Microbial Infections Are a Risk Factor for Neurodegenerative Diseases

Abstract

Neurodegenerative diseases, such as Alzheimer's disease, Parkinson's disease, and amyotrophic lateral sclerosis, comprise a family of disorders characterized by progressive loss of nervous system function. Neuroinflammation is increasingly recognized to be associated with many neurodegenerative diseases but whether it is a cause or consequence of the disease process is unclear. Of growing interest is the role of microbial infections in inciting degenerative neuroinflammatory responses and genetic factors that may regulate those responses. Microbial infections cause inflammation within the central nervous system through activation of brain-resident immune cells and infiltration of peripheral immune cells. These responses are necessary to protect the brain from lethal infections but may also induce neuropathological changes that lead to neurodegeneration. This review discusses the molecular and cellular mechanisms through which microbial infections may increase susceptibility to neurodegenerative diseases. Elucidating these mechanisms is critical for developing targeted therapeutic approaches that prevent the onset and slow the progression of neurodegenerative diseases.

Keywords: Alzheimer’s disease; Parkinson’s disease; amyotrophic lateral sclerosis; infection; microbes; neurodegenerative diseases; viruses.

FIGURE 1

Infectious agents may contribute to neurodegenerative diseases directly or via immune activation. Infection by viral and bacterial pathogens can cause pro-inflammatory activation of CNS resident immune cells, including astrocytes and microglia, resulting in neuronal death. Additionally, cellular death directly caused by infectious agents and the release of damage-associated molecular patterns can exacerbate the inflammatory state through further activation of CNS immune cells, perpetuating a cycle of inflammation. In AD, this is often associated with high levels of pro-inflammatory cytokines TNF-α and IL-1β, reduced clearance of infected cells, and accumulation of neurotoxic aggregates composed of Aβ and Tau. This pro-inflammatory state has also been documented in the context of PD, where increased accumulation of neurotoxic α-synuclein is accompanied by high levels of TNF-α, ICAM-1, LIX, RANTES, IFN-α, and IFN-β, produced by infected and activated astrocytes and microglia. Additionally, some pathogens can directly infect neurons resulting in alterations in metabolism, enhanced neuronal excitotoxicity, and enhanced apoptosis, as seen in ALS. Created with BioRender.com.