Oral tolerance induced by gut-processed antigen

The Gut-Renal Connection in IgA Nephropathy

The connection between a dysregulated gut-associated lymphoid tissue and IgA nephropathy (IgAN) was supposed decades ago after the observation of increased association of IgAN with celiac disease. Pivotal studies have shown a role for alimentary antigens, particularly gliadin in developing IgAN in BALB/c mice, and a reduction in IgA antigliadin antibodies and proteinuria was reported after gluten free-diet in patients with IgAN. Recently a genome-wide association study showed that most loci associated with IgAN also are associated with immune-mediated inflammatory bowel diseases, maintenance of the intestinal barrier, and response to gut pathogens. Transgenic mice that overexpress the B-cell activating factor develop hyper-IgA with IgAN modulated by alimentary components and intestinal microbiota. Mice expressing human IgA1 and a soluble form of the IgA receptor (sCD89) develop IgAN, which is regulated by dietary gluten. Recent observations have confirmed gut-associated lymphoid tissue hyper-reactivity in IgAN patients with IgA against alimentary components. Interesting results were provided by the NEFIGAN randomized controlled trial, which adopted an enteric controlled-release formulation of the corticosteroid budesonide targeted to Peyer's patches. After 9 months of treatment, a reduction in proteinuria was observed with stabilized renal function and limited adverse events. The gut-renal connection is an area of promising new treatment approaches for patients with IgAN.

Oral administration of bovine whey proteins to mice elicits opposing immunoregulatory responses and is adjuvant dependent

Most studies investigating the induction of oral tolerance (OT) use purified proteins such as ovalbumin (OVA), bovine serum albumin (BSA) and beta-lactoglobulin (beta-LG). Little information is available regarding the induction of OT to a protein mixture, e.g. cow's milk. In this study we compared the regulatory mechanisms induced after the oral administration of a whey protein concentrate (WP) derived from cow's milk following immunization with two different adjuvants, complete Freund's adjuvant (CFA) and alum. OVA was used as a control antigen. Animals were given a single feed of these proteins at an equivalent dose of 1 mg/g body weight before they were immunized seven days later with the antigen in Freund's adjuvant or alum. Delayed type hypersensitivity (DTH) responses were suppressed by both a feed of WP and OVA after immunization with CFA. However, only OVA feeding suppressed antigen specific IgG responses. In an attempt to investigate whether WP would tolerize the more susceptible IgE responses, alum immunization replaced CFA as the adjuvant used for systemic immunizations. WP, after a single feed, significantly primed for DTH and IgE responses indicating oral sensitization to WP. In contrast, OVA suppressed DTH, IgE and IgG responses. Antigen specific proliferation of mononuclear cells was suppressed in mice fed OVA, but primed in those fed with WP. In addition cells taken from sensitized mice fed WP up-regulated levels of specific interleukin (IL) -4, -10 and -12 in vitro whereas these cytokines were suppressed in cultures from tolerant WP fed mice. Global suppression was obtained in cultures from tolerant OVA fed mice. TGF-beta was not detected in draining PLN cell cultures of either tolerant or sensitized mice. These data suggest that a whey protein mixture induces divergent responses following immunization with either CFA or alum despite being fed at an identical dose. We suggest that that the choice of the adjuvant may determine the immunoregulatory outcome and this is also reflected by the systemic cytokine profile.

Oral tolerance: immune mechanisms and the generation of Th3-type TGF-beta-secreting regulatory cells

Oral tolerance is a long recognized method to induce peripheral immune tolerance. Oral tolerance has been used successfully to treat animal models of autoimmune diseases and is being tested in human diseases. Low doses of oral antigen induce active suppression, whereas high doses induce clonal anergy and deletion. Oral antigen preferentially generates a Th2(IL-4/IL-10)- or a Th3(TGF-beta)-type response. Th3-type cells are a unique T-cell subset which primarily secrete TGF-beta, provide help for IgA and have suppressive properties for Th1 and other immune cells. Th3-type cells appear distinct from the Th2 cells as CD4(+) TGF-beta-secreting cells with suppressive properties in the gut have been generated from IL-4-deficient animals. In vitro differentiation of Th3-type cells from Th0 precursors from TCR transgenic mice is enhanced by culture with TGF-beta, IL-4, IL-10 and anti-IL-12. Because regulatory T cells generated by oral antigen are triggered in an antigen-specific fashion but suppress in an antigen-nonspecific fashion, they mediate bystander suppression when they encounter the fed autoantigen at the target organ. Thus, mucosal tolerance can be used to treat inflammatory processes that are not autoimmune in nature. Mucosal antigen has also been used to treat animal models of stroke and of Alzheimer's disease. Induction of low-dose oral tolerance is enhanced by oral administration of IL-4 and IL-10. Coupling antigen to CTB or administration of Flt-3 ligand enhances oral tolerance. Anti-B7.2 but not anti-B7.1 blocks low-dose, but not high-dose oral tolerance. High-dose oral tolerance is blocked by anti-CTLA-4. CD25(+) CD4(+) regulatory T-cell function also appears to be related to TFG-beta.

IL-12 and Th1 immune responses in human Peyer's patches

Oral tolerance is a well-characterized phenomenon in animals and is highly effective when induced as a treatment for experimental autoimmune disease. However, its use as a therapeutic modality for the treatment of autoimmune disease in humans has been disappointing. Much of the rationale for its use in humans is based on the finding that feeding antigen to rodents elicits regulatory T cells in Peyer's patches (PPs) that secrete immunosuppressive cytokines such as transforming growth factor (TGF)-beta. By contrast, human antigen-specific PP T-cell responses, and mucosal T-cell responses in general, are strongly biased towards T helper 1 (Th1) cells, which are pro-inflammatory rather than immunosuppressive. This is caused by the high local levels of interleukin (IL)-12 in PPs.

Prevention of murine EAE by oral hydrolytic enzyme treatment

Clinical trials that test the efficacy of Phlogenzym (consisting of the hydrolytic enzymes bromelain and trypsin and the anti-oxidant rutosid) as a treatment for T cell-mediated autoimmune diseases including multiple sclerosis (MS), type 1 diabetes and rheumatoid arthritis are presently ongoing. We tested the effects of Phlogenzym treatment in the murine model for MS, experimental allergic encephalomyelitis (EAE), a disease induced in SJL mice by immunization with proteolipid protein (PLP) peptide 139-151. Oral administration of Phlogenzym resulted in complete protection from EAE. In Phlogenzym-treated mice, the dose response curve of the PLP:139-151-specific T cell response was shifted to the right, that is, the primed T cells required higher peptide concentrations to become activated. Additionally, the T cell response to this peptide was shifted towards the T helper 2 cytokine profile. Both effects are consistent with an increased T cell activation threshold. In support of this interpretation, we found that the accessory molecules CD4, CD44, and B7-1 (all of which are involved in T cell co-stimulation) were cleaved by Phlogenzym, while CD3 and MHC class II molecules (which are involved in the recognition of antigens by T cells) and LFA-1 were unaffected. These data show the efficacy of oral Phlogenzym treatment in an animal model of T cell-mediated autoimmune disease and suggest that the protective effect might be the result of an increase in the activation threshold of the autoreactive T lymphocytes brought about by the cleavage of accessory molecules involved in the interaction of T cells and antigen presenting cells.

Suppression of adjuvant arthritis in rats by oral administration of type II collagen in combination with type I interferon

The oral administration of 3 micrograms but not 300 micrograms of type II collagen (CII) significantly suppressed adjuvant arthritis in rats that was induced by immunization with Mycobacterium tuberculosis. Feeding 5000 units of type I interferon was also effective in downregulating the disease. More suppression of adjuvant arthritis was observed when both CII and interferon were orally given. Delayed-type hypersensitivity responses to M. tuberculosis were inhibited in interferon- but not in CII-fed animals. There were no delayed responses to CII in M. tuberculosis-immunized rats fed either CII or interferon. However, the delayed response to M. tuberculosis plus CII was significantly reduced by CII as well as interferon given orally. Feeding both CII and interferon was more effective in suppressing the delayed responses to M. tuberculosis plus CII. A similar suppression was observed in proliferative responses of lymph-node cells to M. tuberculosis, CII, or M. tuberculosis plus CII in-vitro. These results suggest that the suppression of adjuvant arthritis by oral administration of CII is due to tolerance to CII in which a bystander suppression mechanism appears to be involved. Orally administered interferon seems to suppress nonspecifically cellular immune responses. The oral administration of CII in combination with interferon may be a novel way to treat T cell-mediated diseases.

Prevention of antigen-induced arthritis in rats by oral administration of the inducing antigen

We investigated the effect of oral administration of methylated bovine serum albumin (mBSA) on antigen-induced arthritis (AIA) in rats that was induced by immunization with mBSA followed by the intra-articular injection of the same antigen. The results showed that the development of AIA was suppressed in a dose-dependent manner by orally given mBSA. The suppression of AIA was associated with decreases in the delayed type hypersensitivity to mBSA and also in the proliferative response of inguinal lymph node cells to the antigen in mBSA-fed animals. These results indicate that oral administration of an antigen is an effective way to suppress arthritis induced by the antigen and that oral tolerance to the antigen appears to be critically involved in the suppression of arthritis.

Induction of anergy in Th1 lymphocytes by oral tolerance. Importance of antigen dosage and frequency of feeding

Oral tolerance, a biologically relevant pathway for inducing peripheral tolerance in T lymphocytes, occurs by two distinct mechanisms. Multiple low doses of antigen induce regulatory T lymphocytes that secrete immunosuppressive cytokines, whereas feeding a single high dose of antigen induces anergy of antigen-specific Th1 lymphocytes (diminished IgG2a, IL-2, and IFNgamma) with intact Th2 responses (IgG1 and IL-4). Anergy was demonstrated by the ability to reverse tolerant state after culturing tolerant cells in rIL-2. Reversal of the tolerant state was established in vitro by increase in frequency of IL-2 secreting cells, and in vivo by specific IgG2a production in irradiated mice adoptively transferred with cells cultured in rIL-2. Inasmuch as the induction of anergy was inhibited by the presence of antibodies specific for the tolerizing antigen, it appears that the oral induction of anergy might depend on the systemic dissemination of antigen (or its fragments) absorbed from the gut. It is suggested that tolerance is insured by the fact that this absorbed antigen is presented to Th1 lymphocytes in draining lymph nodes in the absence of inflammatory and costimulatory molecules.

Induction of anergy or active suppression following oral tolerance is determined by antigen dosage

Oral tolerance was generated to hen egg white lysozyme in the mouse or to guinea pig myelin basic protein in the rat by a low-dose (1 mg) or a high-dose (5-20 mg) feeding regimen. High doses of antigen induced tolerance characterized by anergy with little or no active suppression and increased secretion of interleukin 4 (IL-4). Anergy was shown by an increase in frequency of IL-2-secreting cells following culture in recombinant IL-2. Low doses of antigen induced tolerance characterized by antigen-driven active suppression with increased secretion of transforming growth factor beta (TGF-beta) and IL-4 and minimal anergy. Without further immunization, spleen cells from animals orally tolerized by both regimens secreted increased levels of IL-4 and TGF-beta in an antigen-specific manner. Animals fed high doses secreted more IL-4 and less TGF-beta, whereas those fed low doses secreted more TGF-beta and less IL-4. These results demonstrate that the two feeding regimens induced cell populations that differed in their cytokine secretion profile and their capacity to actively suppress in vitro and to induce anergy. Our results provide a basis for distinguishing different forms of antigen-driven peripheral tolerance and have important implications for orally induced antigen-specific modulation of human autoimmune diseases.