Neuroimmune Mechanisms of Recovery from Comorbid Depression and Chronic Pain

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SUMMARY Depression and chronic pain frequently co-occur and are difficult to treat. In the first award period, we identified mechanisms common to both depression and pain as well as mechanisms specific to depression. We showed that inflammatory activity in the spinal cord is at the origin of both pain and depression in a mouse model of chronic neuropathic pain in response to nerve injury. However, depression additionally requires in- flammation-induced activation of the tryptophan metabolizing enzyme indoleamine 2,3 dioxygenase (IDO1). In this renewal application, we propose to change our focus from the mechanisms underlying devel- opment of depression and chronic pain to the endogenous resolution mechanism that normally prevents transition to these maladaptive, long-lasting consequences of inflammation. We have obtained exciting new findings identifying a key role for CD8 T cells in the resolution of depression and pain. Our preliminary data indicate that T cells and endogenous peripheral monocytes that produce the cyto- kine interleukin (IL)-10 are required for resolution of inflammation-induced pain and depression. Mice that genetically lack T cells develop prolonged pain and depression in two different models of peripheral inflamma- tion. Adoptive transfer of T cells to these mice normalizes resolution of pain and depression without altering the course of peripheral inflammation. The prolonged depression in T cell-deficient mice versus control mice is associated with persistent elevation of IDO1 and lack of IL-10 production in the brain. Our overall hypothesis is that CD8 T cells promote resolution of depression and pain by inducing IL-10 production by monocytes/macrophages. This leads to the downregulation of glial activation in the central nerv- ous system. In addition, we propose that CD8 T cells that have been educated in vivo in either an antigen-spe- cific or a non–antigen-specific way will be more efficient than T cells from naïve mice will be in promoting res- olution of inflammation-induced pain and depression. We will pursue 3 specific aims to test this set of hypotheses: Aim 1: Examine the role of T cells in the resolution of depression-like behavior and pain; Aim 2: Investigate the contribution, source, and target cell of endogenous IL-10 in promoting resolution of depression and pain; Aim 3: Assess whether T cells are educated in vivo to promote resolution of depression and pain. Our proposal is innovative because the concept that neuroimmune T cell-dependent mechanisms are re- quired for recovery from depression pain opens a totally novel perspective on the treatment of comorbid pain and depression. This project is significant because of the high prevalence of comorbid depression and chronic pain and the lack of effective treatment. If successful, our project will unravel unexplored endogenous path- ways governing resolution of depression and pain, and thereby allow the development of novel strategies for treatment, including ex vivo T cell education or vaccination strategies.