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Role of RGC-32 in multiple sclerosis and neuroinflammation – few answers and many questions

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RGC-32 as a key regulator of Th17 cell differentiation Using an RGC-32 knock-out (KO) mouse model, we have been able to demonstrate that RGC-32 promotes the differentiation of Th17 cells both in vitro and in vivo. When compared to wild-type (WT) cells, CD4+ cells isolated from RGC-32 KO mice express lower levels of IL-17, as well as some of the transcription factors necessary for Th17 differentiation, including retinoic acid receptor-related orphan receptor gamma t (RORgt), B cell–activating transcription factor (BATF), and interferon regulatory factor 4 (IRF4) under Th17-polarizing conditions (16). On the other hand, we have observed that the differentiation of Th1, Th2, and Tregs is not affected by the lack of RGC-32. Further analysis has revealed a defect in SMAD2 and AKT phosphorylation in RGC-32 KO CD4+ cells, suggesting that RGC-32 preferentially facilitates the differentiation of Th17 cells in a TGF-b-dependent and independent manner (16). Moreover, we have observed that RGC-32 KO mice develop a milder EAE phenotype than do their WT counterparts, with a lower clinical score at the peak of disease (day 14). Immunohistochemical analysis has revealed a smaller inflammatory infiltrate and fewer demyelination foci in the spinal cords of RGC-32 KO mice, and a lower number of IL17+ and GM-CSF+ cells (16). Interestingly, one study has shown that overexpression of RGC-32 in peripheral blood mononuclear cells (PBMC) isolated from patients with dilated cardiomyopathy augments the number of Th17 cells (25). We have also shown that B and T cells from patients with systemic lupus erythematous exhibit higher levels of RGC-32 and that overexpression of RGC-32 in Abbreviations: AGM, axonal guidance molecules; BBB, blood-brain barrier; CNS, central nervous system; CTGF, connective tissue growth factor; EAE, experimental autoimmune encephalomyelitis; ECM, extracellular matrix; EPHA7, ephrin receptor type 7A; GM-CSF, granulocyte macrophage colony-stimulating factor; FBN, fibrillin; FBLN, fibulin; GFAP, glial fibrillary acidic protein; HSPG2, heparan sulfate proteoglycan 2; HOPX, homeodomain-only protein homeobox; KO, knockout; MMP, matrix metalloproteinase; MS, multiple sclerosis; PLAUR, plasminogen activator, urokinase receptor; PLXNA1, plexin A1; RGC-32, response gene to complement 32; SPOCK3, Sparc/osteonectin, cwcv and kazal-like domains proteoglycan 3; STAT3, signal transducer and activator of transcription 3; STC1, stanniocalcin-1; VEGF, vascular endothelial growth factor; VCAN, versican; WDFY1, WD repeat and FYVE domain-containing protein 1; WT, wild type. Tatomir et al. 10.3389/fimmu.2022.979414 Frontiers in Immunology 02 human naïve CD4+ T cells augments the expression of IL-17 (26). These studies provide evidence of RGC-32’s role in the differentiation of human Th17 cells. RGC-32 as a blood-based biomarker in MS The first evidence for a potential role of RGC-32 in MS came from experiments showing that RGC-32 is present in MS plaques in perivascular and parenchymal areas and colocalizes with CD3+ and CD68+ cells, indicating that inflammatory cells express RGC-32 in MS brains (27). In addition, astrocytes have also been found to express RGC32 (27). RGC-32 is also expressed in PBMC isolated from patients with relapsing-remitting MS (RRMS). The mRNA levels of RGC-32 are significantly lower in patients with relapses than in stable patients or in patients who do not respond to glatiramer acetate (GA) (28). Furthermore, RGC-32 can potentially serve as a reliable biomarker in MS, with a 90% probability of detecting relapses and 85% probability of correctly predicting responses to GA therapy (28). Moreover, in vitro experiments have shown that silencing RGC-32 in PBMC leads to decreased levels of Fas ligand (FasL) and SIRT1, key regulators of apoptosis, suggesting that RGC-32 can regulate immune cell survival by influencing FasL and SIRT1 expression (27). Collectively, these results suggest that RGC-32 is a novel regulator of the diffrentiation of Th17 cells, making it a potential new therapeutic target in autoimmunity (Figure 1). Astrocyte emerges as an important contributor to the development and progression of MS and EAE The morphological and molecular changes undergone by astrocytes after brain injury are collectively called reactive astrocytosis (29). Most experts in the field consider this a continuum phenomenon of transformations that can range from subtle changes in gene expression and cell metabolomics to gross morphological changes, such as cellular hypertrophy, with glial scar sitting at the extreme endpoint on this axis (30–32). Reactive astrocytes are capable of mounting and perpetuating cellular processes leading to neuroinflammation and tissue remodeling (33). While they can exert both beneficial and detrimental effects by gain of function or loss of normal physiological properties, the net result is estimated to be pathogenic, and reactive astrocytes are currently seen as being a major contributor to MS pathogenesis (8, 34, 35). RGC-32 regulates the ability of astrocytes to undergo reactive changes during EAE We have shown that the levels of glial fibrillary acidic protein (GFAP), a universal marker for reactive astrocytosis, are significantly lower in the spinal cords of RGC-32 KO mice than in WT mice under both normal conditions and in acute EAE. We have found similar results in cultured neonatal brain astrocytes, with RGC-32 KO cells having lower levels of GFAP than WT cells (18). Our team has also observed that RGC-32 KO astrocytes from the spinal cord white matter of mice with acute EAE display an elongated, bipolar morphology, reminiscent of radial glia and astrocyte progenitors, while the WT astrocytes near the inflammatory infiltrate have a reactive phenotype with body hypertrophy and process branching (17, 18). Interestingly, the number of cells that are positive for vimentin and fatty acid binding protein 7 (FABP7) and display radial glia morphology is significantly higher in RGC-32 KO mice than in WT mice on both day 0 and day 14 (18). These two markers are normally expressed by astrocyte lineage cells during brain development but can persist in mature astrocytes and adult radial glia (36–39). Their expression is increased in reactive astrocytes following brain injury (40, 41). We have observed that vimentin+ and FABP7+ radial cells have a much broader distribution in RGC-32 KO mice, whereas in WT mice they are distributed mostly around inflammatory infiltrates (18), suggesting that these cells are more likely radial glia and immature astrocytes in RGC-32 KO mice, whereas in WT mice they are vimentinand FABP7-re-expressing reactive astrocytes. Moreover, RGC32 KO spinal cord astrocytes display a higher proliferative index, as measured by the expression of the proliferation marker Ki-67 (18). Collectively, these results suggest that astrocytes lacking RGC-32 have an immature phenotype and display an intrinsic inability to respond to inflammation, to upregulate GFAP, and to undergo the morphological changes associated with glial scar formation at the peak of EAE (Figure 2). The immature phenotype of RGC-32 KO astrocytes translates into an impaired expression of gliotic scar components and growth factors Glial scar plays a major role in the evolution of inflammatory lesions. While during the acute phase it might play a beneficial role by fencing the inflammatory infiltrate in and thus avoiding its spread into healthy tissue, during chronic phases it might have a rather detrimental role by inhibiting remyelination and axonal regeneration (42). However, recent Tatomir et al. 10.3389/fimmu.2022.979414 Frontiers in Immunology 0

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Role Of RGC-32 In Multiple Sclerosis And Neuroinfl
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Role of RGC-32 in multiple sclerosis and neuroinfl

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TYPE Mini Review
PUBLISHED 12 September 2022
DOI 10.3389/fimmu.2022.979414




Role of RGC-32 in multiple
OPEN ACCESS sclerosis and neuroinflammation
EDITED BY
Fumitaka Shimizu,
Yamaguchi University School of
– few answers and
Medicine, Japan

REVIEWED BY
many questions
Shiyou Chen,
University of Missouri, United States
Alexandru Tatomir 1,2, Jacob Cuevas 1, Tudor C. Badea 3,
*CORRESPONDENCE
Horea Rus Dafin F. Muresanu 2, Violeta Rus 4 and Horea Rus 1,5*

1
Department of Neurology, University of Maryland, School of Medicine, Baltimore,
SPECIALTY SECTION MD, United States, 2 Department of Neurosciences, “Iuliu Hatieganu” University of Medicine and
This article was submitted to Pharmacy, Cluj-Napoca, Romania, 3 Research and Development Institute, Faculty of Medicine,
Multiple Sclerosis Transylvania University of Brasov, Brasov, Romania, 4 Department of Medicine, Division of
and Neuroimmunology, Rheumatology and Clinical Immunology, University of Maryland, School of Medicine, Baltimore,
a section of the journal MD, United States, 5 Neurology Service, Baltimore Veterans Administration Medical Center,
Frontiers in Immunology Baltimore, MD, United States
RECEIVED 27 June 2022
ACCEPTED 22 August 2022
PUBLISHED 12 September 2022

CITATION Recent advances in understanding the pathogenesis of multiple sclerosis (MS)
Tatomir A, Cuevas J, Badea TC, have brought into the spotlight the major role played by reactive astrocytes in
Muresanu DF, Rus V and Rus H (2022)
this condition. Response Gene to Complement (RGC)-32 is a gene induced by
Role of RGC-32 in multiple sclerosis
and neuroinflammation – few answers complement activation, growth factors, and cytokines, notably transforming
and many questions. growth factor b, that is involved in the modulation of processes such as
Front. Immunol. 13:979414.
doi: 10.3389/fimmu.2022.979414 angiogenesis, fibrosis, cell migration, and cell differentiation. Studies have
uncovered the crucial role that RGC-32 plays in promoting the differentiation
COPYRIGHT
© 2022 Tatomir, Cuevas, Badea, of Th17 cells, a subtype of CD4+ T lymphocytes with an important role in MS
Muresanu, Rus and Rus. This is an and its murine model, experimental autoimmune encephalomyelitis. The latest
open-access article distributed under
the terms of the Creative Commons data have also shown that RGC-32 is involved in regulating major
Attribution License (CC BY). The use, transcriptomic changes in astrocytes and in favoring the synthesis and
distribution or reproduction in other
secretion of extracellular matrix components, growth factors, axonal growth
forums is permitted, provided the
original author(s) and the copyright molecules, and pro-astrogliogenic molecules. These results suggest that RGC-
owner(s) are credited and that the 32 plays a major role in driving reactive astrocytosis and the generation of
original publication in this journal is
cited, in accordance with accepted
astrocytes from radial glia precursors. In this review, we summarize recent
academic practice. No use, advances in understanding how RGC-32 regulates the behavior of Th17 cells
distribution or reproduction is and astrocytes in neuroinflammation, providing insight into its role as a
permitted which does not comply with
these terms. potential new biomarker and therapeutic target.

KEYWORDS

RGC-32, multiple sclerosis, EAE (experimental autoimmune encephalomyelitis), radial
glia, neuroinflammation, astrocyte, Th17




Frontiers in Immunology 01 frontiersin.org

, Tatomir et al. 10.3389/fimmu.2022.979414




Introduction of Th17 cells (16) as well as the ability of astrocytes to undergo
reactive changes (17–19).
Recent years have brought an appreciable increase in our In this mini-review, we seek to summarize the most recent
understanding of the pathogenesis of multiple sclerosis (MS), an advances in understanding the contribution of RGC-32 to
autoimmune, demyelinating disorder of the central nervous multiple sclerosis and neuroinflammation, as well as its ability
system (CNS) with a potentially huge socioeconomic impact (1). to regulate astrocyte and Th17 cell biology.
MS pathogenesis results from the combined action of
multiple effectors, including autoreactive myelin-specific T and
B cells, pro-inflammatory cytokines, macrophages, microglia, Th17 cells and their role in MS
astrocytes, and the complement system (2–4). A central role is
played by CD4+ T cells, which are thought to be primed in the Th17 cells differentiate from naïve CD4+ T cells in the
periphery against myelin-specific antigens and then to migrate presence of IL-6 and TGF-b (20). They have high pathogenic
into the CNS, where they launch an inflammatory cascade potential in light of their ability to generate pro-inflammatory
against myelin and oligondedrocytes (OLG), leading to cytokines, including IL-17, IL-21, IL-22 and granulocyte
demyelination and eventually, in the chronic progressive macrophage colony-stimulating factor (GM-CSF) (20, 21). IL-
phases, to axonal loss and neurodegeneration (5). 17 is particularly effective in promoting BBB disruption and in
Astrocytes play vital roles in regulating physiological recruiting immune cells into the CNS (22, 23), while GM-CSF is
processes necessary for maintaining CNS homeostasis, such as highly pro-inflammatory and augments the recruitment of
synaptogenesis, neurotransmitter clearance, ion and water peripheral immune cells into the CNS (23, 24).
balance, formation and maintenance of the blood-brain barrier
(BBB) and regulation of blood flow (6, 7). Astrocytes are also
critical players in the pathogenesis of MS and its murine model, RGC-32 as a key regulator of Th17 cell
experimental autoimmune encephalomyelitis (EAE) by differentiation
sustaining key pathological processes involved in disease
initiation and progression (8–10). Using an RGC-32 knock-out (KO) mouse model, we have
First isolated from rat OLG stimulated by sublytic been able to demonstrate that RGC-32 promotes the
complement activation, RGC-32 was found to be induced by a differentiation of Th17 cells both in vitro and in vivo. When
number of growth factors, hormones, and cytokines, such as compared to wild-type (WT) cells, CD4+ cells isolated from
transforming growth factor (TGF)-b (11–13). RGC-32 RGC-32 KO mice express lower levels of IL-17, as well as some
modulates a number of cellular processes, including cell cycle of the transcription factors necessary for Th17 differentiation,
regulation, cell migration, cellular differentiation, and fibrosis, including retinoic acid receptor-related orphan receptor gamma
and influences pathological processes such as carcinogenesis, t (RORgt), B cell–activating transcription factor (BATF), and
metabolic disorders, atherosclerosis, and autoimmunity (13–15). interferon regulatory factor 4 (IRF4) under Th17-polarizing
Our work has demonstrated that RGC-32 plays an important conditions (16). On the other hand, we have observed that the
role in the pathogenesis of EAE by regulating the differentiation differentiation of Th1, Th2, and Tregs is not affected by the lack
of RGC-32. Further analysis has revealed a defect in SMAD2 and
AKT phosphorylation in RGC-32 KO CD4+ cells, suggesting
that RGC-32 preferentially facilitates the differentiation of Th17
Abbreviations: AGM, axonal guidance molecules; BBB, blood-brain barrier; cells in a TGF-b-dependent and independent manner (16).
CNS, central nervous system; CTGF, connective tissue growth factor; EAE, Moreover, we have observed that RGC-32 KO mice develop
experimental autoimmune encephalomyelitis; ECM, extracellular matrix; a milder EAE phenotype than do their WT counterparts, with a
EPHA7, ephrin receptor type 7A; GM-CSF, granulocyte macrophage lower clinical score at the peak of disease (day 14).
colony-stimulating factor; FBN, fibrillin; FBLN, fibulin; GFAP, glial Immunohistochemical analysis has revealed a smaller
fibrillary acidic protein; HSPG2, heparan sulfate proteoglycan 2; HOPX, inflammatory infiltrate and fewer demyelination foci in the
homeodomain-only protein homeobox; KO, knockout; MMP, matrix spinal cords of RGC-32 KO mice, and a lower number of IL-
metalloproteinase; MS, multiple sclerosis; PLAUR, plasminogen activator, 17+ and GM-CSF+ cells (16).
urokinase receptor; PLXNA1, plexin A1; RGC-32, response gene to Interestingly, one study has shown that overexpression of
complement 32; SPOCK3, Sparc/osteonectin, cwcv and kazal-like domains RGC-32 in peripheral blood mononuclear cells (PBMC) isolated
proteoglycan 3; STAT3, signal transducer and activator of transcription 3; from patients with dilated cardiomyopathy augments the
STC1, stanniocalcin-1; VEGF, vascular endothelial growth factor; VCAN, number of Th17 cells (25). We have also shown that B and T
versican; WDFY1, WD repeat and FYVE domain-containing protein 1; WT, cells from patients with systemic lupus erythematous exhibit
wild type. higher levels of RGC-32 and that overexpression of RGC-32 in




Frontiers in Immunology 02 frontiersin.org

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