Neuroscience 241 (2013) 22–31
SPINAL INJECTION OF DOCOSAHEXAENOIC ACID ATTENUATES CARRAGEENAN-INDUCED INFLAMMATORY PAIN THROUGH INHIBITION OF MICROGLIA-MEDIATED NEUROINFLAMMATION IN THE SPINAL CORD Y. LU, a,b L.-X. ZHAO, a D.-L. CAO a AND Y.-J. GAO a*
Key words: inﬂammatory pain, carrageenan, docosahexaenoic acid, microglia, cytokines, chemokines.
Institute of Nautical Medicine, Jiangsu Key Laboratory of Neuroregeneration, Nantong University, Nantong 226001, China
Department of Nutrition and Food Hygiene, Public Health School of Nantong University, Nantong 226001, China
INTRODUCTION Pain is one of the most common symptoms encountered in the clinic, and inﬂammatory pain represents an important type of pain (Woolf and Costigan, 1999; Kuner, 2010; Ji et al., 2011). Neuroinﬂammation in both peripheral and central nervous system plays an important role in the pathogenesis of chronic pain (White et al., 2005; Moalem and Tracey, 2006; Myers et al., 2006). In peripheral, multiple inﬂammatory mediators such as prostaglandin, nerve growth factor, and proinﬂammatory cytokines [e.g., tumor necrosis factor-a (TNF-a) and interleukin-1b (IL-1b)] are produced in inﬂamed or damaged tissues and sensitize the nerve endings (Abbadie et al., 2009; Stein and Lang, 2009). In the central nervous system, glial cells (e.g. microglia and astrocytes) release powerful neuromodulators such as cytokines and chemokines (e.g. CCL2, CCL3, CXCL10) and are involved in the modulation of the excitability of spinal cord sensory neurons (DeLeo and Yezierski, 2001; Abbadie et al., 2009; Milligan and Watkins, 2009; Gao and Ji, 2010a; Ji et al., 2011). Inhibition of the neuroinﬂammation that mediated by glial cells has been shown to attenuate inﬂammatory or neuropathic pain (Raghavendra et al., 2003; Ledeboer et al., 2005; Zhuang et al., 2006). Docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) are two major bioactive components of omega-3 polyunsaturated fatty acids (n-3 PUFAs), which were found in fatty ﬁsh and highly concentrated in the brain and retina in humans (Fliesler and Anderson, 1983; Lands, 1992). Compared to only 0.1% of EPA in total brain fatty acid, DHA comprises 10–20% and is the main n-3 PUFAs in the brain (McNamara and Carlson, 2006). Human studies have shown that an increased dietary intake of n-3 PUFAs is associated with reduced pain in rheumatoid arthritis (Ruggiero et al., 2009; Miles and Calder, 2012), inﬂammatory bowel disease (Bassaganya-Riera and Hontecillas, 2010), and dysmenorrheal (Harel et al., 1996). Rats treated with n-3 PUFAs have shown to markedly increase threshold for thermal pain (Yehuda and Carasso, 1993). However, the antinociceptive eﬀect and the underlying mechanism of DHA in inﬂammatory pain still remain unclear.
Abstract—Neuroinﬂammation in the spinal cord plays a critical role in the processing of inﬂammatory pain. Docosahexaenoic acid (DHA), a predominant omega-3 polyunsaturated fatty acid in the central nervous system, is known to modulate inﬂammatory responses in various neurodegenerative disorders. In this study, we investigated whether DHA could reduce inﬂammatory pain and inhibit neuroinﬂammation in the spinal cord following carrageenan injection in mice. Intrathecal (i.t.) injection of DHA at 15 min before carrageenan injection blocked carrageenan-induced pain hypersensitivity for more than 6 h. In addition, i.t. injection of DHA at 3 h after carrageenan transiently reversed carrageenan-induced heat hyperalgesia and mechanical allodynia. Furthermore, DHA treatment reduced carrageenan-induced activation of microglia, phosphorylation of p38 mitogen-activated protein kinase (MAPK), and production of proinﬂammatory cytokines (tumor necrosisfactor-a – TNF-a and interleukin-1b – IL-1b) in the L4–5 spinal cord. In cultured microglial cells, DHA dose-dependently reduced lipopolysaccharide (LPS)-induced phosphorylation of p38, production of proinﬂammatory cytokines (TNF-a, IL-1b, IL-6) and chemokines (CCL2, CCL3 and CXCL10). p38 inhibitor SB203580 inhibited LPS-induced expression of proinﬂammatory cytokines and chemokines in a dosedependent manner. Taken together, these results provide evidence that DHA has antinociceptive eﬀect in inﬂammatory pain, which may be attributed to, at least partially, suppressing a microglia-mediated inﬂammatory response through inhibition of p38 MAPK activation. Ó 2013 IBRO. Published by Elsevier Ltd. All rights reserved.
*Corresponding author. Address: Institute of Nautical Medicine, Nantong University, 19 Qixiu Road, Nantong 226001 China. Tel: +86-513-85051799; fax: +86-513-85051796. E-mail address: [email protected]
(Y.-J. Gao). Abbreviations: COX-2, cyclooxygenase-2; DHA, docosahexaenoic acid; DMEM, Dulbecco’s Modiﬁed Eagle’s Medium; EPA, eicosapentaenoic acid; FBS, fetal bovine serum; GAPDH, glyceraldehyde-3-phosphate dehydrogenase; GFAP, glial ﬁbrillary acidic protein; IL-1b, interleukin-1b; iNOS, inducible NO synthase; i.t., intrathecal; LPS, lipopolysaccharide; MAPK, mitogen-activated protein kinase; n-3 PUFAs, omega-3 polyunsaturated fatty acids; PWL, paw withdrawal latency; PWT, paw withdrawal threshold; TNF-a, tumor necrosisfactor-a.
0306-4522/12 $36.00 Ó 2013 IBRO. Published by Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.neuroscience.2013.03.003 22
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DHA has long been considered neuroprotective and anti-inﬂammatory (De Smedt-Peyrusse et al., 2008; Ebert et al., 2009). DHA-rich n-3 fatty acid supplementation decreases the release of IL-6 and IL-1b from peripheral blood mononuclear cells after stimulation with lipopolysaccharide (LPS) (Vedin et al., 2008), and changes the inﬂammation regulation-related gene expression in the blood (Vedin et al., 2012). DHA supplementation also signiﬁcantly prevented hypoxia/ ischemia-induced upregulation of TNF-a, IL-1b, IL-6, cyclooxygenase-2 (COX-2) and inducible NO synthase (iNOS) in the cortex (Zhang et al., 2010). In addition, DHA suppresses interferon-c-induced inﬂammatory cytokine expression in BV2 microglial cultures (Lu et al., 2010). Whether DHA in the spinal cord level could regulate the production of pain-related inﬂammatory mediators is largely unknown. In the present study, we compared the prevention and reversal eﬀect of the spinal injection of DHA on carrageenan-induced inﬂammatory pain, and checked the eﬀect of DHA on carrageenan-induced activation of microglia and astrocytes in the spinal cord. As p38 mitogen-activated protein kinase (MAPK) has been implicated to play an important role in mediating the expression of inﬂammatory mediators (Ji and Suter, 2007), we further examined whether the antiinﬂammatory eﬀect of DHA is mediated by inhibition of p38 MAPK in microglial cells in both spinal cord and cell cultures.
EXPERIMENTAL PROCEDURES Animals Male ICR mice (8-week-old), obtained from the Experimental Animal Center of Nantong University, were used in this study. The animals were maintained on a 12:12-light–dark cycle at a room temperature of 22 ± 1 °C with free access to food and water. Blinded experiments were performed according to the guidelines of the International Association for the Study of Pain. The experimental procedures were approved by the Animal Care and Use Committee of Jiangsu Province. Inﬂammatory pain was induced by intraplantar injection of 20-ll carrageenan (1%, Sigma, St. louis, MO, USA) in sterile 0.9% saline. The control group was injected with the same volume of saline.
Drugs and administration DHA salt (Sigma, St. louis, MO, USA) was dissolved in saline. For intrathecal injection, a spinal cord puncture was made with a 30-gauge needle between the L4 and L5 level to deliver the reagents (10 ll) to the cerebral spinal ﬂuid. Immediately after the needle entry into subarachnoid space, a brisk tail ﬂick could be observed.
Behavioral analysis Animals were habituated to the testing environment daily for at least 2 days before baseline testing. The room temperature and humidity remained stable for all experiments. For testing heat sensitivity, animals were put in plastic boxes placed on a glass plate, and the plantar surface was exposed to a beam of radiant heat through a transparent glass surface (Plantar Test Apparatus 390G, IITC Life Science, Woodland Hills, CA, USA).
The glass temperature was set at 30 °C during all experiments. The baseline latencies were adjusted to 10–14 s with a maximum of 20 s as cutoﬀ to prevent potential injury. The latencies were averaged over three trials, separated by a 5-min interval. For testing mechanical sensitivity, animals were put in boxes on an elevated metal mesh ﬂoor and allowed 30 min for habituation before examination. The plantar surface of the hindpaw was stimulated with a series of von Frey hairs with logarithmically incrementing stiﬀness (0.02–2.56 g, Stoelting, Kiel, WI, USA), presented perpendicular to the plantar surface (2–3 s for each hair). The 50% paw withdrawal threshold (PWT) was determined using Dixon’s up-down method (Dixon, 1980).
Cell culture The microglial BV2 cells were seeded in a 6-well plate at a density of 3 105 cells/cm2 and cultured in a medium containing 10% FBS (fetal bovine serum) in high glucose DMEM (Dulbecco’s Modiﬁed Eagle’s Medium). For primary microglial culture, the cerebral hemispheres (neonatal mice, P2) were isolated and transferred to ice-cold Hank’s buﬀer and the meninges were carefully removed. Tissues were then minced into 1-mm pieces, triturated, ﬁltered through a 100-lm nylon screen, and collected by centrifugation at 3000g for 5 min. The cell pellets were dispersed with a pipette and resuspended in a medium containing 10% FBS in high glucose DMEM. After trituration, the cells were ﬁltered through a 10-lm screen and then plated into 75-cm2 ﬂasks. The medium was replaced twice a week. After 12–14 days, the ﬂasks were shaken on a rotary shaker at 220 rpm for 4 h. The resulting cell suspension, rich in microglia, was placed in a 6-well plate at a density of 5 105 cells/cm2. Prior to stimulation with LPS, OPTI-MEM was replaced. The cells were incubated with LPS for either 1 or 6 h. The treatment of the DHA (3, 10, 30 lM) or SB203580 (5, 50 lM) was started 30 min prior to LPS treatment. After the treatments, the cells were collected for Real-time PCR or Western blot.
Tissue collection Animals were rapidly killed after deep anesthesia with isoﬂurane, and the L4–5 spinal segments were quickly removed and frozen at 80 °C for later Real-time PCR or Western blot analysis.
Real-time PCR The total RNA of the spinal cord or cultured cells was extracted using Trizol reagent (Invitrogen). RNA quantity and purity were determined using Eppendorf Biophotometer. One microgram of total RNA was reverse transcribed using a mixture of random primers according to the manufacturer’s protocol (TaKaRa, Japan). Real-time quantitative PCR analysis was performed in the Real-time Detection System (Rotor-Gene 6000) by SYBR green I dye detection. The mRNA expressions of IBA-1 (ionized calcium binding adaptor molecule 1), GFAP (glial ﬁbrillary acidic protein), TNF-a, IL-1b, IL-6, CCL2, CCL3, CXCL10 and glyceraldehyde-3-phosphate dehydrogenase (GAPDH) were checked. The detailed primer sequences for each gene are listed in Table 1. The PCR reaction process for cells was ﬁrst incubated at 95 °C for 30 s, followed by 40 cycles of thermal cycling at 95 °C for 5 s and 60 °C for 45 s. Data were collected after each cycle and displayed graphically (Rotor-Gene 6000 Series Software 1.7). Melt curves were performed on completion of the cycles to ensure that nonspeciﬁc products were absent. Quantiﬁcation was performed by normalizing Ct (cycle threshold) values with GAPDH Ct and analyzed with the 2DDCt method.
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Table 1. Summary of the real-time polymerase chain reaction (PCR) primers sequences Gene
Forward primer sequences (50 ?30 )
Reverse primer sequences (50 ?30 )
IBA-1 GFAP TNF-a IL-1b IL-6 CCL2 CCL3 CXCL10 GAPDH
ATGAGCCAAAGCAGGGATT CCAAGATGAAACCAACCTGA GTTCTATGGCCCAGACCCTCAC TCCAGGATGAGGACATGAGCAC CCACTTCACAAGTCGGAGGCTTA GCATCCACGTGTTGGCTCA CATGACACTCTGCAACCAAGTCTT TGAATCCGGAATCTAAGACCATCAA AAATGGTGAAGGTCGGTGTGAAC
CTTCAAGTTTGGACGGCAG TCCAGCGATTCAACCTTTC GGCACCACTAGTTGGTTGTCTTTG GAACGTCACCCAGCAGGTTA CCAGTTTGGTAGCATCCATCATTTC CTCCAGCCTACTCATTGGGATCA GAGCAAAGGCTGCTGGTTTCA AGGACTAGCCATCCACTGGGTAAAG CAACAATCTCC CTTTGCCACTG
Immunohistochemistry Animals were terminally anesthetized with isoﬂurane and perfused through the ascending aorta with saline followed by 4% paraformaldehyde. After the perfusion, the spinal cord segments (L4–5) were removed and postﬁxed in the same ﬁxative overnight, then replaced with 15% sucrose overnight. Spinal sections (transverse, free-ﬂoating, 30 lm) were cut in a cryostat and blocked with 2% goat serum in 0.3% Triton for 1 h at RT and incubated over night at 4 °C with p-p38 or IBA-1 primary antibodies (anti-p-p38, 1:300, mouse, Cell Signaling, Beverly, MA, USA; anti-IBA-1, 1:3000, rabbit, Wako, Tokyo, Japan). The sections were then incubated for 1 h at RT with Cy3- or FITC-conjugated secondary antibodies (1:1000, Jackson ImmunoResearch, West Grove, PA, USA). The stained sections were examined with a Leica ﬂuorescence microscope, and images were captured with a CCD Spot camera.
Western blot The spinal cord or cultured cells were homogenized in a SDS sample buﬀer containing a mixture of proteinase and phosphatase inhibitors (Sigma, St. Louis, MO, USA). Protein concentrations were determined by BCA Protein Assay (Pierce, Rockford, IL, USA). Protein samples (30 lg) were separated on SDS–PAGE gel and transferred to nitrocellulose blots. The blots were blocked with 5% milk and incubated overnight at 4 °C with antibody against p-p38 (rabbit, 1:500; Cell Signaling, Beverly, MA, USA), and b-actin (mouse, 1:20,000; Sigma, St. Louis, MO, USA). These blots were further incubated with HRP-conjugated secondary antibody, developed in enhanced chemiluminescence (ECL) solution, and exposed onto Hyperﬁlm (Amersham Biosciences) for 1–10 min. Speciﬁc bands were evaluated by apparent molecular size. The intensity of the selected bands was captured and analyzed using Image J software (NIH).
Quantiﬁcation and statistics For behavioral studies, one-way ANOVA followed by Newman– Keuls post hoc test was used for comparison of temporal variations within the same group and student t-test was used for comparisons between groups. For the quantiﬁcation of Western blot, the density of speciﬁc bands for p-p38, b-actin was measured with imaging analysis software (Image J, NIH). The size of rectangle was ﬁxed for each band and the background near that band was subtracted. p-p38 levels was normalized to b-actin. The quantiﬁcation of Real time-PCR was normalized to GAPDH. The Western blot and Real-time PCR data were analyzed with student t-test. All the data were presented as mean ± SEM, and P < 0.05 was considered statistically signiﬁcant in all cases.
RESULTS Intrathecal injection of DHA inhibits carrageenaninduced heat hyperalgesia and mechanical allodynia We tested the paw withdrawal latency (PWL) to radiant heat stimulation and the PWT to von Fey ﬁlaments stimulation both before and 1, 3, 6, 24, and 48 h after unilateral injection of carrageenan or saline. As shown in Fig. 1A, carrageenan injection induced a signiﬁcant decrease of PWL (P < 0.001). The PWL dropped from 13.0 ± 0.3 s to 8.4 ± 0.3 s at 1 h (P < 0.001 vs. baseline), 7.1 ± 0.2 s at 3 h (P < 0.001 vs. baseline), 8.2 ± 0.6 s at 24 h (P < 0.001 vs. baseline), and recovered at 48 h. Saline injection did not change the PWLs at all time points (P > 0.05). In addition, carrageenan also induced mechanical allodynia. The PWT dropped from 1.91 ± 0.2 g before carrageenan (baseline) to 0.42 ± 0.09 g at 1 h after carrageenan injection. The mechanical allodynia remained at the peak level for 6 h, and fully recovered at 48 h. The animals in saline group did not show signiﬁcant changes of PWT (Fig. 1B). These results indicate that intraplantar carrageenan induces signiﬁcant heat hyperalgesia and mechanical allodynia. To examine whether pretreatment of DHA could prevent the development of carrageenan-evoked pain hypersensitivity, DHA at the doses of 1, 3, and 10 lg were administered intrathecally 15 min before the injection of carrageenan. As shown in Fig. 1C, DHA at the dose of 10 lg blocked carrageenan-induced heat hyperalgesia. The eﬀect appeared at 2 h after carrageenan injection (10.74 ± 0.47 s for DHA and 7.67 ± 0.23 s for vehicle, P < 0.001) and maintained for more than 24 h (11.28 ± 0.40 s for DHA and 8.63 ± 0.41 s for vehicle, P < 0.001). However, intrathecal injection 1 or 3-lg DHA had no signiﬁcant eﬀect on PWL (Fig. 1C). We also tested mechanical allodynia for animals injected with vehicle, 3-lg DHA, and 10-lg DHA. The results showed that pretreatment with 10-lg DHA attenuated carrageenan-induced mechanical allodynia from 0.5 h to 6 h. DHA at the dose of 3 lg only increased PWT at 3 h after carrageenan injection (Fig. 1D). To test whether DHA could reverse the established pain hypersensitivity, we intrathecally administered DHA at 3 h after carrageenan injection when heat hyperalgesia and mechanical allodynia were fully
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Fig. 1. Intrathecal DHA reduces carrageenan-induced heat hyperalgesia and mechanical allodynia. (A, B) Intraplantar injection of carrageenan induces signiﬁcant heat hyperalgesia and mechanical allodynia, which started from 1 h and maintained for more than 24 h. ⁄⁄⁄P < 0.001, vs. BL (baseline), n = 5. (C) i.t. injection of 10-lg DHA 15 min before carrageenan injection increases the PWL from 2 h and maintained for more than 24 h, whereas 1 or 3-lg DHA had no signiﬁcant eﬀect ⁄P < 0.05, ⁄⁄P < 0.01 and ⁄⁄⁄P < 0.001 vs. vehicle, n = 5. (D) i.t. injection of 10-lg DHA 15 min before carrageenan injection increases the PWT from 1 h and maintained for more than 6 h; 3-lg DHA increases the PWT at 3 h. ⁄P < 0.05, ⁄⁄ P < 0.01 and ⁄⁄⁄P < 0.001 vs. vehicle, n = 4. (E) i.t. injection of DHA (3 or 10 lg) given at 3 h post-carrageenan injection attenuates ongoing hyperalgesia, which starts from 0.5 h and lasts for more than 1 h, but 1-lg DHA had no eﬀect. ⁄P < 0.05, ⁄⁄P < 0.01, and ⁄⁄⁄P < 0.001 vs. vehicle, n = 5. (F) i.t. injection of 10-lg DHA given at 3 h post-carrageenan injection attenuates mechanical allodynia at 0.5 h after DHA injecyion. 3-lg DHA had no eﬀect on the PWT at all time points. ⁄⁄⁄P < 0.001 vs. vehicle, n = 4.
developed. As shown in Fig. 1E, intrathecal 10-lg DHA attenuated ongoing hyperalgesia (10.97 ± 0.39 s for DHA and 7.74 ± 0.23 s for vehicle, P < 0.01) and lasted for more than 1 h (9.73 ± 0.78 s for DHA and 7.47 ± 0.34 s for vehicle, P < 0.05). DHA at 3 lg also showed mild but signiﬁcant analgesic eﬀect, whereas
DHA at 1 lg had no eﬀect (Fig. 1E). DHA at the dose of 10 lg, but not 3 lg partially reversed mechanical allodynia at 30 min after DHA injection (1.01 ± 0.06 g for DHA and 0.30 ± 0.05 g for vehicle, P < 0.001, Fig. 1F). These data suggest the analgesic eﬀect of DHA by pretreatment persists longer than that by posttreatment.
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Intrathecal DHA suppresses carrageenan-induced activation of microglia To investigate whether the eﬀect of DHA on carrageenaninduced inﬂammatory pain is mediated through inhibition of glial activation, we checked the mRNA expression of microglial marker, IBA-1 and astrocytic marker, GFAP in the spinal cord after carrageenan injection by Real-time PCR. Carrageenan induced rapid IBA-1 mRNA increase, which began from 1 h, peaked at 3 h and maintained for more than 24 h. However, GFAP mRNA was only increased at 6 and 24 h after carrageenan injection (Fig. 2A). We then tested the eﬀect of DHA on IBA-1 and GFAP mRNA expression. The mice were intrathecally injected 10-lg DHA 15 min prior to carrageenan injection. The mRNA expression of IBA-1 and GFAP in the spinal cord was checked at 3 h after carrageenan injection. As shown in Fig. 2B, intrathecal 10-lg DHA decreased carrageenan-induced upregulation of IBA-1 mRNA. But GFAP mRNA was not aﬀected. These results indicate that microglial activation precedes astrocytic activation following carrageenan injection and pretreatment DHA reduces the activation of microglia. Intrathecal DHA suppresses carrageenan-induced activation of p38 MAPK in the spinal cord Studies have shown that spinal p38 MAPK is an important intracellular kinase in microglia and plays a crucial role in the pathogenesis of chronic pain (Ji and Suter, 2007). We then examined whether DHA could inhibit carrageenaninduced p38 activation in the spinal cord. The immunohistochemistry showed a marked increase in the number of p-p38 immunoreactivity (p-p38-IR) cells in the dorsal horn of carrageenan mice compared with naı¨ ve mice (Fig. 3A, B). IBA-1 immunostaining was also increased at 3 h after carrageenan injection (Fig. 3C, D). Double immunoﬂuorescence indicated that p-p38 was co-localized with IBA-1 (Fig. 3E–G). We then checked p-p38 expression by Western blot. As shown in Fig. 3H, I, carrageenan increased p-p38 expression in the spinal cord at 3 h after injection (P < 0.05). Pretreatment with DHA blocked
carrageenan-induced upregulation (vehicle vs. DHA, P < 0.05).
Intrathecal DHA reduces carrageenan-induced upregulation of proinﬂammatory cytokines in the spinal cord It has been reported that the activated astrocytes and microglia can release a number of signaling molecules including the classic immune signals: cytokines (e.g. TNF-a, IL-1b and IL-6) and chemokines (e.g. CCL2, CCL3, and CXCL10), which play important roles in inﬂammatory pain (Ji and Suter, 2007; Gao and Ji, 2010a). Therefore, the mRNA expression of these proinﬂammatory cytokines and chemokines in the spinal cord was further examined by Real-time PCR. As shown in Fig. 4, high levels of TNF-a, IL-1b, IL-6 and CCL2 mRNA were observed at 3 h after carrageenan injection. Intrathecally injection of DHA (10 lg) attenuated upregulation of TNF-a and IL-1b induced by carrageenan, whereas the mRNA expression of other cytokines or chemokines did not change (Fig. 4).
DHA inhibits LPS-induced expression of proinﬂammatory cytokines and chemokines through p38 MAPK in cultured microglial cells To further check whether the inhibition eﬀect of DHA on inﬂammatory mediators’ production is through p38 MAPK pathway in microglia, we cultured BV2 cells. BV2 is an immortalized murine microglial cell line which replicate readily and is easy to maintain in culture (Blasi et al., 1990). Based on others’ work (Lu et al., 2010; Zhang et al., 2010), the DHA doses of 3, 10, and 30 lM were chosen. Cells were pretreated with various concentrations of DHA for 30 min and then stimulated with LPS (1 lg/ml) for another 6 h. The Real-time PCR results showed that exposure to LPS induced a signiﬁcant upregulation of TNF-a, IL-1b, IL-6, CCL2, CCL3 and CXCL10 compared with control. DHA at the dose of 30 lM eﬀectively decreased LPS-induced production of these cytokines and chemokines,
Fig. 2. Intrathecal DHA suppresses carrageenan-induced activation of microglia. (A) Real-time PCR analysis shows that intraplantar carrageenan induces signiﬁcant mRNA upregulation of IBA-1 (microglial marker) and GFAP (astrocytic marker) in the spinal cord. IBA-1 mRNA are increased from 1 to 24 h. GFAP mRNA are increased at 6 and 24 h. (B) Intrathecal DHA 15 min before carrageenan injection decreases carrageenan-induced mRNA upregulation of IBA-1 but not GFAP at 3 h after carrageenan. ⁄P < 0.05 and ⁄⁄P < 0.01 vs. naive; #P < 0.05 vs. vehicle, n = 5.
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Fig. 3. Intrathecal DHA suppresses carrageenan-induced activation of p38 MAPK in the spinal cord. (A, B) Immunohistochemistry shows carrageenan increases expression of p-p38 (A, B) and IBA-1 (C, D) in the ipsilateral dorsal horn of spinal cord 3 days after inﬂammation. (E–G) Double staining shows a colocalization of p-p38 (E) and IBA-1 (F). (H) Western blot analysis shows intrathecal DHA suppresses spinal p-p38 levels induced by carrageenan. (I) shows the density of p-p38 band after being normalized to b-actin. ⁄P < 0.05 vs. naive, #P < 0.05 vs. vehicle, n = 5.
Fig. 4. Intrathecal injection of DHA reduces carrageenan-induced upregulation of proinﬂammatory cytokines in the spinal cord. Real-time PCR analysis shows carrageenan injection increases the mRNA expression of TNF-a, IL-1b, IL-6 and CCL2 at 3 h. Intrathecally administered DHA 15 min before carrageenan decreases upregulation of TNF-a and IL-1b mRNA expression, whereas has no eﬀect on mRNA expression of IL-6, CCL2, CCL3, or CXCL10. ⁄P < 0.05, ⁄⁄P < 0.01 and ⁄⁄⁄P < 0.001 vs. naı¨ ve. #P < 0.05 and ##P < 0.01 vs. vehicle, n = 5.
compared with LPS treatment. DHA at the concentration of 3 and 10 lM had no signiﬁcant eﬀect (Fig. 5A). As Horvath et al. (2008) reported that BV2 cells partially model primary microglia, we then primarily cultured microglia and compared the eﬀect of DHA. As shown in Fig. 5B, LPS induced similar mRNA increase of TNF-a, CCL2, CCL3, and CXCL10. The IL-1b expression in BV2 is higher than in primary cultures, whereas IL-6 expression in BV2 is lower than in primary cultures. However, pretreatment with 30 lM DHA signiﬁcantly inhibited LPS-induced enhancement of TNF-a, IL-1b, IL-6, CCL2, CCL3 and CXCL10, and the inhibitory magnitude is similar to that in BV2, suggesting the similar role of DHA on the production of these inﬂammatory mediators in BV2 and in primary microglia (Fig. 5B). We then checked activation of p38 by Western blot in BV2. Cells were pretreated with 30 lM DHA for 30 min and then stimulated with LPS (1 lg/ml) for another 1 h. The Western blot results showed that LPS induced a
rapid activation (phosphorylation) of p38. Pretreatment of cells with 30 lM DHA decreased p38 activation (Fig. 6A, B). These results suggest that DHA suppresses p38 activation and inﬂammatory mediators’ production in cultured microglia. To assess whether p38 is involved in LPS-induced expression of proinﬂammatory mediators, the eﬀect of p38 inhibitor SB203580 was tested. According to our previous experiment (Gao et al., 2009), the doses of 5 and 50 lM were chosen. Cells were pretreated with SB203580 for 30 min and then stimulated with LPS (1 lg/ml) for another 6 h. The Real-time PCR results showed pretreatment of 5 lM SB203580 had no eﬀect on the expression of these mediators. But SB203580 at a dose of 50 lM eﬀectively inhibited mRNA expression of TNF-a, IL-1b, IL-6, CCL2, CCL3, and CXCL10. These results suggest that p38 plays an important role in mediating the eﬀects of LPS on production of inﬂammatory mediators (Fig. 6C).
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Fig. 5. DHA dose-dependently reduces LPS-induced expression of proinﬂammatory cytokines and chemokines in BV2 microglial cells (A) and primary cultured microglia (B). DHA at the dose of 30 lM suppressed LPS-induced mRNA upregulation of TNF-a, IL-1b, IL-6, CCL2, CCL3 and CXCL10. Cells were pretreated with DHA (3, 10, and 30 lM) for 30 min and then exposed to LPS (1 lg/ml) for 6 h. ⁄P < 0.05, ⁄⁄P < 0.01, and ⁄⁄⁄ P < 0.001, vs. control. #P < 0.05, ##P < 0.01, and ###P < 0.001, vs. LPS treatment (positive control), n = 3.
Fig. 6. DHA inhibits LPS-induced p38 activation in BV2 microglial cells. (A) Western blot shows protein levels of p38 phosphorylation after stimulation with LPS or pretreated with DHA. Cells were pretreated with DHA (30 lM) for 30 min and then exposed to LPS (1 lg/ml) for 1 h. (B) The panel shows the density of p-p38 band after being normalized to b-actin. ⁄P < 0.05, vs. control. #P < 0.05, vs. LPS treatment (positive control), n = 3. (C) p38 inhibitor SB203580 inhibits LPS-induced production of proinﬂammatory cytokines and chemokines in BV2 microglial cells in a dosedependent manner. ⁄⁄P < 0.01 and ⁄⁄⁄P < 0.001, vs. control. #P < 0.05 and ##P < 0.01, vs. LPS treatment (positive control), n = 3.
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DISCUSSION In this study, we investigated the antinociceptive eﬀect of DHA on carrageenan-induced inﬂammatory pain and explored possible mechanisms. We demonstrated that DHA exhibited a signiﬁcant antinociceptive eﬀect in a dose-dependent manner. In particular, the eﬀect of pretreatment is more persistent than that of posttreatment. We further illustrated that pretreatment with DHA blocked carrageenan-induced microglial activation, p38 MAPK phosphorylation and TNF-a and IL-1b mRNA expression in the spinal cord. DHA also inhibited LPS-induced inﬂammatory mediators’ production through activation of p38 in cultured microglia. DHA prevents carrageenan-induced inﬂammatory pain A meta-analysis demonstrates that dietary omega-3 fatty acids alleviate inﬂammatory pain in patients (Goldberg and Katz, 2007). Rats treated with a high n-3/n-6 PUFA ratio diet exhibit a markedly increased threshold for thermal pain and neuropathic pain (Yehuda and Carasso, 1993; Perez et al., 2005). In addition, recent study showed that oral administration of DHA dosedependently reduced pain-related behaviors induced by formalin (Nakamoto et al., 2010). Our study for the ﬁrst time examined the prevention and reversal eﬀect of spinal DHA on carrageenan-induced inﬂammatory pain. Intrathecal injection DHA (10 lg) 15 min before carrageenan eﬀectively prevented the development of heat hyperalgesia and mechanical allodynia, and the eﬀect persists for 24 h for heat hyperalgesia and 6 h for mechanical allodynia. However, the reversal eﬀect of DHA is only 1 h for heat hyperalgesia and 30 min for mechanical allodynia. Xu et al. (2010) showed that intrathecal injection of DHA attenuated complete Freund’s adjuvant (CFA)-induced heat hyperalgesia for 30 min. These results suggest that dietary supplement DHA may play an important role in the prevention of inﬂammatory pain, whereas the treatment eﬀect of DHA is relatively weak. In addition, the eﬀect of DHA on heat hyperalgesia persists longer than on mechanical allodynia. DHA inhibits microglia activation and P38 activation In recent years, non-neuronal cells such as immune cells and glial cells (microglia and astrocytes) have been implicated to play a critical role in the pathogenesis of chronic pain (Milligan et al., 2003; Tsuda et al., 2004; Marchand et al., 2005; Chiang et al., 2007; RomeroSandoval et al., 2008). Although both microglia and astrocytes were activated in the spinal cord following peripheral nerve injury or tissue injury, microglial activation precedes astrocytic reaction in most cases (Ji and Suter, 2007; Gao and Ji, 2010b). Behavioral studies have shown that inhibition of microglial activation by minocycline prevents/delays neuropathic pain development (Raghavendra et al., 2003; Ledeboer et al., 2005), whereas inhibition of astrocytes’ function reverses nerve-injury- or nerve inﬂammation-induced
mechanical allodynia (Milligan et al., 2003; Zhuang et al., 2006), suggesting the respective role of microglia and astrocytes in the development and maintenance of neuropathic pain. In this study, carrageenan injection induced early microglial activation and late astrocytic activation. Pretreatment with DHA in the spinal cord blocked carrageenan-induced pain and decreased IBA-1 mRNA upregulation. It was reported that intrathecal administration of microglial inhibitor minocycline attenuates carrageenan-induced hyperalgesia (Wirkner et al., 2007). These data support the pivotal role of microglia in the initiation of carrageenan-induced inﬂammatory pain. The MAPKs -JNK (c-Jun N-terminal kinase), ERK (extracellular signal-regulated kinase), and p38 are important molecules in chronic pain sensitization and are diﬀerentially activated in spinal cord glial cells (Ji et al., 2009). In particular, p38 MAPK has been shown to be activated in spinal microglia after nerve injury or tissue injury (Jin et al., 2003; Tsuda et al., 2004). Behavioral studies showed that i.t. injection of p38 inhibitor SB203580, FR167653 or CNI-1493 prevents the development of neuropathic pain (Jin et al., 2003; Tsuda et al., 2004; Hains and Waxman, 2006; Wen et al., 2007). Our study showed that carrageenan induced p38 activation in the spinal cord microglia at 3 h after injection, which was reduced by pretreatment with DHA. Our in vitro data also showed DHA (30 lM) diminished LPS-induced p38 activation in BV2 microglia. Other studies using diﬀerent cells showed that DHA reduced the basal expression of p-p38 in CD4 (+) T-cells (Attakpa et al., 2009) and lung cancer cells (Serini et al., 2008). DHA also suppresses the activity of p38 MAPK in LPS-stimulated dendritic cells (Wang et al., 2007) and TNF-a-stimulated endothelial cells (Xue et al., 2006). These data indicate that the analgesic eﬀect of DHA may be mediated by inhibition of p38 activation in microglia.
DHA reduces inﬂammatory mediators’ production It has been demonstrated that activated microglia and astrocytes release neuromodulators, such as growth factors, proinﬂammatory cytokines, and chemokines, which contribute to pain facilitation (Watkins et al., 2001; Gao and Ji, 2010a; Gwak et al., 2012; Yang et al., 2012). Our results showed that carrageenan induced pain hypersensitivity that associated with increased mRNA expression of TNF-a, IL-1b, IL-6 and CCL2 in the spinal cord at 3 h after injection. However, CCL3 and CXCL10 mRNA expression was not changed, suggesting they, in the spinal cord level, may not be related with carrageenan-induced inﬂammatory pain at this time point. Electrophysiological studies have shown that TNF-a, IL-1b, IL-6, and CCL2 could directly regulate synaptic transmission in dorsal horn neurons (Kawasaki et al., 2008; Gao et al., 2009). Milligan et al. (2003) showed that inhibition of TNF-a and IL-1b prevent or reverse inﬂammatory neuropathy in rats. Here DHA intrathecal administration decreased TNF-a and IL-1b expression, suggesting the antinociceptive
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eﬀect of DHA may be through inhibition of the proinﬂammatory cytokines TNF-a and IL-1b. Although intrathecal DHA only reduced the expression of TNF-a and IL-1b mRNA in the spinal cord, our in vitro data showed that DHA reduced LPS-induced mRNA expression of more other mediators, including IL-6, CCL2, CCL3, and CXCL10. The discrepancy may be due to the low expression of these chemokines in the spinal cord and the relative low dose of DHA given by intrathecal. It was reported that DHA supplementation signiﬁcantly prevented hypoxia/ischemia-induced upregulation of TNF-a, IL-1b, IL-6, COX-2 and iNOS in the ipsilateral cortex (Zhang et al., 2010). DHA also reduced expressions of TNF-a, IL-6, iNOS induced by IFN-c in BV2 microglial cells (Lu et al., 2010). Given that DHA blocked LPS-induced p38 activation and p38 inhibitor decreased LPS-induced expression of inﬂammatory mediators, the inhibition eﬀect of DHA on inﬂammatory mediators’ production is through the p38 MAPK pathway in microglia.
CONCLUSIONS Inﬂammatory pain, such as arthritis pain, is a growing health problem. The commonly used opioids and COX inhibitors for treating inﬂammatory pain are limited by side eﬀects. Our results showed that intrathecally given DHA mainly targeting at the spinal cord level could eﬀectively block carrageenan-induced pain hypersensitivity, suggesting dietary supplementation of DHA or n-3 PUFA may have preventive eﬀect on inﬂammatory pain. Furthermore, our in vivo and in vitro data indicate that the analgesic eﬀect of DHA in the spinal cord may be through p38 MAPK-mediated microglia activation and subsequent inﬂammatory mediators’ production. Collectively, our results provide a novel implication of antinociceptive mechanism of DHA. Acknowledgements—This study was supported by the National Natural Science Foundation of China (NSFC 31171062), the Program for New Century Excellent Talents (NCET-09-0164), the Natural Science Foundation of Jiangsu Province (BK2010273), the Science and Technology Planning Project of Nantong (BK2011049) and a project funded by the Priority Academic Program Development of Jiangsu Higher Education Institutions. The authors declare no conﬂicts of interest.
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(Accepted 4 March 2013) (Available online 14 March 2013)