PT  - JOURNAL ARTICLE
AU  - Takeshita, Yukio
AU  - Fujikawa, Susumu
AU  - Serizawa, Kenichi
AU  - Fujisawa, Miwako
AU  - Matsuo, Kinya
AU  - Nemoto, Joe
AU  - Shimizu, Fumitaka
AU  - Sano, Yasuteru
AU  - Tomizawa-Shinohara, Haruna
AU  - Miyake, Shota
AU  - Ransohoff, Richard M.
AU  - Kanda, Takashi
TI  - New BBB Model Reveals That IL-6 Blockade Suppressed the BBB Disorder, Preventing Onset of NMOSD
AID  - 10.1212/NXI.0000000000001076
DP  - 2021 Nov 01
TA  - Neurology - Neuroimmunology Neuroinflammation
PG  - e1076
VI  - 8
IP  - 6
4099  - http://nn.neurology.org/content/8/6/e1076.short
4100  - http://nn.neurology.org/content/8/6/e1076.full
SO  - Neurol Neuroimmunol Neuroinflamm2021 Nov 01; 8
AB  - Background and Objectives To evaluate the pathophysiology of neuromyelitis optica spectrum disorder (NMOSD) and the therapeutic mechanism and levels of interleukin-6 (IL-6) blockade (satralizumab), especially with respect to blood-brain barrier (BBB) disruption with the new in vitro and ex vivo human BBB models and in vivo model.Methods We constructed new static in vitro and flow-based ex vivo models for evaluating continued barrier function, leukocyte transmigration, and intracerebral transferability of neuromyelitis optica-immunoglobulin G (NMO-IgG) and satralizumab across the BBB using the newly established triple coculture system that are specialized to closely mimic endothelial cell contact of pericytes and endfeet of astrocytes. In the in vivo study, we assessed the effects of an anti–IL-6 receptor antibody for mice (MR16-1) on in vivo BBB disruption in mice with experimental autoimmune encephalomyelitis in which IL-6 concentration in the spinal cord dramatically increases.Results In vitro and ex vivo experiments demonstrated that NMO-IgG increased intracerebral transferability of satralizumab and NMO-IgG and that satralizumab suppressed the NMO-IgG–induced transmigration of T cells and barrier dysfunction. In the in vivo study, the blockade of IL-6 signaling suppressed the migration of T cells into the spinal cord and prevented the increased BBB permeability.Discussion These results suggest that (1) our triple-cultured in vitro and in ex vivo BBB models are ideal for evaluating barrier function, leukocyte transmigration, and intracerebral transferability; (2) NMO-IgG increased the intracerebral transferability of NMO-IgG via decreasing barrier function and induced secretion of IL-6 from astrocytes causing more dysfunction of the barrier and disrupting controlled cellular infiltration; and (3) satralizumab, which can pass through the BBB in the presence of NMO-IgG, suppresses the BBB dysfunction and the infiltration of inflammatory cells, leading to prevention of onset of NMOSD.AQP4=aquaporin-4; BBB=blood-brain barrier; EAE=experimental autoimmune encephalomyelitis; EC=endothelial cell; ELISA=enzyme-linked immunosorbent assay; hAST=human astrocyte; hEC=human brain microvascular EC; hPCT=human pericyte; IgG=immunoglobulin G; IL-6=interleukin-6; NF-κB=nuclear factor-kappa B; NMO-IgG=neuromyelitis optica-immunoglobulin G; NMOSD=neuromyelitis optica spectrum disorder; PBMC=peripheral blood mononuclear cell; SEM=standard error of mean; TEER=transepithelial electrical resistance