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Anticoagulation with warfarin and rivaroxaban ameliorates experimental autoimmune encephalomyelitis
(2017)
Background: In multiple sclerosis, coagulation factors have been shown to modulate inflammation. In this translational study, we investigated whether long-term anticoagulation with warfarin or rivaroxaban has beneficial effects on the course of autoimmune experimental encephalomyelitis (EAE).
Methods: Female SJL/J mice treated with anticoagulants namely warfarin or rivaroxaban were immunized with PLP139–151. Stable anticoagulation was maintained throughout the entire experiment. Mice without anticoagulation treated with the vehicle only were used as controls. The neurological deficit was recorded during the course of EAE, and histopathological analyses of inflammatory lesions were performed.
Results: In preventive settings, both treatment with warfarin and rivaroxaban reduced the maximum EAE score as compared to the control group and led to a reduction of inflammatory lesions in the spinal cord. In contrast, therapeutic treatment with warfarin had no beneficial effects on the clinical course of EAE. Signs of intraparenchymal hemorrhage at the site of the inflammatory lesions were not observed.
Conclusion: We developed long-term anticoagulation models that allowed exploring the course of EAE under warfarin and rivaroxaban treatment. We found a mild preventive effect of both warfarin and rivaroxaban on neurological deficits and local inflammation, indicating a modulation of the disease induction by anticoagulation.
Boswellia serrata gum resin extracts (frankincense) have been used for centuries in folk medicine in Asia and Africa. They have shown beneficial therapeutic effects, particularly in the treatment of chronic inflammatory diseases. Clinical studies on humans confirmed an anti-inflammatory and anti-cancer potential of Frankincense preparations. Boswellic acids (BAs) are the major ingredients, responsible for the pharmacological action of the extracts. Molecular and cellular studies with BAs revealed a number of targets including 5-lipoxygenase (LO), topoisomerases and the NF-κB pathway. Since there is little information on the modulation of cellular physiology by BAs, this work was designed to provide a detailed investigation of the cellular and molecular effects of BAs in several cell types related to inflammation. We report that 11-keto-BAs are potent activators of functional responses in human neutrophils, a type of leukocytes mediating acute inflammatory processes. Neutrophil activation by 11-keto-BAs is reflected by enhanced generation of oxygen radicals, release of arachidonic acid (AA) and the subsequent transformation of AA to pro-inflammatory eicosanoids. Investigation of the participating signalling pathways identified Ca2+, phosphoinositide-3 kinase, and members of the MAP kinase family (ERKs) as mediators. Second, we present a detailed study of the modulation of human platelet physiology and intracellular signalling events by BAs. Intriguingly, we discovered an inverse structure-activity relationship of BAs regarding platelet activation, with 11-methylene-BAs being superior over 11-keto-BAs. Thus, 11-methylene-BAs stimulated platelet Ca2+ mobilisation, MAP kinase and Akt activation, AA release, 12-LO and cyclooxygenase product formation, and thrombin generation. Novel Ca2+-independent activation pathways of platelet lipid metabolism were discovered. In contrast, 11-keto-BAs were inactive but found to inhibit platelet (p)12-LO directly. Interaction with p12-LO was confirmed in a pulldown assay using immobilised BAs as bait. Finally, BAs were shown to attenuate the activation of monocytes, a cell type responsible for the maintenance of chronic inflammatory states. Impairment of Ca2+ homeostasis is likely conferred by inhibition of Ca2+ influx channels. Taken together, our results shed light on the modulation of intracellular physiology of inflammatory cells by BAs, contributing to a better understanding of the anti-inflammatory effects exerted by frankincense preparations.