Negative regulation of Toll-like receptor signaling plays an essential role in homeostasis of the intestine

A healthy intestinal tract is characterized by controlled homeostasis due to the balanced interaction between commensal bacteria and the host mucosal immune system. Human and animal model studies have supported the hypothesis that breakdown of this homeostasis may underlie the pathogenesis of inflammatory bowel diseases. However, it is not well understood how intestinal microflora stimulate the intestinal mucosal immune system and how such activation is regulated. Using a spontaneous, commensal bacteria-dependent colitis model in IL-10-deficient mice, we investigated the role of TLR and their negative regulation in intestinal homeostasis. In addition to IL-10(-/-) MyD88(-/-) mice, IL-10(-/-) TLR4(-/-) mice exhibited reduced colitis compared to IL-10(-/-) mice, indicating that TLR4 signaling plays an important role in inducing colitis. Interestingly, the expression of IRAK-M, a negative regulator of TLR signaling, is dependent on intestinal commensal flora, as IRAK-M expression was reduced in mice re-derived into a germ-free environment, and introduction of commensal bacteria into germ-free mice induced IRAK-M expression. IL-10(-/-) IRAK-M(-/-) mice exhibited exacerbated colitis with increased inflammatory cytokine gene expression. Therefore, this study indicates that intestinal microflora stimulate the colitogenic immune system through TLR and negative regulation of TLR signaling is essential in maintaining intestinal homeostasis.

Glucose-6-phosphate dehydrogenase deficiency and the inflammatory response to endotoxin and polymicrobial sepsis*

OBJECTIVE

Glucose-6-phosphate dehydrogenase (G6PD) deficiency is a common human genetic polymorphism. The deficiency protects against malaria but was shown to worsen the clinical course after severe trauma. This study tested whether the deficiency is associated with altered cytokine responses in vitro and in vivo and affects survival after endotoxemia or polymicrobial sepsis (cecal ligation and puncture).

DESIGN

Genotyping of animals was carried out using a novel and improved allele-specific polymerase chain reaction assay. Macrophage and splenocyte responses in vitro and ex vivo were compared using gene array analyses and enzyme-linked immunosorbent assays and flow cytometry under both baseline and lipopolysaccharide-stimulated conditions. Endotoxemia- or sepsis-induced mortality was compared under a variety of treatment and resuscitation protocols.

SETTINGS

Medical school research laboratories.

SUBJECTS

Litter mates of wild-type and G6PD-mutant mice that display a degree of G6PD deficiency similar to that observed in the African-type human deficiency (20% of normal).

MEASUREMENTS AND MAIN RESULTS

Lipopolysaccharide in vivo (lipopolysaccharide from Escherichia coli, 10-35 mg/kg body weight intraperitoneally) resulted in greater interleukin-1beta, interleukin-6, and interleukin-10 levels in serum and peritoneal lavage in G6PD-deficient mice compared with wild type. Prevailing doses of lipopolysaccharide in vivo increased mortality in G6PD-deficient animals (40-70%) as compared with wild type (5-40%). In contrast, mortality after cecal ligation and puncture-induced sepsis was similar in G6PD-deficient and wild-type animals either in saline-resuscitated or antibiotic-treated animals. Splenic and blood phagocytes from septic G6PD-deficient and wild-type animals displayed attenuated ex vivo lipopolysaccharide responsiveness.

CONCLUSIONS

This study demonstrates that G6PD deficiency augments cytokine responses after inflammatory challenges. The deficiency is disadvantageous as reflected in increased mortality after hyperinflammation caused by acute endotoxemia. However, the deficiency may not manifest worsened survival after the immunosuppressed condition associated with severe sepsis.

Adenosine A2A receptor inactivation increases survival in polymicrobial sepsis

The mechanisms governing the impairment of bacterial clearance and immune function in sepsis are not known. Adenosine levels are elevated during tissue hypoxia and damage associated with sepsis. Adenosine has strong immunosuppressive effects, many of which are mediated by A(2A) receptors (A(2A)R) expressed on immune cells. We examined whether A(2A)R are involved in the regulation of immune function in cecal ligation and puncture-induced murine polymicrobial sepsis by genetically or pharmacologically inactivating A(2A)R. A(2A)R knockout (KO) mice were protected from the lethal effect of sepsis and had improved bacterial clearance compared with wild-type animals. cDNA microarray analysis and flow cytometry revealed increased MHC II expression in A(2A)-inactivated mice, suggesting improved Ag presentation as a mechanism of protection. Apoptosis was attenuated in the spleen of A(2A) KO mice indicating preserved lymphocyte function. Levels of the immunosuppressive cytokines IL-10 and IL-6 were markedly lower following A(2A)R blockade. Similar to observations with A(2A)R KO mice, an A(2A)R antagonist increased survival even when administered in a delayed fashion. These studies demonstrate that A(2A)R blockade may be useful in the treatment of infection and sepsis.

Augmented IL-10 production and redox-dependent signaling pathways in glucose-6-phosphate dehydrogenase-deficient mouse peritoneal macrophages

Glucose-6-phosphate dehydrogenase (G6PD) supports cellular antioxidant pathways. G6PD deficiency is associated with malaria protection but was shown to worsen the clinical course to injury. This study tested whether G6PD deficiency manifests in altered cytokine responses using peritoneal macrophages from a G6PD-deficient mouse model with a degree of defect similar to the common type A(-) human G6PD deficiency. Lipopolysaccharide (LPS)-induced interleukin (IL)-10 and IL-12 production was doubled in G6PD-deficient macrophages compared with wild-type (WT). Protein kinase C (PKC) activation by phorbol-ester prior to LPS resulted in a fivefold greater IL-10 production in G6PD-deficient macrophages compared with WT. Interferon-gamma treatment prior to LPS augmented IL-12 production in G6PD-deficient and WT macrophages and partially inhibited IL-10 production by G6PD-deficient macrophages. The antioxidants (N-acetyl-L-cysteine and glutathione ethyl-ester) blunted IL-10 and IL-12 production, indicating a role for oxidative stress in the observed response differences between deficient and WT macrophages. LPS-induced activation of nuclear factor-kappaB, cyclic adenosine monophosphate response element-binding protein, and specificity protein 3 was augmented in G6PD-deficient cells compared with WT. The PKCdelta inhibitor Rottlerin inhibited IL-10 and IL-12 production at different 50% effective-dose concentrations between deficient and WT macrophages, indicating elevated PKCdelta activity in deficient cells. This study reveals that activated G6PD-deficient macrophages display an augmented production of cytokines with a prominent impact on IL-10 production. The altered cytokine responses are associated with augmented activation of redox-dependent transcription factors and PKCdelta. Alterations in signaling pathways and associated changes in cytokine production may play a role in modulating the inflammatory responses following bacterial or malarial infections in G6PD deficiency.

Lung compartmentalization of inflammatory cells in sepsis

Lung injury commonly occurs in the setting of systemic inflammatory response syndrome occurring during bacterial sepsis. There has been little work quantifying different leukocytes within the different compartments of the lung and their association with overt lung injury in sepsis. We examined the pathogenesis of lung injury after cecal ligation and puncture (CLP), a clinically relevant model of sepsis. To assess the sequestration and migration of leukocytes, leukocyte differentials were obtained for the lung vascular compartment and the bronchoalveolar airspace. At 24 h post CLP, there were signs of edema in the lung, while at 48 h after CLP, there were clear indications of alveolar wall thickening with increased cellularity and diffuse alveolar hemorrhage. The number of lymphocytes in the pulmonary vascular compartment dropped by 50% and doubled in the (bronchoalveolar lavage) BAL, 24 h after CLP compared to sham controls suggesting that there was transendothelial migration of lymphocytes. At 48 h after CLP, lymphocyte numbers in the vasculature was similar to controls but BAL lymphocyte numbers were still raised. The number of pulmonary intravascular neutrophils were similar to controls at 24 h post CLP but were greatly elevated 48 h after CLP. The increase in neutrophils was partly due to a substantial increase in the percentage of immature band cells, indicating recruitment of neutrophils from the bone marrow. There were very few neutrophils in the BAL of sham controls and CLP rats. Perfusate monocyte/macrophages were significantly increased 48 h after CLP and a similar increase in macrophages was observed in the BAL. These results strongly suggest a role for lymphocytes and macrophages in the development of overt lung injury as the migration of these cells corresponds to that of the appearance of lung injury 48 h after CLP. Importantly our data also demonstrates the compartmentalization and migration of different inflammatory cell-types during the development of sepsis.