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Urinary tract infections trigger synucleinopathy via the innate immune response.

Published version
Peer-reviewed

Repository DOI


Type

Article

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Authors

Mercado, Gabriela 
George, Sonia 
Villumsen, Marie 
Kasen, Alysa 

Abstract

Symptoms in the urogenital organs are common in multiple system atrophy (MSA), also in the years preceding the MSA diagnosis. It is unknown how MSA is triggered and these observations in prodromal MSA led us to hypothesize that synucleinopathy could be triggered by infection of the genitourinary tract causing ɑ-synuclein (ɑSyn) to aggregate in peripheral nerves innervating these organs. As a first proof that peripheral infections could act as a trigger in MSA, this study focused on lower urinary tract infections (UTIs), given the relevance and high frequency of UTIs in prodromal MSA, although other types of infection might also be important triggers of MSA. We performed an epidemiological nested-case control study in the Danish population showing that UTIs are associated with future diagnosis of MSA several years after infection and that it impacts risk in both men and women. Bacterial infection of the urinary bladder triggers synucleinopathy in mice and we propose a novel role of ɑSyn in the innate immune system response to bacteria. Urinary tract infection with uropathogenic E. coli results in the de novo aggregation of ɑSyn during neutrophil infiltration. During the infection, ɑSyn is released extracellularly from neutrophils as part of their extracellular traps. Injection of MSA aggregates into the urinary bladder leads to motor deficits and propagation of ɑSyn pathology to the central nervous system in mice overexpressing oligodendroglial ɑSyn. Repeated UTIs lead to progressive development of synucleinopathy with oligodendroglial involvement in vivo. Our results link bacterial infections with synucleinopathy and show that a host response to environmental triggers can result in ɑSyn pathology that bears semblance to MSA.

Description

Keywords

Mice, Female, Animals, Synucleinopathies, Case-Control Studies, Escherichia coli, Mice, Transgenic, alpha-Synuclein, Multiple System Atrophy, Urinary Tract Infections, Immunity, Innate

Journal Title

Acta Neuropathol

Conference Name

Journal ISSN

0001-6322
1432-0533

Volume Title

145

Publisher

Springer Science and Business Media LLC