Microbial infection and associated inflammasome in the retina of Alzheimer’s disease patients

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Abstract Background Recent advances in Alzheimer’s disease (AD) research revealed that AD pathology is not confined to the brain but also occur in the neurosensory retina. Data have further suggested parallels between retinal and brain AD biomarkers. While the exact etiology of AD pathogenesis is undefined, an emerging theory has linked AD with microbial infection as a plausible cause for AD progression. The presence of several microbes including Chlamydia pneumoniae (Cp), Borrelia burgdorferi, Porphyromonas gingivalis, and Toxoplasma gondii have been reported in the post‐mortem brain of AD patients and murine models. However, the existence and role of microbial infection in AD retina has never been studied. Method We employed a range of histological, biochemical, and genetic techniques to detect bacterial infection and other associated biomarkers in postmortem retinas of patients with mild cognitive impairment (MCI) or AD dementia, compared to retinas from age‐matched individuals who displayed normal cognition (NC). We assessed the presence and burden of Cp and correlated with gliosis, inflammasome, and apoptosis markers. Result We discovered the presence of Cp inclusions in postmortem retinas of patients with MCI and AD as compared to age‐ and sex‐matched NC individuals. Our experimental evidence revealed Cp‐infected retinal neuronal cells in AD patients, with no increase in retinal Cp infection in MCI versus CN and a significant 4‐fold increase in of Cp immunoreactivity in retinas of AD patients versus MCI and CN subjects. These data possibly indicate that Cp infection mainly occur during the dementia phase of AD and is less observable at the early functional impairment stages of AD. Retinal microglia were found to aggregate around and engulf Cp‐infected cells. Alongside Cp infection, retinal tissues from MCI and AD patients exhibited increased NLRP3 inflammasome and gliosis. Our data suggest Cp‐triggered inflammasome activation, that can lead to neuronal degeneration. We further found a relationship between the severity of retinal Cp infection and brain pathology; retinal Cp burden was associated with brain neurofibrillary tangles, neuropil threads, Braak stage. Conclusion Cp‐triggered chronic inflammation could be a detrimental process leading to retinal degeneration in AD, suggesting potential new therapeutic avenues involving early antibiotic treatment or inflammasome attenuation.

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