In this study, we demonstrated that menopause amplified the age-related increase in the expression of macrophage-associated genes in the frontal cortex. From the major findings we conclude that i) the microglia phenotype shifts from the resting towards the activated state in a rat model of menopause, ii) the shift is reversible, iii) altered expression of phagocytic receptors may indicate modified phagocytic activity, iv) impairment of regulatory mechanisms may contribute to the early state of microglia activation, and v) strikingly similar changes occur in the forebrain of postmenopausal women.
The microglia phenotype shifts from the resting toward the activated state in the frontal cortex of middle-aged ovariectomized rats
Slight up-regulation of Cd11b, Fcgr2b, Tlr9, RT1-Aw2, and Cd74 in the frontal cortex of middle-aged rats indicates an initial age-related alteration in microglial gene expression. Elevated expression of C1q, C3 and Il1b is in accord with previous studies [18–22]. As these genes are expressed in astrocytes and microglia, it is likely that changes of glial phenotypes are intertwined. It is worth noting that the expression of C1-Inh, encoding the sole regulator of the classical activation pathway , does not change, suggesting that the control of the classical pathway may be impaired.
Ovarian hormone deficiency enhanced the expression of Cd11b, Cd18, Cd32, Cd45, Cd86, Tlr4, RT1-Aw2, and decreased Cd36, reflecting an initial shift in the microglia phenotype. The increase in the expression of IFN regulatory factors Irf7 and Irf9 is in accord with the shift of microglia from the resting phenotype . Down-regulation of Cd36  is also a characteristic feature of the acquired microglia phenotype. We suggest that down-regulation of Cd36 may underlie the decreased internalization of amyloid-β by aged compared to young microglia .
Our human microarray data analysis identified strikingly similar changes. Based on these results we propose that in the PG and SG of postmenopausal women the microglia phenotype is characterized by the up-regulation of CD11b, CD14, CD18, CD45, CD74, CD86, TLR4, and down-regulation of CD36. Notably, the expression of CD40 and NOS2 does not change.
The effect of E2 indicates that the shift in microglia phenotype is reversible
E2 replacement attenuated the ovarian hormone deprivation-related increase in the expression of Cd11b, Cd18, Fcgr2b, Msr2, Cd45, Cd86, Tlr4, RT1-Aw2 and RT1-N1. Down-regulation of these macrophage-associated genes suggests that E2 may attenuate microglial activation. This notion is consistent with the regulatory role of E2 on macrophage functions  and microglia activation in inflammatory [12, 50] and injury  models.
Complement-mediated phagocytosis may increase in the middle-aged cortex
Age-dependent elevation takes place in the expression of C1q, and its phagocytic receptor CD93 in the frontal cortex of female rats. C1q binds to pathogens and apoptotic cells, directly or through antibodies and pentraxins . C1q binding initiates the classical pathway of complement resulting in recruitment of phagocytes, phagocytosis of apoptotic cells and destruction of invading pathogens. In the brain C1q also recognizes and binds to proteins with pathogenic conformation, such as amyloid-β and prion protein. Elevated expression of C1q may facilitate early recognition and phagocytosis of pathogenic substances in the aging brain.
C3 is the central component of the complement system . Activation pathways converge at C3, and its proteolytic fragments are ligands for complement receptors on various cell types including microglia. The interaction between C3 fragment iC3b and CR3 links complement activation and phagocyte functions. In the presence of C3 activators, elevated expression of C3 and CR3 may contribute to early steps of microglia activation, often referred to as microglial priming . This notion is supported by the co-localization of C3b fragments and activated microglia in humans and in rodent models of neuroinflammatory diseases [52–54]. The impact of the interaction between C3 fragments and CR3 on microglia priming has been recently demonstrated in a multiple sclerosis model .
Neuronal inhibitory pathways and estrogen signaling are altered after menopause
Neuronal inhibitory ligands play a pivotal role in the tight control of microglia reactivity [24, 43]. We demonstrated age- and ovariectomy-related alterations in the expression of inhibitory ligands, including down-regulation of Cx3cl1 and Cd200, and up-regulation of Cd47 in the frontal cortex of middle-aged rats. The expression of microglial receptors for these ligands also showed changes, including down-regulation of Cd200r and up-regulation of Cx3cr1. Decreased expression of Cd200r is in accord with the age-related decrease in the expression of CD200R protein in the mouse brain . CD200 fusion protein decreases microglia activation in the hippocampus of aged rats . These data suggest that decreased expression of Cd200 and Cd200r may contribute to the increased expression of macrophage-associated genes. In the PG and SG of postmenopausal women, down-regulation of CD200 and CX3CL1 also indicates the impairment of major regulatory mechanisms for the control of microglia reactivity.
Estrogen signaling is also involved in the regulation of microglia reactivity [4, 50]. Direct regulation is supported by the presence of ERα and ERβ in microglial cells  and by the well-known effects of E2 on macrophages . However, ERα and ERβ are also expressed in neurons, astrocytes , and oligodendrocytes , so the role of indirect effects cannot be ruled out either. Here, we provide evidence for inverse age-related regulation of ERα and ERβ. Decreased expression of ERα together with the declining levels of E2 is likely to reduce estrogen signaling in the aging rat cortex following ovariectomy. However, we found no sign of alteration of ESR1 and ESR2 expression in the forebrain of postmenopausal women.
Summing up, the results provide evidence for microglial activation in the cortex of middle-aged rats following surgical menopause. Based on the overlapping changes from rodent and human studies, we propose that in the forebrain of postmenopausal women the microglia phenotype shifts from the resting towards the reactive state, which is characterized by up-regulation of CD11b, CD18, CD45, CD74, CD86, TLR4, down-regulation of CD36 and unchanged CD40 expression. This early state of activation, called microglial priming, seems to be reversible, as E2 replacement attenuates the expression of macrophage-associated genes in the rat frontal cortex. Microglia priming results in a phenotype with a lower threshold for subsequent activation [2, 59]. It is proposed that in the presence of primed microglia, systemic infection and inflammation pose a higher threat for the aging brain .