Fatima Banine, Xi Gong, Thomas J. Montine, Jaime Struve, Clayton W. Winkler, Weiping Su, Larry S. Sherman, Scott Foster, Marnie A. Preston, S. G. Matsumoto, Stephen A. Back, Justin M. Dean, Paul H. Weigel, Rubing Xing, and Bruce A. Baggenstoss
Demyelination occurs following numerous insults to the CNS and is the hallmark of multiple sclerosis (MS), causing conduction deficits that compromise motor, sensory and cognitive functions. Some recovery of function is associated with the recruitment of oligodendrocyte progenitor cells (OPCs) to demyelinating lesions, generating oligodendrocytes (OLs) that remyelinate spared axons.1 However, OPCs often accumulate in chronically demyelinated lesions and fail to give rise to myelinating OLs.2–7 Strategies that promote OPC maturation within demyelinating lesions therefore have the potential to promote remyelination and functional recovery in affected individuals. Multiple signals within the microenvironments of demyelinating lesions contribute to the failure of OPC maturation and remyelination.8, 9 We previously found that high molecular weight (HMW) forms of the glycosaminoglycan hyaluronan (HA) are among these signals. HA is synthesized by transmembrane synthases and is composed of multiple disaccharide units of glucuronic acid and N-acetylglucosamine. HA molecules range in size from ≤2.5×105 Da to ≥4×106 Da. Different molecular weight forms of HA have distinct functions in the nervous system including the regulation of cell motility, growth, and differentiation.10, 11 We found that HA accumulates coincident with astrogliosis in demyelinating MS lesions,12 traumatic spinal cord injuries,13 perinatal white matter injuries,14 lesions associated with vascular cognitive impairment15 and during normal aging.16 HA blocks OPC maturation and remyelination in lysolecithin-induced demyelinating lesions, suggesting that HMW HA accumulation contributes to remyelination failure.12 We reasoned that one strategy to promote remyelination within demyelinating lesions is to degrade accumulated HMW HA using hyaluronidases. During inflammatory responses outside the central nervous system (CNS), activated fibroblasts or other cells secrete hyaluronidases that degrade HA, generating HA digestion products that act as immune regulators.17 Reactive oxygen species at sites of inflammation further promote this degradation.18 Although hyaluronidases are expressed in the CNS,19, 20 it is unclear if HA is similarly degraded at extracellular sites of CNS inflammation where astrocytes are the principle source of HA.21 Paradoxically, we and others have found that the digestion of HMW HA by some hyaluronidases prevents OPC maturation. A recent study found that treatment of OPCs with HA degraded by a combination of hyaluronidases and β-glucuronidase blocked OPC maturation in vitro through a mechanism involving toll-like receptor-2 (TLR2).20 This study also demonstrated that lower MW forms of HA accumulate in MS lesions, that OPCs in vitro express multiple hyaluronidases, and that a broad spectrum hyaluronidase inhibitor can promote OPC maturation in vitro. The focus of the present study was to determine if hyaluronidases are expressed in human and rodent demyelinating lesions; if specific hyaluronidases alone can block OPC maturation; and if blocking hyaluronidase activity can promote remyelination in vivo. Here, we report that an extracellular hyaluronidase, called PH20, is elevated in rodent and human demyelinating lesions. We demonstrate that PH20 expression is elevated in OPCs and astrocytes in chronic demyelinated MS lesions and in acute lesions in mice with experimental autoimmune encephalomyelitis (EAE). Elevated expression of PH20, but not other hyaluronidases, is sufficient to block OPC maturation. Digestion products of PH20, but not those generated by another hyaluronidase, potently block remyelination in vivo. Furthermore, inhibiting HA synthesis does not influence OPC maturation but blocking hyaluronidase activity promotes OPC maturation and remyelination. Collectively, these data suggest that PH20 is a potential therapeutic target to promote remyelination.