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Kumar R, Mickael C, Chabon J, Gebreab L, Rutebemberwa A, Garcia AR, Koyanagi DE, Sanders L, Gandjeva A, Kearns MT, Barthel L, Janssen WJ, Mauad T, Bandeira A, Schmidt E, Tuder RM, Graham BB. The Causal Role of IL-4 and IL-13 in Schistosoma mansoni Pulmonary Hypertension. Am J Respir Crit Care Med 2016; 192:998-1008. [PMID: 26192556 DOI: 10.1164/rccm.201410-1820oc] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
RATIONALE The etiology of schistosomiasis-associated pulmonary arterial hypertension (PAH), a major cause of PAH worldwide, is poorly understood. Schistosoma mansoni exposure results in prototypical type-2 inflammation. Furthermore, transforming growth factor (TGF)-β signaling is required for experimental pulmonary hypertension (PH) caused by Schistosoma exposure. OBJECTIVES We hypothesized type-2 inflammation driven by IL-4 and IL-13 is necessary for Schistosoma-induced TGF-β-dependent vascular remodeling. METHODS Wild-type, IL-4(-/-), IL-13(-/-), and IL-4(-/-)IL-13(-/-) mice (C57BL6/J background) were intraperitoneally sensitized and intravenously challenged with S. mansoni eggs to induce experimental PH. Right ventricular catheterization was then performed, followed by quantitative analysis of the lung tissue. Lung tissue from patients with schistosomiasis-associated and connective tissue disease-associated PAH was also systematically analyzed. MEASUREMENTS AND MAIN RESULTS Mice with experimental Schistosoma-induced PH had evidence of increased IL-4 and IL-13 signaling. IL-4(-/-)IL-13(-/-) mice, but not single knockout IL-4(-/-) or IL-13(-/-) mice, were protected from Schistosoma-induced PH, with decreased right ventricular pressures, pulmonary vascular remodeling, and right ventricular hypertrophy. IL-4(-/-)IL-13(-/-) mice had less pulmonary vascular phospho-signal transducer and activator of transcription 6 (STAT6) and phospho-Smad2/3 activity, potentially caused by decreased TGF-β activation by macrophages. In vivo treatment with a STAT6 inhibitor and IL-4(-/-)IL-13(-/-) bone marrow transplantation also protected against Schistosoma-PH. Lung tissue from patients with schistosomiasis-associated and connective tissue disease-associated PAH had evidence of type-2 inflammation. CONCLUSIONS Combined IL-4 and IL-13 deficiency is required for protection against TGF-β-induced pulmonary vascular disease after Schistosoma exposure, and targeted inhibition of this pathway is a potential novel therapeutic approach for patients with schistosomiasis-associated PAH.
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Affiliation(s)
- Rahul Kumar
- 1 Program in Translational Lung Research, Department of Medicine, Anschutz Medical Campus, Aurora, Colorado
| | - Claudia Mickael
- 1 Program in Translational Lung Research, Department of Medicine, Anschutz Medical Campus, Aurora, Colorado
| | - Jacob Chabon
- 1 Program in Translational Lung Research, Department of Medicine, Anschutz Medical Campus, Aurora, Colorado
| | - Liya Gebreab
- 1 Program in Translational Lung Research, Department of Medicine, Anschutz Medical Campus, Aurora, Colorado
| | - Alleluiah Rutebemberwa
- 1 Program in Translational Lung Research, Department of Medicine, Anschutz Medical Campus, Aurora, Colorado
| | - Alexandra Rodriguez Garcia
- 1 Program in Translational Lung Research, Department of Medicine, Anschutz Medical Campus, Aurora, Colorado
| | - Daniel E Koyanagi
- 1 Program in Translational Lung Research, Department of Medicine, Anschutz Medical Campus, Aurora, Colorado
| | - Linda Sanders
- 1 Program in Translational Lung Research, Department of Medicine, Anschutz Medical Campus, Aurora, Colorado
| | - Aneta Gandjeva
- 1 Program in Translational Lung Research, Department of Medicine, Anschutz Medical Campus, Aurora, Colorado
| | - Mark T Kearns
- 2 Department of Medicine, National Jewish Health, Denver, Colorado
| | - Lea Barthel
- 2 Department of Medicine, National Jewish Health, Denver, Colorado
| | | | - Thais Mauad
- 3 Department of Pathology, Sao Paulo University Medical School, Sao Paulo, Brazil; and
| | - Angela Bandeira
- 4 Department of Medicine, Memorial S. Jose Hospital, Universidade de Pernambuco, Recife, Brazil
| | - Eric Schmidt
- 1 Program in Translational Lung Research, Department of Medicine, Anschutz Medical Campus, Aurora, Colorado
| | - Rubin M Tuder
- 1 Program in Translational Lung Research, Department of Medicine, Anschutz Medical Campus, Aurora, Colorado
| | - Brian B Graham
- 1 Program in Translational Lung Research, Department of Medicine, Anschutz Medical Campus, Aurora, Colorado
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