TABLE 3 Dextran-binding receptors: roles in infections
DC, dendritic cell; DC-SIGN, dendritic cell–specific intercellular adhesion molecule (ICAM)-3-grabbing nonintegrin; IFN, interferon; L-SIGN, liver/lymph node-specific intercellular adhesion molecule (ICAM)-3-grabbing nonintegrin; SARS, severe acute respiratory syndrome; SIV, simian immunodeficiency virus.
Dextran-isoniazid has shown interesting results in a model of tuberculosis-like granulomatosis induced by Bacillus Calmette–Guérin (BCG) injection. The intensity of fibrotic lesions in this model after treatment with dextran conjugate was compared with free isoniazid treatment. Fibrosis of the lung decreased 30%, of the spleen 3.5-fold, and of the liver more than fourfold. Hepatotoxicity decreased 2.2-fold, and the development of necrosis into granulomas decreased 10-fold (159). Decreased lung remodeling may be beneficial for prevention of caviation and subsequent transmission (160) of tuberculosis, and could also help drugs reach the mycobacteria inside granulomas, that is itself an important problem (161). Dextran influences the phagosomal-lysosomal fusion and the death rate of mycobacteria BCG inside mouse peritoneal macrophages. The control rate of death inside macrophages was 33%, and with dextran (22 mg/ml) it was 39%. Isoniazid treatment (7 mg/ml) yielded a bacterial death rate of 43%, while the conjugate of dextran with isoniazid (25 mg/ml, same isoniazid content) yielded a 53% death rate. The latter result may be explained by targeted delivery of dextran into the phagosomes and lysosomes where the pathogen is taken up (162). An increase in phagocytic activity after dextran uptake is probably connected with NADPH oxidase 2 upregulation which is responsible for antimicrobial activity (163). In the systemic candidiasis model the dextran-amphotericin B conjugate given 10 days after infection decreased the number of granulomas in the liver by fourfold (164). In experiments on dextran–rimantadine this conjugate has shown to have a significantly better defencive effect in the chicken embryo and mouse models for influenza A and B virus and in the mouse model of tick-borne encephalitis (165). It remained unclear whether dextran alone could cause similar effects in the treatment of infections. Regularly infused in mice in a model of BCG-induced granulomatosis, oxidized dextran (OD; in these studies-the molecule of clinical dextran containing less than 3% of glucose units oxidized with formation of aldehyde groups) reduced the number and size of granulomas in the organs; increased numbers of fibroblasts (with reduced activity) in the granulomas; decreased destructive and necrotic changes in the liver; and decreased fibrosis in the liver and lungs (166). In a mouse influenza model, OD decreased fatality by 3.3-fold and significantly decreased lung fibrosis (167). In a model of systemic candidiasis, the number of granulomas in the brain decreased eightfold after OD treatment compared with antifungal amphotericin B. While the control group of mice died, 60% of OD-treated mice survived (168). The mechanism of OD action is still undiscovered; however, this form of dextran has been shown to increase the degree of adhesion of peritoneal cells, which may indicate increased activity of macrophages (169). OD reduces the viability of these cells, but conversely it stimulates metabolic and oxidative processes (169). In vitro dextran, and to a greater extent OD, are able to stimulate macrophage production of granulocyte-macrophage colony-stimulating factor (169), which supports the differentiation and activation of antigen-presenting cells (170). OD causes a shift in the balance of activities between nitric oxide synthase and arginase towards increasing nitric oxide production by macrophages (171). Another effect is increased macrophage ROS production (172). Chemical differences between dextran and OD are not significant; it is unknown whether oxidation played a role in in vivo results. Probably specific binding of MR and DFRs by dextran modulates pathogen-induced T helper responses (Figure 4) (173, 174). Thus antifibrotic action of dextran in BCG model (159, 166) could be linked to restricted Th2 reaction contributing to tissue remodelling. If this hypothesis is true, dextran could also modulate the immune response to Th2 overreaction-inducing allergens dependent on MR (175) and DC-SIGN (176, 177). Preliminary results are available concerning the in vivo action of nonmodified dextran in models of infections dependent on dextran-binding receptors. Dextran introduced intranasally simultaneously with heat-killed M. tuberculosis H37Rv decreased lung concentrations of both IFN-g and IL-10, while the IFN-g/IL-10 ratio decreased 2.5-fold, a result that rather illustrates suppression of Th1 response (178). Dextran introduced intranasally simultaneously or a day before infection with 10 LD50 of the H5N1 influenza virus saved or prolonged lives of mice (179). These experiments do not provide evidence on dextran’s mechanisms of action, a question that will be addressed in future works. They show, however, that dextran may be a promising molecule to add to the long list of treatments against infections dependent on dextran-binding receptors (Table 3).
Figure 4. Dextran and glycan-lectin interactions. This simplified scheme shows that if dextran decrease the availability of MR and DC-SIGN for the pathogens, this may influence immune responses. It is known that DC-SIGN ligands prevent binding and entry of pathogens, interfere with trans-infection of T cells by DCs, skew the myeloid cells activation phenotypes and influence immune response.
DEXTRAN IN PREVENTING HIV INFECTION AND TRANSMISSION Sexual transmission of HIV is the most prevalent route for infection (180, 181). DCs of intestinal and genital mucosae express DC-SIGN (21). They can be productively infected with HIV and have high capacity to trans-infect the T cells―the main HIV targets. DC-SIGN itself is an important player in the formation of DC-T cell infectious synapses (182, 183); signaling via DC-SIGN promotes increased viral uptake (184) and productive infection (185), and also influences DCs regulatory roles (30). HIV entry inhibitors are commonly used antiretrovirals (186), but there are still no inhibitors of HIV-DC-SIGN interaction introduced into the clinics, in spite of proven importance of receptor in myeloid cells infection and trans-infection of T cells. Dextran 60 given before and after infection provides significant decrease of the HIV-1 viral RNA inside the B-THP-1/DC-SIGN cells. Dextran oligomers also inhibit infection (S. Pustylnikov and P. Jain, unpublished results) and indeed carbohydrate-binding domain of DC-SIGN binds to ~3 carbohydrate units (187). This suggests dextran is an effective inhibitor of HIV-DC-SIGN interaction. It was shown that dextran decreases the mortality rate of HIV-infected human monocyte-derived macrophages from 84% to 48% (188). This could be a result of the inhibition of the minor HIV-DC-SIGN binding (189), as well as a result of the inhibition of HIV-MR interaction shown in macrophage infection and viral transmission (98). We suggest that dextran as a DC-SIGN and MR ligand could not only decrease the rates of HIV infection and trans-infection in myeloid cells, but could also serve to deliver the antiretrovirals or vaccines to DCs. Anti-HIV gel formulations have proven their efficiency in clinical trials (190); use of viral entry inhibitors in gel formultions can provide full protection in vivo (191). If dextran proves to be an HIV entry inhibitor, it could be used as a gel formulation.
CONCLUSIONS The combination of dextran properties is unique. Dextran is a hydrophilic, nonionic molecule with adjustable molecular mass distribution (Figure 2) and viscosity/density in solutions. Dextran’s lack (or near lack) of toxic effects, pyrogenic or allergic reactions and accumulation in the body; its thermal and chemical stability allowing sterilization and obtaining the derivatives; its applicability in mass production at comparably low costs (82, 192): all make dextran an appealing biopolymer for multiple applications. Antimicrobial strategies that could exploit dextran is a speculative topic due to the lack of data. Despite lack of direct evidence, dextran's applications as shown in Figure 2 can be numeous in fields of research and medicine where dextran is applied. Dextran is a popular component of conjugates and nano-particles. Numerous works on drug-dextran conjugates show interesting results in vitro and in vivo and provide arguments for improved pharmaceutical properties of such compounds (reviewed in (193-198). Our analysis suggests that concept of targeted delivery―the conjugation of dextran with antimicrobials to reach the pathogens inside the specific cells that take up dextran (liver cells, macrophages and DCs)―being itslef not a new idea, can benefit from knowledge of dextran-binding receptors and their roles in a number of infections. Dextran’s influences on infections has not been studied comprehensively to date and only minor influences are known. Dextran-binding MR, DC-SIGN (in human)/SIGN-R1/SIGN-R3 (in mice), L-SIGN, and langerin play large roles in infectious diseases (Table 3). Besides regulation of immune cell interplay, these receptors participate in binding, recognition, and uptake of different pathogens. Targeting of dextran-binding receptors (e.g., MR and DC-SIGN) is a popular concept. In recent years studies devoted to the development of DC-SIGN therapeutic ligands have yielded new data in cell biology (203), immunology (204), and biochemistry (205, 206). The concept of therapeutic DC-SIGN antagonists/inhibitors is promising and in need of further development (9, 207). Targeting the MR is suggested for vaccine development (201), for delivery of cargo into macrophages (202) or liver cells (195). Dextran can play a role in the prevention of pathogen binding, entry and signaling in MR-expressing myeloid cells wich participate in blood-brain barrier disruption in neuroinvasive infections (208): this was probably the case in prevention of C. albicans infection in the brain (168). Skewing the T helper responses could be a mechanism that allowed dextran derivatives to decrease tissue remodelling in the BCG infection model (159, 166) (Figure 4). Dextran has been recently used as a backbone for the nucleic acids delivery conjugate and our analysis could help in the development of this field (199). We also note that dextran could be of use in the glycosilation of adenoviruses used for gene transfer (200), possibly improving the biocompatibility and providing predictable uptake by certain cell types and receptors. Further, the route of delivery of dextran and its derivatives require to be taken into consideration. Infusion will result in primary uptake in the liver, which is not a target of respiratory or mucosal infections. Dextran-based sprays or gels are an option, but they are not helpful in generalized infections. Clinical dextrans with molecular weights in the range 35,000 to 80,000 cannot reach a systemic infection if given orally, but smaller molecules such as dextran with an average molecular weight of 1,000 probably can. Dextrans with high molecular weights induce active endocytosis, while smaller molecules do not (36). They may not only decrease the amount of available dextran-binding receptors on the cell surface but also prevent endocytosis and following recycling of receptors (shown for both MR (209) and DC-SIGN (210)) and keep the cells’ endocytic capacity at its initial level. Medical and biological applications of dextran can be considered in a new way via the prism of receptor-specific interactions. This can be an instrument to interpret the data on dextran conjugates and derivatives. If antimicrobial properties of dextran can be applied in humans, dextran might become an approved, specific, nontoxic, cheap, and accessible immunomodulatory drug. These qualities are extremely important in the case of deadly infections that affect resource-limited populations. Dextran may possess antimicrobial and antiallergic effects owing to binding to MR, DFRs, and langerin. This review suggests a primary aim for future studies: testing of the ability of dextran to act against a panel of pathogens exploiting dextran-binding receptors to enter the cells and to modulate the immune responses.
ACKNOWLEDGMENTS This work was supported in part by Novosibirsk Tuberculosis Research Institute, Novosibirsk, Russia and Scientific Center for Clinical and Experimental Medicine, Novosibirsk, Russia. We thank Stefan Martin from University of Freiburg, Germany, for help in preparing the manuscript and helpful comments. All authors have no potential conflicts of interest to declare.
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