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Final Report Summary - INFLAM-MITO-CO (Mechanistic Studies on Carbon Monoxide (CO)-Induced Modulation of Mitochondrial Function in Neuroinflammation)

Neuroinflammation is a hallmark of a number of neurodegenerative disorders, including Alzheimer and Parkinson disease. In this context, it is critical to identify more effective therapeutic strategies aimed at controlling inflammation and thus the progressions of these diseases. Reports have shown that lipopolysaccharide (LPS), a molecule that induces inflammation, causes alterations in cellular metabolism that is associated with its pro-inflammatory activity. There are cellular mechanisms that are activated to counteract inflammation and heme oxygenase-1 (HO-1) is recognised as a powerful system that reduces inflammatory and oxidative stress. HO-1 is an antioxidant protein that breaks down heme, a constituent of haemoglobin in blood, and generates carbon monoxide (CO) and bilirubin that act as a beneficial signalling molecule within the body. Because of these positive features, HO-1 and CO are being investigated as drug targets to develop novel pharmacological tools to combat inflammatory conditions. For over a decade our laboratory has been studying several CO-releasing molecules (CO-RMs) specifically designed for the controlled delivery of CO to cells, which were shown to prevent cell death and tissue damage in different models of disease. More recently the group has been working on a new concept by designing molecules that possess dual functionality and maximise the protective activities of the HO-1/CO system, termed HYCOs (see Figure 1). The biological characterisation of these molecules was an important achievement of the current project and the results of three independent studies are described in detail below. Recent scientific evidence also shows that CO interacts with mitochondria, the powerhouses of cells that generate energy in the form of ATP. We hypothesised that the anti-inflammatory activities of the HO-1/CO system are mediated by an interaction of CO with mitochondria and investigated how CO affects metabolism and the inflammatory status of microglia cells, the resident immune cells of the brain that control neuroinflammation.

HYCOs are composed of a CO-RM bound to a HO-1 inducer and were conceived to provide greater tissue protection by first limiting inflammation through CO delivery, and subsequently promoting cellular repair by activating the protective HO-1 system. In collaboration with chemists we produced several HYCOs that were characterised for their pharmacological and beneficial properties in mammalian cells. In our initial proof of concept study we showed that the first generation of HYCOs release CO in solution and that their behaviour is linked to their chemical structures. We also reported that the molecules induce HO-1 in cardiac cells, brain microglia and circulating inflammatory cells and are able to reduce inflammation (Wilson et al. 2014. Chemistry: A European Journal. 20:14698-14704). These preliminary results confirmed the feasibility of designing and synthesising molecules that possess dual functionality and inspired the creation and diversification of new chemical structures.

In a second study we expanded our work by investigating the action of a new family of HYCOs in which diverse HO-1 inducers were bound to the same CO-RM (Nikam et al. 2016. Journal of Medicinal Chemistry. 59:756-62). We found that they released CO and activated HO-1 with various potencies depending on the structural differences of the molecules. Two of the most effective HYCOs were tested in an animal model and shown to release CO in the blood, as well as increase HO-1 levels in the liver and lungs when fed to mice. In addition to demonstrating the efficacy of these new compounds in cells and in animals, this study indicated that it is important to compare the biological activities of different classes of HYCOs in order to identify the most promising molecules that can alleviate inflammatory conditions.

In a third study we focused our attention on investigating the properties of HYCO-3. This molecule was chosen among different HYCOs because it releases large quantities of CO and exhibits a greater capacity for CO delivery to mammalian cells compared to previous hybrid molecules. HYCO-3 is also more powerful at increasing the levels of HO-1 in cells and we are currently assessing its activity using an animal model of inflammation. Our results indicate that inflammatory mediators are significantly decreased by the hybrid molecule 3 days after the initiation of inflammation and this effect is accompanied by an increase in the anti-inflammatory response. We are continuing this work by testing dose-dependent effects of HYCO-3 and by identifying which immune cells are affected by the action of the molecule. This work is unpublished and the results will form the basis of a new research article. This study will also help to identify specific modes of action that underlie the anti-inflammatory activity of the HYCO.

For the metabolic part of the project we focused on the effects of CO delivered to microglia cells by CORM-401 or generated inside the cells by HO-1 induction. CORM-401 was the CO-releasing molecule of choice as it represents the most recent advancement in the CO-RM technology. In addition to being soluble in water, it releases 3 times the quantity of CO than previous CO-RMs and delivers a higher amount of CO to the cells, rendering it a more appealing candidate for therapeutic application as less of the molecule is required to achieve beneficial effects. For this study, we used a machine called the Seahorse Bioscience XF Analyzer that is specifically built to measure cellular metabolism. In particular, the consumption of oxygen and glucose are continuously monitored in the cell over time giving an indication of cellular metabolic activity and energy (ATP) production. When CORM-401 was added to microglia cells we observed a biphasic effect because low quantities of CO increased oxygen consumption, while higher amounts were inhibitory. By investigating in detail the function of mitochondria, which use oxygen to produce energy, we found that low levels of CO uncouple oxygen consumption from energy production. Uncoupling is a natural phenomenon that is stimulated in cells to protect mitochondria from the harmful effects of oxidative stress. We also confirmed that this uncoupling effect occurs when CO is produced inside the cells by HO-1 induction and is similar to that observed with external delivery of CO. Thus, these initial findings suggested that CO exerts beneficial actions by directly modulating mitochondrial function. To verify whether this unique property of CO was also important during inflammation, we exposed microglia cells to the inflammatory insult LPS in the presence or absence of CORM-401. LPS alone decreased oxygen consumption and increased the use of glucose, which are important characteristics of the metabolic adaptation of the body during a severe inflammatory state. In contrast, the presence of CO prevented the decrease in oxygen consumption and further increased glucose utilisation. We demonstrated that this effect was directly linked to the uncoupling activity of CO and the results in general indicate that CO improves cellular metabolism during inflammatory stress. In parallel with these experiments, we found that CO modulates the levels of inflammatory mediators, suggesting that the metabolic effects of CO influence the inflammatory response of microglia to LPS. A research manuscript describing these interesting findings is currently in preparation.

In conclusion, the work carried out during this project has yielded important data on the synthesis of potentially useful new molecules that represent a promising advancement in the development of therapeutic tools that exploit, in a comprehensive fashion, the HO-1/CO protective system. The results of this work also highlight the importance of CO as a modulator of cellular metabolic function that has significant implications for the inflammatory response. By identifying how CO exerts its beneficial activity we have gained novel insights into its potential pharmacological application in the context of neuroinflammatory disorders, which are a global concern due to the growing ageing population.

Website address of the project: For additional information on this project please contact Dr. Roberto Motterlini ( or Dr. Jayne Louise Wilson (

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