Clark M. Blatteis

The febrile response to lipopolysaccharide is blocked in cyclooxygenase-2-/-, but not in cyclooxygenase-1-/- mice

Various lines of evidence have implicated inducible cyclooxygenase-2 (COX-2) in fever production. Thus, its expression is selectively enhanced in brain after peripheral exogenous (e.g., lipopolysaccharide [LPS]) or endogenous (e.g., interleukin-1) pyrogen administration, while selective COX-2 inhibitors suppress the fever induced by these pyrogens. In this study, we assessed the febrile response to LPS of congenitally constitutive COX-1 (COX-1-/-) and COX-2 (COX-2-/-)-deficient C57BL/6J-derived mice. COX-1+/- and COX-2+/- mice were also evaluated; controls were wild-type C57BL/6J mice (Jackson Labs.). All the animals were pretrained daily for two weeks to the experimental procedures. LPS was injected intraperitoneally at 1 microgram/mouse; pyrogen-free saline (PFS) was the vehicle and control solution. Core temperatures (Tcs) were recorded using thermocouples inserted 2 cm into the colon. The presence of the COX isoforms was determined in cerebral blood vessels immunocytochemically after the experiments, without knowledge of the functional results. The data showed that the wild-type, COX-1+/-, and COX-1-/- mice all responded to LPS with a 1 degrees C rise in Tc within 1 h; the fever gradually abated over the next 4 h. By contrast, COX-2+/- and COX-2-/- mice displayed no Tc rise after LPS. PFS did not affect the Tc of any animal. It would appear therefore that COX-2 is necessary for LPS-induced fever production.

Suppression of fever after lesions of the anteroventral third ventricle in guinea pigs.

Endogenous pyrogen (EP), injected systemically or intracerebrally, evokes fever and certain changes in plasma trace metal and glycoprotein levels which are characteristic of the acute-phase reaction. It is generally assumed that EP enters the brain from the blood, although it has not yet been demonstrated that EP crosses the blood-brain barrier (BBB). The possibility that EP might penetrate the brain through the organum vasculosum laminae terminalis (OVLT), which is outside of the BBB and located in close proximity to the medial preoptic region (MPO, the primary site sensitive to locally applied EP), was investigated by making electrolytic lesions (3 mA, 20 sec, anodal) in the anteroventral wall of the third ventricle of guinea pigs (AV3V-X). After 10 days, their febrile and selected acute-phase responses (plasma iron, zinc, copper, and sialic acid levels) to endotoxin (LPS, S. enteritidis, 2 micrograms/kg, IP), which induces EP production by the host, were measured; controls were sham-operated guinea pigs. LPS did not induce in the AV3V-X animals either fever or rises in plasma copper and sialic acid levels; however, as in the controls, it caused hypoferremia and hypozincemia. To exclude damage to the MPO as a cause of these responses, sham and AV3V-X guinea pigs were administered homologous EP intrapreoptically (1 microliter bilaterally). Comparable fevers developed in both groups of animals. Hence, the integrity of the AV3V region including the OVLT seems to be critical for the EP-induced elevations of both body temperature and plasma levels of acute-phase proteins, but not for the fall of plasma iron and zinc levels. It may be that EP passes into the brain through the OVLT.

Blockade of lipopolysaccharide-induced fever by subdiaphragmatic vagotomy in guinea pigs.

It is generally believed that fever is mediated by certain cytokines produced by immune cells activated by exogenous pyrogens, e.g., lipopolysaccharides (LPS), released into the circulation and transported to the brain There, the cytokines are thought to stimulate prostaglandin (PG) E2 production within the organum vasculosum laminae terminalis region. PGE2 then may act as a febrigenic mediator locally or in the surrounding preoptic area (POA). However, whereas the increases in preoptic PGE2 and body (core) temperature (Tc) following the intravenous (i.v.) administration of LPS correlate temporally, cytokine levels in blood lag both these increases. From recent data in the literature, we have conjectured that a possible, alternative communication pathway between the i.v. LPS-activated immune system and brain PGE2 may be provided by the vagi. To test this possibility, we measured the levels of PGE2 in the extracellular fluid of the POA (collected by microdialysis) of conscious, subdiaphragmatically vagotomized or sham-operated guinea pigs following LPS administration (2 micrograms/kg; i.v.); controls received pyrogen-free saline (PFS). The effluents from the microdialysis probes were collected over 30-min periods throughout the experiments and the samples analyzed by radioimmunoassay; Tc was monitored continuously using thermocouples inserted 5 cm into the colon. LPS induced a biphasic fall in Tc and failed to increase preoptic PGE2 levels in the vagotomized guinea pigs (n = 10), whereas in their sham-operated controls (n = 10) it induced increases in both preopitc PGE2 and Tc within 15 min after its injection; PFS (n = 13) had no effect on either variable. We postulate that peripheral immune cell-derived signals may be transmitted via the vagi to the medulla. From other data, we suggest further that they may be conveyed from here via the ventral noradrenergic bundle to the POA region, where the released norepinephrine induces the local synthesis of PGE2 and, hence, fever onset.

Chapter 53: Role of the OVLT in the febrile response to circulating pyrogens

The available data suggest that circulating endogenous pyrogens (EPs) probably do not penetrate the brain, but interact with sensory elements in the organum vasculosum laminae terminalis (OVLT) which may involve 5HT and SP as neurotransmitters. It is proposed that substance P (SP) may affect thermo-regulatory neurons in the preoptic area (POA) directly or induce the local synthesis of cytokines that secondarily act on these neurons. Recent evidence indicates that endothelial cells in the OVLT bind circulating cytokines to receptors on their luminal surface. This may result in the release of putative neuroregulators which then process the original signals inwardly to the POA, where they then affect neuronal functions leading to fever production. Thus, trans-BBB passage of cytokines is prevented, but the brain site mediating their pyrogenic effect is informed and the appropriate responses are activated. It is emphasized, however, that this suggested mechanism is still speculative.

The onset of fever: new insights into its mechanism.

The classical view of fever production is that it is modulated in the ventromedial preoptic area (VMPO) in response to signaling by pyrogenic cytokines elaborated in the periphery by mononuclear phagocytes and the consequent induction of cyclooxygenase (COX)-2-dependent prostaglandin (PG)E(2) in the VMPO. This mechanism has, however, been questioned, in particular because the appearance of circulating cytokines lags the onset of the febrile response to intravenously (iv) injected bacterial endotoxic lipopolysaccharide (LPS), an exogenous pyrogen. Moreover, COX-2, in this case, is itself an inducible enzyme, the de novo synthesis of which similarly lags significantly the onset of fever. Issues also exist regarding the accessibility of the POA to blood-borne cytokines. New data adduced over the past 10 years indicate that the peripheral febrigenic message is conveyed to the VMPO via a neural rather than a humoral route, specifically by the vagus to the nucleus tractus solitarius (NST), and that the peripheral trigger is PGE(2), not cytokines; vagal afferents express PGE(2) receptors (EP(3)). Thus, the initiation of the febrile responses to both iv and intraperitoneal (ip) LPS is temporally correlated with the appearance of LPS in the livers Kupffer cells (Kc), its arrival immediately activating the complement (C) cascade and the consequent production of the anaphylatoxin C5a; the latter is the direct stimulus for PGE(2) production, catalyzed non-differentially by constitutive COX-1 and -2. From the NST, the signal proceeds to the VMPO via the ventral noradrenergic bundle, causing the intrapreoptic release of norepinephrine (NE) which then evokes two distinct core temperature (T(c)) rises, viz., one alpha(1)-adrenoceptor (AR)-mediated, rapid in onset, and PGE(2)-independent, and the other alpha(2)-AR-mediated, delayed, and COX-2/PGE(2)-dependent, i.e., the prototypic febrile pattern induced by iv LPS. The release of NE is itself modulated by nitric oxide contemporaneously released in the VMPO.

Pyrogen Sensing and Signaling: Old Views and New Concepts

Fever is thought to be caused by endogenous pyrogenic cytokines, which are elaborated and released into the circulation by systemic mononuclear phagocytes that are activated by exogenous inflammatory agents and transported to the preoptic-anterior hypothalamic area (POA) of the brain, where they act. Prostaglandin (PG) E2 is thought to be an essential, proximal mediator in the POA, and induced by these cytokines. It seems unlikely, however, that these factors could directly account for early production of PGE2 following the intravenous administration of bacterial endotoxic lipopolysaccharides (LPS), because PGE2 is generated before the cytokines that induce it are detectable in the blood and the before cyclooxygenase-2, the synthase that they stimulate, is expressed. Hence other, more quickly evoked mediators are presumed to be involved in initiating the febrile response; moreover, their message may be conveyed to the brain by a neural rather than a humoral pathway. This article reviews current conceptions of pyrogen signalling from the periphery to the brain and presents new, developing hypotheses about the mechanism by which LPS initiates fever.

Hypothalamic prostaglandin E2 during lipopolysaccharide-induced fever in guinea pigs

Prostaglandin E2 (PGE2) is postulated to be a central mediator of fever. It is generally believed that it is produced in the preoptic area of the anterior hypothalamus (POA) because, among other evidence, its level increases both in the third ventricle and in the POA in response to pyrogens. However, lately, the question has arisen whether PGE2 might, in fact, be formed outside of the brain substance and then penetrate it, in particular through the organum vasculosum laminae terminalis. If produced outside the brain substance, the peripheral blockade of its synthesis should prevent lipopolysaccharides (LPS)-induced fever, whereas the intracarotid infusion of PGE2 should produce an increase in core temperature (T(C)) as well as in preoptic PGE2. To verify this hypothesis, continuous measurements of T(C) and preoptic PGE2 levels were made in conscious guinea pigs administered the PGE2 synthase inhibitor, indomethacin (10 or 50 mg/kg, im) 30 min before S. enteritidis LPS (2 mu g/kg, iv) or before PGE2 microdialyzed into the POA (1 mu g/mu l at 2 mu g/min for 2.5 h) and during PGE2 infused into a carotid artery (1 mu g and 10 mu g/mu l at 2 mu g/min for 1 h). LPS induced a biphasic 1.4 degrees C fever that was consistently associated with an increase in the level of PGE2 in the POA. Indomethacin at 10 mg/kg attenuated the course of the LPS-induced fever and prevented the associated increase in preoptic PGE2 for 90 min after fever onset; thereafter, PGE2 was significantly reduced by comparison with controls. Indomethacin at 50 mg/kg completely abolished both the fever and the increased levels of PGE2 in the POA; the fever induced by PGE2 microdialyzed into the POA was not affected by indomethacin pretreatment The intracarotid infusion of PGE2 produced T(C) falls and no increase in preoptic PGE2 levels. The indomethacin-induced blockade of fever and inhibition of the associated increase in preoptic PGE2 levels further substantiates the presumptive link between PGE2 in the POA and fever caused by LPS. The failure of exogenous PGE2 infusion to induce increases in T(C) and preoptic PGE2 levels excludes the possibility that PGE2 formed outside of the brain penetrates the POA and induces fever. Thus, in guinea pigs, the PGE2 associated with LPS-induced fever may be synthesized in the POA.

Physiology and Pathophysiology of Temperature Regulation

Thermal physiology - brief history and perspectives, A.S. Milton body temperature, C.M. Blatteis biophysics of heat exchange between the body and the environment, J. Werner heat production mechanisms - shivering thermogenesis, L. Jansky heat production mechanisms - nonshivering thermogenesis, B. Cannon heat loss mechanisms, T. Morimoto neural thermoreception and regulation of body temperature, J.A. Boulant behavioural temperature regulation, M. Cabanac temperature regulation in exercise - thermal factors, B.N. Johannsen temperature regulation in exercise - nonthermal factors, H. Kaciuba-Uscilko body temperature and age - neonates H.P. Laburn body temperature and age - elderly, K.E. Cooper fever, C.M. Blatteis thermoregulatory consequences of prolonged exposure to thermal extremes - heat, M. Horowitz thermoregulatory consequences of prolonged exposure to thermal extremes - cold, E. Zeisberger pathophysiological consequences of exposure to thermal extremes - heat illnesses and hyperthermia, M. Horowitz pathophysiological consequences of exposure to thermal extremes - cold injuries and hypothermia, J.B. Mercer temperature regulation in different environments or in special cases, C.M. Blatteis.

SIGNALING THE BRAIN IN SYSTEMIC INFLAMMATION: THE ROLE OF COMPLEMENT

The complement (C) cascade is activated in almost immediate reaction to the appearance in the body of pathogenic microorganims and their products, e.g., bacterial endotoxic lipopolysaccharide (LPS), resulting in the generation of a series of potent bioactive fragments that have critical roles in the innate immune response of the afflicted host, including, potentially, the production of the fever that so characteristically marks bacterial infections. For instance, its derivatives C3a, C3b, iC3b, C5a, and C5b-9 independently induce the production by myeloid and non-myeloid cells of the cytokines interleukin (IL)-1(, IL-6 and tumor necrosis factor-(, and of prostaglandin (PG)E2, all putative mediators of fever. Therefore, any one of these C components could be involved, centrally or peripherally, in the induction of the febrile response to LPS. Indeed, we have shown that hypocomplementation by cobra venom factor (CVF) dose-dependently attenuates LPS-induced fever in guinea pigs and wild-type (WT) mice, and that C5 gene-ablated mice are unable to develop fever after LPS. In further studies, we found that a specific antagonist to the C5a receptor, C5aR1a, prevents the LPS-induced febrile rise of WT and C3 null mutant mice, implicating C5a as the responsible factor. Various lines of evidence from our laboratory suggest that the macrophages of the liver (Kupffer cells [Kc]) may be the specific target cells of C5a and that the product they release may be PGE2. PGE2, in turn, may be the substance that binds to vagal afferents in the liver that convey the pyrogenic message to the brain. Other studies by our group (not included in this review) have separately traced the neural pathway by which this message may be transmitted from the liver to the brain and processed there for action. The purpose of this article is to review the studies that have led us to conclude that C5a, Kc and Kc-generated PGE2 may be integrally involved in the pathogenesis of LPS fever. If further verified, these results will be important for better understanding how infectious stimuli may trigger the multivariate acute-phase responses generally, and fever particularly, that promptly spring into action to defend the continued well-being of the afflicted host.

Age-Dependent Changes in Temperature Regulation – A Mini Review

It is now well recognized that the body temperature of older men and women is lower than that of younger people and that their tolerance of thermal extremes is more limited. The regulation of body temperature does not depend on a single organ, but rather involves almost all the systems of the body, i.e. systems not exclusively dedicated to thermoregulatory functions such as the cardiovascular and respiratory systems. Since these deteriorate naturally with advancing age, the decrement in their functions resonates throughout all the bodily processes, including those that control body temperature. To the extent that the age-related changes in some of these, e.g. in the musculoskeletal system, can be slowed, or even prevented, by certain measures, e.g. fitness training, so can the decrements in thermoregulatory functions. Some deficits, however, are unavoidable, e.g. structural skin changes and metabolic alterations. These impact directly on the ability of the elderly to maintain thermal homeostasis, particularly when challenged by ambient thermal extremes. Since the maintenance of a relatively stable, optimal core temperature is one of the body’s most important activities, its very survival can be threatened by these disorders. The present article describes the principal, age-associated changes in physiological functions that could affect the ability of seniors to maintain their body temperature when exposed to hot or cold environments.