(Journal of Leukocyte Biology. 2000;68:423-428.)
© 2000
by Society for Leukocyte Biology
Induction of cyclooxygenase-2 expression during HIV-1-infected monocyte-derived macrophage and human brain microvascular endothelial cell interactions
Cândida F. Pereira,
Leonie A. Boven,
Jeena Middel,
Jan Verhoef and
Hans S. L. M. Nottet
Eijkman-Winkler Institute for Microbiology, Infectious Diseases and Inflammation, University Medical Center, Utrecht, The Netherlands
Correspondence: Cândida da Fonseca Pereira, Eijkman-Winkler Institute, Section Neuroimmunology, UMC, hp G04.614, Heidelberglaan 100, NL-3584 CX Utrecht, The Netherlands. E-mail: C.F.Pereira{at}lab.azu.nl

ABSTRACT
Human immunodeficiency virus type-1 (HIV-1)-associated dementia
(HAD)
is a neurodegenerative disease characterized by HIV infection
and
replication in brain tissue. HIV-1-infected monocytes overexpress
inflammatory
molecules that facilitate their entry into the brain.
Prostanoids
are lipid mediators of inflammation that result from
cyclooxygenase-2
(COX-2) activity. Because COX-2 is normally induced
during inflammatory
processes, the aim of this study was to investigate
whether
COX-2 expression is up-regulated during monocyte-brain
endothelium
interactions.
In vitro cocultures of
HIV-infected macrophages
and brain endothelium showed an up-regulation
of COX-2 expression
by both cell types. This up-regulation occurs via
an interleukin-1ß
(IL-1ß)-dependent mechanism in macrophages and
via
an IL-1ß-independent mechanism in endothelial cells.
Thus,
interactions between HIV-infected monocytes and brain
endothelium
result in COX-2 expression and, as such, might contribute
to the
neuropathogenesis of HIV infection.
Key Words: HIV-1-associated dementia cytokines eicosanoids in vitro cocultures reverse transcriptase-polymerase chain reaction Western blot

INTRODUCTION
Human immunodeficiency virus type-1 (HIV-1) -associated dementia
(HAD)
occurs in approximately one-third of adults and one-half of
children
with AIDS and is characterized by progressive motor and
cognitive
loss. The most severe neurological complication of this
disease
is HIV encephalitis that is characterized by neuronal damage
and
loss, multinucleated giant cell formation, microglial nodes,
astrocytosis,
myelin pallor, and infiltration of monocytic cells into
brain
parenchyma [
1
,
2
]. HIV entry and
monocyte migration into the
brain are key events in HAD
[
2
,
3
]. Selective induction of
adhesion
molecules by HIV-infected monocytes was indicated as
a possible
mechanism for the transendothelial migration of HIV-infected
monocytes
into the brain [
4
]. Also, CC chemokines, cytokines
capable
of attracting monocytes/macrophages to sites of inflammation,
have
been found to be elevated in the brains of demented AIDS patients
[
5
,
6
]. Blood-derived monocytes that
infiltrate into the brain
during HIV-1 infection were shown to be
immune-activated and
to express proinflammatory cytokines like
interleukin-1ß
(IL-1ß) and tumor necrosis factor

(TNF-

)
[
7
,
8
].
These cytokines are known to induce
nitric oxide synthase (iNOS)
and cyclooxygenase-2 (COX-2), enzymes that
produce nitric oxide
(NO) and prostanoids, respectively
[
9
10
11
12
13
].
In this study, the role of COX-2 in the neuropathogenesis of HIV
infection was investigated. COX-2 is the inducible isoform of COX,
which is the enzyme responsible for the conversion of arachidonic acid
into prostanoids: prostaglandins and thromboxanes. COX-2 expression can
be induced in inflammatory cells and in the central nervous system
after stimulation with proinflammatory cytokines, platelet-activating
factor (PAF), and also HIV-1 gp120 [12
, 14
,
15
]. COX-2 cytotoxicity mechanisms may be related to
production of reactive oxygen species (ROS), production of prostanoids,
or induction of apoptosis via prostaglandin E2
(PGE2) [11
, 16
]. Within the
brain, COX-2 expression was shown to be induced in neurons
[17
, 18
], astrocytes [10
],
brain endothelial cells [13
, 19
],
monocytes/macrophages [14
], and microglia
[20
]. Increased levels of COX-2 were found to be
associated with several neurological diseases such as Alzheimers
disease [21
], ischemia [16
], acute
systemic experimental inflammation [22
], experimental
fever [13
], and infarct [23
]. In
addition, some studies showed that non-steroidal anti-inflammatory
drugs (NSAIDs) could ameliorate disease progression in Alzheimers
disease and ischemia [16
, 21
].
Several studies have already attempted to correlate COX-2 with HAD.
Prostaglandin levels were found to be elevated in cerebrospinal fluid
(CSF) of HIV-demented patients [24
]. Genis and
colleagues showed that HIV neuropathogenesis is mediated, in part,
through cytokines and arachidonic acid metabolites produced during
cell-cell interactions between HIV-infected brain macrophages and
astrocytes [25
]. HIV gp120 was shown to induce apoptosis
via enhancement of COX-2 expression in rat neocortex
[15
]. Some preliminary data demonstrated COX-2
expression in perivascular areas of brain tissue from demented AIDS
patients [26
]. Still, there is no information concerning
COX-2 expression during monocyte transendothelial migration into the
brain. Therefore, the aim of this study was to investigate whether
COX-2 expression was induced during monocyte-brain endothelium
interactions.

MATERIALS AND METHODS
Isolation and culture of primary human monocytes and brain
microvascular endothelial cells (BMVEC)
Peripheral blood mononuclear cells were isolated from
heparinized
blood from HIV-1-, HIV-2-, and hepatitis B-seronegative
donors
and obtained on Ficoll-Hypaque density gradients. Cells were
washed
twice and monocytes were purified by countercurrent centrifugal
elutriation.
Cells were >98% monocytes by criteria of cell morphology
on
May-Grünwald-Giemsa-stained cytosmears and by nonspecific
esterase
staining using

-naphthylacetate (Sigma, St. Louis, MO) as
substrate.
Monocytes were cultured in suspension at a concentration of
2
x 10
6 cells/mL in Teflon flasks (Nalgene,
Rochester, NY) in
Dulbeccos modified Eagles medium (DMEM) with 10%
heat-inactivated
human AB serum negative for anti-HIV antibodies, 10
µg/mL
gentamicin, and 10 µg/mL ciprofloxacin (Sigma). As previously
described,
HIV-1 infection of nonadherent macrophages, especially when
using
a low multiplicity of infection, appears much more reproducible
than
infection of macrophages that were first allowed to adhere
[
27
].
Human BMVEC were obtained from Cell Systems (Kirkland, WA) and
propagated as adherent monolayers on highly purified type 1
collagen-coated T-75 tissue culture flasks (Costar, Cambridge, MA)
[4
].
Cocultivation of HIV-1-infected macrophages and BMVEC
After 7 days monocyte-derived macrophages (MDM) were recovered
from the Teflon flasks and infected with HIV-1Ba-L (strain
titered in MDM) at a multiplicity of infection of 0.01 for 2 h.
HIV-infected and mock-infected MDM were washed twice to remove unbound
virus and cultured in Teflon flasks for an additional 5 days to
establish a chronic infection. Then, MDM were washed and added directly
or in a chamber insert (trans-well) to 24-well plates containing a
monolayer of BMVEC at a 1:1 ratio. For the IL-1ß blocking
experiments, 5 µg/mL anti-human IL-1ß polyclonal goat antibody (R &
D Systems, Minneapolis, MN) was added. At different time points cells
were lysed for RNA isolation.
RT-PCR detection of COX-2 mRNA
Cocultures of MDM and BMVEC were homogenized and lysed in 1 mL
TRIzol (Life Technologies, Gaithersburg, MD) according to the
manufacturers guidelines. Total RNA was dissolved in
diethylpyrocarbonate (DEPC)-treated water, 1 µg of RNA was used
for the synthesis of complementary DNA, and PCR reactions were
performed as described previously [27
]. COX-2 primers
were 5-TTCAAATGAGATTGTGGGAAAATTGCT-3 (sense) and
5-AGATCATCTCTGCCTGAGTATCTT-3 (antisense). GAPDH primers were
5-CCATGGAGAAGGCTGGGG-3 (sense) and 5-CAAAGTTGTCATGGATGACC-3
(antisense). For semi-quantification every primer pair was tested at
different cycle numbers to determine the linear range. GAPDH mRNA
levels were measured at 23 cycles, whereas cDNA had to be subjected to
37 cycles to detect COX-2 mRNA. Aliquots of 5 µL of the biotinylated
PCR product were semi-quantitatively analyzed using a fluorescent
digoxigenin detection enzyme-linked immunosorbent assay (ELISA) kit
(Boehringer Mannheim) according to the manufacturers protocol as
described previously [27
]. The digoxigenin-labeled probe
for COX-2 was 5-GTTTGCATTCTTTGCCCAGC-3 and for GAPDH was
5-CTGCACCACCAACTGCTTAGC-3. All data were normalized against GAPDH
mRNA levels, which was used as an internal standard. COX-2 mRNA
expression levels were expressed as relative fluorescence units (RFU).
Detection of COX-2 protein by Western blot
Samples were collected with TRIzol (Life Technologies) according
to the manufacturers guidelines. Proteins were isolated as described
previously [28
]. Total protein amount was determined by
the method of Bradford [29
]. Samples were diluted in
gel-loading buffer [125 mM Tris-HCl, 1% sodium dodecyl sulfate (SDS),
20% glycerol, 0.005% bromophenol blue, and 4% ß-mercaptoethanol]
to a final concentration of 125 µg/mL and boiled for 10 min.
Solubilized proteins were fractionated in an SDS-polyacrylamide gel
electrophoresis (10% gradient gel) and transferred to a nitrocellulose
membrane. The immunoblot was washed with phosphate-buffered saline
(PBS)-0.1% Tween-20 and incubated with primary antibody (anti-COX-2
polyclonal goat antibody specific for human, rat, and mouse COX-2,
Santa Cruz Biotechnology, Santa Cruz, CA) diluted 1:200 in PBS/bovine
serum albumin (BSA)/azide, for 1 h at room temperature (RT).
Afterwards the immunoblot was washed with PBS-0.1% Tween-20 and
incubated with peroxidase-labeled conjugate (rabbit anti-goat, DAKO,
Denmark) diluted 1:1000 in PBS, for 1 h at RT. Finally, the
immunoblot was washed with PBS-0.1% Tween-20, colored with
3,3-diaminobenzidine-tetrahydrochloride, and washed with tap water.

RESULTS
COX-2 mRNA levels are up-regulated in cocultures allowing cell-cell
contact between BMVEC and HIV-1-infected or uninfected macrophages
Because COX-2 is expressed mainly in perivascular areas of brain
tissue
from AIDS patients with HAD and monocytic cell infiltration
is a
common feature in HAD [
26
], the effect of the
interactions
between MDM and BMVEC on COX-2 production was investigated
in vitro. BMVEC, HIV-infected, and uninfected MDM were
cultured
separately and cocultures of BMVEC and HIV-infected or
uninfected
MDM were performed. Results are depicted in
Figure 1
. COX-2
mRNA expression levels increased in cocultures of
uninfected
or HIV-infected MDM and BMVEC compared with all other
culture
conditions (
P < 0.05 according to Students
t test).
The RFU for cocultures of uninfected or
HIV-infected MDM and
BMVEC were 131 ± 21 and 261 ± 32,
respectively.
The RFU for BMVEC, uninfected MDM, and HIV-infected MDM
were
80 ± 16, 47 ± 6, and 70 ± 27, respectively.
Cocultures
of HIV-infected MDM and BMVEC expressed the highest levels
of
COX-2 mRNA.
Soluble factors produced by HIV-1-infected macrophages are
responsible for the induction of COX-2 mRNA expression in BMVEC
To determine whether soluble factors produced by MDM had any
effect
on COX-2 expression by BMVEC, cocultures of MDM and BMVEC were
performed
with the use of a trans-well system. Uninfected or
HIV-infected
MDM were cultured in a chamber insert with BMVEC in the
lower
compartment. This coculture system did not allow any cell-cell
contact.
mRNA was isolated from BMVEC cultivated alone or in the
trans-well
system and RT-PCR was performed (
Fig. 2
). When BMVEC were cocultured
with uninfected MDM there was no
significant up-regulation of
COX-2 expression when compared to BMVEC
cultivated alone (
P > 0.05 according to Students
t test). When BMVEC were
cocultured with HIV-infected MDM
there was a twofold increase
in COX-2 expression when compared to all
other culture conditions
(
P < 0.05 according to
Students
t test). Thus, soluble
factors produced by
HIV-infected macrophages cause an increase
in COX-2 mRNA expression in
BMVEC.
Soluble factors produced by BMVEC are responsible for the induction
of COX-2 mRNA expression in macrophages
To determine whether soluble factors produced by BMVEC had any
effect
on COX-2 expression by macrophages, cocultures of MDM and BMVEC
were
performed using a trans-well system as described in the previous
section.
mRNA was isolated from uninfected or HIV-1-infected MDM
cultured
alone or in the trans-well system and RT-PCR was performed.
The
results are shown in
Figure 3
. The RFU for uninfected MDM was
9 ± 4, whereas the RFU for
uninfected MDM cultured in
the presence of BMVEC was 38 ± 18
(
P < 0.05 according
to Students
t test).
Also, COX-2 expression by HIV-infected
MDM was 42 ± 14 while the
RFU for HIV-infected MDM cultured
with BMVEC was 97 ± 12
(
P < 0.05 according to Students
t test).
This suggests that soluble factors produced by BMVEC
cause an increase
in COX-2 mRNA expression in macrophages.
COX-2 protein levels are elevated in cocultures of macrophages and
BMVEC
COX-2 protein levels in the
in vitro cocultures
mentioned in
the previous sections were determined by Western blot. The
results
are shown in
Figure 4
. Cocultures of BMVEC and uninfected MDM
(lane 2) or HIV-infected
MDM (lane 3) showed higher COX-2 protein
levels than any of these cell
types cultivated alone (lanes
1, 8, and 9). COX-2 protein levels in
BMVEC were higher when
they were cocultured in a trans-well with
uninfected MDM or
HIV-infected MDM (lanes 4 and 5, respectively). Also,
COX-2
protein levels in uninfected MDM and HIV-infected MDM were higher
when
they were cocultured in a trans-well with BMVEC (lanes 6 and
7,
respectively). The Western blot technique is less sensitive
than the
RT-PCR. For instance, lanes 1, 8, and 9 do not show
any COX-2 protein,
whereas the same three samples in
Figure 1 show low but detectable
levels of COX-2 mRNA. Thus, COX-2
mRNA expression and protein levels
are correlated.
IL-1ß produced by BMVEC induces COX-2 mRNA expression in
macrophages
Because some studies implicate IL-1ß as a proinflammatory
cytokine
capable of inducing COX-2 expression in macrophages and
endothelial
cells [
13
,
30
,
31
], trans-well coculture experiments were
repeated in
the presence or absence of a neutralizing antibody
against IL-1ß
(anti-IL-1ß). COX-2 mRNA expression
by BMVEC and MDM was measured by
RT-PCR. Addition of anti-IL-1ß
resulted in a 1.5-fold decrease in
endogenous COX-2 mRNA expression
by BMVEC (
P < 0.05
according to Students
t test) but
did not decrease COX-2
mRNA expression by BMVEC cocultured with
MDM (
P > 0.05
according to Students
t test). The results
are shown in
Figure 5
. On the other hand, addition of anti-IL-1ß
did not affect
endogenous COX-2 mRNA expression by MDM (
P >
0.05
according to Students
t test) but resulted in a
decrease
of COX-2 mRNA expression by fivefold in uninfected
MDM and 10-fold in
HIV-infected MDM cocultured with BMVEC (
P < 0.05
according to Students
t test). Results are
depicted in
Figure 6
. IL-1ß mRNA expression in MDM
and BMVEC was decreased when
anti-IL-1ß antibody was
added (data not shown). Addition of an
isotype-matched negative
control antibody to the cultures did not
affect COX-2 mRNA expression
(data not shown). These data indicate that
COX-2 expression
by macrophages is up-regulated by IL-1ß produced by
BMVEC,
whereas other soluble factor(s) produced by macrophages are
responsible
for the induction of COX-2 expression by BMVEC.

DISCUSSION
Because increased COX-2 expression levels are associated with
several
neuroinflammatory diseases [
13
,
16
,
21
22
23
24
25
], the
expression levels of COX-2 were investigated
in an
in vitro model that mimics some aspects of HIV
neuropathogenesis. COX-2
immunoreactivity in brain tissue from demented
AIDS patients
was mainly detected in perivascular areas with observed
cellular
infiltration [
26
]. Our
in vitro data
did show that interactions
between macrophages and brain endothelial
cells result in increased
COX-2 mRNA expression. HIV-1 infection of
macrophages resulted
in an even higher increase of COX-2 expression.
COX-2 up-regulation
did not require cell-cell contact and occurred via
an IL-1ß-dependent
mechanism in macrophages. Some conclusions can be
drawn from
this study.
First, HIV-1 infection of macrophages potentiates COX-2 expression in
cocultures of macrophages and brain endothelial cells. This finding is
supported by reports that showed elevated levels of prostaglandins in
brains of demented AIDS patients [24
], inducibility of
both prostaglandins and leukotrienes by HIV gp120 [32
],
and enhanced production of leukotrienes by cocultures of HIV-infected
macrophages and astrocytes [25
].
Second, COX-2 expression is up-regulated during macrophage/brain
endothelial cell interactions. This suggests that COX-2 might be
involved in the massive monocyte transendothelial migration observed in
HAD. Some previous studies showed a correlation between increased
endothelium permeability, lipid mediators of inflammation, cytokines,
and COX-2. Leukotrienes, products of the lipoxygenase pathway of
arachidonic acid metabolism, were found to induce blood-brain barrier
permeability [33
] and Bjork and colleagues demonstrated
that platelet-activating factor, an inducer of COX-2 expression, can
increase microvascular permeability [34
]. It was also
suggested that prostaglandin E2 (PGE2) acting
in conjunction with nitric oxide could disrupt the blood-brain barrier
in an experimental model of bacterial meningitis [35
].
IL-1ß and TNF-
were shown to have the capacity to regulate
blood-brain barrier permeability and induce transendothelial migration
of lymphocytes [36
37
38
].
Third, the up-regulation of COX-2 expression occurs via an
IL-1ß-dependent mechanism in macrophages and via an
IL-1ß-independent mechanism in brain endothelial cells.
Cytokine-induced production of inflammatory molecules such as COX-2 is
a complex network. Interferon-
was shown to have both stimulatory
[12
, 39
] and inhibitory [40
]
effects on COX-2 production. IL-1ß and TNF-
are frequently
mentioned as inducers of COX-2 together or in combination with other
molecules [10
11
12
13
, 41
42
43
]. Another study
showed that CD40 engagement up-regulates COX-2 expression
[44
]. It is conceivable that not one but a combination
of cytokines are responsible for the induction of COX-2 in brain
endothelial cells.
In conclusion, we showed that COX-2 expression is up-regulated during
interactions between HIV-infected macrophages and brain endothelial
cells but whether this is a secondary effect caused by macrophage
infiltration and subsequent release of inflammatory products or an
essential step in macrophage transendothelial migration remains to be
investigated. The full comprehension of these phenomena may prove
beneficial for future therapeutic strategies designed to prevent
infiltration of monocytic cells into the brain.

ACKNOWLEDGEMENTS
This work was supported by grants from the Training and Mobility
of
Researchers of the European Commission (ERBFMBICT983314)
and the Royal
Netherlands Academy of Sciences and Arts. Dr.
Hans S. L. M.
Nottet is a fellow of the Royal Netherlands Academy
of Sciences and
Arts and Cândida da Fonseca Pereira is
a Marie Curie fellow. The
authors wish to thank Gerwin A. Huls
for kindly providing COX-2
polyclonal antibody.
Received June 2, 2000;
accepted June 2, 2000.

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