Citation

Objective Natalizumab blocks 4integrinmediated leukocyte migration into the central nervous system (CNS). It diminishes disease activity in multiple sclerosis (MS), but carries a high risk of progressive multifocal encephalopathy (PML), an opportunistic infection with JV virus that may be prompted by diminished CNS immune surveillance. The initial host response to viral infections entails the synthesis of type I interferons (IFN) upon engagement of TLR3 receptors. We hypothesized that TLR3 agonism reestablishes CNS immune competence in the setting of 4integrin deficiency. Method We generated the conditional knock out mouse strain Mx1.Cre+4integrinfl/fl, in which the 4integrin gene is ablated upon treatment with the TLR3 agonist poly I:C. Adoptive transfer of purified lymphocytes from poly I:Ctreated Mx1.Cre+4integrinfl/fl donors into naive recipients recapitulates immunosuppression under natalizumab. Active experimental autoimmune encephalomyelitis (EAE) in Mx1.Cre+4integrinfl/fl mice treated with poly I:C represents immunereconstitution. Results Adoptive transfer of T cells from poly I:C treated Mx1.Cre+4integrinfl/fl mice causes minimal EAE. The in vitro migratory capability of CD45+ splenocytes from these mice is reduced. In contrast, activelyinduced EAE after poly I:C treatment results in full disease susceptibility of Mx1.Cre+ 4integrinfl/fl mice, and the number and composition of CNS leukocytes is similar to controls. Extravasation of Evans Blue indicates a compromised bloodbrain barrier. Poly I:C treatment results in a 2fold increase in IFN transcription in the spinal cord. Interpretation Our data suggest that TLR3 agonism in the setting of relative 4integrin deficiency can reestablish CNS immune surveillance in an experimental model. This pathway may present a feasible treatment strategy to treat and prevent PML under natalizumab therapy and should be considered for further experimental evaluation in a controlled setting.