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Liu Y, Huang W, Dai K, Liu N, Wang J, Lu X, Ma J, Zhang M, Xu M, Long X, Liu J, Kou Y. Inflammatory response of gut, spleen, and liver in mice induced by orally administered Porphyromonas gingivalis. J Oral Microbiol 2022; 14:2088936. [PMID: 35756539 PMCID: PMC9225697 DOI: 10.1080/20002297.2022.2088936] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Periodontitis is a chronic multifactorial inflammatory disease. Porphyromonas gingivalis is a primary periopathogen in the initiation and development of periodontal disease. Evidence has shown that P. gingivalis is associated with systemic diseases, including IBD and fatty liver disease. Inflammatory response is a key feature of diseases related to this species. Methods C57BL/6 mice were administered either PBS, or P. gingivalis. After 9 weeks, the inflammatory response in gut, spleen, and liver was analyzed. Results The findings revealed significant disturbance of the intestinal microbiota and increased inflammatory factors in the gut of P. gingivalis-administered mice. Administrated P. gingivalis remarkably promoted the secretion of IRF-1 and activated the inflammatory pathway IFN-γ/STAT1 in the spleen. Histologically, mice treated with P. gingivalis exhibited hepatocyte damage and lipid deposition. The inflammatory factors IL-17a, IL-6, and ROR-γt were also upregulated in the liver of mice fed with P. gingivalis. Lee’s index, spleen index, and liver index were also increased. Conclusion These results suggest that administrated P. gingivalis evokes inflammation in gut, spleen, and liver, which might promote the progression of various systemic diseases.
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Affiliation(s)
- Yingman Liu
- Department of Periodontics, School and Hospital of Stomatology, China Medical University, Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang, Liaoning, China
| | - Wenkai Huang
- Department of Orthodontics, School of Stomatology, China Medical University, Shenyang, Liaoning, China
| | - Ke Dai
- Department of Stomatology, Lishui University School of Medicine, Lishui, Zhejing, China
| | - Ni Liu
- Department of Periodontics, School and Hospital of Stomatology, China Medical University, Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang, Liaoning, China
| | - Jiaqi Wang
- Department of Periodontics, School and Hospital of Stomatology, China Medical University, Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang, Liaoning, China
| | - Xiaoying Lu
- Department of Oral Biology, School and Hospital of Stomatology, China Medical University, Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang, Liaoning, China
| | - Jiaojiao Ma
- Department of Periodontics, School and Hospital of Stomatology, China Medical University, Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang, Liaoning, China
| | - Manman Zhang
- Department of Oral Biology, School and Hospital of Stomatology, China Medical University, Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang, Liaoning, China
| | - Mengqi Xu
- Department of Periodontics, School and Hospital of Stomatology, China Medical University, Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang, Liaoning, China
| | - Xu Long
- Department of Oral Biology, School and Hospital of Stomatology, China Medical University, Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang, Liaoning, China
| | - Jie Liu
- Department of Stomatology, Science Experiment Center, China Medical University, Shenyang, Liaoning, China
| | - Yurong Kou
- Department of Periodontics, School and Hospital of Stomatology, China Medical University, Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang, Liaoning, China.,Department of Oral Biology, School and Hospital of Stomatology, China Medical University, Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang, Liaoning, China
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Lettau M, Wiedemann A, Schrezenmeier EV, Giesecke-Thiel C, Dörner T. Human CD27+ memory B cells colonize a superficial follicular zone in the palatine tonsils with similarities to the spleen. A multicolor immunofluorescence study of lymphoid tissue. PLoS One 2020; 15:e0229778. [PMID: 32187186 PMCID: PMC7080255 DOI: 10.1371/journal.pone.0229778] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 02/13/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Memory B cell (mBC) induction and maintenance is one of the keys to long-term protective humoral immunity. MBCs are fundamental to successful medical interventions such as vaccinations and therapy in autoimmunity. However, their lifestyle and anatomic residence remain enigmatic in humans. Extrapolation from animal studies serves as a conceptual basis but might be misleading due to major anatomical distinctions between species. METHODS AND FINDINGS Multicolor immunofluorescence stainings on fixed and unfixed frozen tissue sections were established using primary antibodies coupled to haptens and secondary signal amplification. The simultaneous detection of five different fluorescence signals enabled the localization and characterization of human CD27+CD20+Ki67- mBCs for the first time within one section using laser scanning microscopy. As a result, human tonsillar mBCs were initially identified within their complex microenvironment and their relative location to naïve B cells, plasma cells and T cells could be directly studied and compared to the human splenic mBC niche. In all investigated tonsils (n = 15), mBCs appeared to be not only located in a so far subepithelial defined area but were also follicle associated with a previous undescribed gradual decline towards the follicular mantle comparable to human spleen. However, mBC areas around secondary follicles with large germinal centers (GCs) in tonsils showed interruptions and a general widening towards the epithelium while in spleen the mBC-containing marginal zones (MZ) around smaller GCs were relatively broad and symmetrical. Considerably fewer IgM+IgD+/- pre-switch compared to IgA+ or IgG+ post-switch mBCs were detected in tonsils in contrast to spleen. CONCLUSIONS This study extends existing insights into the anatomic residence of human mBCs showing structural similarities of the superficial follicular area in human spleen and tonsil. Our data support the debate of renaming the human splenic MZ to 'superficial zone' in order to be aware of the differences in rodents and, moreover, to consider this term equally for the human palatine tonsil.
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Affiliation(s)
- Marie Lettau
- Department of Rheumatology and Clinical Immunology, Charité University Medicine Berlin, Berlin, Germany
- German Rheumatism Research Center Berlin (DRFZ), Berlin, Germany
| | - Annika Wiedemann
- Department of Rheumatology and Clinical Immunology, Charité University Medicine Berlin, Berlin, Germany
- German Rheumatism Research Center Berlin (DRFZ), Berlin, Germany
| | - Eva Vanessa Schrezenmeier
- Department of Rheumatology and Clinical Immunology, Charité University Medicine Berlin, Berlin, Germany
- German Rheumatism Research Center Berlin (DRFZ), Berlin, Germany
- Department of Nephrology and Medical Intensive Care, Charité University Medicine Berlin, Berlin, Germany
| | - Claudia Giesecke-Thiel
- Department of Rheumatology and Clinical Immunology, Formerly at the Charité University Medicine Berlin, Berlin, Germany
- Max Planck Institute for Molecular Genetics, Berlin, Germany
| | - Thomas Dörner
- Department of Rheumatology and Clinical Immunology, Charité University Medicine Berlin, Berlin, Germany
- German Rheumatism Research Center Berlin (DRFZ), Berlin, Germany
- * E-mail:
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3
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Zhu H, Liu Y, Li S, Jin Y, Zhao L, Zhao F, Feng J, Yan W, Wei Y. Altered gut microbiota after traumatic splenectomy is associated with endotoxemia. Emerg Microbes Infect 2018; 7:197. [PMID: 30498207 PMCID: PMC6265257 DOI: 10.1038/s41426-018-0202-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 10/31/2018] [Indexed: 12/28/2022]
Abstract
Splenectomy carries a long-term risk of postoperative infection, and the chronic, low-grade inflammation associated with endotoxemia may be related to the gut microbiota. In this study, to increase our understanding of the potential cause of the high rate of infection in postsplenectomy patients, we evaluated the differences in the gut microbiota and plasma lipopolysaccharide level of patients after splenectomy relative to those of healthy controls. Thirty-two patients having undergone splenectomy and 42 healthy individuals were enrolled into the splenectomy (SP) and healthy control (HC) groups, respectively. The SP group was subdivided into three subgroups according to the length of their postoperative time. Fecal samples were used for gut microbiota analysis via 16s rRNA gene sequencing, blood examinations and plasma lipopolysaccharide measurements were also taken. Significant differences were observed in gut microbiota composition with regard to the relative bacterial abundances of 2 phyla, 7 families, and 15 genera. The lipopolysaccharide level was significantly higher in the SP group than in the HC group and were negatively associated with five bacterial families with low abundance in the SP group. The degree of the microbiota alteration increased with the length of the postoperative time. The PICRUSt analysis showed that the relative abundances of lipopolysaccharide biosynthesis proteins and lipopolysaccharide biosynthesis pathways were higher in the SP group and were positively associated with the plasma lipopolysaccharide level. Significant alterations were observed in the gut microbiota of the splenectomized patients and were associated with plasma lipopolysaccharide level. Further studies are needed to verify whether such alterations after splenectomy are related to an increased risk of complications.
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Affiliation(s)
- Hua Zhu
- Department of Oncology and Laparoscopy Surgery, the First Affiliated Hospital of Harbin Medical University, 150001, Harbin, China
| | - Yang Liu
- Department of Oncology and Laparoscopy Surgery, the First Affiliated Hospital of Harbin Medical University, 150001, Harbin, China
| | - Shengda Li
- Department of Oncology and Laparoscopy Surgery, the First Affiliated Hospital of Harbin Medical University, 150001, Harbin, China
| | - Ye Jin
- Department of Oncology and Laparoscopy Surgery, the First Affiliated Hospital of Harbin Medical University, 150001, Harbin, China
| | - Lei Zhao
- Department of Oncology and Laparoscopy Surgery, the First Affiliated Hospital of Harbin Medical University, 150001, Harbin, China
| | - Fuya Zhao
- Department of Oncology and Laparoscopy Surgery, the First Affiliated Hospital of Harbin Medical University, 150001, Harbin, China
| | - Jing Feng
- Department of Oncology and Laparoscopy Surgery, the First Affiliated Hospital of Harbin Medical University, 150001, Harbin, China
| | - Wei Yan
- Department of Oncology and Laparoscopy Surgery, the First Affiliated Hospital of Harbin Medical University, 150001, Harbin, China
| | - Yunwei Wei
- Department of Oncology and Laparoscopy Surgery, the First Affiliated Hospital of Harbin Medical University, 150001, Harbin, China.
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Weiberg D, Basic M, Smoczek M, Bode U, Bornemann M, Buettner M. Participation of the spleen in the IgA immune response in the gut. PLoS One 2018; 13:e0205247. [PMID: 30286198 PMCID: PMC6171922 DOI: 10.1371/journal.pone.0205247] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 09/23/2018] [Indexed: 11/18/2022] Open
Abstract
The role of the spleen in the induction of an immune response to orally administered antigens is still under discussion. Although it is well known that after oral antigen administration specific germinal centres are not only formed in the Peyers patches (PP) and the mesenteric lymph nodes (mLN) but also in the spleen, there is still a lack of functional data showing a direct involvement of splenic B cells in an IgA immune response in the gut. In addition, after removal of mLN a high level of IgA+ B cells was observed in the gut. Therefore, in this study we analysed the role of the spleen in the induction of IgA+ B cells in the gut after mice were orally challenged with antigens. Here we have shown that antigen specific splenic IgM+ B cells after in vitro antigen stimulation as well as oral immunisation of donor mice were able to migrate into the gut of recipient mice, where they predominantly switch to IgA+ plasma cells. Furthermore, stimulation of recipient mice by orally administered antigens enhanced the migration of the splenic B cells into the gut as well as their switch to IgA+ plasma cells. Removal of the mLN led to a higher activation level of the splenic B cells. Altogether, our results imply that splenic IgM+ B cells migrate in the intestinal lamina propria, where they differentiate into IgA+ plasma cells and subsequently proliferate. In conclusion, we demonstrated that the spleen plays a major role in the gut immune response serving as a reservoir of immune cells that migrate to the site of antigen entrance.
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Affiliation(s)
- Desiree Weiberg
- Institute of Functional and Applied Anatomy, Hannover Medical School, Hannover, Germany
- Department of Nuclear Medicine, Hannover Medical School, Hannover, Germany
| | - Marijana Basic
- Institute for Laboratory Animal Science, Hannover Medical School, Hannover, Germany
| | - Margarethe Smoczek
- Institute for Laboratory Animal Science, Hannover Medical School, Hannover, Germany
| | - Ulrike Bode
- Institute of Functional and Applied Anatomy, Hannover Medical School, Hannover, Germany
| | - Melanie Bornemann
- Institute of Functional and Applied Anatomy, Hannover Medical School, Hannover, Germany
| | - Manuela Buettner
- Institute of Functional and Applied Anatomy, Hannover Medical School, Hannover, Germany
- Institute for Laboratory Animal Science, Hannover Medical School, Hannover, Germany
- * E-mail:
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5
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Zhao Y, Uduman M, Siu JHY, Tull TJ, Sanderson JD, Wu YCB, Zhou JQ, Petrov N, Ellis R, Todd K, Chavele KM, Guesdon W, Vossenkamper A, Jassem W, D'Cruz DP, Fear DJ, John S, Scheel-Toellner D, Hopkins C, Moreno E, Woodman NL, Ciccarelli F, Heck S, Kleinstein SH, Bemark M, Spencer J. Spatiotemporal segregation of human marginal zone and memory B cell populations in lymphoid tissue. Nat Commun 2018; 9:3857. [PMID: 30242242 PMCID: PMC6155012 DOI: 10.1038/s41467-018-06089-1] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 08/17/2018] [Indexed: 01/19/2023] Open
Abstract
Human memory B cells and marginal zone (MZ) B cells share common features such as the expression of CD27 and somatic mutations in their IGHV and BCL6 genes, but the relationship between them is controversial. Here, we show phenotypic progression within lymphoid tissues as MZ B cells emerge from the mature naïve B cell pool via a precursor CD27-CD45RBMEM55+ population distant from memory cells. By imaging mass cytometry, we find that MZ B cells and memory B cells occupy different microanatomical niches in organised gut lymphoid tissues. Both populations disseminate widely between distant lymphoid tissues and blood, and both diversify their IGHV repertoire in gut germinal centres (GC), but nevertheless remain largely clonally separate. MZ B cells are therefore not developmentally contiguous with or analogous to classical memory B cells despite their shared ability to transit through GC, where somatic mutations are acquired.
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Affiliation(s)
- Yuan Zhao
- School of Immunology and Microbial Sciences, King's College London, Guy's Campus, London, SE1 9RT, UK
| | - Mohamed Uduman
- Department of Pathology, Yale University School of Medicine, New Haven, CT, 06511, USA
| | | | - Thomas J Tull
- School of Immunology and Microbial Sciences, King's College London, Guy's Campus, London, SE1 9RT, UK
| | - Jeremy D Sanderson
- School of Immunology and Microbial Sciences, King's College London, Guy's Campus, London, SE1 9RT, UK
| | - Yu-Chang Bryan Wu
- Randall Division of Cell and Molecular Biophysics, King's College London, London, SE1 1UL, UK
| | - Julian Q Zhou
- Interdepartmental Program in Computational Biology and Bioinformatics, Yale University, New Haven, CT, 06511, USA
| | - Nedyalko Petrov
- Biomedical Research Centre, Guy's and St. Thomas' NHS Trust, London, SE1 9RT, UK
| | - Richard Ellis
- Biomedical Research Centre, Guy's and St. Thomas' NHS Trust, London, SE1 9RT, UK
| | - Katrina Todd
- Biomedical Research Centre, Guy's and St. Thomas' NHS Trust, London, SE1 9RT, UK
| | - Konstantia-Maria Chavele
- School of Immunology and Microbial Sciences, King's College London, Guy's Campus, London, SE1 9RT, UK
| | - William Guesdon
- School of Immunology and Microbial Sciences, King's College London, Guy's Campus, London, SE1 9RT, UK
| | - Anna Vossenkamper
- Barts & The London School of Medicine and Dentistry, Blizard Institute, Whitechapel, London, E1 2AT, UK
| | - Wayel Jassem
- Liver Transplant Unit, Institute of Liver Studies, King's College Hospital, Denmark Hill, London, SE5 9NT, UK
| | - David P D'Cruz
- School of Immunology and Microbial Sciences, King's College London, Guy's Campus, London, SE1 9RT, UK
| | - David J Fear
- School of Immunology and Microbial Sciences, King's College London, Guy's Campus, London, SE1 9RT, UK
| | - Susan John
- School of Immunology and Microbial Sciences, King's College London, Guy's Campus, London, SE1 9RT, UK
| | - Dagmar Scheel-Toellner
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Claire Hopkins
- School of Immunology and Microbial Sciences, King's College London, Guy's Campus, London, SE1 9RT, UK
| | - Estefania Moreno
- Barts & The London School of Medicine and Dentistry, Blizard Institute, Whitechapel, London, E1 2AT, UK
| | - Natalie L Woodman
- School of Cancer Sciences, King's College London, Guy's Campus, London, SE1 9RT, UK
| | - Francesca Ciccarelli
- School of Cancer Sciences, King's College London, Guy's Campus, London, SE1 9RT, UK
| | - Susanne Heck
- Biomedical Research Centre, Guy's and St. Thomas' NHS Trust, London, SE1 9RT, UK
| | - Steven H Kleinstein
- Department of Pathology, Yale University School of Medicine, New Haven, CT, 06511, USA.
- Interdepartmental Program in Computational Biology and Bioinformatics, Yale University, New Haven, CT, 06511, USA.
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT, 06511, USA.
| | - Mats Bemark
- Mucosal Immunobiology and Vaccine Center (MIVAC), Department of Microbiology and Immunology, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, SE 405 30, Gothenburg, Sweden.
| | - Jo Spencer
- School of Immunology and Microbial Sciences, King's College London, Guy's Campus, London, SE1 9RT, UK.
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Steiniger BS, Wilhelmi V, Seiler A, Lampp K, Stachniss V. Heterogeneity of stromal cells in the human splenic white pulp. Fibroblastic reticulum cells, follicular dendritic cells and a third superficial stromal cell type. Immunology 2014; 143:462-77. [PMID: 24890772 DOI: 10.1111/imm.12325] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Revised: 05/22/2014] [Accepted: 05/27/2014] [Indexed: 12/28/2022] Open
Abstract
At least three phenotypically and morphologically distinguishable types of branched stromal cells are revealed in the human splenic white pulp by subtractive immunohistological double-staining. CD271 is expressed in fibroblastic reticulum cells of T-cell zones and in follicular dendritic cells of follicles. In addition, there is a third CD2711- and CD271+/) stromal cell population surrounding T-cell zones and follicles. At the surface of follicles the third population consists of individually variable partially overlapping shells of stromal cells exhibiting CD90 (Thy-1), MAdCAM-1, CD105 (endoglin), CD141 (thrombomodulin) and smooth muscle α-actin (SMA) with expression of CD90 characterizing the broadest shell and SMA the smallest. In addition, CXCL12, CXCL13 and CCL21 are also present in third-population stromal cells and/or along fibres. Not only CD27+ and switched B lymphocytes, but also scattered IgD++ B lymphocytes and variable numbers of CD4+ T lymphocytes often occur close to the third stromal cell population or one of its subpopulations at the surface of the follicles. In contrast to human lymph nodes, neither podoplanin nor RANKL (CD254) were detected in adult human splenic white pulp stromal cells. The superficial stromal cells of the human splenic white pulp belong to a widespread cell type, which is also found at the surface of red pulp arterioles surrounded by a mixed T-cell/B-cell population. Superficial white pulp stromal cells differ from fibroblastic reticulum cells and follicular dendritic cells not only in humans, but apparently also in mice and perhaps in rats. However, the phenotype of white pulp stromal cells is species-specific and more heterogeneous than described so far.
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Affiliation(s)
- Birte S Steiniger
- Institute of Anatomy and Cell Biology, University of Marburg, Marburg, Germany
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Barone F, Vossenkamper A, Boursier L, Su W, Watson A, John S, Dunn-Walters DK, Fields P, Wijetilleka S, Edgeworth JD, Spencer J. IgA-producing plasma cells originate from germinal centers that are induced by B-cell receptor engagement in humans. Gastroenterology 2011; 140:947-56. [PMID: 21147106 PMCID: PMC7115992 DOI: 10.1053/j.gastro.2010.12.005] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2010] [Revised: 11/25/2010] [Accepted: 12/02/2010] [Indexed: 12/02/2022]
Abstract
BACKGROUND & AIMS IgA contributes to homeostatic balance between host and intestinal microbiota. Mechanisms that initiate the IgA response are unclear and likely to differ between humans and animal models. We used multiple experimental approaches to investigate the origin of human intestinal plasma cells that produce IgA in the gastrointestinal tract. METHODS Complexity of IgA-producing plasma cell populations in human gastrointestinal mucosa and bone marrow and the specific response to oral cholera vaccine were compared by analysis of immunoglobulin genes. Flow cytometry, gene expression analysis, and immunohistochemistry were used to analyze signaling pathways induced by B-cell receptor engagement in human gut-associated lymphoid tissue (GALT) and involvement of innate immunity in B-cell activation in GALT compared with nonintestinal sites. RESULTS Human intestinal IgA-producing plasma cells appeared to be of germinal center origin; there was no evidence for the population complexity that accompanies multiple pathways of derivation observed in bone marrow. In germinal center B cells of human GALT, Btk and Erk are phosphorylated, CD22 is down-regulated, Lyn is translocated to the cell membrane, and Fos and Jun are up-regulated; these features indicate B-cell receptor ligation during germinal center evolution. No differences in innate activation of B cells were observed in GALT, compared with peripheral immune compartments. CONCLUSIONS IgA-producing plasma cells appear to be derived from GALT germinal centers in humans. B-cell receptor engagement promotes formation of germinal centers of GALT, with no more evidence for innate immune receptor activation in the mucosa than nonintestinal immune compartments. Germinal centers in GALT should be targets of mucosal vaccinations because they are the source of human intestinal IgA response.
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Affiliation(s)
- Francesca Barone
- Peter Gorer Department of Immunobiology, King’s College London, Guy’s Hospital, London SE1 9RT, UK
| | - Anna Vossenkamper
- Queen Mary University of London, Barts & The London School of Medicine and Dentistry, Institute of Cell and Molecular Science, Whitechapel, London E1 2AT, UK
| | - Laurent Boursier
- Peter Gorer Department of Immunobiology, King’s College London, Guy’s Hospital, London SE1 9RT, UK
| | - Wen Su
- Peter Gorer Department of Immunobiology, King’s College London, Guy’s Hospital, London SE1 9RT, UK
| | - Alan Watson
- Centre for Gastroenterology, Barts and the London NHS Trust, London, E1 1BB, UK
| | - Susan John
- Peter Gorer Department of Immunobiology, King’s College London, Guy’s Hospital, London SE1 9RT, UK
| | - Deborah K. Dunn-Walters
- Peter Gorer Department of Immunobiology, King’s College London, Guy’s Hospital, London SE1 9RT, UK
| | - Paul Fields
- Department of Haematology, Guy’s and St Thomas’ NHS Foundation Trust, Guy’s Hospital SE1 9RT, UK
| | - Sonali Wijetilleka
- Peter Gorer Department of Immunobiology, King’s College London, Guy’s Hospital, London SE1 9RT, UK
| | - Jonathan D. Edgeworth
- Directorate of Infection, Guy’s and St Thomas’ NHS Foundation Trust, St Thomas’ Hospital, London SE1 7EH, UK
| | - Jo Spencer
- Peter Gorer Department of Immunobiology, King’s College London, Guy’s Hospital, London SE1 9RT, UK
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