War and peace at mucosal surfaces

Synbiotics and the mucosal barrier in critically ill patients

PURPOSE OF REVIEW

Outcome in severe and critical illnesses is strongly related to premorbid conditions: the strength of the mucosal barriers, the innate immune system, and the built-in resistance to disease. Early risk factors and determinants of poor outcome are factors such advanced age; impaired premorbid health status, especially diabetes and high body mass index (obesity); and immunosuppressive treatments. Combined supplementation of bioactive fibers and lactic acid bacteria (synbiotics) directly and indirectly influences several of these factors.

RECENT FINDINGS

Determinants for poor outcome are degree of oxidative stress, neutrophil activation, and infiltration of tissues, especially in the lungs. Attempts at early reduction of the exaggerated inflammatory storm and limitation of further impairment of the immune function are always given the highest priority. The supply of live lactic acid bacteria and plant fibers can dramatically reduce the hyperinflammation and also the infiltration by neutrophils of organs such as the lungs. New and efficient autopositioning and regurgitation-resistant feeding tubes provide instruments for the early supply of enteral nutrition with immune-boosting antioxidants and synbiotics.

SUMMARY

A meticulous choice of probiotic lactic acid bacteria is recommended because only a small minority of the lactic acid bacteria survive the harsh environment of the upper gastrointestinal tract, ferment strong semiresistant fibers such as inulin, and have the ability to control inflammation and eliminate unwanted pathogens, such as antibiotic-resistant microorganisms and Clostridium difficile.

Mucosal B cells: phenotypic characteristics, transcriptional regulation, and homing properties

Mucosal antibody defense depends on a complex cooperation between local B cells and secretory epithelia. Mucosa-associated lymphoid tissue gives rise to B cells with striking J-chain expression that are seeded to secretory effector sites. Such preferential homing constitutes the biological basis for local production of polymeric immunoglobulin A (pIgA) and pentameric IgM with high affinity to the epithelial pIg receptor that readily can export these antibodies to the mucosal surface. This ultimate functional goal of mucosal B-cell differentiation appears to explain why the J chain is also expressed by IgG- and IgD-producing plasma cells (PCs) occurring at secretory tissue sites; these immunocytes may be considered as 'spin-offs' from early effector clones that through class switch are on their way to pIgA production. Abundant evidence supports the notion that intestinal PCs are largely derived from B cells initially activated in gut-associated lymphoid tissue (GALT). Nevertheless, insufficient knowledge exists concerning the relative importance of M cells, major histocompatibility complex class II-expressing epithelial cells, and professional antigen-presenting cells for the uptake, processing, and presentation of luminal antigens in GALT to accomplish the extensive and sustained priming and expansion of mucosal B cells. Likewise, it is unclear how the germinal center reaction in GALT so strikingly can promote class switch to IgA and expression of J chain. Although B-cell migration from GALT to the intestinal lamina propria is guided by rather well-defined adhesion molecules and chemokines/chemokine receptors, the cues directing preferential homing to different segments of the gut require better definition. This is even more so for the molecules involved in homing of mucosal B cells to secretory effector sites beyond the gut, and in this respect, the role of Waldever's ring (including the palatine tonsils and adenoids) as a regional inductive tissue needs further characterization. Data suggest a remarkable compartmentalization of the mucosal immune system that must be taken into account in the development of effective local vaccines to protect specifically the airways, eyes, oral cavity, small and large intestines, and urogenital tract.

MHC class II+ cells in the gills of Atlantic salmon (Salmo salar L.) affected by amoebic gill disease

Amoebic gill disease (AGD) is characterised by the association of Neoparamoeba sp. with hyperplastic gill tissue of affected fishes, however, the identity and role of host cells associated with AGD lesions are not known. Here, we investigated cells with an immunological role that were associated with AGD lesions by locating cellular MHC class II beta chain. A tank housing Atlantic salmon (Salmo salar) was inoculated with Neoparamoeba sp., and MHC class II beta chain expression in the gills was qualitatively assessed by immunohistochemistry. In AGD-naïve control fish, MHC class II+ cells were detected basolateral to the interlamellar epithelium as well as upon the interlamellar and secondary epithelium. In the gills of AGD affected fish MHC class II+ cells were observed in both affected and unaffected tissue. Within AGD lesions, numerous MHC class II+ cells were present and these cells exhibited variable levels of expression suggesting that like mammals, MHC class II expression is highly regulated. The presence of MHC class II+ cells within gill lesions is indicative of immune cell trafficking and these cells could contribute in an antigen presentation capacity to the development of an antibody response in fish chronically affected by AGD.

The Shigella flexneri effector OspG interferes with innate immune responses by targeting ubiquitin-conjugating enzymes

Bacteria of Shigella spp. are responsible for shigellosis in humans. They use a type III secretion system to inject effector proteins into host cells and induce their entry into epithelial cells or trigger apoptosis in macrophages. We present evidence that the effector OspG is a protein kinase that binds various ubiquitinylated ubiquitin-conjugating enzymes, including UbcH5, which belongs to the stem cell factor SCF(beta-TrCP) complex promoting ubiquitination of phosphorylated inhibitor of NF-kappaB type alpha (phospho-IkappaBalpha). Transfection experiments indicated that OspG can prevent phospho-IkappaBalpha degradation and NF-kappaB activation induced by TNF-alpha stimulation. Infection of epithelial cells by the S. flexneri wild-type strain, but not an ospG mutant, led to accumulation of phospho-IkappaBalpha, consistent with OspG inhibiting SCF(beta-TrCP) activity. Upon infection of ileal loops in rabbits, the ospG mutant induced a stronger inflammatory response than the wild-type strain. This finding indicates that OspG negatively controls the host innate response induced by S. flexneri upon invasion of the epithelium.

Shigella effector IpaH9.8 binds to a splicing factor U2AF(35) to modulate host immune responses

Shigella effectors injected into the host cell via the type III secretion system are involved in various aspects of infection. Here, we show that one of the effectors, IpaH9.8, plays a role in modulating inflammatory responses to Shigella infection. In murine lung infection model, DeltaipaH9.8 mutant caused more severe inflammatory responses with increased pro-inflammatory cytokine production levels than did wild-type Shigella, which resulted in a 30-fold decrease in bacterial colonization. Binding assays revealed that IpaH9.8 has a specific affinity to U2AF(35), a mammalian splicing factor, which interferes with U2AF(35)-dependent splicing as assayed for IgM pre-mRNA. Reducing the U2AF(35) level in HeLa cells and infecting HeLa cells with wild-type caused a decrease in the expression of the il-8, RANTES, GM-CSF, and il-1beta genes as examined by RT-PCR. The results indicate that IpaH9.8 plays a role in Shigella infection to optimize the host inflammatory responses, thus facilitating bacterial colonization within the host epithelial cells.

NOD proteins: an intracellular pathogen-recognition system or signal transduction modifiers?

NOD1 and NOD2 are members of a diverse family of cytoplasmic proteins that contain C-terminal leucine-rich repeats. Because of their similarity to a family of plant proteins involved in pathogen resistance, and because mutations in Card15, encoding NOD2, are frequently found in familial cases of Crohn's disease--an intestinal malady of excessive inflammation--NOD proteins have been proposed to fulfill a role in the intracellular sensing of bacteria. Indeed, NOD proteins seem to alter the ability of cells to respond to fragments from bacterial cell walls. This system could function analogously to the Toll-like receptors--extracellular proteins that play an essential role in pathogen recognition. However, the idea of an intracellular system that specifically recognizes bacterial cell components is controversial and alternative functions of NODs are possible including regulating signal transduction systems.

Bartonella–host-cell interactions and vascular tumour formation

Bartonellae are arthropod-borne bacterial pathogens that typically cause persistent infection of erythrocytes and endothelial cells in their mammalian hosts. In human infection, these host-cell interactions result in a broad range of clinical manifestations. Most remarkably, bartonellae can trigger massive proliferation of endothelial cells, leading to vascular tumour formation. The recent availability of infection models and bacterial molecular genetic techniques has fostered research on the pathogenesis of the bartonellae and has advanced our understanding of the virulence mechanisms that underlie the host-cell tropism, the subversion of host-cell functions during bacterial persistence, as well as the formation of vascular tumours by these intriguing pathogens.

The gut: beyond immunology

The immune system is characterized by the ability to distinguish self from non-self. The intestinal immune system bears this latter property but, furthermore, it must discriminate among nutritious and beneficial substances from toxic or harmful ones. Considering that the gut has to be colonized by commensal bacteria participating in digestion as well as in the control of pathogen microorganisms, it is not surprising that mucosal surfaces are the largest and probably the most exquisitely specialized immune system's compartment. This means that not only innate and adaptive immunity are present, but further, particular structures, cells, and mechanisms such as physical barrriers, epithelia, Peyer's patches, M cells among others, which together are involved in the dynamic control of the homeostasis between gut and its flora. The present review deals with some popular conceptions about the digestive system with particular emphasis on the gut's immunology.

Oral spore vaccine based on live attenuated nontoxinogenic Bacillus anthracis expressing recombinant mutant protective antigen

An attenuated nontoxinogenic nonencapsulated Bacillus anthracis spore vaccine expressing high levels of recombinant mutant protective antigen (PA), which upon subcutaneous immunization provided protection against a lethal B. anthracis challenge, was found to have the potential to serve also as an oral vaccine. Guinea pigs immunized per os with the recombinant spore vaccine were primed to B. anthracis vegetative antigens as well as to PA, yet only a fraction of the animals (30% to 50%) mounted a humoral response to all of these antigens. Protective immunity provided by per os immunization correlated with a threshold level of PA neutralizing antibody titers and was long-lasting. Protection conferred by per os immunization was attained when the vaccine was administered in the sporogenic form, which, unlike the vegetative cells, survived passage through the gastrointestinal tract. A comparison of immunization of unirradiated spores with immunization of gamma-irradiated spores demonstrated that germination and de novo synthesis of PA were prerequisites for mounting an immune protective response. Oral immunization of guinea pigs with attenuated B. anthracis spores resulted in a characteristic anti-PA immunoglobulin isotype profile (immunoglobulin [G1 IgG1] versus IgG2), as well as induction of specific anti-PA secretory IgA, indicating development of mucosal immunity.

Inducible lymphoid tissues in the adult gut: recapitulation of a fetal developmental pathway?

The intestinal immune system faces an extraordinary challenge from the large numbers of commensal bacteria and potential pathogens that are restrained by only a single layer of epithelial cells. Here, I discuss evidence that the intestinal immune system develops an extensive network of inducible, reversible lymphoid tissues that contributes to the vital equilibrium between the gut and the bacterial flora. I propose that this network is induced by cryptopatches, which are small clusters of dendritic cells and lymphoid cells that are identical to fetal inducers of lymph-node and Peyer's-patch development.

Lactobacilli activate human dendritic cells that skew T cells toward T helper 1 polarization

Professional antigen-presenting dendritic cells (DCs) are critical in regulating T cell immune responses at both systemic and mucosal sites. Many Lactobacillus species are normal members of the human gut microflora and most are regarded as safe when administered as probiotics. Because DCs can naturally or therapeutically encounter lactobacilli, we investigated the effects of several well defined strains, representing three species of Lactobacillus on human myeloid DCs (MDCs) and found that they modulated the phenotype and functions of human MDCs. Lactobacillus-exposed MDCs up-regulated HLA-DR, CD83, CD40, CD80, and CD86 and secreted high levels of IL-12 and IL-18, but not IL-10. IL-12 was sustained in MDCs exposed to all three Lactobacillus species in the presence of LPS from Escherichia coli, whereas LPS-induced IL-10 was greatly inhibited. MDCs activated with lactobacilli clearly skewed CD4(+) and CD8(+) T cells to T helper 1 and Tc1 polarization, as evidenced by secretion of IFN-gamma, but not IL-4 or IL-13. These results emphasize a potentially important role for lactobacilli in modulating immunological functions of DCs and suggest that certain strains could be particularly advantageous as vaccine adjuvants, by promoting DCs to regulate T cell responses toward T helper 1 and Tc1 pathways.