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de la Fuente J, Pacheco I, Villar M, Cabezas-Cruz A. The alpha-Gal syndrome: new insights into the tick-host conflict and cooperation. Parasit Vectors 2019; 12:154. [PMID: 30944017 PMCID: PMC6448316 DOI: 10.1186/s13071-019-3413-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 03/27/2019] [Indexed: 02/04/2023] Open
Abstract
This primer focuses on a recently diagnosed tick-borne allergic disease known as the alpha-Gal syndrome (AGS). Tick bites induce in humans high levels of IgE antibodies against the carbohydrate Galα1-3Galβ1-(3)4GlcNAc-R (α-Gal) present on tick salivary glycoproteins and tissues of non-catarrhine mammals, leading to the AGS in some individuals. This immune response evolved as a conflict and cooperation between ticks and human hosts including their gut microbiota. The conflict is characterized by the AGS that mediate delayed anaphylaxis to red meat consumption and certain drugs such as cetuximab, and immediate anaphylaxis to tick bites. The cooperation is supported by the capacity of anti-α-Gal IgM and IgG antibody response to protect against pathogens with α-Gal on their surface. Despite the growing diagnosis of AGS in all world continents, many questions remain to be elucidated on the tick proteins and immune mechanisms triggering this syndrome, and the protective response against pathogen infection elicited by anti-α-Gal antibodies. The answer to these questions will provide information for the evaluation of risks, diagnosis and prevention of the AGS, and the possibility of using the carbohydrate α-Gal to develop vaccines for the control of major infectious diseases.
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Affiliation(s)
- José de la Fuente
- SaBio, Instituto de Investigación en Recursos Cinegéticos (IREC), Consejo Superior de Investigaciones Científicas (CSIC), Universidad de Castilla-La Mancha (UCLM)-Junta de Comunidades de Castilla-La Mancha (JCCM), Ronda de Toledo s/n, 13005 Ciudad Real, Spain
- Department of Veterinary Pathobiology, Center for Veterinary Health Sciences, Oklahoma State University, Stillwater, OK 74078 USA
| | - Iván Pacheco
- SaBio, Instituto de Investigación en Recursos Cinegéticos (IREC), Consejo Superior de Investigaciones Científicas (CSIC), Universidad de Castilla-La Mancha (UCLM)-Junta de Comunidades de Castilla-La Mancha (JCCM), Ronda de Toledo s/n, 13005 Ciudad Real, Spain
| | - Margarita Villar
- SaBio, Instituto de Investigación en Recursos Cinegéticos (IREC), Consejo Superior de Investigaciones Científicas (CSIC), Universidad de Castilla-La Mancha (UCLM)-Junta de Comunidades de Castilla-La Mancha (JCCM), Ronda de Toledo s/n, 13005 Ciudad Real, Spain
| | - Alejandro Cabezas-Cruz
- UMR BIPAR, INRA, ANSES, Ecole Nationale Vétérinaire d’Alfort, Université Paris-Est, Maisons-Alfort, 94700 France
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Affinity war: forging immunoglobulin repertoires. Curr Opin Immunol 2019; 57:32-39. [PMID: 30690255 DOI: 10.1016/j.coi.2018.12.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 12/03/2018] [Indexed: 11/20/2022]
Abstract
B cell immunoglobulin (Ig) repertoire composition shapes immune responses. The generation of Ig diversity begins with Ig variable region exon assembly from gene segments, random inter-segment junction sequence diversity, and combinations of Ig heavy and light chain. This generates vast preemptive sequence freedom in early developing B lineage cell Ig genes that can anticipate a great diversity of threats. This freedom is met with large restrictions that ultimately define the naïve (i.e. preimmune) Ig repertoire. Activation-induced somatic hypermutation (SHM), which further diversifies Ig V regions, is also met with strong selection that shapes Ig affinity maturation. While individual repertoire features, such as affinity for self and competition for foreign antigen, are known to drive selection, the selection filters themselves may be subject to regulation. Large sequence freedom coupled with strong selection for each diversification process provides flexibility for demand-driven regulation to dynamically balance antigen recognition capacities and associated autoimmune risks according to host needs.
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Hilger C, Fischer J, Wölbing F, Biedermann T. Role and Mechanism of Galactose-Alpha-1,3-Galactose in the Elicitation of Delayed Anaphylactic Reactions to Red Meat. Curr Allergy Asthma Rep 2019; 19:3. [PMID: 30673913 PMCID: PMC6344609 DOI: 10.1007/s11882-019-0835-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Purpose of Review The alpha-Gal (α-Gal) syndrome is characterized by the presence of IgE antibodies directed at the carbohydrate galactose-alpha-1,3-galactose (α-Gal). In this article, we review the presence of α-Gal in food and non-food sources; we discuss the evolutionary context of the antibody response to α-Gal and highlight immune responses to α-Gal and other carbohydrates. Recent findings IgE antibodies have been associated with delayed allergy to red meat. In addition to food, drugs, and other products of animal origin are increasingly perceived as a risk for patients sensitized to α-Gal. The link between tick bites and anti-α-Gal IgE-antibody production that has been established first by epidemiological studies has now been confirmed in mouse models. Summary The anti-α-Gal immune response is complex and characterized by a unique feature. IgM and IgG antibodies have been found to confer protection against pathogens whereas the IgE-response to α-Gal is detrimental and causes severe reactions upon exposure to mammalian meat and other products.
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Affiliation(s)
- Christiane Hilger
- Department of Infection and Immunity, Luxembourg Institute of Health (LIH), 29, rue Henri Koch, L-4354, Esch-sur-Alzette, Luxembourg.
| | - Jörg Fischer
- Department of Dermatology, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Florian Wölbing
- Department of Dermatology and Allergy Biederstein, Technical University of Munich, Munich, Germany
| | - Tilo Biedermann
- Department of Dermatology and Allergy Biederstein, Technical University of Munich, Munich, Germany.,Clinical Unit Allergology, Helmholtz Zentrum München, German Research Center for Environmental Health GmbH, Neuherberg, Germany
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Tick galactosyltransferases are involved in α-Gal synthesis and play a role during Anaplasma phagocytophilum infection and Ixodes scapularis tick vector development. Sci Rep 2018; 8:14224. [PMID: 30242261 PMCID: PMC6154994 DOI: 10.1038/s41598-018-32664-z] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 09/12/2018] [Indexed: 12/25/2022] Open
Abstract
The carbohydrate Galα1-3Galβ1-(3)4GlcNAc-R (α-Gal) is produced in all mammals except for humans, apes and old world monkeys that lost the ability to synthetize this carbohydrate. Therefore, humans can produce high antibody titers against α-Gal. Anti-α-Gal IgE antibodies have been associated with tick-induced allergy (i.e. α-Gal syndrome) and anti-α-Gal IgG/IgM antibodies may be involved in protection against malaria, leishmaniasis and Chagas disease. The α-Gal on tick salivary proteins plays an important role in the etiology of the α-Gal syndrome. However, whether ticks are able to produce endogenous α-Gal remains currently unknown. In this study, the Ixodes scapularis genome was searched for galactosyltransferases and three genes were identified as potentially involved in the synthesis of α-Gal. Heterologous gene expression in α-Gal-negative cells and gene knockdown in ticks confirmed that these genes were involved in α-Gal synthesis and are essential for tick feeding. Furthermore, these genes were shown to play an important role in tick-pathogen interactions. Results suggested that tick cells increased α-Gal levels in response to Anaplasma phagocytophilum infection to control bacterial infection. These results provided the molecular basis of endogenous α-Gal production in ticks and suggested that tick galactosyltransferases are involved in vector development, tick-pathogen interactions and possibly the etiology of α-Gal syndrome in humans.
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Aguilar R, Ubillos I, Vidal M, Balanza N, Crespo N, Jiménez A, Nhabomba A, Jairoce C, Dosoo D, Gyan B, Ayestaran A, Sanz H, Campo JJ, Gómez-Pérez GP, Izquierdo L, Dobaño C. Antibody responses to α-Gal in African children vary with age and site and are associated with malaria protection. Sci Rep 2018; 8:9999. [PMID: 29968771 PMCID: PMC6030195 DOI: 10.1038/s41598-018-28325-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 06/20/2018] [Indexed: 01/12/2023] Open
Abstract
Naturally-acquired antibody responses to malaria parasites are not only directed to protein antigens but also to carbohydrates on the surface of Plasmodium protozoa. Immunoglobulin M responses to α-galactose (α-Gal) (Galα1-3Galβ1-4GlcNAc-R)-containing glycoconjugates have been associated with protection from P. falciparum infection and, as a result, these molecules are under consideration as vaccine targets; however there are limited field studies in endemic populations. We assessed a wide breadth of isotype and subclass antibody response to α-Gal in children from Mozambique (South East Africa) and Ghana (West Africa) by quantitative suspension array technology. We showed that anti-α-Gal IgM, IgG and IgG1–4 levels vary mainly depending on the age of the child, and also differ in magnitude in the two sites. At an individual level, the intensity of malaria exposure to P. falciparum and maternally-transferred antibodies affected the magnitude of α-Gal responses. There was evidence for a possible protective role of anti-α-Gal IgG3 and IgG4 antibodies. However, the most consistent findings were that the magnitude of IgM responses to α-Gal was associated with protection against clinical malaria over a one-year follow up period, especially in the first months of life, while IgG levels correlated with malaria risk.
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Affiliation(s)
- Ruth Aguilar
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Itziar Ubillos
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Marta Vidal
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Núria Balanza
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Núria Crespo
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Alfons Jiménez
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Catalonia, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Augusto Nhabomba
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Chenjerai Jairoce
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - David Dosoo
- Kintampo Health Research Center, Kintampo, Ghana
| | - Ben Gyan
- Kintampo Health Research Center, Kintampo, Ghana
| | - Aintzane Ayestaran
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Hèctor Sanz
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Joseph J Campo
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Catalonia, Spain
| | | | - Luis Izquierdo
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Catalonia, Spain.
| | - Carlota Dobaño
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Catalonia, Spain.
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56
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Apostolovic D, Rodrigues R, Thomas P, Starkhammar M, Hamsten C, van Hage M. Immunoprofile of α-Gal- and B-antigen-specific responses differentiates red meat-allergic patients from healthy individuals. Allergy 2018; 73:1525-1531. [PMID: 29319188 DOI: 10.1111/all.13400] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND The galactose-α-1,3-galactose (α-Gal) epitope is involved in red meat allergy. As α-Gal is structurally similar to the blood group B-antigen, we explored the relationship between the immune responses to α-Gal- and the B-antigen in red meat-allergic patients compared to healthy A/O or B blood donors. METHODS Sera from 51 red meat-allergic patients IgE-positive to α-Gal and 102 healthy blood donors (51 blood group A/O; 51 blood group B) were included. α-Gal- and B-antigen-specific IgE (ImmunoCAP) and IgG/IgG1-4 (ELISA) responses were determined. Basophil activation tests were performed. RESULTS Fifteen healthy donors were IgE positive to α-Gal, of which 3 had blood group B. The allergic patients had significantly higher α-Gal IgE levels compared to the healthy donors. The majority of the allergic patients, but none of the healthy donors, had IgE against the B-antigen. Inhibition studies revealed cross-reactivity between α-Gal and the B-antigen. The biological activity of the B-antigen was confirmed by basophil activation tests. Anti-α-Gal IgG1 and IgG4 levels were significantly higher in the patients compared to the healthy donors. Moreover, the IgG response to the B-antigen was comparable between the allergic patients and healthy A/O donors. CONCLUSION Red meat-allergic patients showed significantly higher α-Gal IgE, IgG1 , and IgG4 levels, reflecting a Th2 response, compared to healthy blood donors. Blood group B donors had significantly reduced antibody responses to α-Gal, due to similarities with the B-antigen, resulting in a lower risk of sensitization to α-Gal and development of red meat allergy.
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Affiliation(s)
- D. Apostolovic
- Department of Medicine Solna; Immunology and Allergy Unit; Karolinska Institutet and University Hospital; Stockholm Sweden
| | - R. Rodrigues
- Department of Clinical Immunology and Transfusion Medicine; Karolinska University Hospital; Stockholm Sweden
| | - P. Thomas
- Department of Medicine Solna; Immunology and Allergy Unit; Karolinska Institutet and University Hospital; Stockholm Sweden
| | - M. Starkhammar
- Department of Internal Medicine; Södersjukhuset; Stockholm Sweden
| | - C. Hamsten
- Department of Medicine Solna; Immunology and Allergy Unit; Karolinska Institutet and University Hospital; Stockholm Sweden
| | - M. van Hage
- Department of Medicine Solna; Immunology and Allergy Unit; Karolinska Institutet and University Hospital; Stockholm Sweden
- Department of Clinical Immunology and Transfusion Medicine; Karolinska University Hospital; Stockholm Sweden
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de la Fuente J. Controlling ticks and tick-borne diseases…looking forward. Ticks Tick Borne Dis 2018; 9:1354-1357. [PMID: 29656834 DOI: 10.1016/j.ttbdis.2018.04.001] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 04/02/2018] [Accepted: 04/04/2018] [Indexed: 01/05/2023]
Abstract
Tick-borne diseases (TBDs) represent a growing burden for human and animal health worldwide. Several approaches including the use of chemicals with repellency and parasiticidal activity, habitat management, genetic selection of hosts with higher resistance to ticks, and vaccines have been implemented for reducing the risk of TBDs. However, the application of latest gene editing technologies in combination with vaccines likely combining tick and pathogen derived antigens and other control measures should result in the development of effective, safe, and environmentally sound integrated control programs for the prevention and control of TBDs. This paper is not a review of current approaches for the control of ticks and TBDs, but an opinion about future directions in this area.
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Affiliation(s)
- José de la Fuente
- SaBio, Instituto de Investigación en Recursos Cinegéticos IREC (CSIC-UCLM-JCCM), Ronda de Toledo s/n, 13005 Ciudad Real, Spain; Department of Veterinary Pathobiology, Center for Veterinary Health Sciences, Oklahoma State University, Stillwater, OK 74078, USA, USA.
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58
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Cabezas-Cruz A, de la Fuente J. Immunity to α-Gal: The Opportunity for Malaria and Tuberculosis Control. Front Immunol 2017; 8:1733. [PMID: 29255472 PMCID: PMC5723007 DOI: 10.3389/fimmu.2017.01733] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 11/23/2017] [Indexed: 01/07/2023] Open
Affiliation(s)
- Alejandro Cabezas-Cruz
- UMR BIPAR, INRA, ANSES, Ecole Nationale Vétérinaire d'Alfort, Université Paris-Est, Paris, France.,Faculty of Science, University of South Bohemia, České Budějovice, Czechia.,Institute of Parasitology, Biology Center, Czech Academy of Sciences, České Budějovice, Czechia
| | - José de la Fuente
- SaBio, Instituto de Investigación en Recursos Cinegéticos IREC (CSIC-UCLM-JCCM), Ciudad Real, Spain.,Department of Veterinary Pathobiology, Center for Veterinary Health Sciences, Oklahoma State University, Stillwater, OK, United States
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59
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Cabezas-Cruz A, de la Fuente J, Fischer J, Hebsaker J, Lupberger E, Blumenstock G, Aichinger E, Yazdi AS, Enkel S, Oehme R, Biedermann T. Prevalence of type I sensitization to alpha-gal in forest service employees and hunters: Is the blood type an overlooked risk factor in epidemiological studies of the α-Gal syndrome? Allergy 2017; 72:2044-2047. [PMID: 29159820 DOI: 10.1111/all.13206] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- A. Cabezas-Cruz
- UMR BIPAR; Animal Health Laboratory; INRA; ANSES; ENVA; Université Paris-Est; Maisons Alfort Cedex France
- Faculty of Science; University of South Bohemia; České Budějovice Czech Republic
- Biology Center; Institute of Parasitology; Czech Academy of Sciences; České Budějovice Czech Republic
| | - J. de la Fuente
- SaBio; Instituto de Investigación en Recursos Cinegéticos IREC (CSIC-UCLM-JCCM); Ciudad Real Spain
- Department of Veterinary Pathobiology; Center for Veterinary Health Sciences; Oklahoma State University; Stillwater OK USA
| | - J. Fischer
- Department of Dermatology; Faculty of Medicine; Eberhard Karls University Tuebingen; Tuebingen Germany
| | - J. Hebsaker
- Department of Dermatology; Faculty of Medicine; Eberhard Karls University Tuebingen; Tuebingen Germany
| | - E. Lupberger
- Department of Dermatology; Faculty of Medicine; Eberhard Karls University Tuebingen; Tuebingen Germany
| | - G. Blumenstock
- Department of Clinical Epidemiology and Applied Biostatistics; Faculty of Medicine; Eberhard Karls University Tuebingen; Tuebingen Germany
| | - E. Aichinger
- Baden-Württemberg State Health Office; District Government Stuttgart; Stuttgart Germany
| | - A. S. Yazdi
- Department of Dermatology; Faculty of Medicine; Eberhard Karls University Tuebingen; Tuebingen Germany
| | - S. Enkel
- Clinical Transfusion Medicine; ZKT Tuebingen; University Hospital Tuebingen; Tuebingen Germany
| | - R. Oehme
- Baden-Württemberg State Health Office; District Government Stuttgart; Stuttgart Germany
| | - T. Biedermann
- Department of Dermatology; Faculty of Medicine; Eberhard Karls University Tuebingen; Tuebingen Germany
- Department of Dermatology and Allergy Biederstein; Technische Universität; Munich Germany
- Clinical Unit Allergology; Helmholtz Zentrum München; German Research Center for Environmental Health; Neuherberg Germany
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60
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Cabezas-Cruz A, de la Fuente J. Immunity to α-Gal: Toward a Single-Antigen Pan-Vaccine To Control Major Infectious Diseases. ACS CENTRAL SCIENCE 2017; 3:1140-1142. [PMID: 29202015 PMCID: PMC5704288 DOI: 10.1021/acscentsci.7b00517] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Alejandro Cabezas-Cruz
- UMR BIPAR, INRA, ANSES, Ecole Nationale Vétérinaire d’Alfort, Université Paris-Est, Maisons-Alfort, 94700, France
- Faculty of Science, University of South Bohemia, České Budějovice 37005, Czech Republic
- Institute of Parasitology, Biology Center, Czech Academy of Sciences, České Budějovice 37005, Czech Republic
| | - José de la Fuente
- SaBio, Instituto de Investigación de Recursos Cinegéticos, IREC-CSIC-UCLM-JCCM, 13005 Ciudad Real, Spain
- Department of Veterinary Pathobiology, Center for Veterinary Health Sciences, Oklahoma State University, Stillwater, Oklahoma 74078, United States
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Cabezas-Cruz A, Mateos-Hernández L, Chmelař J, Villar M, de la Fuente J. Salivary Prostaglandin E2: Role in Tick-Induced Allergy to Red Meat. Trends Parasitol 2017; 33:495-498. [DOI: 10.1016/j.pt.2017.03.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 12/20/2016] [Accepted: 03/10/2017] [Indexed: 01/31/2023]
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