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RESEARCHARTICLE Enhancement of immune cytokines and splenic CD4+ T cells by electroacupuncture at ST36 acupoint of SD rats LongyunChen1☯,AnliXu1☯,NinaYin2,MinZhao1,ZhigangWang3,TaoChen2, YishengGao2,ZebinChen2* 1 DepartmentofBiochemistry,BasicMedicalCollege,HubeiUniversityofChineseMedicine,Wuhan,China, 2 DepartmentofAnatomy,BasicMedicalCollege,HubeiUniversityofChineseMedicine,Wuhan,China, 3 DepartmentofPathogenicBiology,BasicMedicalCollege,HubeiUniversityofChineseMedicine,Wuhan, China a1111111111 a1111111111 ☯Theseauthorscontributedequallytothiswork. a1111111111 *[email protected] a1111111111 a1111111111 Abstract ElectroacupunctureattheST36acupointcanenhancethebody’simmunefunction.How- ever,themechanismforthisenhancementhasnotbeenfullydescribed.Ourstudywas OPENACCESS designedtoinvestigatetheeffectofelectroacupunctureontheimmunefunctionofSprague- Citation:ChenL,XuA,YinN,ZhaoM,WangZ, Dawley(SD)rats.Theratswererandomlydividedintothreegroups:acontrolgroup,anon- ChenT,etal.(2017)Enhancementofimmune cytokinesandsplenicCD4+Tcellsby acupointgroup(abdominalmuscleacupuntured)andaST36acupointgroup.Ourresults electroacupunctureatST36acupointofSDrats. showedthatsuccessiveelectroacupunctureattheST36acupointfor3dsignificantly PLoSONE12(4):e0175568.https://doi.org/ enhancedtheinterferon-γ(IFN-γ)levelintheserumofSDrats.Theresultsalsoshowedthat 10.1371/journal.pone.0175568 theserumandextractsfromspleencellsoftheST36acupointgroupcontainedhigherlevels Editor:BrijSingh,UniversityofNorthDakota ofinterleukin(IL)-2andIL-17comparedtothoseoftheothertwogroups.Immunohisto- SchoolofMedicineandHealthSciences,UNITED chemicalanalysisshowedthatelectroacupunctureappliedtotheST36acupointenhanced STATES theexpressionlevelofCD4inspleencells.Furthermore,itwasobservedthatCD4co-local- Received:October2,2016 izedwithtransientreceptorpotentialvanilloid(TRPV)channelsatthemembraneofsplenic Accepted:March28,2017 CD4+TcellsandtheexpressionlevelofCD4wasrelatedtoTRPVchannelsintheelectroa- Published:April13,2017 cupuncturetreatment.Theseobservationsindicatedthatelectroacupuncturestimulationat Copyright:©2017Chenetal.Thisisanopen theST36acupointenhancedthelevelofimmunecytokinesandsplenicCD4+Tcells accessarticledistributedunderthetermsofthe throughTRPVchannelsinthissystem. CreativeCommonsAttributionLicense,which permitsunrestricteduse,distribution,and reproductioninanymedium,providedtheoriginal authorandsourcearecredited. DataAvailabilityStatement:Allrelevantdataare withinthepaperanditsSupportingInformation Introduction files. Electroacupuncture(EA)treatmentisoneofthemostpopularapproachesincomplementary Funding:Thisstudywassupportedbygrantsfrom medicineandhealthmaintenance.Ithasbeenshowntohavesomeanalgesiceffectsinreliev- theHealthandFamilyPlanningCommissionof ingpain[1–5].Recently,someexperimentalandclinicalstudieshaveshownthatsequential HubeiProvince(no.2013Z-Z01)andHubei electroacupuncturestimulationappliedtotheST36acupoint(Zusanliacupuncturepoint)per- ProvincialDepartmentofEducation(no. formedwellinthetreatmentofstress-inducedimmunodeficiency[5,6].Apreviousstudy B2016112).Thefunders’websitesarehttp://www. hbwsjs.gov.cn/andhttp://www.hbe.gov.cn/.Zebin demonstratedthatelectricalstimulationattheST36acupointscanactivatetheimmunesystem PLOSONE|https://doi.org/10.1371/journal.pone.0175568 April13,2017 1/13 ElectroacupuctureatST36acupointcouldenhanceimmunefunction Chenreceivedthefunding.Hehadaroleinthe andhelpsupportanti-cancertreatments[7–9].However,thecurativemechanismsofelectroa- studydesign. cupunctureremainpoorlyunderstood,whichlimitstheapplicationofelectroacupunctureon Competinginterests:Theauthorshavedeclared alargerscale. thatnocompetinginterestsexist. CD4+Tcellsareoneoftheimportantcellsinthehumanimmunesystem.Tcellsplaya veryimportantroleintheimmunesystem.CD4+Tcells,whichareknownasthe"helper"of theimmunesystem,protectthebodyagainstmicrobessuchasviruses.TheCD4+Tcellisan importantcomponentoftheadaptiveimmuneresponse.Afterdifferentstimuli,CD4+Tcells candifferentiateintodifferentsubsetsofcells,includingTh1andTh2cells,follicularhelper (Tfh)cells,Th17cells,andregulatoryTcells(T ).ThefunctionsoftheCD4+Tcellare REG diverse,suchastheactivationofimmunecells,directcytotoxiceffects,andimmunoregulation [10]. FreeCa2+ionsareusedassecondmessengersformostcells,includingimmunecells.Rest- ingTcellsandBcellsareknowntomaintainlowintracellularCa2+concentrations[11].Some receptorslocatedontheimmunecellsurfaceareknowntoincreasetheconcentrationofintra- cellularCa2+,suchastheTcellreceptor,theBcellreceptorandco-stimulatoryreceptors[12]. ApreviousstudyalsonotedthatCa2+signalinginimmunecellsisimportantforthedifferenti- ationofimmunecellsandgenetranscription[11–13].Ithasbeenshownthattheactivationof TcellscancauseanincreaseintheIFN-γandIL-2levels[14].Further,electroacupuncturehas beendemonstratedtoenhancethelevelsofsplenicIFN-γandIL-2releasedbyhelperTcells [15,16].HowtheincreasesintheIFN-γandIL-2levelswereinducedbyelectroacupuncture requiresfurtherstudy,andtheeffectofelectroacupunctureonsplenicTcellsneedstobe explored.Hence,theaimsofthisstudyweretoinvestigatetheeffectandmechanismofelectro- acupunctureonthereleaseofimmunecytokinesandtheactivationofsplenicTcells. Materialsandmethods Animalsandelectroacupuncturetreatment AdultmaleSprague-Dawley(SD)ratsweighting200±25gwerepurchasedfromtheExperi- mentalAnimalCenterofHubeiUniversityofTraditionalChineseMedicine(medicallabora- toryanimalcertificatenumber:SCXK(Hubei)2015–0018).TRPV1knockout(TRPV1-/-) micewerepurchasedfromNanjingBiomedicalResearchInstituteofNanjingUniversity (medicallaboratoryanimalcertificatenumber:SCXK(Jiangsu)2015–0001).Alltheanimals werekeptintheExperimentalAnimalCenterofHubeiUniversityofChineseMedicine.The ExperimentalAnimalCenterofHubeiUniversityofChineseMedicineobtainedalaboratory animaladministrativelicensefromtheScienceandTechnologyDepartmentofHubeiProv- ince(number:SYXK(Hubei)2012–0067).Theanimalswererandomlydividedinto3groups: (a)acontrolgroupinwhichtheanimalsreceivednotreatmentandwerehousedattheanimal facilities(20–23˚C,50%±5%humidity,12-hourlight/darkcyclewithlightsonat8:00am); (b)anon-acupointgroupinwhichelectroacupuncturestimulationwasappliedtotheabdomi- nalmuscleasdescribedinapreviousstudy[16];(c)andaST36acupointgroupinwhichelec- troacupuncturestimulationwasappliedtotheST36acupoint.ThelocationofST36acupoint wasshowninFig1Aand1B.Twosterilizedacupunctureneedles(diameter0.16mm,length 25mm,Zhongyantaihe,Tianjin,China)wereinsertedattheST36acupointortheexternal obliqueabdominalmuscletoadepthof4–5mm,andtheneedleswereconnectedbytheirhan- dlestoaHANS(Han’sAcupointNerveStimulator)electro-stimulator.Thedisperse-dense wavesatthealternatingfrequencies2Hzand15Hzandanintensityof1mAwereusedas electricalstimulationfor30min.Thestimulationprotocolwasrepeatedeachdayfor1,3,7or 14days.Femaleanimalswereexcludedfromourstudy.Allmanipulationswereperformed between8:00a.m.and12:00a.m.everydaytominimizetheinfluenceofcircadianrhythms. PLOSONE|https://doi.org/10.1371/journal.pone.0175568 April13,2017 2/13 ElectroacupuctureatST36acupointcouldenhanceimmunefunction Fig1.(AandB)ThelocationofST36acupointonthebodyofSDrats. https://doi.org/10.1371/journal.pone.0175568.g001 Aftertheelectroacupuncturetreatment,theanimalswereanesthetizedbyanintraperitoneal injectionwith50mg/kgpentobarbitalsodiumforthefollowingexperiments.Allexperiments wereperformedatroomtemperature.Alltheanimalswereallowedtocalmdowninthenew environmentforatleast30min. PreparationofextractfromST36acupointarea Topreparetheextract,theratswereanesthetizedbyanintraperitonealinjectionwith50mg/ kgpentobarbitalsodium.Then,thetissuesaroundtheST36acupoint(10mmlength,10mm widthand5mmdepth)werecutoff,weighed,mincedintosmallpiecesandhomogenizedin coldPBS(10mgtissueper100μlPBS).Theresultingsuspensionwassubjectedtofurther breakdownviaultrasonication,andthehomogenateswerethencentrifugedat1500gfor15 min.Thesupernatantswerecollectedandstoredat-80˚C. ELISAassay AnELISAassaywasusedtoassesstheIFN-γ,IL-2andIL-17levelsintheserumandextracts fromtheST36acupointarea.Aftertheelectroacupuncturetreatment,oneeyeoftheanesthe- tizedratswaspulledoutusingtweezers,andthefreshbloodwascollectedina10mlEPtube. Thetubesweremaintainedat4˚Cfor24h,andtheserumwasharvestedandstoredat-80˚C. Theserumandextractsweresubjectedtoanenzyme-linkedimmunosorbentassay(ELISA)to detectIFN-γ,IL-2andIL-17expressionaccordingtothemanufacturer’sprotocol(Thermo Fischer).Allassaysweredoneatleastthreetimesinthreeseparateexperiments. Immunohistochemicalanalysis Thetissuesweredehydratedusingsequentialincubationswith75%,85%,90%,95%and100% ethanol.Thetissuesweretreatedwithatransparentagentafterthedehydration.Transparent PLOSONE|https://doi.org/10.1371/journal.pone.0175568 April13,2017 3/13 ElectroacupuctureatST36acupointcouldenhanceimmunefunction tissuesweresoakedandembeddedinparaffinwax.Theywereslicedandplacedonslides.The slideswereimmersedinxylenefor10minutes.Then,thesectionsweredehydratedbysequen- tialincubationswith100%,95%,80%and60%ethanolfor5minuteseach.Thesectionswere rinsedwithdistilledwaterthreetimesfor3minuteseach.Theslidesweretransferredtoa microwave-proofcontainerandcoveredwithcitratebufferforantigenretrieval.Sectionswere blockedusing5%normalblockingserumfor1hour.Then,theywereincubatedwiththe respectiveprimaryantibodyfor1houratroomtemperature.Followingprimaryantibody incubation,theslideswereincubatedinasufficientamountofperoxidase-labeledpolymerfor 30minutesandthesubstratefor5–10minutes,successively,untilabrowncolordeveloped. Then,theslidesweretreatedbyhematoxylincounterstaining.Afterdehydrationandmount- ing,theslideswereobservedunderamicroscope. SDS-PAGEandWB Thetissuesofthespleenwerecutout,weighedandmincedintosmallpiecesasbefore.Then, thetissueswerehomogenizedinlysisbuffer(20mMTris-HCl[pH8.0],100mMNaCl,1.9% [wt/vol]TritonX-100,1mM1,4-dithiothreitol,and5%[vol/vol]glycerol)onicefor30min. Thehomogenateswerecentrifugedat12,000rpmfor5minat4˚C.Aftercentrifugation,the supernatantswerecollected.Theconcentrationoftheproteinineachsamplewasdetermined usingtheBradfordmethod.Equalamountsofproteinwereseparatedby12%SDS-PAGEand transferredontoanitrocellulosemembrane(GEHealthcare).Themembranewasblocked with5%nonfatmilkandincubatedwiththeprimaryantibodiesforIL-2andIL-17,followed byincubationwiththegoatanti-rabbitsecondaryantibodies. DetectionofCa2+concentration TheserumwassubjectedtoacolorimetricmethodforthedetectionoftheCa2+concentration accordingtothemanufacturer’sprotocol(CalciumAssayKit,BioVision). TodetecttheCa2+concentrationinspleencells,thefreshspleentissuewasmadeintoasin- glecellsuspension(2x106cellsperEPtube).Thecellswereresuspendedinserum-free mediumatafinalconcentrationof2.5μmol/LofFluo3-Am.Thesuspensionwasplacedat 37˚Cat5%CO for30min.Thesuspensionwascentrifugedat1500rpmfor5min,andthe 2 supernatantwasdiscarded.Thecellswerewashedwithcalcium-freePBStwiceandsuspended in500μlcalcium-freePBS.TheCa2+concentrationofthespleencellswasdetectedbyflow cytometry. Immunofluorescenceanalysis Thespleenwastreatedusingthemethoddescribedintheimmunohistochemicalanalysiswith differentprimaryandsecondaryantibodies.ThespecificprimaryAbsforCD4,TRPV1or TRPV4wereused.Followingtheprimaryantibodyincubation,thegoatanti-rabbitIgG(Cy3) orgoatanti-mouseIgG(FITC)fluorescencesecondaryantibodieswereadded.DAPIwasused tostainthenucleusfor5min. Results EffectofelectroacupunctureontheexpressionofIFN-γ ApreviousstudyreportedthatelectroacupunctureappliedtotheST36acupointforthreecon- secutivedaysenhancedthelevelofIFN-γinthespleenofrats[15,17].Thus,wewantedto determinewhetherelectroacupuncturecausesthelevelofIFN-γintheserumtoincrease.Male SDratsweredividedintothreegroups:acontrolgroup,anon-acupointgroupandaST36 PLOSONE|https://doi.org/10.1371/journal.pone.0175568 April13,2017 4/13 ElectroacupuctureatST36acupointcouldenhanceimmunefunction Fig2.EffectofelectroacupunctureatST36acupointonIFN-γlevelofSDrats.(A)Electroacupuncturewasapplied totheleftandrightST36acupointinthesameratfor30min.Theelectroacupunturestimulationwasrepeatedeachday for1,3,7or14consecutivedaysondifferentrats.TheIFN-γlevelinserumofSDratswasdetected.(D1=1day)(B) ElectroacupunctureattheST36acupointcausedtheIFN-γlevelinserumincreased.*P<0.05forST36acupointgroup versuscontrolgroupandnonacupointgroup.(C)AftertheratsweretreatedbyelectroacupunctureattheST36 acupoint,theIFN-γlevelinextractsfromST36acupointareaincreased.*P<0.05forST36acupointgroupversuscontrol groupandnonacupointgroup.(D)TheIFN-γlevelinspleenwasdetectedviaimmunohistochemicalanalysis.The positivesignalisbrownordarkbrown.Mock=Control;Nonacupoint=electroacupunctureatabdominalmuscle; ST36=electroacupunctureattheST36acupoint. https://doi.org/10.1371/journal.pone.0175568.g002 acupointgroup.Forthenon-acupointgroup,electroacupuncturewasappliedtotheabdomi- nalmuscle.ElectroacupunctureattheST36acupointwasappliedtotheSDratsfor1,3,7or 14consecutivedays.ThelevelofIFN-γintheserumwasdetectedviatheIFN-γELISAassay. TheresultsshowedthatelectroacupunctureattheST36acupointforthreeconsecutivedays significantlyincreasedtheIFN-γlevelinserum(Fig2Aand2B).Basedontheseresults,the electroacupuncturetreatmentatST36acupointwasonlyappliedforthreeconsecutivedaysin ourresidualresearch.WefurtherstudiedtheeffectofelectroacupunctureontheIFN-γlevelin theextractsfromtheST36acupointarea.TheIFN-γELISAassaydemonstratedthattheIFN-γ levelintheextractsoftheST36acupointgroupincreasedbecauseoftheelectroacupuncture (Fig2C).Consistentwithapreviousstudy[15],ourresultsdemonstratedthatelectroacupunc- tureattheST36acupointenhancedthelevelofIFN-γinthespleen,asshownbyimmunohis- tochemicalanalysis(Fig2D). TheeffectofelectroacupunctureappliedtotheST36acupointontheIL- 2andIL-17levels BecauseIFN-γ,IL-2andIL-17arethecytokinesreleasedbyhelperTcells,weexamined whetherelectroacupunctureattheST36acupointenhancedT-cellcytokineproduction.First, theserumandthetissueextractwereprepared,andtheexpressionleveloftheendogenous cytokineswasexamined.AsshowninFig3Aand3B,theIL-2andIL-17levelsintheserumof theST36acupointgroupweresignificantlyhigherthanthoseofthenon-acupointandcontrol PLOSONE|https://doi.org/10.1371/journal.pone.0175568 April13,2017 5/13 ElectroacupuctureatST36acupointcouldenhanceimmunefunction Fig3.EffectofelectroacupunctureatST36acupointonIL-2andIL-17levelsofSDrats.(AandB)IL-2 andIL-17levelofserumincreasedinratstreatedbyelectroacupunctureattheST36acupoint.*P<0.05for ST36acupointgroupversuscontrolgroupandnonacupointgroup.(CandD)TheexpressionlevelsofIL-2 andIL-17inextractsfromspleencellswereanalyzedviawesternblot.GAPDHwasusedascontrol. https://doi.org/10.1371/journal.pone.0175568.g003 groups.However,therewasnodifferencebetweentheacupuncturedabdominalmuscleand thoseofthecontrolrats. TodeterminewhethertheIL-2andIL-17levelswerealsoincreasedintheextractsfromthe spleen,westernblotanalysiswasused.AsshowninFig3Cand3D,theincreasesintheIL-2 andIL-17levelswereaccompaniedbyelectroacupunctureattheST36acupoint.Thesefind- ingsindicatedthattheelectroacupunctureappliedtotheST36acupointactivatedhelperT cellsandenhancedthereleaseofT-cellcytokines. ElectroacupunctureappliedtotheST36acupointenhancedsplenic CD4+cells ItisknownthatCD4moleculesmainlydistributeonthesurfaceofThelpercellsubsets.To investigatetheeffectofelectroacupunctureonhelperTcells,immunohistochemicalanalysis wasused.Fig4Aand4BshowthattheelectroacupunctureappliedtotheST36acupointsignif- icantlyincreasedtheproportionofTcellswiththeexpressionofCD4.Thisresultmaysuggest thattheenhancementofthedifferentiationandproliferationofsplenicCD4+Tcellswas inducedbyelectroacupuncturestimulationattheST36acupoint. EffectofelectroacupunctureonthedistributionofCa2+ IthasbeenreportedthatahigherlevelofintracellularCa2+isimportantforIL-2receptor expression,IL-2productionandTcellactivation[18].Weassessedwhetherthelevelofintra- cellularCa2+waschangedbyelectroacupuncture.TheconcentrationofCa2+inthespleencells wasdetectedviaflowcytometry.AsshowninFig5A,theintracellularCa2+leveloftheST36 acupointgroupwashigherthanthatofthenon-acupointandcontrolgroups.Becausethe levelofintracellularCa2+increased,wehypothesizedthatthelevelofextracellularCa2+may PLOSONE|https://doi.org/10.1371/journal.pone.0175568 April13,2017 6/13 ElectroacupuctureatST36acupointcouldenhanceimmunefunction Fig4.TheexpressionlevelofCD4inspleenwasassayedviaimmunohistochemicalanalysis.Thepositivesignalisbrownordarkbrown. (A)TheexpressionlevelofCD4increasedinspleencellsoftheratstreatedbyelectroacupunctureattheST36acupoint.(B)Proportionsof immunopositiveCD4+Tcells. https://doi.org/10.1371/journal.pone.0175568.g004 decrease.Tocheckthis,wedetectedtheCa2+concentrationintheserumbyusingacolorimet- ricmethod.TheresultsshowedthattheCa2+concentrationintheserumdecreasedbecauseof theelectroacupunctureattheST36acupoint(Fig5B).Thesefindingssupporttheideathat electroacupunctureappliedtotheST36acupointledtoCa2+influxinspleencells. TRPV1andTRPV4locatedatthesurfaceofsplenicCD4+Tcells TRPVchannelsareagroupofnon-selectivecationchannelsinTcells.Apreviousstudydem- onstratedthatTRPV1andTRPV4belongtotheTRPVsubfamilyandareexpressedendoge- nouslyinhumanandmiceTcells.TheactivationofTRPV1andTRPV4leadstoaCa2+influx inpurifiedmurineTcells[14].IthasalsobeenreportedthatelectroacupunctureattheST36 acupointhasaneffectonTRPV1andTRPV4[19,20].Toprobethecorrelationbetweenthe CD4andTRPVchannels,wedetectedtheexpressionofTRPV1andTRPV4inCD4+Tcells viaimmunofluorescence.WefoundthatTRPV1andTRPV4co-localizedwithCD4atthe membraneofsplenicCD4+Tcells(Fig6Aand6B).Thisfindingsuggestedthatelectroacu- punctureattheST36acupointledtoaCa2+influxinsplenicTcellsviaTRPVchannels. Fig5.TheconcentrationofCa2+inspleencellsandserum.(A)Thevaluesmentionedintheuppercornerofeachflowcytometricdot-plot indicatetheconcentrationofCa2+inspleencells.Representativedot-plotsofthreeindependentexperimentsareshown.Theconcentrationof Ca2+increasedinspleencellsoftheratstreatedbyelectroacupunctureattheST36acupoint.(B)TheconcentrationofCa2+inserumoftheratsin eachgroupwasdetected.ElectroacupunctureattheST36acupointcausedthedecreasingofCa2+contentinserum.*P<0.05forST36acupoint groupversuscontrolgroupandnonacupointgroup. https://doi.org/10.1371/journal.pone.0175568.g005 PLOSONE|https://doi.org/10.1371/journal.pone.0175568 April13,2017 7/13 ElectroacupuctureatST36acupointcouldenhanceimmunefunction Fig6.CD4andTRPVchannelsco-localizedatTcellmembrane.(A)Confocalimagesdemonstratedthat CD4andTRPV1co-localizedinTcellmembrane.CellswereimmunostainedwithspecificantibodiesforCD4 andTRPV1.(B)CD4andTRPV4co-localizedatTcellmembrane. https://doi.org/10.1371/journal.pone.0175568.g006 EffctofelectroacupunctureatST36acupointonTRPV1-/-mice InordertocheckiftheTRPVisnecessaryforelectroacupunctureenhancedimmunefunction, electroacupunctureatST36acupointwasappliedtoTRPV1-/-mice.Theresultsshowedthat theexpressionlevelofIFN-γhadnoobviouschangeinserumandspleenofTRPV1-/-mice withtheelectroacupunctureatST36acupoint(Fig7A,7Band7C).WithoutTRPV1,thereis nosignificantincreaseintheproportionofTcellswiththeexpressionofCD4underelectroa- cupuncturetreatment(Fig7D).WealsofoundthattheconcentrationofCa2+inthespleen cellsoftheST36acupointgroupwithTRPV1knockoutdidn’tincreasesignificantly(Fig7E). TheseresultssuggestedthatelectroacupunctureatST36acupointhadlittleeffectonTRPV1 -/-mice. Discussion InChina,acupuncture,especiallyattheST36acupoint,hasalonghistoryofuseasasupple- mentarytherapyforthetreatmentofacuteandchronicdiseases.Althoughthedetailedmecha- nismsunderlyingelectroacupunctureneedfurtherstudy,severalstudieshaveindicatedthat localmolecularandcellularchangesoccuratandaroundthelocationoftheacupoint.Some mechanismshavebeenproposedtoexplaintheeffectsofelectroacupuncture,including1)the extracellularsignal-regulatedkinase(ERK)pathway[20,21],2)theregulationofthenervous controlsystem(neurotransmitterregulation)[22,23],and3)anincreaseinfunctionofthe immunesystem[8,15,16].Inaddition,ithasbeensuggestedthatthemorphologicalchanges inducedbyacupunctureinfibroblastsandconnectivetissueareinvolvedinthetherapeutic effectofacupuncture[24,25].However,theexactmechanismsbywhichacupuncturefavor- ablyincreasesthefunctionofimmunesystemarenotwellknown.Ourpresentstudyclearly showedthatelectroacupuncturestimulationatthebilateralST36acupointonceaday(30min) for3dayssignificantlyenhancedthelevelsofIFN-γ,IL-2andIL-17(Figs2and3).Italso showedthatelectroacupunctureappliedtotheST36acupointincreasedthenumberofCD4+ Tcellsinthespleencomparedtothoseobservedinthenon-acupointandcontrolgroups PLOSONE|https://doi.org/10.1371/journal.pone.0175568 April13,2017 8/13 ElectroacupuctureatST36acupointcouldenhanceimmunefunction Fig7.ElectroacupunctureatST36acupointhadlittleeffectonTRPV1-/-mice.(A)TheIFN-γlevelsinserumofTRPV1-/-miceweredetected. (B)TheexpressionofTRPV1inspleenwasdetected.(C)TheexpressionlevelsofIFN-γinspleenweredetectedviawesternblot.GAPDHwasused ascontrol.(D)ProportionsofimmunopositiveCD4+TcellsinspleenofTRPV1-/-mice.(E)TheconcentrationofCa2+inspleencellsofTRPV1-/- mice.Thevaluesmentionedintheuppercornerofeachflowcytometricdot-plotindicatetheconcentrationofCa2+inspleencells.Representativedot- plotsofthreeindependentexperimentsareshown.TheconcentrationofCa2+hadnosignificantincreaseinspleencellsoftheTRPV1-/-micetreated byelectroacupunctureattheST36acupoint. https://doi.org/10.1371/journal.pone.0175568.g007 (Fig4Aand4B).Theseresultsindicatedasignificantlypositivecorrelationbetweenthelevels ofimmunecytokinesandCD4+Tcells. CD4isamarkerforhelperTcells.IL-2isprimarilyreleasedbyactivatedhelperTcells[26]. Intheimmunesystem,IL-2servesasanimportantfactorintheup-regulationofnaturalkiller (NK)activity.IFN-γcanbereleasedbybothhelperTcellsandIL-2-activatedNKcells[27– 29].IL-17isreleasedbyIL-17-producingCD4+Tcells(Th17cells).Asagrowthfactorfor botheffectorandregulatoryTcells,IL-2hasbeenshowntoenhancetheindirectrelationship thatexistsbetweenT andTh17cells.ApreviousstudydemonstratedthatT canbecon- REG REG vertedintoIL-17-expressingCD4+TcellsinthepresenceofexogenousIL-2[30].Considering thesereportsandthepresentresults,itispossiblethattheenhancementofIFN-γ,IL-2andIL- 17byelectroacupunctureattheST36acupointisdue,inpart,tothedifferentiationandactiva- tionofCD4+Tcells. ItisgenerallyacceptedthatCa2+signalingisimportantinthecontextofTcellactivation anddifferentiation.TheinvolvementofCa2+intheregulationoftheimmunesystemhasbeen demonstratedviathemodulationofextracellularandintracellularCa2+concentrationsusing severalCa2+chelatingagents.IthasbeenreportedthatEGTA,asachelatorofextracellular Ca2+,inhibitstheriseincytoplasmicCa2+,IL-2productionandthefurtherproliferationof naiveTcellsinresponsetoactivationstimuli[31].Additionally,Tcellactivationmediatedby concanavalinA(ConA)wassustainedforalongertimebecauseoftheimmediateriseinintra- cellularCa2+.Similarly,theexpressionofTcellantigenreceptorβ(TCR-β)isregulatedbythe PLOSONE|https://doi.org/10.1371/journal.pone.0175568 April13,2017 9/13 ElectroacupuctureatST36acupointcouldenhanceimmunefunction depletionofintracellularCa2+[18].Consideringthesereports,weassessedthelevelofintracel- lularCa2+inspleencells.TheresultsshowedthatthelevelofintracellularCa2+increased becauseofelectroacupunctureattheST36acupoint(Fig5A).Atthesametime,adecreasein theCa2+concentrationintheserumwasobserved(Fig5B).Theseresultsprovedthattherise intheintracellularCa2+inducedbyelectroacupunctureattheST36acupointwasresponsible forthedifferentiation,proliferationandactivationofsplenicCD4+Tcells. TRPV1andTRPV4arenon-selectiveCa2+ionchannelsbelongingtotheTRPVsubfamily. TheyareendogenouslyexpressedandfunctioninthesplenicTcellsofmice[14].Thefunc- tionalroleofTRPV1andTRPV4inthecontextofTcellactivationandeffectorfunctionshas beendescribedinapreviousstudy.Inthisstudy,itwasfoundthatCa2+influxwasinduced byTRPV1andTRPV4activationinpurifiedmurineTcells.IfTRPV1andTRPV4were inhibitedbyspecificinhibitors,theConA-drivenmitogenicactivationofTcellsdecreasedto significantlevels.TcellactivationwasalmostabolishedbythecombinationofTRPV1and TRPV4inhibitors.ThisfindingindicatesthatTRPV1andTRPV4playanimportantrolein Tcellactivation.Italsohasbeenreportedthattheinhibitionofthesechannelshadastrong inhibitoryeffectonthereleaseofcytokines,suchasTNF,IL-2andIFN-γ[14].FromFig6A and6B,wecanseeTRPV1andTRPV4wereexpressedandco-localizedwithCD4atthe membraneofsplenicTcells.Inpreviousstudy,ithasbeenreportedthatelectroacupunture atST36acupointhadeffectonTRPV1[32].Sowecheckedtheeffectofelectroacupuncture treatmentonTRPV1-/-mice.OurresultsshowedthatelectroacupunctureatST36acupoint hadlittleeffectonTRPV1-/-mice(Fig7).Accordingtotheseresults,weproposethatthe activationofTRPVchannelsbyelectroacupunctureattheST36acupointareresponsiblefor theCa2+influxinspleencells. Asacriticalcomponentoftheadaptiveimmunesystem,Tlymphocytesmediateprotection againstinfectionandmalignancybutarealsoinvolvedinmanyimmunepathologies.T-cell developmentplaysakeyroleinregulatingadaptiveimmuneresponses.Itisalsousedasa modelsystemforstudyingcelldifferentiation.T-celldevelopmenthasbeenofinterestto immunologistsforalongtime.Theeffectofacupunctureonimmunefunctionandthetreat- mentofacuteandchronicdiseaseshasbeendemonstratedbyclinicalandexperiment research.OurfindingsindicatedthatelectroacupunctureattheST36acupointenhance immunefunctionthroughtheactivationsplenicTcells. Inconclusion,thepresentstudyhasdemonstratedthatelectroacupunctureattheST36acu- pointwasabletoregulatetheproductionofimmunecytokines(IFN-γ,IL-2andIL-17)and thedifferentiationandactivationofsplenicTcells,whichwasmediatedbytheregulationof extracellularandintracellularCa2+concentrations.OurresultsalsosuggestedthatCa2+influx inspleencellsinducedbyelectroacupunctureattheST36acupointmightbemediatedby TRPVchannels.Furtherresearchonthemechanismofhowelectroacupunctureenhances immunefunctioniscurrentlybeingcarriedout. Supportinginformation S1Table.SpecificcriteriaformonitoringSDrats.Wetooknotesonfoodintake,water intakeandbodyweightofSDratsinaweektomonitoranimalhealth.Electroacupuncture treatmentwasappliedfromday5today7. (XLSX) S2Table.SpecificcriteriaformonitoringTRPV1knockoutmice.Wetooknotesonfood intake,waterintakeandbodyweightofTRPV1knockoutmiceinaweektomonitoranimal health.Electroacupuncturetreatmentwasappliedfromday5today7. (XLSX) PLOSONE|https://doi.org/10.1371/journal.pone.0175568 April13,2017 10/13

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ing pain [1–5]. Recently, some experimental and clinical studies have shown that sequential electroacupuncture stimulation applied to the ST36 acupoint (Zusanli acupuncture point) per- formed well in the treatment of stress-induced immunodeficiency [5, 6]. A previous study demonstrated that elect
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