Conjunctival epithelial cells infected with Chlamydia trachomatis express HLA-DR antigens

Chlamydia trachomatis and the HLA involvement in the development of infection and disease: a narrative review

Introduction

CT (Chlamydia trachomatis) is among the most common pathogens leading to sexually transmitted diseases. Considering the uncertain mechanism by which HLA polymorphisms influence the CT infection, reinfection, comorbidities or evolution and because there is no consensus regarding the alleles involved in the pathogenesis of the infection, we considered necessary to perform a review to summarize the current knowledge of HLA related to CT.

Methods

Pubmed was researched using key terms. Out of the 198 results found, we analyzed articles of all types which describe how the MHC, through HLA alleles, participates in the different stages of CT penetration in the body, including studies about cells or other molecules involved in the process.

Results

Almost 40% of the variation in the clinical course of CT infection depends on host genetic factors. There are haplotypes that influence the infection susceptibility/resistance, haplotypes that are involved in the recurrence of the infection, haplotypes that are related to tubal infertility, pelvic inflammatory disease development or trachoma. Antibody to Chsp60 (influenced by MHC genes) has been observed to correlate with late tissue-damaging sequelae. Toll-like receptors were found to increase the susceptibility to CT. The association of HLA-B27 creates susceptibility of reactive arthritis in the organisms infected by CT, but does not influence the carriage of CT.

Conclusion

We identified HLA haplotypes belonging both to MHC class l and ll, which influence different stages of CT infection. Genetic risk factors still need research, especially on Caucasians. Studies are moving towards designing a safe and effective vaccine.

Chlamydia muridarum-specific CD4 T-cell clones recognize infected reproductive tract epithelial cells in an interferon-dependent fashion

During natural infections Chlamydia trachomatis urogenital serovars replicate predominantly in the epithelial cells lining the reproductive tract. This tissue tropism poses a unique challenge to host cellar immunity and future vaccine development. In the experimental mouse model, CD4 T cells are necessary and sufficient to clear Chlamydia muridarum genital tract infections. This implies that resolution of genital tract infection depends on CD4 T-cell interactions with infected epithelial cells. However, no laboratory has shown that Chlamydia-specific CD4 T cells can recognize Chlamydia antigens presented by major histocompatibility complex class II (MHC-I) molecules on epithelial cells. In this report we show that MHC-II-restricted Chlamydia-specific CD4 T-cell clones recognize infected upper reproductive tract epithelial cells as early as 12 h postinfection. The timing of recognition and degree of T-cell activation are dependent on the interferon (IFN) milieu. Beta IFN (IFN-beta) and IFN-gamma have different effects on T-cell activation, with IFN-beta blunting IFN-gamma-induced upregulation of epithelial cell surface MHC-II and T-cell activation. Individual CD4 T-cell clones differed in their degrees of dependence on IFN-gamma-regulated MHC-II for controlling Chlamydia replication in epithelial cells in vitro. We discuss our data as they relate to published studies with IFN knockout mice, proposing a straightforward interpretation of the existing literature based on CD4 T-cell interactions with the infected reproductive tract epithelium.

Chlamydial protease-like activity factor induces protective immunity against genital chlamydial infection in transgenic mice that express the human HLA-DR4 allele

There is no licensed vaccine available against Chlamydia trachomatis, the leading cause of bacterial sexually transmitted disease. We have found that intranasal immunization with recombinant chlamydial protease-like activity factor (CPAF) induces CD4(+) T-cell- and gamma interferon (IFN-gamma)-dependent protective immunity against murine genital chlamydial infection, thus making CPAF a viable vaccine candidate for further characterization. HLA-DR4 is the predominant allele involved in chlamydial antigen presentation to CD4(+) T cells in humans. We used engineered mice that lack endogenous major histocompatibility complex class II (MHC-II) alleles but express a human HLA allele (HLA-DR4 transgenic [tg] mice) to examine primary immune and CPAF-mediated responses against genital Chlamydia muridarum challenge. Upon primary bacterial exposure, HLA-DR4 tg mice developed Chlamydia-specific IFN-gamma and antibody production and resolved the infection within 30 days, similar to challenged conventional C57BL/6 animals. Moreover, C. muridarum-challenged HLA-DR4 tg mice exhibited CPAF-specific antibody and IFN-gamma production. Upon CPAF-plus-interleukin-12 (IL-12) vaccination, HLA-DR4 tg animals exhibited robust CPAF-specific IFN-gamma production and elevated titers of anti-CPAF total antibody and immunoglobulin G2a (IgG2a) and lower titers of IgG2b and IgG1 antibodies. HLA-DR4 tg and C57BL/6 mice vaccinated with CPAF plus IL-12 resolved the primary genital chlamydial infection significantly earlier than mock-immunized animals, whereas similarly vaccinated MHC class II-deficient mice displayed minimal antigen-specific immune responses and failed to resolve the infection even at 30 days postchallenge. Together, these results demonstrate the importance of human HLA-DR4 molecules in the recognition and presentation of CPAF epitopes, leading to the generation of protective antichlamydial immunity and making these mice a valuable model for mapping HLA-DR4-restricted chlamydial epitopes.

Expression of gelatinase B in trachomatous conjunctivitis

BACKGROUND/AIMS

Gelatinase B is a matrix metalloproteinase involved in extracellular matrix (ECM) breakdown often associated with scarring and other pathological disorders. It was investigated whether gelatinase B is involved in the pathogenesis of ECM degradation associated with trachomatous conjunctivitis.

METHODS

Conjunctival biopsy specimens obtained from six patients with active trachoma, six patients with active vernal keratoconjunctivitis (VKC), and seven control subjects were studied. Immunohistochemical techniques and a specific monoclonal antibody against human gelatinase B were used, and a monoclonal antibody against macrophage CD68 to identify mononuclear cells with gelatinase B immunoreactivity. In addition, quantitative zymography was used to compare the activity of gelatinase B in conjunctival biopsy specimens from seven patients with active trachoma and seven control subjects.

RESULTS

Gelatinase B was detected by immunohistochemistry only in polymorphonuclear cells located in the vascular lumens in three normal conjunctival biopsy specimens. In all trachoma specimens and in five VKC specimens, gelatinase B was localised in monocyte/macrophage cells, positive for the CD68 marker, and in polymorphonuclear cells. The majority of the latter cell type was located in intravascular spaces. Compared with VKC specimens, trachoma specimens showed significantly more immunoreactive gelatinase B monocyte/macrophage cells (52.3 (21.9) v 8.2 (6.4); p <0.001) and polymorphonuclear cells (23.2 (14.2) v 6.3 (5.4); p = 0. 013). Activated macrophages with giant cell morphology clearly stained with the gelatinase B specific monoclonal antibody were observed in trachoma specimens. Zymography revealed that gelatinase B levels in trachoma specimens were significantly higher than the levels found in normal conjunctiva (1739.6 (1078.3) v 609.3 (395.9) scanning units; p = 0.0127).

CONCLUSIONS

The increased activity of gelatinase B and numbers of inflammatory cells containing gelatinase B in trachoma specimens suggest that this enzyme plays a part in the pathogenesis of conjunctival scarring in trachoma.

Collagen content and types in trachomatous conjunctivitis

PURPOSE

To study alterations in conjunctival collagen in the conjunctiva of patients with active trachoma.

METHODS

We studied conjunctival biopsy specimens obtained from nine subjects with active trachoma and from four control subjects. We used immunohistochemical techniques and a panel of monoclonal and polyclonal antibodies directed against types I, III, IV and V collagen.

RESULTS

In normal conjunctiva, the staining for types I and III collagen was localised to the substantia propria. Type IV collagen was located in the epithelial and capillary endothelial basement membranes. The staining for type V collagen was absent. In trachoma biopsy specimens, staining for types I and III collagen showed collagen fibrils among epithelial cells, patchy increase in staining intensity in the upper stroma, and thicker and irregularly arranged collagen fibrils in the substantia propria. Staining for type IV collagen showed irregularly thickened epithelial basement membrane. Staining for type V collagen showed patchy staining in the upper substantia propria; it was also noted in the cytoplasm of fibroblasts, in the walls of blood vessels in the substantia propria, and in the walls of accessory lacrimal glands.

CONCLUSIONS

Our data indicate new type V collagen formation, and increased types I, III and IV collagen content, in the conjunctiva from patients with active trachoma.

Immunopathogenesis of conjunctival scarring in trachoma

PURPOSE

Trachoma, a chronic follicular conjunctivitis caused by infection with Chlamydia trachomatis, is the leading cause of preventable blindness. The blinding complications are associated with progressive conjunctival scarring that may result from immunologically mediated responses. We studied the processes involved in the regulation of inflammation and fibrosis in trachoma by investigating the expression of fibrogenic cytokines in the conjunctiva.

METHODS

We studied conjunctival biopsy specimens obtained from nine subjects with active trachoma and from four control subjects. We used immunohistochemical techniques and a panel of monoclonal and polyclonal antibodies directed against interleukin-1 alpha (IL-1 alpha), interleukin-1 beta (IL-1 beta), tumour necrosis factor-alpha (TNF-alpha) and platelet-derived growth factor (PDGF). In addition, we characterised the composition of the inflammatory infiltrate by the use of a panel of monoclonal antibodies. Sirius red and Van Gieson stains were used to characterise the extent of fibrous tissue in the substantia propria.

RESULTS

Trachoma specimens showed greater numbers of inflammatory cells than control specimens. The expression of cytokines was absent in the normal conjunctiva. Cytoplasmic IL-1 alpha and IL-1 beta expression was noted in the conjunctival epithelium in all trachoma specimens. IL-1 alpha, IL-1 beta, TNF-alpha and PDGF were detected in macrophages infiltrating the substantia propria. B lymphocytes predominated over T lymphocytes in six trachoma biopsies with fibrosis confined to the deep substantia propria, whereas T lymphocytes predominated over B lymphocytes in three biopsies with more extensive fibrosis. In all trachoma biopsies helper/inducer T lymphocytes outnumbered suppressor/cytotoxic T lymphocytes.

CONCLUSIONS

The upregulated local production of IL-1 alpha, IL-beta, TNF-alpha and PDGF might contribute to conjunctival damage and scarring in trachoma.

Histopathological and immunohistochemical investigation of naturally occurring chlamydial conjunctivitis and urogenital inflammation in koalas (Phascolarctos cinereus)

Formalin-fixed conjunctival and urogenital (urinary bladder, urogenital sinus and prostate or penis, or both) samples obtained from 29 free-living koalas were examined histopathologically and immunohistochemically for the presence and character of inflammation and for evidence of chlamydiae. Five koalas had no inflammation at any site examined and were chlamydia-negative. Twenty-four koalas had inflammation at one or more sites and 18 were positive for chlamydiae by serology or antigen detection tests, or both. Histopathological and immunohistochemical findings were consistent with those seen in chlamydial infections in other species. The inflammatory infiltrate was most dense in the lamina propria-submucosa and, in most tissues, predominantly consisted of lymphocytes and plasma cells. Neutrophils and macrophages were variable in number. Lymphocytes in uninflamed and inflamed tissues consisted largely of T cells. B lymphocytes and plasma cells were mainly distributed immediately beneath the epithelium, but T cells were widely distributed. MHC H-positive lymphoid cells were present in variable numbers and, in some inflamed tissue samples, epithelial cell labelling was also seen. Chlamydial inclusion bodies were uncommon in routinely stained sections. Immunoperoxidase labelling for chlamydiae was positive in 16 of 52 inflamed tissues. The proportion of positive test results for chlamydial antigen by any method was directly related to the severity of inflammation.

Effects of antibody isotype and host cell type on in vitro neutralization of Chlamydia trachomatis

Monoclonal antibodies (MAbs) E-4, E-21, and DIII A3, which recognize the same or similar overlapping peptides in the variable domain IV of the major outer membrane protein of Chlamydia trachomatis but differ in isotype, were used in a complement-independent (CI) in vitro neutralization assay. These MAbs had previously been shown to neutralize chlamydial infectivity in HeLa 229 cells in a complement-dependent assay. In this report, all three MAbs neutralized chlamydial infectivity in HaK cells in a CI assay. However, when HeLa cells were used as the host cell, MAb E-4 (immunoglobulin G2b [IgG2b]) and MAb DIII A3 (IgG2b) failed to neutralize infectivity, while MAb E-21 (IgG1) neutralized chlamydial infectivity. These findings are consistent with the proposal that because of the presence of Fc gamma RIII receptors, HeLa cells facilitate infectivity and thus block neutralization through the uptake of an IgG2b-chlamydia complex. Since Fc gamma RIII receptors do not bind or bind poorly to IgG1, neutralization of C. trachomatis by MAb E-21 in HeLa cells is also corroborative evidence for the role of Fc gamma RIII receptors in this interaction. A fivefold enhancement of infectivity was seen when 10 and 1 micrograms of MAb E-4 per ml were tested in a CI assay with HeLa cells. In performing CI neutralization synergy studies in HeLa cells with MAbs E-4 and E-21, antagonism between MAbs E-4 and E-21 was observed at MAb E-4 concentrations of 10 and 1 micrograms/ml for all concentrations of MAb E-21 tested (10 to 0.1 micrograms/ml). When HaK cells were used in the same studies, no antagonism between the MAbs was found. In addition, when HeLa cells were used in a CI assay, polyclonal serum raised to a peptide representing variable domain IV of the major outer membrane protein inhibited the neutralizing ability of MAb E-21. The blocking of neutralization and the enhancement of infectivity by chlamydia-specific antibodies seen in this investigation with HeLa cells may have important clinical implications for developing preventive strategies for chlamydial infections.