The adhesion to BMECs appears to be an important step in invasion of Acanthamoeba in the BBB, as nonpathogenic environmental isolates show minimal binding to BMECs (Alsam et al., 2003). Phospholipases influence the release of arachidonic acid from the cell surface (Dieter et al., 2002). Arachidonic acid is a prostaglandin precursor that increases BBB vascular permeability and nitric oxide production in BMECs (Harris et al., 2002). Similarly, extracellular serine proteases and/or mannose-binding protein cause redistribution/alteration of TJ proteins, such as ZO-1 and occludin (Khan & Siddiqui, 2009) (Table 1). In addition, it is reported
that during the process of adhesion to BMECs, Acanthamoeba upregulates the production of proteases (Alsam et al., 2005). Acanthamoeba also induces the activation of Rho-associated intracellular signaling cascades. RhoA regulates myosin light-chain
phosphorylation causing a Rapamycin Panobinostat datasheet change in structure and rearrangement of ZO-1 and occludin, which in turn causes an increase in BBB permeability (Shen et al., 2006; Khan & Siddiqui, 2009). Sissons and coworkers have shown that PI 3-kinase plays an important role in the amoeba-mediated BMECs apoptosis (Alsam et al., 2005). Moreover, Acanthamoeba has been shown to be able to stimulate the expression of GADD45A and p130Rb genes, which are associated with cell cycle arrest (Sissons et al., 2004). These events are sufficient for BMEC dysfunction. There are two possible routes by which T. gondii may cross the BBB. It may enter into the CNS through infected cells, such as monocytes and macrophages. Toxoplasma gondii modulates gene expression (E-selectin and P-selectin, ICAM-1, toll-like receptor 4, etc.) of BMECs to promote its own migration across the BBB in a ‘Trojan horse’ manner through PAK5 the cells expressing CD11b either with or without CD11c (Lachenmaier et al., 2011). Besides, the parasites may infect and destroy ECs (Daubener et al., 2001).
Surface antigen 1 (SAG1), major tachyzoite surface molecule, has been proposed as a ligand that mediates BMEC invasion (Gay-Andrieu et al., 1999). Viruses probably account for the most cases of meningitis. The commonest viruses causing meningitis, enteroviruses, flaviviruses, and lentiviruses, in immunocompromised infants lead to substantial neurological complications and mortality. Remaining viral meningitis and CNS infections are caused by herpes simplex virus (HSV) and flaviviruses, although mumps infection is re-emerging. Viruses enter the CNS through several mechanisms (1) by hematogenous spread and direct traversal through BBB (enteroviruses), (2) virus particles are carried across infected leukocytes (mumps, measles, or herpes viruses) and (3) axonal flow through peripheral and cranial nerves (polio, rabies, and HSV) (Chadwick, 2005).