Slow CCL2-dependent translocation of biopersistent particles from muscle to brain
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Long-term biodistribution of nanomaterials used in medicine is largely unknown. This is the case for alum, the most widely used vaccine adjuvant, which is a nanocrystalline compound spontaneously forming micron/submicron-sized agglomerates. Although generally well tolerated, alum is occasionally detected within monocyte-lineage cells long after immunization in presumably susceptible individuals with systemic/neurologic manifestations or autoimmune (inflammatory) syndrome induced by adjuvants (ASIA).
On the grounds of preliminary investigations in 252 patients with alum-associated ASIA showing both a selective increase of circulating CCL2, the major monocyte chemoattractant, and a variation in the CCL2 gene, we designed mouse experiments to assess biodistribution of vaccine-derived aluminum and of alum-particle fluorescent surrogates injected in muscle. Aluminum was detected in tissues by Morin stain and particle induced X-ray emission) (PIXE) Both 500 nm fluorescent latex beads and vaccine alum agglomerates-sized nanohybrids (Al-Rho) were used.
Intramuscular injection of alum-containing vaccine was associated with the appearance of aluminum deposits in distant organs, such as spleen and brain where they were still detected one year after injection. Both fluorescent materials injected into muscle translocated to draining lymph nodes (DLNs) and thereafter were detected associated with phagocytes in blood and spleen. Particles linearly accumulated in the brain up to the six-month endpoint; they were first found in perivascular CD11b+ cells and then in microglia and other neural cells. DLN ablation dramatically reduced the biodistribution. Cerebral translocation was not observed after direct intravenous injection, but significantly increased in mice with chronically altered blood-brain-barrier. Loss/gain-of-function experiments consistently implicated CCL2 in systemic diffusion of Al-Rho particles captured by monocyte-lineage cells and in their subsequent neurodelivery. Stereotactic particle injection pointed out brain retention as a factor of progressive particle accumulation.
Nanomaterials can be transported by monocyte-lineage cells to DLNs, blood and spleen, and, similarly to HIV, may use CCL2-dependent mechanisms to penetrate the brain. This occurs at a very low rate in normal conditions explaining good overall tolerance of alum despite its strong neurotoxic potential. However, continuously escalating doses of this poorly biodegradable adjuvant in the population may become insidiously unsafe, especially in the case of overimmunization or immature/altered blood brain barrier or high constitutive CCL-2 production.
KeywordsAlum Vaccine adverse effect Vaccine adjuvant Nanomaterial biodistribution Nanomaterial neurodelivery Macrophages Macrophagic myofasciitis CCL-2 Single nucleotide polymorphisms (SNPs)
Al(OH)3 rhodamine nanohybrid
antigen presenting cells
autoimmune/inflammatory syndrome induced by adjuvant
blood brain barrier
chemokine (C-C motif) ligand 2
central nervous system
draining lymph nodes
(Dulbecco’s) modified Eagle’s medium
fluorescent latex bead
graphite furnace atomic absorption spectrometry
dystrophin deficient mouse
monocyte chemoattractive protein 1
proton induced X-ray emission
single nucleotide polymorphism
tibialis anterior muscle
transversely heated graphite atomizer.
Nanomaterials have various innovative medical applications including drug and gene delivery, imaging contrast fluids, topical antimicrobials, surgery tools and vaccines . Due to the growing number of novel compounds and formulations, data on their specific biodistribution, persistence and toxicity are generally lacking , and clarification regarding how the body handles small particles, especially those which interact with immune cells , is urgently needed. Once defined, these basic mechanisms which govern host-particle interactions should be integrated with specific properties of nanomaterials (size, shape, surface, and solubility) to enable predictions of their beneficial or adverse effects.
The use of nanomaterials in humans is not as contemporary as is recently portrayed. For decades, alum, a nanocrystalline compound formed of aluminum oxyhydroxide, has been the most commonly used adjuvant in vaccines. The mechanism by which it stimulates the immune response is incompletely understood . While alum is generally well tolerated, it is occasionally reported as the cause of disabling health problems in individuals with ill-defined susceptibility factors [4, 5, 6]. Clinical manifestations attributed to alum are paradigmatic of the so-called autoimmune/inflammatory syndrome induced by adjuvants (ASIA), a syndrome also observed in patients exposed to silicone gel . They include delayed onset of diffuse myalgia , chronic fatigue  and stereotyped cognitive dysfunction . The persistence of alum-loaded macrophages is typically detected at sites of previous injections (up to >12 years later), resulting in a specific granuloma called macrophagic myofasciitis or MMF . Although the biopersistence of adjuvants is a priori undesirable, the exact significance of this remains the subject of some debate since the biodistribution of slowly biodegradable particles following injection into muscle is currently unknown.
There appears to be a fine balance between the efficacy of alum adjuvant and its potential toxicity, and there is good evidence that these may be one and the same effect . Both the efficacy and the potential toxicity of alum will be influenced by whether the bioactive nanomaterial remains localized at injection points or rather scatters and accumulates in distant organs and tissues. A reference study based on isotopic 26Al showed poor (6%) 26Al clearance in the urine at the day 28 (d28) endpoint after i.m. injection of isotopic alum to rabbits, and detected 26Al, in an unknown form, in lymph nodes, spleen, liver, and brain . Aluminum oxyhydroxide is composed of micron/submicron-sized aggregates of nano-sized (about 13 nm) particles and these aggregates were initially believed to remain extracellular until their complete solubilization in interstitial fluids . We now know that quite the reverse is the case and that antigen presenting cells (APCs) avidly take up alum particles , and, in so doing, become long-lived cells  and impede alum solubilization [4, 13, 14]. Inflammatory monocytes (MOs) are attracted into muscle by danger signals through a monocyte chemoattractant protein-1 (MCP-1)/chemokine (C-C motif) ligand 2 (CCL2) driven-mechanism, becoming macrophages (MPs) and MO-derived dendritic cells (DCs), before migrating to the draining lymph nodes (DLNs) . One function of migratory DCs is to transfer antigenic material to a large network of distant resident APCs . Moreover, injections of alum alone induce significant changes linked to activation of the innate immune system in distant organs [17, 18]. Therefore, we examined whether nanomaterials injected into muscle could translocate to distant organs as part of a general mechanism linked to phagocytosis and CCL2/MCP-1 signaling.
All animal experiments were conducted in accordance with the European guidelines for animal care. To facilitate mechanistic investigation of particle biodistribution, mice of the B57/B6 genetic background, that are used to generate genetically-manipulated models, were preferred to more toxic-sensitive mouse strains. Male eight- to ten-week-old C57BL/6, mdx (with leaky blood brain barrier (BBB)), CX3CR1GFP/+ (with GFP reporter gene insertion allowing visualization of microglia), and CCL2−/− mice were used (Jackson, West Grove, PA, USA). Mice were protected from Al-containing materials, fed with manufactured animal food and water ad libitum, and exposed to 12:12 light/dark cycles. Experiments using fluorescent particles were extremely labor intensive and expensive to perform. All of them were done in triplicate. Homogeneity of results made it unnecessary to use more than three mice per point.
The dose of alum-containing vaccine administered to mice was calibrated to mimic the mean number of doses received by MMF patients. One dose of commercially available anti-hepatitis B vaccine contains 0.5 mg Al according to the product data sheet. Based on an average of human body weight of 60 kg (most patients being women), the amount received for each immunization is 8.33 μg/kg. The allometric conversion from human to mouse (FDA Guidance 5541) gives a final amount of approximately 100 μg/kg. A dose of 36 μL vaccine, which corresponds to 18 μg Al, was injected to mimic the cumulative effect induced by 5.2 human doses to 35 g mice (the mean weight at the d180 midtime of brain analysis). This dose represents an equivalent 6.8 human doses in the youngest animal (27 g body weight, 11 weeks of age at sacrifice) and 4.3 in the oldest one (42 g at 62 weeks).
Furnace atomic absorption spectrometry
Al concentrations were determined in whole tibialis anterior (TA) muscles and brains dried at 37°C and digested with concentrated HNO3 (14 mol/L). Digests were allowed to cool before dilution to 10% HNO3 with ultra-pure water. The total aluminum in each digest was measured by transversely heated graphite atomizer graphite furnace atomic absorption spectrometry (TH GFAAS) and results were expressed as Al mg/g tissue dry weight.
As in normal conditions Al may be detected with marked interindividual variations in tissues, de novo incorporation of aluminum in too low doses does not cause easily detectable changes when global conventional approaches are used . Here we used particle induced X-ray emission (PIXE), a procedure analyzing radiation emitted from the interaction of a proton beam with the matter , to detect areas enclosing small Al spots. Sections (20 μm-thick) carefully protected from environmental Al were mounted on fresh formvar films, kept in the cryostat for 6 hours and stored under Al-free silica gel. Mineral and metal ions were detected using the nuclear microprobe of the Centre d’Etudes Nucléaires de Bordeaux-Gradignan. A 1 MeV proton beam focused down to a 2 μm spot was randomly scanned over multiple 500 × 500 μm fields of tissue sections. In the case of an Al signal, a re-test of 100 × 100 μm areas of interest was performed. PIXE and Rutherford backscattering spectrometry analyses were employed simultaneously and quantitative results were computed, as previously described . Al spots were considered eligible on three criteria: a size of more than 3 pixels (that is, above the background noise), a depot not colocalized with Si, and a depot surrounded by a rounded halo of decreased intensity (both characteristics limiting confusion with contamination by external dust overcoming the protection procedures).
Synthesis of Al-Rho particles
Gadolinium oxide nanohybrids with Al(OH)3 coating were obtained in three steps: (i) gadolinium oxide nanoparticles were first synthesized; (ii) polysiloxane shell growth was then induced by hydrolysis-condensation of convenient silane precursors in the presence of the nanoparticles; and (iii) the nanohybrids were coated by the addition of aluminum nitrate and soda in stoichiometric conditions.
Gadolinium chloride hexahydrate ((GdCl3, 6H2O]) 99.99%), sodium hydroxide (NaOH, 99.99%), tetraethyl orthosilicate (Si(OC2H5)4, TEOS, 98%), (3-aminopropyl) triethoxysilane (H2N(CH2)3-Si(OC2H5)3, APTES, 99%), triethylamine (TEA, 99.5%), rhodamine B isothiocyanate (RBITC), aluminium nitrate nonahydrate (Al(NO3)3.9H2O, ACS reagent ≥ 98%) and dimethyl sulfoxide (DMSO, 99.5%) were purchased from Sigma-Aldrich (St Louis, MO, USA). Diethylene glycol (DEG, 99%) was purchased from SDS Carlo Erba, Val de Reuil (France).
Preparation of gadolinium oxide core
A first solution was prepared by dissolving GdCl3, 6H2O (0.56 g) in 50 mL DEG at room temperature. A second solution was prepared by adding a NaOH solution (0.49 mL, 10 M) in 50 mL DEG. The second solution was progressively added to the first one, at room temperature, for 15 hours. A transparent colloid of gadolinium oxide nanoparticles in DEG was obtained.
Encapsulation of Gd2O3cores by polysiloxane shell
A total of 105 μL of APTES and 67 μL of TEOS was added to 100 mL of the gadolinium oxide nanoparticle solution under stirring at 40°C. A total of 5 μL of APTES was previously coupled to 1 mg RBITC in DMSO (1 mL) used as solvent and then added to the colloidal solution. After 1 hour, 1,913 μL of a DEG solution (0.1 M of TEA, 10 M of water) was added. The whole coating procedure was repeated three more times (with no more addition of RBITC), every 24 hours. The final mixture was stirred for 48 hours at 40°C. The obtained solution could be stored at room temperature for weeks without alteration.
Coating of fluorescent nanohybrids with a Al(OH)3shell
A total of 2.5 mL of the colloidal solution was diluted by 2 to obtain a 5 mL solution in DEG. A total of 75 mg of aluminum nitrate nonahydrate was dissolved in 10 mL of water before addition to the colloidal solution. The resulting mixture was stirred for 5 minutes and 4 mL of a soda solution (0.2 M) was added before stirring for 1 hour.
Purification of Al-Rho was performed by tangential filtration through Vivaspin filtration membranes (MWCO = 10 kDa) purchased from Sartorius Stedim Biotech (Aubagne, France). The colloidal solution was introduced into 20 mL Vivaspin tubes and centrifuged at 4,100 rpm. This step was repeated several times, by filling the tubes with water and centrifuging again, until the desired purification rate was reached (≥100). The purified colloidal solution was freeze dried for storage in five pillboxes, using a Christ Alpha 1–2 lyophilisator. The compound contained 4 μg Al per μL of Al-Rho suspension. Control transmission electron microscopy showed non-fibrous particles about 10 nm in size, typical of aluminum hydroxyde (traditional precipated alum). Similarly to vaccine alum, they formed agglomerates of submicronic/micronic size. The immunological properties of such traditional alum-protein precipitates are quite similar to those of the reference adjuvant approved by the FDA (Al oxyhydroxyde: Alhydrogel®, Invivogen, Toulouse France) and differ from other formulations not licensed for human use (18).
Peripheral injections of fluorescent nanomaterials
Two types of fluorescent nanomaterials were used: exploratory polychromatic fluorescent latex beads (FLBs) (500 nm fluorospheres, Polysciences, Warrington, PA, USA) and confirmatory Al-Rho nanohybrids constructed with a rhodamine containing core and an Al(OH)3 shell. FLBs were used first because they offer several characteristics that facilitate their detection in tissues, including strong fluorescence, spheric appearance and homogeneous size. This allowed us to get a clear picture of what was happening in terms of biodistribution of these avidly phagocytosed particles. Al Rho particles were less fluorescent and more heterogeneous in shape and size than FLBs but better represented alum adjuvant surrogates. Almost all biodistribution experiments performed with FLBs in wild type mice were also done with Al-Rho. In contrast, FLBs and Al Rho were differentially used in mutated/genetically-modified mice: FLBs were preferred to study particle biodistribution in mdx mice with BBB alterations and when the GFP marker was used (that is, CX3CR1GFP/+ mice with fluorescent microglia, GFP + BMT studies); Al-Rho particles were preferred in gain/loss of CCL2/MCP-1 function studies designed on the basis of preliminary results on the CCL2 status of alum-intolerant humans.
FLB suspension diluted at 1:1 in PBS contained 1.8 × 1011 particles per mL. A total volume of 40 μL (20 μL in each TA muscle) was injected, corresponding to a total amount of 7.2 × 109 particles. The same volume of Al-Rho suspension was injected in TA muscles. PBS-injected mice were used as controls. Tissues, including popliteal and inguinal DLNs, spleen, brain and blood, were collected at various time points post injection. Three mice were included per group at each time point for both injected materials and their controls. Other administration routes were compared to the standard i.m. injection, including s.c. injection of 20 μL FLBs in each hindlimb, and i.v. injection of 40 μL FLBs in the tail vein.
Stereotactic cerebral injections
Mice were anaesthetized with ketamine and xylazine. Al-Rho suspension (0.5 μL) was stereotactically injected in the striatum using a 1 μL Hamilton syringe. Biodistribution of i.c. injected Al-Rho to cervical DLNs, assessed by serial sectioning of the whole cervical region, and spleen, was compared to biodistribution to the popliteal DLN and spleen of the same amount of Al-Rho injected in the TA muscle.
Pharmacological and physical migration blockade
The prostaglandin analog BW245C, an agonist of the PGD2 receptor, was used to inhibit APC migration as previously reported . Since BW245C is active for two days after injection, BW245C (100 nM, Cat.no.12050, Cayman Chemical, Ann Arbor, MI, USA) was injected twice in the TA muscle: it was first co-injected with FLBs at d0 and a second time alone at d2, and DLNs were removed for examination at d4. Untreated FLB-injected mice were used as controls. In another set of experiments DLNs were surgically ablated and mice immediately injected with FLBs in the TA muscle.
Loss and gain of CCL2 function experiments
Exploratory analyses performed in MMF patients with ASIA [see Additional file 1: supplementary information section] yielded a CCL2 signal in the form of: (1) a selective increase of CCL2 in the serum of MMF patients compared to healthy controls; and (2) a given haplotype in the CCL2 gene tending to be more frequent in MMF patients than in the general population. These results led us to use mouse models to explore the role of CCL2 in the biodisposition of particulate materials. Loss of CCL2 function studies were done using CCL2−/− mice injected i.m. with 40 μL Al-Rho. Gain of CCL2 function experiments consisted first of i.m. co-injection of 10 μL murine rCCL2 (100 μg/ml; R&D, Minneapolis, MN, USA) with 40 μL Al-Rho. DLNs were removed at d4, spleen, brain and blood at d21. In other experiments murine rCCL2 was infused into the brain through a catheter stereotactically inserted into the striatum at d7 post-Al-Rho, fed by a subcutaneously implanted osmotic micropump fixed into the neck (0.25 μL/hour Alzet brain infusion kit, Charles River, L’Arbresle, France). rCCL2 was infused for 14 days (diffusion rate 180 pg/day), with or without rCCL2 i.m. injection concurrent with Al-Rho injection. At d21 post Al-Rho injection, animals were sacrificed, and blood and tissues were collected. For controls, osmotic pumps filled with PBS were used.
Tissue preparation and particle counting
Mice under terminal anesthesia were transcardially perfused with PBS followed by ice-cold 4% paraformaldehyde (PFA) in 0.1 M phosphate buffer. Tissues and organs were removed, post-fixed in PFA for 4 hours at 4°C, immersed overnight at 4°C in a 30% sucrose solution, and quickly frozen. Whole brains were serially cut into coronal cryosections of 40 μm, spleen and muscle into 20 μm, and DLNs into 10 μm, and stored at −20°C until particle counting or treatment. Brain sections were successively deposited on 10 different Superfrost® slides in order to obtain 10 identical series, thus allowing determination of total particle content by multiplying by 10 the number of particles found in one series. A similar approach was used for DLNs and spleen. Blood was collected by heart puncture and 100 μL were smeared for particle counting.
Immunohistochemistry and Morin staining
Immunostaining was done using commercial primary antibodies routinely used in the lab, raised against CD11b (1/200, AbD Serotec, Oxford, UK), F4/80 (1/50, AbCam, Cambridge, UK), GFAP (1/200, DakoCytomation, Trappes, France), vimentin (1/500 DakoCytomation), collagen IV (1/100 Millipore, Temecula, CA, USA), NG2 (1/200, Millipore, Molsheim, France), MAP2 (1/100, Sigma-Aldrich, Lyon, France), and IL1β (1/100, AbCam, Paris, France) or nonspecific mouse IgG (Jackson ImmunoResearch, Suffolk, UK). Then, biotinylated anti-rat and anti-rabbit antibodies (1/200, Vector Laboratories, Paris, France) were used accordingly and were revealed using Alexa fluor 488-conjugated streptavidin (1/200 Invitrogen, Cergy-Pontoise, France). Neuron labeling was done using NeuroTrace® blue fluorescent Nissl Stain according to the manufacturer” instructions (Invitrogen). Al was stained with Morin (M4008-2 G, Sigma-Aldrich) used as 0.2 g dissolved in a solution consisting of 0.5% acetic acid in 85% ethanol . Formation of a fluorescent complex with Al was detected under a 420 nm excitation wavelength as an intense green fluorescence with a characteristic 520 nm emission. Notably, nanohybrids (Gd2O3) core encapsulated by polysiloxane shell were not positively stained by Morin. In contrast, when coated with Al(OH)3, these particles were strongly positive for Morin. Fluorescence microscopy and spectral analyses were done using Carl Zeiss light and confocal microscopes.
Cell isolation from blood and tissues and flow cytometry
For blood cell immunophenotyping, 100 μL blood was treated with ethylenediaminetetraacetic acid (EDTA) and stained with fluorescein isothiocyanate (FITC)-conjugated antibodies. Erythrocytes were lysed using hypotonic lysis solution, and then cells were washed with (D)MEM and sorted using a MoFlo cell sorter (Beckman Coulter, Villepinte, France). Cells were extracted from tissues of exsanguinated mice perfused with PBS. Tissues were removed and freshly dissociated in (D)MEM. DLNs and spleen were dissociated in (D)MEM containing 0.2% collagenase-B (Roche Diagnostics, Meylan, France) and 0.2% trypsine-EDTA at 37°C for 45 minutes twice. Brain tissue was dissociated in 1% Trypsin-HBSS (Thermo Scientific HyClone, South Logan, UK) containing 100 U/mL DNase (Roche Diagnostics). Cell suspensions were filtered and counted. CD45+ or CD11b+ cells were isolated using magnetic cell sorting (MACS, Miltenyi Biotec, Paris, France) and stained with one of the following antibodies and their isotypes: FITC-conjugated anti-CD11b, FITC–conjugated anti–Ly-6C (GR1), FITC–conjugated anti-CD11c (BD-Pharmingen Bioscience, San Diego, CA, USA). Cells were sorted using a cell sorter. Populations presenting >90% purity were used. Sorted cells were cytospinned and stained with Hoechst-33342 for nucleus. Particle loaded cells were counted under a fluorescence microscope.
Bone marrow transplantation experiments
GFP+ bone marrow (BM) cells were obtained by flushing the femurs of adult CAG-GFP mice and were injected retroorbitally (1 × 107 cells per mouse) to four-week-old C57BL/6 mice, as previously described . Recipient mice were irradiated at 9.0 Gy on d1 before transplantation, and were treated with 10 mg/kg/day ciprofloxacin for 10 days. Blood chimerism of >90% was controlled at three to four weeks post-transplantation.
All experimental values are presented as means and standard deviation except when indicated. Statistical analyses used unpaired Student’s t-test (genotypes); P <0.05 was considered significant.
Intramuscular alum-containing vaccine injection in mouse induces Al deposition in distant tissues
Fluorospheres injected into mouse muscle undergo lymphatic and systemic biodistribution
Fluorosphere incorporation into brain is delayed and depends on prior cell loading in peripheral and lymphoid tissues
Distribution of particles (percent of total) according to post-injection time
This BM transplantation model is known to be associated with irradiation-induced BBB alteration. Dystrophin-deficient mdx mice also have chronically altered BBB . As a corollary, compared to age-matched controls, they show significantly more CD31+ brain capillaries, and a dramatic increase of perivascular CD11b+ macrophages (Figure 6c) at the expense of deep ramified microglia. FLB injection in mdx mouse muscle resulted in increased brain incorporation of particles at both d21 and d90, as assessed by both histology and cytospins of CD45+/CD11b+cells extracted from brain (Figure 6d,e,f). Thus, BBB alteration and/or the associated inflammatory/angiogenic response likely favors brain incorporation of circulating particle-loaded cells.
Fluorescent nanohybrids coated with Al(OH)3undergo CCL2-dependent systemic scattering and brain penetration
Time of peak observation and peak value of particle loaded cells in studied organs (total number ± SD)
Number of loaded cells
Number of loaded cells
Number of loaded cells
Number of loaded cells
Number of loaded cells
4,462 ± 257
Fluorescent nanohybrids coated with Al(OH)3are retained in brain
An apparently irreversible accumulation of nanomaterials after i.m. injection was unique to brain tissue which lacks conventional lymphatic pathways and may retain immune cells . We stereotactically injected 0.5 μL Al-Rho in the striatum of C57Bl6 mice, and counted particles in cervical LNs, blood, and spleen at d4 and d21. Compared to the same amount of Al-Rho injected in the TA muscle, i.c. injection was associated with almost no particle translocation to regional DLNs (Figure 10d), and the appearance of eight-fold fewer particles in spleen (Figure 10e). Since 25 free Al-Rho particles per 100 μL were detected in blood at hour 1, it is likely that the rare particles subsequently detected in spleen reflected direct particle passage into blood during i.c. injection. It seems, therefore, that lack of recirculation likely contributed to progressive cerebral particle accumulation.
Particles injected by the i.m. or s.c. route gained access to distant tissues. Latex and Al-Rho particles showed closely similar biodistribution, suggesting a shared basic scattering mechanism. Initial cell uptake in peripheral and DLN tissues and subsequent transport within inflammatory MO-derived cells was critically involved, as indicated by immunophenotyping, cell migration blockade and DLN ablation. Cells were heavily loaded with particles soon after i.m. injection but usually contained only one to two particles after d4 and downstream the popliteal DLN, pointing to either dilution by cell division  or particle dispatching to other cells  within DLNs. Previous studies have reported particle cell transport from skin to DLNs  but downstream particle fate remained largely unexplored . There is strong evidence that, in inflammatory conditions, all DCs reaching DLNs do not die locally but may rather gain access to the blood through efferent lymphatics and the thoracic duct, and present antigens in spleen and bone marrow . Ingested adjuvant particles boost this phenomenon which in turn likely favors their translocation from the injection point to distant sites as: (i) alum induces rapid differentiation of monocyte-lineage cells into APCs  and stimulates their migration to DLNs ,(ii) beryllium hydroxide, a closely similar particulate adjuvant, strongly stimulates DC egress through efferent lymphatics ; and, as shown herein, (iii) Al deposits may be detected by PIXE in spleen and brain after i.m. injection of alum.
Delayed and slowly progressive particle accumulation occurred in intact brains. Experiments using the parabiosis model  or avoiding brain irradiation prior to BM transplantation  have shown that endogenous microglia are not replenished by the periphery under normal central nervous system (CNS) conditions. Although low chimerism inherent in these experimental approaches may lead to some underestimation of slow microglia turnover from the periphery , a more likely explanation of our findings is that particles exert stimulatory effects on myeloid cell trafficking . Both latex particles and aluminum hydroxide agglomerates promote inflammation [40, 41] and non-specific immune stimulation can increase monocyte transendothelial migration by up to 20-fold in in vitro models of the BBB . Consistently, i.m. injection of rCCL2 strongly increased particle incorporation into intact brain while CCL2-deficient mice had decreased neurodelivery. rCCL2 likely induced the exit of inflammatory MOs and hematopoietic stem and progenitor cells from BM , followed by their transmigration to the injected muscle and to DLNs , prior to particle loading and dissemination. Cerebral infusion of low doses of rCCL2, mimicking pathological states attracting inflammatory monocytes, also increased particle neurodelivery. Intracerebral particles translocated with time from perivascular macrophages to the sentinel network of parenchymal microglia and to other resident neural cells and likely failed to recirculate, thus explaining their progressive cerebral accumulation.
Taken together, our results indicate that, similarly to intracellular bacteria , nanomaterials can be transported by MO-lineage cells to DLNs, blood and spleen, and, similarly to HIV  and other pathogens , may use CCL2-dependent MO transmigration across the BBB to enter the brain. This occurs at an extremely low rate in normal mice, the percentage of injected particles found in tissues being estimated at 1:105 in d21 spleen and 1:107 in d90 brain, consistent with the excellent tolerance of almost all individuals to limited doses of alum and other injected particles. Neurodelivery of nanomaterials significantly increased in mice with either a weak BBB or high tissue levels of CCL2, as previously suspected for pathogens in humans . On the one hand, such a cerebral incorporation of nanomaterials injected into tissues should be regarded as an interesting characteristic in the setting of therapeutic strategies targeting the CNS. On the other hand, alum has high neurotoxic potential , and planning administration of continuously escalating doses of this poorly biodegradable adjuvant in the population should be carefully evaluated by regulatory agencies since the compound may be insidiously unsafe. It is likely that good tolerance to alum may be challenged by a variety of factors including overimmunization, BBB immaturity, individual susceptibility factors, and aging that may be associated with both subtle BBB alterations and a progressive increase of CCL2 production .
This work has benefited from research funding from two patients associations: E3M (Entraide aux Malades de Myofasciite à Macrophages) “Neurodélivrance des particules injectées par voie intra musculaire et sécurité des adjuvants aluminiques” , AFM (Association Française contre les Myopathies) “Etude des mécanismes de la myofasciite à macrophages” and Dwoskin Foundation (Nano in brain); from Région Ile-de-France through a programme PICRI (Partenariat Institutions-Citoyens pour la Recherche et l’Innovation) “Recherche de polymorphismes dans les gènes codant pour des facteurs inflammatoires (chimiokines) dans la myofasciite à macrophages”, and through two post-doctoral positions from NeRF (Neuropole de Recherche Francilien) on the topic “The macrophage as a Trojan horse for brain delivery” and “Brain delivery of i.m. injected nanoparticles: relevance to safety of aluminum-containing adjuvants of vaccines”; and from the European Community’s Seventh Framework Programme in the project ENDOSTEM “Activation of vasculature associated stem cells and muscle stem cells for the repair and maintenance of muscle tissue” (Grant agreement number 241440). We would like to thank for their most useful contributions: Dr Sophie Hue, Dr Fabrice Chrétien, Dr Madly Brigitte, Dr Anne Hulin, Lucie Poupel, Emilie House, Yasmine Baba-Amer, and Mathieu Surenaud.
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