Characterization of an interleukin-6- and adrenocorticotropin-dependent, immune-to-adrenal pathway during viral infection.

There has been longstanding interest in the capacity of the immune system to access immunomodulatory glucocorticoid responses without invoking upstream neuroendocrine secretagogues, including CRH and ACTH. Here, we investigate the role of CRH and ACTH in adrenal glucocorticoid responses to murine cytomegalovirus (MCMV). Mice infected with MCMV exhibit IL-6-dependent glucocorticoid responses that peak at 36 h post infection and protect against cytokine (TNFalpha)-mediated lethality. Acute administration of a CRH-antibody (Ab) completely eliminated ACTH responses to both low- and high-dose MCMV. However, corticosterone responses in CRH-Ab-treated animals remained apparent in mice infected with low-dose MCMV and were robust in mice infected with high-dose MCMV. CRH-knockout (KO) mice exhibited robust corticosterone responses to both MCMV doses, despite reduced baseline and MCMV-induced ACTH. Interestingly, robust corticosterone responses in CRH-Ab-treated and CRH-KO mice were associated with exaggerated IL-6 levels, and IL-6 and corticosterone concentrations in infected CRH-Ab-treated animals were significantly correlated. Neutralization of IL-6 responses in infected CRH-KO mice reduced corticosterone responses by approximately 70%. Finally, MCMV-infected mice deprived of ACTH by hypophysectomy failed to elicit glucocorticoid responses, despite elevated plasma IL-6 concentrations. Taken together, these results suggest that a greater than normal induction of IL-6 compensates for the absence of a normal CRH-dependent ACTH surge during viral infection. This enhanced IL-6 response, in turn, may mediate a direct immune-adrenal pathway that can become a predominant driving force for glucocorticoid induction in the absence of CRH. However, the presence of ACTH appears to serve as a necessary permissive factor, enabling direct cytokine actions on the adrenal gland.