To be responsive or not to be responsive, that is the mucosal question

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.

Enteric bacterial antigens activate CD4(+) T cells from scid mice with inflammatory bowel disease

Scid mice transplanted with CD4(+) T cells from congenic donor mice develop a chronic and lethal inflammatory bowel disease (IBD) 2-3 months post-transplantation. In the present study we have investigated the response of CD4(+) T cells from scid mice with colitis against fecal extracts. Our results show that in contrast to CD4(+) T cells from normal BALB/c mice, CD4(+) T cells from scid mice with colitis proliferate strongly in response to antigen-presenting cells (APC) pulsed with fecal extracts. The IBD-associated T cells did not respond to either extracts from food antigens or fecal extracts from germ-free mice, which indicates that they recognize bacterial antigens in the fecal extracts. CD4(+) T cells isolated from the colonic lamina propria of scid mice 3 weeks post transplantation also responded vigorously to fecal extracts, demonstrating that reactive CD4(+) T cells are present in the gut mucosa of transplanted scid mice prior to clinical manifestations of IBD. CD4(+) T cells activated by fecal extracts produced high amounts of IL-2 and IFN-gamma, intermediate amounts of IL-4 and low amounts of IL-10, consistent with a Th1 profile. The proliferative reactivity towards fecal extracts was restricted by MHC class II molecules and dependent on antigen processing, as the response could be blocked by anti-MHC class II antibodies or a short fixation of the APC. This study demonstrates that class II-restricted CD4(+) Th1 cells, which recognize enteric bacterial antigens, infiltrate the gut mucosa and spleen of transplanted scid mice prior to and during the course of colitis.

The immunologic basis for intestinal food allergy

There has been considerable recent broadening of basic concepts of intestinal food allergy, in particular the importance of non-IgE-mediated mechanisms. The traditional emphasis on IgE-mediated allergy now appears inappropriate in light of current studies of the basic mechanisms of oral tolerance to dietary antigen and of increasing recognition of the requirement for early infectious challenge in the prevention of allergic sensitization. This major change in emphasis has been forced both by basic scientific studies and by recognition of novel patterns of food allergic disease within the pediatric population, in which rapid increase in food-allergic sensitization has been noted in the last decade and previously rare phenomena such as multiple food allergies and sensitization of exclusively breast-fed infants to antigens eaten by the mother have become commonplace. It is thus emerging that the possession of exaggerated IgE responses may not be the direct cause of food allergic sensitization but may ensure that such sensitization is clinically obvious. Those without such immediate responses have a complex of symptoms, including diet-responsive eczema and a marked disturbance of intestinal motility. The clear demographic links with socioeconomic privilege and relative protection from gastrointestinal infarctions concord with recent murine data suggesting an obligatory input from innate immune responses to the gut flora in the establishment of oral tolerance.

Nutrition in inflammatory bowel disease

Nutrition is clearly disturbed by active intestinal inflammation. Appetite is reduced, yet energy substrates are diverted into the inflammatory process, and thus weight loss is characteristic. The nutritional disturbance represents part of a profound defect of somatic function. Linear growth and pubertal development in children are notably retarded, body composition is altered, and there may be significant psychosocial disturbance. Macrophage products such as tumour necrosis factor-alpha and interleukins-1 and 6 may be the central molecules that link the inflammatory process to this derangement of homeostasis. Intriguingly, there is also increasing evidence that an aggressive nutritional programme may in itself be sufficient to reduce the mucosal inflammatory response. Recent evidence suggests that enteral nutrition alone may reduce many pro-inflammatory cytokines to normal and allow mucosal healing. In addition, specific nutritional components, such as n-3 polyunsaturated fatty acids, may have an anti-inflammatory effect as they may alter the pattern of leukotrienes generated during the immune response. The recent discovery of the specific molecular mediators of appetite and body composition, such as leptin and myostatin, may allow increased therapeutic specificity and further improvement in the nutritional treatment of the inflammatory bowel diseases.