivo. Evaluar la susceptibilidad antimicrobiana de Streptococcus pneumoniae aislado del líquido cefalorraquídeo de niños con meningitis, así como describir y comparar las características clínicas y microbiológicas, el tratamiento y la evolución del padecimiento entre niños infectados con cepas sensibles y resistentes a la penicilina y la cefalosporina. Material y métodos. Treinta y ocho niños con meningitis neumocóica, durante el lapso 1994-1998. Los datos clínicos y de laboratorio se colectaron de cada expediente. Resultados. Del total de niños, 63 por ciento era menor de dos años de edad, 28.9 por ciento mostró cepas insensible a la penicilina, 18.4 por ciento tenía resistencia intermedia, y 10.5 por ciento tenía resistencia elevada. El 2.6 por ciento mostró también resistencia a la cefotaxima. La única característica (por la prueba exacta de Fisher) asociada con la resistencia fue: enfermedad de base previa al procesos (p< 0.001), y condiciones de gravedad al ingreso como convulsiones, choque tóxico y coma (p< 0.07). El curso de la enfermedad y la evolución clínica fue similar para los niños infectados con cepas sensibles a la penicilina o a la cefotaxima vs. las cepas no susceptibles. Conclusiones. El perfil actual de resistencia del S. pneumoniae a la penicilina y la cefalosporina no se encontró asociado con un aumento en la mortalidad de niños con meningitis neumocóica

Inmunización contra neumococos / Immunization against pneumococcus

Streptococus pneumoniae o neumococo, es una bacteria Gram-positiva considerada como uno de los principales agentes patógenos del aparato respiratorio en personas de todas las edades, particularmente aquellas de edad avanzada. En este último grupo de edad, la neumonía neumocócica sigue siendo una de las causas más importantes de morbilidad y mortalidad. Vacunas disponibles: el primer programa de vacunación antineumocócica se efectuó en 1911 en Africa del Sur en los trabajadores mineros, pues en ellos la incidencia de la enfermedad era muy alta y producía muchas defunciones. Al principio de la década de los 70 se usó la primera vacuna polisacarídica antineumocócica; en 1977 en los Estados Unidos se autorizó y en 1978 se inició la comercialización de la vacuna neumocócica de 14 serotipos, con 50 g. de polisacárido capsular. Hasta 1983 fue que se volvieron a autorizar cambios en la vacuna, ahora con 25 g. de cada polisacárido de 23 serotipos. Por lo que respecta a las vacunas en desarrollo se anota: desde su aparición, muchos se ha dicho sobre la antigenicidad y seguridad de la vacuna neumocócica. Aunque quedan por despejarse muchas dudas, lo que si está claro es que se necesita una vacuna más inmunogénica, especialmente para los niños menores de 2 años. Hasta el momento, lo más promisorio son las vacunas conjugadas a proteínas. Existen otras posibilidades de nuevas vacunas, las cuales se encuentran aún en estudio experimental e incluyen utilización de conjugados hexasacáridos y de anticuerpos monoclonales