GAE due to
Acanthamoeba is a serious infection that almost always is fatal; however, the pathogenesis and pathophysiology of
Acanthamoeba encephalitis are not known. Several lines of evidence suggest that hematogenous spread is a primary requirement in GAE (
19-
21), but how circulating amoebae cross the blood-brain barrier remains to be determined. We recently isolated HBMEC, which constitute the blood-brain barrier, and developed an in vitro model to study host-parasite interactions. Previous studies using such models have focused on intracellular pathogens, such as meningitis-causing bacteria. For example, it has been shown that
Escherichia coli K1 can invade brain microvascular endothelial cells on the apical side, traffic through the cytoplasm in a membrane-bound vacuole, and exit on the basolateral side to produce meningitis without affecting the blood-brain barrier function, as determined by HBMEC monolayer integrity, HBMEC permeability, and high electrical resistance (
16,
28). In contrast, extracellular pathogens, such as
Acanthamoeba, are unlikely to use similar mechanisms due to size limitations and must develop strategies to produce blood-brain barrier perturbations to gain access to the CNS to produce disease. In support of this, we show for the first time that
Acanthamoeba produces programmed cell death in HBMEC. Findings of this study are of physiological relevance as we used a clinical isolate of
Acanthamoeba from a deceased GAE patient. Moreover, our finding that
Acanthamoeba-mediated HBMEC death is dependent on PI3K activation is novel. Previous reports have extensively shown the role of PI3K-mediated signaling in cell proliferation or antiapoptotic effects in an Akt-dependent fashion. For example, activated PI3K phosphorylates the 3′ OH position of the inositol ring of PIs, generating the second messengers PIP2 and PIP3 (
17). These PI3K lipid products interact with proteins containing a PH domain. Among other proteins, Akt is a major downstream effector of PI3K that interacts with PIP
2 or PIP
3 through its PH domain and is phosphorylated at residues Ser473 (carboxy-terminal domain) and Thr308 (catalytic domain), resulting in activated Akt kinase. Phosphorylated and activated Akt stimulates cell proliferation or cytoprotective effects by modulating the function of a variety of downstream molecules, including BAD, caspase-9, CREB Forkhead, MDM2, NF-κB, cyclin D1, and p53 (
3,
6). Overall, these findings suggest that Akt-mediated signaling pathways result in cell survival and/or cytoprotective effects. In support of this, our results show that
Acanthamoeba interactions with HBMEC show a biphasic response. First, we found that
Acanthamoeba incubation resulted in Akt dephosphorylation (inactivation) within 15 min. However, longer incubation of
Acanthamoeba with HBMEC resulted in a more-than-twofold increase in Akt phosphorylation. This raises the question of why
Acanthamoeba induces Akt activation, which almost always results in cytoprotective effects. One explanation is that Akt activation is a stress compensation response of HBMEC and may be independent of PI3K activation. This may involve direct phosphorylation of Akt by integrin-linked kinase 1 (
35) or by Ca
2+/calmodulin-dependent kinase kinase, leading to cell survival pathways (
34). Additional studies are needed to determine the precise role of Akt activation in response to
Acanthamoeba.
To determine the role of PI3K in
Acanthamoeba-mediated HBMEC death, apoptosis assays were performed in the presence of LY294002, a selective PI3K inhibitor. We observed that direct inhibition of PI3K significantly reduced
Acanthamoeba-mediated HBMEC death. This is somewhat surprising, as PI3K-mediated signaling has been traditionally involved in cell proliferation and cell survival effects. To further confirm these findings, we used HBMEC expressing dominant negative forms of PI3K and used for cytotoxicity assays. We observed that
Acanthamoeba exhibited significantly less cytotoxicity with HBMEC expressing dominant negative forms of PI3K than with HBMEC transfected with the vector alone. Overall, these findings indicate that
Acanthamoeba-mediated host cell death is dependent on PI3K activation. In support of this, Thyrell et al. (
31) have shown that alpha interferon induces PI3K-mediated apoptosis in myeloma cells without Akt phosphorylation. It was further shown that downstream effectors of PI3K-mediated apoptosis involve activation of the proapoptotic molecules Bak and Bax, loss of mitochondrial membrane potential, and release of cytochrome
c, all well-known mediators of apoptosis. Similar mechanisms may exist in
Acanthamoeba-mediated host cell death, and studies are in progress to address these issues. In addition, previous studies have shown that
Acanthamoeba induces increased cytosolic free calcium, resulting in apoptosis (
1,
22); however, the relationships between calcium fluxes and PI3K and whether pathways involving calcium fluxes and PI3K are dependent or independent of each other remain to be determined.
Other pathologies due to
Acanthamoeba include sight-threatening keratitis associated with severe pain due to radial neuritis, inflammation with redness, and photophobia. We determined whether
Acanthamoeba uses similar signaling pathways to produce corneal epithelial cell death. For this, we used a clinical isolate of
Acanthamoeba from a keratitis patient belonging to the T4 genotype and determined its effects on HCEC (
29). Similar host responses were observed (data not shown). More interestingly,
Acanthamoeba (T4 isolate) abolished HCEC Akt activation within 15 min of incubation, but longer incubation times resulted in a more-than-sixfold increase in Akt activation, a response similar to that of HBMEC stimulated with T1 amoebae, clearly indicating that
Acanthamoeba induces similar mechanisms to produce host cell death. These findings may have important clinical implications in our search for drugs against infections due to
Acanthamoeba. Overall, these studies suggest that
Acanthamoeba-mediated HBMEC cytotoxic effects are dependent on PI3K signaling pathways. A complete understanding of mechanisms associated with
Acanthamoeba-mediated host cell death may help us develop strategies to treat these serious infections.