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Bracken SJ, Suthers AN, DiCioccio RA, Su H, Anand S, Poe JC, Jia W, Visentin J, Basher F, Jordan CZ, McManigle WC, Li Z, Hakim FT, Pavletic SZ, Bhuiya NS, Ho VT, Horwitz ME, Chao NJ, Sarantopoulos S. Heightened TLR7 signaling primes BCR-activated B cells in chronic graft-versus-host disease for effector functions. Blood Adv 2024; 8:667-680. [PMID: 38113462 PMCID: PMC10839617 DOI: 10.1182/bloodadvances.2023010362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 11/02/2023] [Accepted: 11/20/2023] [Indexed: 12/21/2023] Open
Abstract
ABSTRACT Chronic graft-versus-host disease (cGVHD) is a debilitating, autoimmune-like syndrome that can occur after allogeneic hematopoietic stem cell transplantation. Constitutively activated B cells contribute to ongoing alloreactivity and autoreactivity in patients with cGVHD. Excessive tissue damage that occurs after transplantation exposes B cells to nucleic acids in the extracellular environment. Recognition of endogenous nucleic acids within B cells can promote pathogenic B-cell activation. Therefore, we hypothesized that cGVHD B cells aberrantly signal through RNA and DNA sensors such as Toll-like receptor 7 (TLR7) and TLR9. We found that B cells from patients and mice with cGVHD had higher expression of TLR7 than non-cGVHD B cells. Using ex vivo assays, we found that B cells from patients with cGVHD also demonstrated increased interleukin-6 production after TLR7 stimulation with R848. Low-dose B-cell receptor (BCR) stimulation augmented B-cell responses to TLR7 activation. TLR7 hyperresponsiveness in cGVHD B cells correlated with increased expression and activation of the downstream transcription factor interferon regulatory factor 5. Because RNA-containing immune complexes can activate B cells through TLR7, we used a protein microarray to identify RNA-containing antigen targets of potential pathological relevance in cGVHD. We found that many of the unique targets of active cGVHD immunoglobulin G (IgG) were nucleic acid-binding proteins. This unbiased assay identified the autoantigen and known cGVHD target Ro-52, and we found that RNA was required for IgG binding to Ro-52. Herein, we find that BCR-activated B cells have aberrant TLR7 signaling responses that promote potential effector responses in cGVHD.
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Affiliation(s)
- Sonali J. Bracken
- Division of Rheumatology and Immunology, Department of Medicine, Duke University Medical Center, Durham, NC
| | - Amy N. Suthers
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, NC
| | - Rachel A. DiCioccio
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, NC
| | - Hsuan Su
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, NC
| | - Sarah Anand
- Division of Hematology and Medical Oncology, Department of Medicine, University of Michigan, Ann Arbor, MI
| | - Jonathan C. Poe
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, NC
| | - Wei Jia
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, NC
| | - Jonathan Visentin
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, NC
- Department of Immunology and Immunogenetics, Bordeaux University Hospital, Bordeaux, France
- UMR CNRS 5164 ImmunoConcEpT, Bordeaux University, Bordeaux, France
| | - Fahmin Basher
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, NC
| | - Collin Z. Jordan
- Division of Nephrology, Department of Medicine, Duke University Medical Center, Durham NC
| | - William C. McManigle
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Duke University Medical Center, Durham NC
| | - Zhiguo Li
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham NC
- Duke Cancer Institute, Duke University Medical Center, Durham NC
| | - Frances T. Hakim
- Experimental Transplantation and Immunology Branch, National Cancer Institute, Bethesda, MD
| | - Steven Z. Pavletic
- Experimental Transplantation and Immunology Branch, National Cancer Institute, Bethesda, MD
| | - Nazmim S. Bhuiya
- Experimental Transplantation and Immunology Branch, National Cancer Institute, Bethesda, MD
| | - Vincent T. Ho
- Division of Hematologic Malignancies and Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Mitchell E. Horwitz
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, NC
- Duke Cancer Institute, Duke University Medical Center, Durham NC
| | - Nelson J. Chao
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, NC
- Duke Cancer Institute, Duke University Medical Center, Durham NC
- Department of Integrated Immunobiology, Duke University School of Medicine, Durham, NC
| | - Stefanie Sarantopoulos
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, NC
- Duke Cancer Institute, Duke University Medical Center, Durham NC
- Department of Integrated Immunobiology, Duke University School of Medicine, Durham, NC
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2
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Poe JC, Fang J, Zhang D, Lee MR, DiCioccio RA, Su H, Qin X, Zhang JY, Visentin J, Bracken SJ, Ho VT, Wang KS, Rose JJ, Pavletic SZ, Hakim FT, Jia W, Suthers AN, Curry-Chisolm IM, Horwitz ME, Rizzieri DA, McManigle WC, Chao NJ, Cardones AR, Xie J, Owzar K, Sarantopoulos S. Single-cell landscape analysis unravels molecular programming of the human B cell compartment in chronic GVHD. JCI Insight 2023:169732. [PMID: 37129971 PMCID: PMC10393230 DOI: 10.1172/jci.insight.169732] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023] Open
Abstract
Alloreactivity can drive autoimmune syndromes. After allogeneic hematopoietic stem cell transplantation (allo-HCT) chronic graft-versus-host disease (cGVHD), a B cell-mediated autoimmune-like syndrome, commonly occurs. Because donor-derived B cells continually develop under selective pressure from host alloantigens, aberrant B Cell Receptor (BCR)-activation and IgG production can emerge and contribute to cGVHD pathobiology. To better understand molecular programing of B cells under selective pressure of alloantigens, we performed scRNA-Seq analysis on high numbers of purified B cells from allo-HCT patients. An unsupervised analysis revealed 10 clusters, distinguishable by signature genes for maturation, activation and memory. We found striking transcriptional differences in the memory B cell compartment after allo-HCT compared to healthy or infected individuals. To identify intrinsic properties when B-cell tolerance is lost after allo-HCT, we then assessed clusters for differentially expressed genes (DEGs) between patients with vs. without autoimmune-like manifestations (Active cGVHD vs. No cGVHD, respectively). DEGs were found in Active cGVHD in both naive and BCR-activated clusters, suggesting functional diversity. Some DEGs were also differentially expressed across most clusters, suggesting common molecular programs that may promote B cell plasticity. Our study of human allo-HCT and cGVHD provides new understanding of B-cell memory in the face of chronic alloantigen stimulation.
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Affiliation(s)
- Jonathan C Poe
- Department of Medicine, Division of Hematological Malignancies and Cellular, Duke University Medical Center, Durham, United States of America
| | - Jiyuan Fang
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, United States of America
| | - Dadong Zhang
- Duke Cancer Institute, Duke University Medical Center, Durham, United States of America
| | - Marissa R Lee
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, United States of America
| | - Rachel A DiCioccio
- Department of Medicine, Division of Hematological Malignancies and Cellular, Duke University Medical Center, Durham, United States of America
| | - Hsuan Su
- Department of Medicine, Division of Hematological Malignancies and Cellular, Duke University Medical Center, Durham, United States of America
| | - Xiaodi Qin
- Duke Cancer Institute, Duke University Medical Center, Durham, United States of America
| | - Jennifer Y Zhang
- Department of Dermatology, Duke University Medical Center, Durham, United States of America
| | - Jonathan Visentin
- Department of Medicine, Division of Hematological Malignancies and Cellular, Duke University Medical Center, Durham, United States of America
| | - Sonali J Bracken
- Department of Medicine, Division of Rheumatology and Immunology, Duke University Medical Center, Durham, United States of America
| | - Vincent T Ho
- Medical Oncology, Dana-Farber Cancer Institute, Boston, United States of America
| | - Kathy S Wang
- Medical Oncology, Dana-Farber Cancer Institute, Boston, United States of America
| | - Jeremy J Rose
- Experimental Transplantation and Immunology Branch, National Cancer Institute, Bethesda, United States of America
| | - Steven Z Pavletic
- Experimental Transplantation and Immunology Branch, National Cancer Institute, Bethesda, United States of America
| | - Frances T Hakim
- Experimental Transplantation and Immunology Branch, National Cancer Institute, Bethesda, United States of America
| | - Wei Jia
- Department of Medicine, Division of Hematological Malignancies and Cellular, Duke University Medical Center, Durham, United States of America
| | - Amy N Suthers
- Department of Medicine, Division of Hematological Malignancies and Cellular, Duke University Medical Center, Durham, United States of America
| | - Itaevia M Curry-Chisolm
- Department of Medicine, Division of Hematological Malignancies and Cellular, Duke University Medical Center, Durham, United States of America
| | - Mitchell E Horwitz
- Department of Medicine, Division of Hematological Malignancies and Cellular, Duke University Medical Center, Durham, United States of America
| | - David A Rizzieri
- Department of Medicine, Division of Hematological Malignancies and Cellular, Duke University Medical Center, Durham, United States of America
| | - William C McManigle
- Department of Medicine, Division of Hematological Malignancies and Cellular, Duke University Medical Center, Durham, United States of America
| | - Nelson J Chao
- Department of Medicine, Division of Hematological Malignancies and Cellular, Duke University Medical Center, Durham, United States of America
| | - Adela R Cardones
- Department of Dermatology, Duke University Medical Center, Durham, United States of America
| | - Jichun Xie
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, United States of America
| | - Kouros Owzar
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, United States of America
| | - Stefanie Sarantopoulos
- Department of Medicine, Division of Hematological Malignancies and Cellular, Duke University Medical Center, Durham, United States of America
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Lin C, DiCioccio RA, Haykal T, McManigle WC, Li Z, Anand SM, Poe JC, Bracken SJ, Jia W, Alyea EP, Cardones AR, Choi T, Gasparetto C, Grunwald MR, Hennig T, Kang Y, Long GD, Lopez R, Martin M, Minor KK, Quinones VLP, Sung AD, Wiggins K, Chao NJ, Horwitz ME, Rizzieri DA, Sarantopoulos S. A Phase I Trial of SYK Inhibition with Fostamatinib in the Prevention and Treatment of Chronic Graft-Versus-Host Disease. Transplant Cell Ther 2023; 29:179.e1-179.e10. [PMID: 36577483 PMCID: PMC10433369 DOI: 10.1016/j.jtct.2022.12.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 12/02/2022] [Accepted: 12/19/2022] [Indexed: 12/26/2022]
Abstract
Despite the exciting advancement of novel therapies, chronic graft-versus-host disease (cGVHD) remains the most common cause of non-relapse mortality after allogeneic hematopoietic stem cell transplantation (HCT). Frontline treatment of cGVHD involves systemic steroids, which are associated with significant morbidities. We previously found that inhibition of spleen tyrosine kinase (SYK) with fostamatinib preferentially eradicated aberrantly activated B cells in both ex vivo studies of cGVHD patient B cells, as well as in vivo mouse studies. These and other preclinical studies implicated hyper-reactive B-cell receptor signaling and increased SYK expression in the pathogenesis of cGVHD and compelled this first in-human allogeneic HCT clinical trial. We investigated the safety and efficacy of the oral SYK inhibitor, fostamatinib, for both the prevention and treatment of cGVHD. The primary objective was to evaluate the safety of fostamatinib and determine its maximum tolerated dose in the post-HCT setting. Secondary objectives included assessing the efficacy of fostamatinib in preventing and treating cGVHD, as well as examining alterations in B-cell compartments with treatment. This was a single-institution phase I clinical trial that evaluated the use of fostamatinib in allogeneic HCT patients before the development of cGVHD or at the time of steroid-refractory cGVHD (SR-cGVHD). Patients received fostamatinib at one of three dose levels using a continual reassessment algorithm to determine the maximum tolerated dose. Multiparameter flow cytometry was used to evaluate changes in B cell subpopulations over the first year of treatment with fostamatinib. Nineteen patients were enrolled in this phase I trial, with 5 in the prophylaxis arm and 14 in the therapeutic arm. One patient (5%) required discontinuation of therapy for a dose-limiting toxicity. At a median follow-up of over 3 years, no patients had cancer relapse while on fostamatinib treatment, and recurrent malignancy was observed in 1 patient 2 years after the end of therapy. In the prophylaxis arm, 1 of 5 patients (20%) developed cGVHD while on fostamatinib. In the therapeutic arm, the overall response rate was 77%, with a complete response rate of 31%. The median duration of response was 19.3 months and the 12-month failure-free survival was 69% (95% confidence interval, 48-100). Patients were able to reduce their steroid dose by a median of 80%, with 73% remaining on a lower dose at 1 year compared to baseline. There was an early reduction in the proportion of IgD-CD38hi plasmablast-like cells with fostamatinib treatment, particularly in those SR-cGVHD patients who had an eventual response. B-cell reconstitution was not significantly impacted by fostamatinib therapy after allogeneic HCT. Fostamatinib featured a favorable safety profile in the post-HCT setting. Our data suggests an early efficacy signal that was associated with effects on expected cell targets in both the prophylaxis and treatment of cGVHD, providing rationale for a phase II investigation.
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Affiliation(s)
- Chenyu Lin
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Rachel A DiCioccio
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Tarek Haykal
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - William C McManigle
- Division of Pulmonary and Critical Care, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Zhiguo Li
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina
| | - Sarah M Anand
- Division of Hematology and Oncology, Department of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Jonathan C Poe
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Sonali J Bracken
- Division of Rheumatology and Immunology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Wei Jia
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Edwin P Alyea
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Adela R Cardones
- Division of Dermatology, Department of Internal Medicine, University of Kansas Medical Center, Lawrence, Kansas
| | - Taewoong Choi
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Cristina Gasparetto
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Michael R Grunwald
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health, Charlotte, North Carolina
| | - Therese Hennig
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Yubin Kang
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Gwynn D Long
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Richard Lopez
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Melissa Martin
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Kerry K Minor
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | | | - Anthony D Sung
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Kristi Wiggins
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Nelson J Chao
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Mitchell E Horwitz
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | | | - Stefanie Sarantopoulos
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina.
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Chu P, Cuellar MC, Bracken SJ, Tarrant TK. A Mimic of Ankylosing Spondylitis, Ochronosis: Case Report and Review of the Literature. Curr Allergy Asthma Rep 2021; 21:19. [PMID: 33666743 PMCID: PMC8285993 DOI: 10.1007/s11882-021-01002-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2021] [Indexed: 10/27/2022]
Abstract
PURPOSE OF REVIEW Ochronosis and alkaptonuria are manifestations of the same condition-a rare autosomal recessive disorder resulting from a constitutional lack of homogentisate 1,2-dioxygenase (HGD) with the consequent accumulation of homogentisic acid (HGA). In ochronosis, HGA undergoes autoxidation as well as enzymatic oxidation to form an ochronotic pigment that accumulates in cartilage and connective tissues. In the beginning, there is homogentisic aciduria and pigmentation of cartilages and other connective tissues. In later years, generalized osteoarthritis of the spine and large joints, termed ochronotic arthropathy, develops. RECENT FINDINGS The diagnosis is confirmed by quantitative measurement of HGA in urine and mutation analysis of the HGD gene. One of the differential diagnoses for the skin findings is exogenous ochronosis, a limited hyperpigmentation of skin caused by some chemicals. As for the lumbar spine findings, there can be radiographic similarities with ankylosing spondylitis (AS) including reduced intervertebral disc spaces and loss of lumbar lordosis; however, ochronosis will spare the sacroiliac joint, and the lumbar spine will show dense, wafer-like disk calcification with a vacuum disc phenomenon and broad syndesmophytes. Here, we present a case of a patient with probable ochronosis that was treated many years as ankylosing spondylitis without response, and we provide a review of the current literature on ochronosis pathogenesis, diagnosis, and treatment.
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Affiliation(s)
- Philip Chu
- Division of Rheumatology and Immunology, Department of Medicine, Duke University, Durham, NC, 27710, USA
| | - Maria C Cuellar
- Division of Rheumatology, Department of Medicine, Hospital del Salvador, Santiago, Chile
| | - Sonali J Bracken
- Department of Internal Medicine, Duke University, Durham, NC, 27710, USA
| | - Teresa K Tarrant
- Division of Rheumatology and Immunology, Department of Medicine, Duke University, Durham, NC, 27710, USA.
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Abstract
Urticaria (hives) is a highly prevalent skin disorder that can occur with or without associated angioedema. Chronic spontaneous urticaria (CSU) is a condition which persists for more than 6 weeks in duration and occurs in the absence of an identifiable provoking factor. CSU results from pathogenic activation of mast cells and basophils, which gives rise to the release of proinflammatory mediators that support the generation of urticaria. Several theories have been put forth regarding the pathogenesis of CSU with much evidence pointing toward a potential autoimmune etiology in up to 50% of patients with this condition. In this review, we highlight the evidence surrounding the autoimmune pathogenesis of chronic urticaria including recent data which suggests that CSU may involve contributions from both immunoglobin G (IgG)-specific and immunoglobulin E (IgE)-specific autoantibodies against a vast array of antigens that can span beyond those found on the surface of mast cells and basophils.
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Affiliation(s)
- Sonali J Bracken
- Department of Internal Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Soman Abraham
- Department of Pathology, Duke University Medical Center, Durham, NC, United States.,Department of Immunology, Duke University Medical Center, Durham, NC, United States
| | - Amanda S MacLeod
- Department of Immunology, Duke University Medical Center, Durham, NC, United States.,Department of Dermatology, Duke University Medical Center, Durham, NC, United States
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Adami AJ, Bracken SJ, Guernsey LA, Rafti E, Maas KR, Graf J, Matson AP, Thrall RS, Schramm CM. Early-life antibiotics attenuate regulatory T cell generation and increase the severity of murine house dust mite-induced asthma. Pediatr Res 2018; 84:426-434. [PMID: 29967529 PMCID: PMC6258300 DOI: 10.1038/s41390-018-0031-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 03/29/2018] [Accepted: 04/10/2018] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Early-life exposure to antibiotics (ABX) has been linked to increases in asthma severity and prevalence in both children and laboratory animals. We explored the immunologic mechanisms behind this association using a mouse model of house dust mite (HDM)-induced asthma and early-life ABX exposure. METHODS Mice were exposed to three short courses of ABX following weaning and experimental asthma was thereafter induced. Airway cell counts and differentials; serum immunoglobulin E (IgE); pulmonary function; lung histopathology; pulmonary regulatory T cells (Tregs); and the fecal microbiome were characterized following ABX exposure and induction of experimental asthma. RESULTS Asthma severity was increased in mice exposed to ABX, including: airway eosinophilia, airway hyper-reactivity, serum HDM-specific IgE, and lung histopathology. ABX treatment led to sharp reduction in fecal microbiome diversity, including the loss of pro-regulatory organisms such as Lachnospira. Pulmonary Tregs were reduced with ABX treatment, and this reduction was directly proportional to diminished microbiome diversity. CONCLUSION Intermittent exposure to ABX early in life worsened the severity of experimental asthma and reduced pulmonary Tregs; the latter change correlated with decreased microbiome diversity. These data may suggest targets for immunologic or probiotic therapy to counteract the harmful effects of childhood ABX.
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Affiliation(s)
- Alexander J. Adami
- Department of Immunology, University of Connecticut Health, Farmington, CT
| | - Sonali J. Bracken
- Department of Immunology, University of Connecticut Health, Farmington, CT
| | - Linda A. Guernsey
- Department of Immunology, University of Connecticut Health, Farmington, CT,Department of Pediatrics, University of Connecticut Health, Farmington, CT
| | - Ektor Rafti
- Department of Pediatrics, University of Connecticut Health, Farmington, CT
| | - Kendra R. Maas
- Microbial Analysis, Resources, and Services Facility, University of Connecticut, Storrs, CT
| | - Joerg Graf
- Department of Molecular and Cell Biology, University of Connecticut, Storrs, CT
| | - Adam P. Matson
- Department of Immunology, University of Connecticut Health, Farmington, CT,Department of Pediatrics, University of Connecticut Health, Farmington, CT,Division of Neonatology, Connecticut Children’s Medical Center, Hartford, CT
| | - Roger S. Thrall
- Department of Immunology, University of Connecticut Health, Farmington, CT
| | - Craig M. Schramm
- Department of Pediatrics, University of Connecticut Health, Farmington, CT,Division of Pulmonary Medicine, Connecticut Children’s Medical Center, Hartford, CT,Corresponding Author: Craig M. Schramm, Connecticut Children’s Medical Center, 282 Washington
Street, Hartford, CT 06106; ; Telephone: 860-545- 9440; Fax: 860-545-9445
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Bracken SJ, Adami AJ, Rafti E, Schramm CM, Matson AP. Regulation of IgE activity in inhalational tolerance via formation of IgG anti-IgE/IgE immune complexes. Clin Mol Allergy 2018; 16:13. [PMID: 29796009 PMCID: PMC5960149 DOI: 10.1186/s12948-018-0091-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 05/08/2018] [Indexed: 11/10/2022] Open
Abstract
Background Allergic asthma is an inflammatory disorder of the airways that results from inappropriate production of IgE against harmless, environmental antigens. Sequestration of free IgE using humanized IgG anti-IgE is an effective therapy for asthma and other atopic disorders. However, the status of free IgE in subjects who have naturally developed immune tolerance to inhaled antigens has not been well studied. Methods C57BL/6 mice were sensitized and challenged with ovalbumin (OVA) for 7 days to induce allergic airway disease (AAD) or 6 weeks to induce a state of local inhalational tolerance (LIT). Serum from AAD or LIT mice, diluted to achieve equivalent levels of total OVA-specific IgE, was used to sensitize rat basophil leukemia cells for allergen-mediated degranulation. Levels of degranulation were measured in relation to serum concentrations of free IgE and IgG anti-IgE/IgE immune complexes. Results Serum from AAD animals induced a greater degree of basophil degranulation than serum from LIT animals. These results correlated with higher levels of free IgE in AAD animals, whereas LIT mice demonstrated a significant increase in IgG anti-IgE/IgE immune complexes relative to their diseased counterparts. Conclusions Sequestration of free IgE by naturally occurring IgG anti-IgE may aid in the development of immune tolerance against inhaled allergens. The decrease in bioavailability of free IgE may, in turn, contribute to the overall reduction of asthma symptoms via a mechanism that mimics the therapeutic effects of humanized IgG anti-IgE.
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Affiliation(s)
- Sonali J Bracken
- 1Department of Immunology, University of Connecticut Health, 263 Farmington Avenue, Farmington, CT 06030 USA
| | - Alexander J Adami
- 1Department of Immunology, University of Connecticut Health, 263 Farmington Avenue, Farmington, CT 06030 USA
| | - Ektor Rafti
- 2Department of Pediatrics, Connecticut Children's Medical Center, Hartford, CT USA
| | - Craig M Schramm
- 2Department of Pediatrics, Connecticut Children's Medical Center, Hartford, CT USA
| | - Adam P Matson
- 1Department of Immunology, University of Connecticut Health, 263 Farmington Avenue, Farmington, CT 06030 USA.,2Department of Pediatrics, Connecticut Children's Medical Center, Hartford, CT USA
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Adami AJ, Bracken SJ. Breathing Better Through Bugs: Asthma and the Microbiome. Yale J Biol Med 2016; 89:309-324. [PMID: 27698615 PMCID: PMC5045140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Asthma is a highly heterogeneous disease characterized by inflammation of the airways, which invokes symptoms such as wheeze, dyspnea, and chest tightness. Asthma is the product of multiple interconnected immunological processes and represents a constellation of related, but distinct, disease phenotypes. The prevalence of asthma has more than doubled since the 1980s, and efforts to understand this increase have inspired consideration of the microbiome as a key player in the pathophysiology and regulation of this disease. While recent years have seen an explosion of new research in this area, researchers are only beginning to untangle to mechanisms by which the microbiome may influence asthma. This review will focus on the relationship between the microbiome and the immune system and how this influences development of asthma. This review will also highlight evidence that may point the way toward new therapies and potential cures for this ancient respiratory foe.
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Affiliation(s)
- Alexander J. Adami
- To whom all correspondence should be addressed: Alexander J. Adami, MD/PhD Student, University of Connecticut Health Center, Department of Immunology, 263 Farmington Avenue, MC 1319, Farmington, CT 06030, , Phone: 1-860-679-1995, Fax: 1-860-679-1047
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Szczepanek SM, Roberts S, Rogers K, Cotte C, Adami AJ, Bracken SJ, Salmon S, Secor ER, Thrall RS, Andemariam B, Metzger DW. Poor Long-Term Efficacy of Prevnar-13 in Sickle Cell Disease Mice Is Associated with an Inability to Sustain Pneumococcal-Specific Antibody Titers. PLoS One 2016; 11:e0149261. [PMID: 26910228 PMCID: PMC4766082 DOI: 10.1371/journal.pone.0149261] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 01/30/2016] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND One of the most common causes of morbidity and mortality in children with sickle cell disease (SCD) is infection with the pneumococcal bacterium (Streptococcus pneumoniae). Unfortunately, the polysaccharide-conjugate vaccine appears to be less effective in individuals with SCD when compared to the general population. We sought to better understand the relative efficacy of pneumococcal vaccination in a SCD mouse challenge model. METHODS Transgenic control and SCD mice were monitored for mortality after intranasal pneumococcal infection or pneumococcal vaccination with Prevnar-13 and type-matched challenge. Anti-pneumococcal antibody titers were measured by ELISA and opsonophagocytosis was measured in vitro. RESULTS Mortality after pneumococcal infection was similar between control and SCD mice. However, after three intramuscular polysaccharide-conjugate vaccinations, all control mice were protected following high-dose intranasal infection, whereas 60% of SCD mice died. Anti-pneumococcal antibody titers showed initial IgG and IgM responses in both groups, but waning titers were observed in the SCD group, even after boosting. When functionally assayed in vitro, serum from SCD mice 13 weeks after a second booster shot maintained little to no ability to opsonize pneumococci, while serum from control mice sustained a significantly higher capacity opsonization. Thus, it appears that SCD mice do not maintain antibody responses to pneumococcal polysaccharides after Prevnar-13 vaccination, thereby leaving them susceptible to mortality after type-matched infection. CONCLUSION Our results emphasize the need to better understand the correlates of immune protection in SCD so that pneumococcal vaccines can be improved and mortality reduced in this susceptible population.
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Affiliation(s)
- Steven M. Szczepanek
- Center of Excellence for Vaccine Research, Department of Pathobiology and Veterinary Science, University of Connecticut, Storrs, CT, United States of America, 06269
- * E-mail:
| | - Sean Roberts
- Center for Immunology and Microbial Disease, Albany Medical College, Albany, NY, United States of America, 12208
| | - Kara Rogers
- Center of Excellence for Vaccine Research, Department of Pathobiology and Veterinary Science, University of Connecticut, Storrs, CT, United States of America, 06269
| | - Christina Cotte
- Center of Excellence for Vaccine Research, Department of Pathobiology and Veterinary Science, University of Connecticut, Storrs, CT, United States of America, 06269
| | - Alexander J. Adami
- Department of Immunology, University of Connecticut Health Center, Farmington, CT, United States of America, 06030
| | - Sonali J. Bracken
- Department of Immunology, University of Connecticut Health Center, Farmington, CT, United States of America, 06030
| | - Sharon Salmon
- Center for Immunology and Microbial Disease, Albany Medical College, Albany, NY, United States of America, 12208
| | - Eric R. Secor
- Helen and Harry Gray Cancer Center and Department of Medicine, Division of Integrative Medicine, Hartford Hospital, Hartford, CT, United States of America, 06106
| | - Roger S. Thrall
- Department of Immunology, University of Connecticut Health Center, Farmington, CT, United States of America, 06030
| | - Biree Andemariam
- The Lea’s Foundation Center for Hematological Disorders, Neag Comprehensive Cancer Center, University of Connecticut Health Center, Farmington, CT, United States of America, 06030
| | - Dennis W. Metzger
- Center for Immunology and Microbial Disease, Albany Medical College, Albany, NY, United States of America, 12208
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Bracken SJ, Adami AJ, Szczepanek SM, Ehsan M, Natarajan P, Guernsey LA, Shahriari N, Rafti E, Matson AP, Schramm CM, Thrall RS. Long-Term Exposure to House Dust Mite Leads to the Suppression of Allergic Airway Disease Despite Persistent Lung Inflammation. Int Arch Allergy Immunol 2015; 166:243-58. [PMID: 25924733 DOI: 10.1159/000381058] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 02/18/2015] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Allergic asthma is a major cause of worldwide morbidity and results from inadequate immune regulation in response to innocuous, environmental antigens. The need exists to understand the mechanisms that promote nonreactivity to human-relevant allergens such as house dust mite (HDM) in order to develop curative therapies for asthma. The aim of our study was to compare the effects of short-, intermediate- and long-term HDM administration in a murine asthma model and determine the ability of long-term HDM exposure to suppress allergic inflammation. METHODS C57BL/6 mice were intranasally instilled with HDM for short-term (2 weeks), intermediate-term (5 weeks) and long-term (11 weeks) periods to induce allergic airway disease (AAD). The severity of AAD was compared across all stages of the model via both immunological and pulmonary parameters. RESULTS Short- and intermediate-term HDM exposure stimulated the development of AAD that included eosinophilia in the bronchoalveolar lavage fluid (BALF), pronounced airway hyperreactivity (AHR) and evidence of lung inflammation. Long-term HDM exposure promoted the suppression of AAD, with a loss of BALF eosinophilia and AHR despite persistent mononuclear inflammation in the lungs. Suppression of AAD with long-term HDM exposure was associated with an increase in both Foxp3+ regulatory T cells and IL-10-positive alveolar macrophages at the site of inflammation. CONCLUSIONS This model recapitulates the key features of human asthma and may facilitate investigation into the mechanisms that promote immunological tolerance against clinically relevant aeroallergens.
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Affiliation(s)
- Sonali J Bracken
- Department of Immunology, University of Connecticut Health Center, Farmington, Conn., USA
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Price JJ, Gunster GD, Bracken SJ. Amniocentesis of the sensitized Rh-negative patient. A combined study in 2 community hospitals. Obstet Gynecol 1968; 37:829-35. [PMID: 4995813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Price JJ, Gunster GD, Bracken SJ. Amniocentesis of the sensitized Rh-negative patient. A combined study in 2 community hospitals. Obstet Gynecol 1968; 31:829-35. [PMID: 5754573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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