1. Introduction
Cholesterol is an essential lipidic component of cell membranes that regulates their structure and fluidity, and serves as a precursor of diverse compounds, such as steroid hormones, oxysterol, and bile acids. Cholesterol is involved in a wide range of biological processes, including membrane trafficking, signal transduction, host-pathogen interactions, and the immune function. Thus, the maintenance of cholesterol homeostasis is essential for proper functioning of cells and its disruption has been related to several human congenital (Nieman-Pick type C disease (NPC), Familial hypercholesterolemia) and acquired (cardiovascular disorders, neurodegenerative processes, and certain types of cancer) diseases [
1,
2,
3]. In this context, cellular cholesterol arises as a crossroad in cell pathophysiology which could lead to the discovery of new molecular mechanisms involved in disease progression or even serve as therapeutic targets.
Cholesterol is derived from both dietary sources and de novo biosynthesis, primarily occurring in the liver and the brain. The central nervous system (CNS) contains approximately 20-25% of total cholesterol, highlighting its crucial role in neuronal function. Most of CNS cholesterol resides in myelin, and is essential for synaptogenesis, synaptic transmission, and plasticity [
2]. Cholesterol homeostasis and metabolism have been extensively studied in the context of neurodegenerative diseases such as Alzheimer’s disease (AD) (reviewed in [
4])—the most common form of dementia. Although the main hallmarks of AD—senile plaques mainly composed of beta-amyloid (Aβ) peptides and neurofibrillary tangles composed of hyperphosphorylated tau protein—have been known for more than a century [
5], the molecular mechanisms involved in disease progression remain obscure. Recently, cholesterol, along with other genetic and non-genetic factors, have emerged as a potential contributor to the sporadic forms of the disease [
6].
On the other hand, previous reports have accounted for the ability of certain viruses to induce a metabolic reprogramming in host cells and interfere with cholesterol homeostasis [
7,
8]. For many years, our lab has focused on studying the links between AD and herpes simplex virus type I (HSV-1) infection. HSV-1 is a highly prevalent, ubiquitous, and neurotropic DNA virus that, apart from infecting epithelial cells and causing mucosal lesions, can also reach the nervous system and establish latent infections [
9]. We have characterized several in vitro models using different cell lines—murine and human neuroblastoma cells and human neural precursors—where HSV-1 infection was able to induce an AD-like phenotype. This phenotype is marked by the inhibition of Aβ secretion, intracellular accumulation of Aβ and hyperphosphorylated tau protein, and alterations in autophagy-lysosomal pathway [
10,
11,
12,
13,
14]. These results contribute to the growing evidence supporting the infectious hypothesis of AD and the potential role of HSV-1 in neurodegeneration, initially proposed at the end of the 20
th century [
15,
16]. Recent studies point that susceptibility to HSV-1 could be aggravated by the APOE4 genotype, suggesting a shared risk factor for infection and AD-like neurodegeneration [
17].
Genetic expression studies in our cell model of infection and oxidative stress identified the lysosomal pathway and cholesterol homeostasis as the main pathways altered [
14]. Neurons are particularly vulnerable to disruption of the lysosome system since they live long without cell division. Defects in autophagy and endocytosis may thus play a significant role in neurodegenerative diseases, including AD, as suggested by previous reports [
18,
19]. In line with this, we have described that HSV-1 infection is able to alter both lysosomal load and lysosome activity. Moreover, we found that deficiency in LAMP2—a lysosome membrane protein involved in fusion of autophagosomes with lysosomes and cholesterol trafficking—leads to a significant reduction of viral infection and attenuates the neurodegeneration markers induced by the virus [
20].
Overall, we aim to keep deciphering the connections between HSV-1 infection and AD-like neurodegeneration. In this work, considering that cholesterol dysregulation has been associated with markers of AD neurodegeneration [
4] and proposed to play multiple roles in the HSV-1 replicative cycle [
21], we focus on the potential role of cholesterol as a bridge between HSV-1 and AD neurodegeneration. Using an in vitro approach to modulate cholesterol levels in neuroblastoma cells, we have observed that HSV-1 triggers intracellular cholesterol accumulation. Moreover, lowering cholesterol levels mitigates infection and ameliorates certain aspects of neurodegeneration, including beta-amyloid accumulation, tau hyperphosphorylation and lysosomal alterations within infected cells. These results point to a pivotal role of cellular cholesterol in the AD-like phenotype induced by HSV-1 in neuronal cells.
2. Materials and Methods
Cell lines and culture medium. SK-N-MC cells (HTB-10), initially described as neuroblastoma and afterwards catalogued as part of the Ewing’s sarcoma tumour family [
22], were obtained from the American Type Culture Collection (ATCC). They were cultured as a monolayer in minimal Eagle’s medium (MEM) supplemented with 10% heat-inactivated foetal calf serum, 1 mM sodium pyruvate, nonessential amino acids, 2 mM glutamine, and 50 μg/ml gentamycin. Murine neuroblastoma cell line N2a was supplied by Paul Saftig’s lab [
23]. N2a cells were cultured in Dulbecco’s modified Eagle medium (DMEM) supplemented with 10% foetal calf serum, 2 mM glutamine, nonessential amino acids, 1 mM sodium pyruvate and 50 μg/ml gentamycin. Both cell lines were cultured at 37°C in a humidified 5% CO2 atmosphere.
HSV-1 infection. When cell cultures reached 70-75% confluence, they were infected with wild-type HSV-1 strain KOS 1.1 at a multiplicity of infection (moi) of 10 plaque-forming units per cell (pfu/cell). The virus was obtained, propagated, and purified from Vero cells, as described in [
24]. Two different procedures were followed. In the first procedure, cells were incubated with the viral solution for 1 hour at 37°C. Subsequently, the unbound virus was removed, and the cells were further incubated in culture medium at 37°C until collection. In the second procedure, cells were incubated with the viral solution for 2 hours at 37°C. After viral adsorption, cells were inactivated for two minutes in citrate buffer pH3 and then, culture medium was added. Control samples (mock) were incubated in virus-free suspensions. Viral titres in cell lysates (intracellular viral titre) and cell culture supernatants (extracellular viral titre) were determined by plaque assay. Finally, to modify cholesterol levels, 1.5-3 mM methyl-beta-cyclodextrin (MβCD), 25 μg/ml U18666A and 15 μg/ml cholesterol were used.
Viral DNA quantification. DNA was purified by using the QIAamp® DNA Blood Kit (QIAGEN). The amount of HSV-1 DNA was quantified by real-time quantitative PCR with a CFX-384 Real-Time PCR System (BioRad) using a custom designed TaqMan assay specific for the US12 viral gene (forward primer: 5’-CGTACGCGATGAGATCAATAAAAGG-3’; reverse primer: 5’-GCTCCGGGTCGTGCA-3’; TaqMan probe: 5’-AGGCGGCCAGAACC-3’). Viral DNA content was normalized in terms of human genomic DNA, quantified with a predesigned TaqMan assay specific for the 18S (Hs9999991_s1; Applied Bio-systems). The quantification data were expressed as viral DNA copy number per ng of genomic DNA.
Cell viability assay. To assess cell viability upon different treatments, 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) reduction to formazan colorimetric assay was performed. Briefly, cells were culured in 96-well plates and 0.5 mg/ml MTT (Sigma) was added. After 2 hours of incubation with MTT at 37°C, 100 μl of solubilisation buffer (20% SDS, 50% N, N-dimethyl-formamide, pH 4.7) was added, followed by an overnight incubation at 37°C, protected from light. The next day, formazan absorbance was measured at 550 nm in an ELISA Microplate Reader model 680 (BioRad).
Cholesterol quantification. Intracellular cholesterol levels were quantified using the enzymatic fluorogenic assay Amplex Red Cholesterol Assay Kit (Invitrogen) following the provider’s instructions. For the experiments, 10 μg of protein lysates were analysed. Fluorescence was measured in a plate fluorimeter at 560 nm excitation and 590 nm emission wavelengths.
Immunofluorescence analysis and filipin staining. Cells grown on coverslips were fixed in 4% paraformaldehyde (PFA) and permeabilized with blocking solution (2% horse or foetal calf serum, 0.2% Triton X-100 in phosphate buffer saline [PBS] pH 7.4). Then, coverslips were incubated with primary antibodies and with Alexa Fluor-coupled secondary antibodies diluted in blocking solution (
Table 1). Finally, cells were counterstained with 4,6-diamino-2-phenylindole (DAPI) (Merck) in PBS and mounted on microscope slides using Mowiol medium (Sigma-Aldrich). The overall procedure was performed at room temperature (RT) and samples were protected from light.
For filipin staining, 4% PFA-fixed cells were incubated for 30 minutes with 50 μg/ml filipin and 1 μM TO-PRO-3, a compound that binds to nuclear DNA, in PBS before mounting with Mowiol medium.
Sample visualization was performed in a FRET inverted microscope Axiovert200 (Zeiss) coupled to a monochrome ccd camera and in a LSM 900 laser scanning confocal microscope (Zeiss) coupled to a vertical Axio Imager 2 vertical microscope (Zeiss). Immunofluorescence images were obtained using Metamorph or ZEN Blue 3.4 imaging software and processed with Adobe Photoshop.
Cell lysates and Western blot analysis. Lysates were obtained by incubating cell samples in a preparation containing proteases (CompleteTM, Mini, EDTA-free Protease Inhibitor Cocktail, Roche) and phosphatases inhibitors (PhosSTOPTM, Roche) in the radioimmunoprecipitation assay (RIPA) buffer (10 mM Tris-HCl pH 7.5, 50 mM NaCl, 1% Nonidet P-40, 0.2% sodium deoxycholate, 0.1% sodium dodecyl sulfate [SDS], 1 mM EDTA). Before Western blot analysis, protein concentration in cell lysates was determined by Bicinchoninic acid assay (BCA, Pierce) following the provider’s instructions. Protein separation was performed using Laemmli discontinuous SDS-polyacrylamide gel electrophoresis. After electrophoresis and transfer to a nitrocellulose membrane, membranes were blocked with PBS-3% BSA-0.2% Tween 20 or PBS-5% nonfat milk-0.2% Tween 20 solution. Incubations with primary and secondary antibodies (
Table 1) diluted in dilution buffer (PBS-1% BSA-0.05%Tween 20 or PBS-1% nonfat milk -0.05% Tween 20) were performed at RT. Secondary antibodies were coupled to peroxidase and washing steps were performed in PBS-0.05% Tween 20. Finally, detection by enhanced chemiluminescence was carried out using ECL Western blotting detection reagents (Amersham Biosciences) according to the manufacturer’s instructions.
Quantification of lysosome load. The lysosome load was determined using the acidotropic probe LysoTracker Red DND-99 (LTR), which freely pass through cell membranes and typically concentrate in acidic organelles. As a control, cells were exposed to Bafilomycin A1 (0.1 μM). Before the end of infection or treatments, cells were exposed to 0.5 μM LTR for 1 hour at 37°C in culture medium and then washed with PBS. Then, cells were lysed with RIPA buffer and centrifuged at 13,000 g for 10 minutes. The protein concentration of the lysates was quantified by the BCA method, and fluorescence was recorded using a FLUOstar OPTIMA microplate reader (BMG LABTECH) (excitation wavelength 560 nm and emission wavelength 590 nm).
Cathepsin activity assays. Cathepsin activity assays were conducted following a previously described protocol with minor modifications [
25]. Briefly, cells were lysed in a buffer containing 50 mM sodium acetate (pH 5.5), 0.1 M NaCl, 1 mM EDTA, and 0.2% Triton X-100. Lysates were clarified by centrifugation and immediately used for determination of proteolytic activity. 20-50 μg of protein from cell lysates were incubated for 30 minutes in the presence of the following fluorogenic substrates (all from Enzo Life Sciences): Z-VVR-fluorophore 7-amino-4-methyl-coumarin (AMC) (P-199; most sensitive substrate for cathepsin S; 20 mM), and the Cathepsin D/E fluorogenic substrate Mca-GKPILFFRLK (Dnp)-D-Arg-NH2 (P-145; 10 mM). The AMC released was quantified using a microtiter plate reader (Tecan Trading AG) with excitation at 360 nm and emission at 430 nm (Z-VVR-AMC), or excitation at 320 nm and emission at 400 nm for Cathepsin D and E fluorogenic substrates.
Statistical Analysis. Differences between groups were analysed pairwise using the two-tailed student t-test or the one sample t-test, in the case of data expressed as relative values. Significance levels were denoted at p < 0.05 (*), p < 0.01 (**), and p < 0.001 (***). Statistical analyses were performed using Microsoft Excel and GraphPad Software online resources (
https://www.graphpad.com/quickcalcs/oneSampleT1/).
4. Discussion
HSV-1 is recognized as a risk factor in sporadic AD, as it triggers the appearance of characteristic neurodegeneration markers of the disease. Previous reports have indicated a potential link between cholesterol and both AD and viral infections [
28,
29]. Therefore, we hypothesized that cholesterol could mediate the interactions between HSV-1 infection and neurodegeneration. In this context, previous findings from our laboratory have implicated genes related to cholesterol metabolism and autophagy-lysosome pathway in the process of HSV-1 infection and AD pathogenesis [
20,
30,
31]. Thus, we aimed to assess the impact of cellular cholesterol on both infection and neurodegeneration induced by HSV-1 in murine and human neuroblastoma cell cultures.
The fact that viruses are able to hijack the metabolic machinery of host cells paves the way for identifying potential targets to fight against viral infections and their deleterious effects. Virtually, any cellular pathway can be altered during viral infection [
32], however, lipid and cholesterol metabolism are underscored among them, given their pleiotropic nature and their role as a central node in cell physiology (reviewed in [
33]). In this work, we confirm that changes in cholesterol homeostasis are one of the alterations induced by HSV-1 in our in vitro models. Indeed, we observed an increase in cholesterol levels upon infection along with changes in its intracellular distribution pattern. To date, there are few reports linking herpes virus infections with alterations in cholesterol homeostasis. HSV-1 infection has been shown to impair cholesterol metabolism resulting in the accumulation of cholesteryl esters [
34], and to alter cholesterol trafficking in human arterial smooth muscle cells [
35]. To our knowledge, this is the first study to describe the accumulation of cholesterol in endolysosomal/autophagic compartments as a consequence of HSV-1 infection. This accumulation points to a likely connection between lysosomal dysfunction and alterations in cholesterol homeostasis during HSV-1 infection, supporting previous findings from our research group [
14].
To investigate the role of cholesterol accumulation, we evaluated the effects of MβCD treatment on HSV-1 infection and neurodegeneration. Cyclodextrins (CDs) are commonly used compounds to rapidly deplete cells of cholesterol. They have been tested for clinical purposes in certain Lysosome Storage Disorders (LSDs), such as NPC, and certain neuro-degenerative diseases (reviewed in [
36]). NPC is a severe congenital disease caused by mutations in the NPC1 and NPC2 genes, which are involved in cholesterol transport within the lysosome [
37]. Commonalities between LSDs with central nervous system manifestations and AD, together with increasing evidence regarding the pivotal role of endolysosomal and autophagic dysfunction in AD, have led some authors to propose AD as a LSD itself [
18].
First of all, we established the optimal conditions for MβCD treatment in our experiments to restore cholesterol levels upon infection without compromising cell viability. It is noteworthy that the degree of cholesterol reduction induced by cyclodextrins may vary significantly across different cell types, even under similar concentrations and incubation times. For instance, previous studies have shown that exposure to low concentrations of MβCD for a short duration increased cellular cholesterol in T lymphocytes from young subjects, an effect reversed by extending the exposure time [
38]. These observations emphasize the importance of assessing the impact of MβCD on each specific cell line and experimental conditions. In our neuroblastoma cell-based HSV-1 infection models, an 18-hour treatment with MβCD, initiated after viral adsorption, appears to be the optimal strategy for reversing virus-induced intracellular cholesterol accumulation. However, this approach has some drawbacks when studying the role of intracellular cholesterol in the AD-like phenotype induced by HSV-1. Firstly, it significantly affects the infection process. Secondly, the cholesterol reduction takes place not only in endolysosomal organelles but also in all cellular membranes, raising the possibility of unwanted side effects in non-lysosomal membranes. These limitations should be considered when interpreting the experimental results.
To explore the involvement of cholesterol in the HSV-1 viral cycle in neuroblastoma cells, we evaluated various stages of the infection process. As an initial step, we observed a significant inhibition of viral entry with MβCD treatment. These findings align with previous reports emphasizing the importance of cholesterol in the HSV-1 infection process, particularly in virus entry [
26,
39]. Furthermore, we deepened into these analyses and confirmed the participation of cholesterol in processes subsequent to viral entry phase by adding MβCD after inactivation of non-internalized viral particles, once viral adsorption was completed. Notably, MβCD had a more pronounced effect on the formation of infectious viral particles than on the levels of viral DNA or proteins, with viral particles becoming undetectable in the presence of MβCD. These findings suggest that cholesterol may play a role in later stages of infection such as virion maturation, formation of infectious particles, or virus release from the cell. Thus, we successfully replicated the results obtained by [
21], supporting our experimental hypothesis by ensuring the plausible implication of cholesterol in post entry effects of viral infection, particularly those associated with AD-like neurodegeneration.
Our group has previously shown that HSV-1 impairs two processes closely associated with neurodegeneration: tau phosphorylation and amyloid-beta precursor protein proteolytic processing [
10,
12]. In this report, we describe the accumulation of hyperphosphorylated tau and Aβ in compartments of the autophagy-lysosome pathway in infected cells. Considering the accumulation of both cholesterol and AD-like neurodegeneration markers in these compartments, it is tempting to speculate that neurodegeneration observed in HSV-1-infected cells could be linked to cholesterol accumulation. According to this hypothesis, MβCD completely restored changes related to lysosomal dysfunction, including lysosome load and cathepsin function in infected neuroblastoma cells. In this regard, MβCD is referred as a potential treatment for LSDs and its role restoring autophagy flux and reducing cholesterol accumulation has been confirmed in vitro [
37] and in vivo [
40]. Moreover, several studies have revealed that inhibition or loss of cathepsins triggers lysosomal dysfunction, leading to intracellular cholesterol and Aβ accumulation, suggesting their involvement in the appearance of neurodegeneration markers [
41]. Finally, reduced lysosomal enzyme activity has been associated with AD in various reports (reviewed in [
18]), underscoring the importance of cathepsin activity in maintaining lysosomal function and preventing neurodegenerative processes.
In line with these findings, MβCD also ameliorated the alterations in phosphorylated tau and Aβ levels observed in our models. A decrease in the number of cells showing accumulation of Aβ and phosphorylated tau was observed in MβCD-treated neuroblastoma cells exposed to HSV-1. Consistent with this, quantification of intracellular phosphorylated tau revealed that MβCD treatment leads to a decrease in levels of phosphorylated tau, partially reversing the effects of HSV-1 infection. In this regard, alterations in cholesterol homeostasis have been associated with the accumulation of hyperphosphorylated tau and intracellular Aβ [
42,
43], and cyclodextrin treatment reduced neuroinflammation and cognitive deficits in a transgenic AD mouse model [
44]. The decrease in intracellular Aβ and phosphorylated tau upon MβCD treatment described in this work could be explained by several mechanisms. First, a reduction in the number of cells in which the infection successfully progresses could be behind the alleviation of be-ta-amyloid and tau pathology. Second, this effect could be caused by the restoration of lysosomal function, enabling more efficient degradation of protein aberrant forms, or providing cellular protection against HSV-1 infection.
In conclusion, whereas it is unlikely that efficient treatments for neurodegeneration will consist of single-target strategies, these basic research approaches are useful to progressively elucidate the complex scenarios and molecular networks involved in AD and its links with different environmental risk factors such as HSV-1 infection. Although further analyses are required to confirm these hypotheses, our proposal and the results obtained support the relevance of cholesterol in viral infection and its impact on neurodegeneration, which shed some light on this likely bridge connecting HSV-1 with AD.
Author Contributions
Conceptualization, J.A. and M.J.B.; methodology, J.A. and M.J.B.; validation, J.A and M.J.B.; formal analysis, J.A.; investigation, J.A., B.I., A.Z., I.S., V.M., J.T. and H.K..; resources, J.A and M.J.B.; data curation, J.A.; writing—original draft preparation, B.S. and J.A.; writing—review and editing, B.S., J.A and M.J.B.; visualization, J.A.; supervision, J.A and M.J.B.; project administration, J.A and M.J.B.; funding acquisition, M.J.B.. All authors have read and agreed to the published version of the manuscript.