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Hetemäki I, Jarva H, Kluger N, Baldauf HM, Laakso S, Bratland E, Husebye ES, Kisand K, Ranki A, Peterson P, Arstila TP. Anticommensal Responses Are Associated with Regulatory T Cell Defect in Autoimmune Polyendocrinopathy-Candidiasis-Ectodermal Dystrophy Patients. THE JOURNAL OF IMMUNOLOGY 2016; 196:2955-64. [PMID: 26903483 DOI: 10.4049/jimmunol.1500301] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 01/20/2016] [Indexed: 12/30/2022]
Abstract
Autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED) is a monogenic autoimmune disease caused by mutations in the AIRE gene. Although mainly an endocrine disease, a substantial fraction of patients have gastrointestinal manifestations. In this study, we have examined the role of anticommensal responses and their regulation. APECED patients had increased levels of Abs against Saccharomyces cerevisiae (p < 0.0001) and against several species of commensal gut bacteria, but not against species predominantly associated with other locations. The anticommensal Ab levels did not correlate with gastrointestinal autoantibodies, neutralizing anti-IL-17 or -IL-22 Abs, or gastrointestinal symptoms, although scarcity of the available clinical data suggests that further study is required. However, the anti-S. cerevisiae Ab levels showed a significant inverse correlation with FOXP3 expression levels in regulatory T cells (Treg), previously shown to be dysfunctional in APECED. The correlation was strongest in the activated CD45RO(+) population (ρ = -0.706; p < 0.01). APECED patients also had decreased numbers of FOXP3(+) cells in gut biopsies. These results show that APECED patients develop early and sustained responses to gut microbial Ags in a pattern reminiscent of Crohn's disease. This abnormal immune recognition of gut commensals is linked to a systemic Treg defect, which is also reflected as a local decrease of gut-associated Treg. To our knowledge, these data are the first to show dysregulated responses to non-self commensal Ags in APECED and indicate that AIRE contributes to the regulation of gut homeostasis, at least indirectly. The data also raise the possibility of persistent microbial stimulation as a contributing factor in the pathogenesis of APECED.
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Affiliation(s)
- Iivo Hetemäki
- Department of Bacteriology and Immunology, University of Helsinki, 00290 Helsinki, Finland; Research Programs Unit, Immunobiology Research Program, University of Helsinki, 00014 Helsinki, Finland;
| | - Hanna Jarva
- Department of Bacteriology and Immunology, University of Helsinki, 00290 Helsinki, Finland; Research Programs Unit, Immunobiology Research Program, University of Helsinki, 00014 Helsinki, Finland; HUSLAB, Helsinki University Central Hospital, 00029 Helsinki, Finland
| | - Nicolas Kluger
- Department of Skin and Allergic Diseases, Skin and Allergy Hospital, Helsinki University Central Hospital, 00250 Helsinki, Finland
| | - Hanna-Mari Baldauf
- Department of Bacteriology and Immunology, University of Helsinki, 00290 Helsinki, Finland
| | - Sini Laakso
- Department of Bacteriology and Immunology, University of Helsinki, 00290 Helsinki, Finland
| | - Eirik Bratland
- Department of Medicine, Haukeland University Hospital, 5021 Bergen, Norway; and
| | - Eystein S Husebye
- Department of Medicine, Haukeland University Hospital, 5021 Bergen, Norway; and
| | - Kai Kisand
- Institute of General and Molecular Pathology, University of Tartu, Tartu 50411, Estonia
| | - Annamari Ranki
- Department of Skin and Allergic Diseases, Skin and Allergy Hospital, Helsinki University Central Hospital, 00250 Helsinki, Finland
| | - Pärt Peterson
- Institute of General and Molecular Pathology, University of Tartu, Tartu 50411, Estonia
| | - T Petteri Arstila
- Department of Bacteriology and Immunology, University of Helsinki, 00290 Helsinki, Finland; Research Programs Unit, Immunobiology Research Program, University of Helsinki, 00014 Helsinki, Finland
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Chida N, Kobayashi I. [Difference in target antigens between central tolerance and peripheral tolerance deficiencies]. ACTA ACUST UNITED AC 2015. [PMID: 26213192 DOI: 10.2177/jsci.38.142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Failure of the immunotolerance mechanisms causes multiple organ-specific autoimmune disorders. Mutations of autoimmune regulator (AIRE) gene result in central immunotolerance deficiency named autoimmune polyendocrinopathy, candidiasis, ectodermal dystrophy (APECED). Mutations of FOXP3 genes cause regulatory T cell (Treg) deficiency named immune dysregulation, polyendocrinopathy, enteropathy, X-linked (IPEX) syndrome. Because T cell tolerance influences B cell tolerance, autoantibodies seem to reflect the presence of autoreactive T cells with the same antigen specificity. To date many differences in both clinical features and autoantibody profiles have been described between APECED and IPEX syndrome. In addition to the differences in target organs, we have found differences in the target antigens in the same organ, small intestine, between both disorders; anti-autoimmune enteropathy-related 75 kDa antigen (AIE-75) antibodies are specific to IPEX syndrome, whereas anti-tryptophan hydroxylase-1 (TPH-1) antibodies are specific to APECED. These facts suggest that immunotolerance to AIE-75 depends on the Treg, whereas the tolerance to TPH-1 depends on the central mechanisms. Furthermore, given the earlier onset and more serious clinical features of IPEX syndrome than APECED, physiological roles of Aire on the selection of Treg may be, if present, limited.
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Affiliation(s)
- Natsuko Chida
- Department of Dentistry for Children and Disabled Persons, Hokkaido University Graduate School of Dental Medicine
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