Emerging Roles of Vitamin D-Induced Antimicrobial Peptides in Antiviral Innate Immunity

Vitamin D deficiency, characterized by low circulating levels of calcifediol (25-hydroxyvitamin D, 25D) has been linked to increased risk of infections of bacterial and viral origin. Innate immune cells produce hormonal calcitriol (1,25-dihydroxyvitamin D, 1,25D) locally from circulating calcifediol in response to pathogen threat and an immune-specific cytokine network. Calcitriol regulates gene expression through its binding to the vitamin D receptor (VDR), a ligand-regulated transcription factor. The hormone-bound VDR induces the transcription of genes integral to innate immunity including pattern recognition receptors, cytokines, and most importantly antimicrobial peptides (AMPs). Transcription of the human AMP genes β-defensin 2/defensin-β4 (HBD2/DEFB4) and cathelicidin antimicrobial peptide (CAMP) is stimulated by the VDR bound to promoter-proximal vitamin D response elements. HDB2/DEFB4 and the active form of CAMP, the peptide LL-37, which form amphipathic secondary structures, were initially characterized for their antibacterial actively. Notably, calcitriol signaling induces secretion of antibacterial activity in vitro and in vivo, and low circulating levels of calcifediol are associated with diverse indications characterized by impaired antibacterial immunity such as dental caries and urinary tract infections. However, recent work has also provided evidence that the same AMPs are components of 1,25D-induced antiviral responses, including those against the etiological agent of the COVID-19 pandemic, the SARS-CoV2 coronavirus. This review surveys the evidence for 1,25D-induced antimicrobial activity in vitro and in vivo in humans and presents our current understanding of the potential mechanisms by which CAMP and HBD2/DEFB4 contribute to antiviral immunity.

Association between Mycobacterium avium complex lung disease and serum vitamin D status, antimicrobial peptide levels, and bone mineral density

Vitamin D maintains calcium balance and has immunomodulatory effects. Only few studies have revealed the relationship between vitamin D and its associated factors in Mycobacterium avium complex (MAC) infection. This study aimed to investigate the effects of MAC infection on serum vitamin D, human cationic antimicrobial protein 18, its C-terminal 37 amino acid fragment (hCAP18/LL-37) levels, and bone mineral density (BMD).We enrolled 58 patients with MAC lung disease and 15 control participants. Serum 25-hydroxyvitamin D and hCAP18/LL-37 levels were measured via enzyme-linked immunosorbent assay. Lastly, computed tomography scan density readings of the BMD of the thoracic and lumbar vertebral bones (Th4, Th7, Th10, and L1) were assessed.No significant differences in patient characteristics and serum vitamin D levels were observed. Patients with MAC lung disease had significantly low serum hCAP18/LL-37 levels (P = .049). Moreover, low BMD of the mean thoracic and lumbar vertebrae was observed (mean Th, P = .012; L1, P = .48, respectively). A higher prevalence of scoliosis (P = .031) was observed in the participants with low BMD compared with the control participants. Based on a multivariate analysis, patients with MAC lung disease had significantly lower body mass index [odds ratio (OR), 19.1; 95% confidence interval (CI), 2.0-419.0; P < .01] and vertebral BMD (OR, 12.4; 95% CI, 1.7-160.6; P = .012) than control participants.Serum hCAP18/LL-37 level and BMD were significantly decreased in patients with MAC lung disease without relation to serum vitamin D level. The vitamin D-independent pathway might affect the waning of antimicrobial peptides and decrease in BMD.

Status of cathelicidin IL-37, cytokine TNF, and vitamin D in patients with pulmonary tuberculosis

Development of Mycobacterium tuberculosis (Mtb) infection depends on the ability of the host to elicit the protective immune response to the pathogen. Cathelicidin plays a role in antibacterial innate immunity mechanisms. This peptide contributes to the barrier function of respiratory epithelium and takes part in controlling pulmonary bacterial infections. LL-37 (leucine-leucine-37) is involved in host defense and innate immune response to mycobacterial infections, as well. This study aims to evaluate the serum concentrations of LL-37 in individuals with active pulmonary tuberculosis (TB) and to determine whether any correlations between peptide LL-37, tumor necrosis factor (TNF) and vitamin D serum levels exist. A total of 46 adults with pulmonary TB were recruited for the study. Sixty-one controls were randomly selected as control group. Serum concentrations of cathelicidin LL-37, vitamin D (25(OH)D), as well as TNF, were measured using an enzyme-linked immunosorbent assay (ELISA) kit. The mean (± SEM) level of LL-37 was significantly higher in the TB group (7.45±1.58) compared with healthy controls (1.41±0.22) (p less than 0.001). Mean serum concentration of TNF was significantly higher in the TB group (8.51±1.92) compared with healthy controls (2.69±0.19) (p less than 0.001). There was no significant difference in mean serum levels of vitamin D between healthy (26.10±1.74) and TB subjects (24.18±1.95). No correlations between LL-37, TNF, and vitamin D levels in patients with TB were observed. Our results indicated that serum levels of peptide LL-37 during TB is raised significantly, and this observation is compatible with the general view of the important role of this cathelicidin in defense mechanisms against Mtb infection.

Serum level of cathelicidin LL-37 in patients with active tuberculosis and other infectious diseases

A growing body of evidence indicates the role of cathelicidin LL-37, a member of the antimicrobial peptide family, in host innate defense mechanisms. The important role of this peptide in infectious diseases is also suggested, however, to date, data relating to LL-37 expression in the course of bacterial infections are far from complete. Therefore, the aim of the present study was to determine LL-37 serum levels in adult patients with pulmonary tuberculosis (TB). For comparison, circulating LL-37 levels in patients with pneumonia induced by Gram-positive or Gram-negative bacteria species and in healthy subjects were evaluated. Fifty patients with pulmonary TB, 31 patients with pneumonia caused by gram-positive bacteria, 68 individuals with pneumonia caused by Gram-negative bacteria, and 61 randomly selected healthy subjects were enrolled in the study. Serum LL-37 concentration was measured using an enzyme-linked immunosorbent assay (ELISA). We established that the mean level of LL-37 was statistically significantly higher in TB patients than that in patients with Gram-positive bacteria-induced pneumonia (p < 0.001), in patients with Gram-negative bacteria-induced pneumonia (p < 0.001), and in healthy controls (p < 0.001). In patients with TB, no statistically significant correlations between serum LL-37 and CRP concentrations (r = -0.2042; p = 0.189) and between serum LL-37 concentration and WBC count (r = -0.1277; p = 0.414) were observed. Our observations clearly documented that cathelicidin LL-37 plays a role in defense mechanisms against infectious agents, and is particularly important when the infection is caused by an intracellular pathogen.

Intermittent exercises reduce the hypertension syndromes and improve the quality of life

BACKGROUND

Hypertension is one of the most common causes for cardiovascular mortality in China and physical exercises have been well recognized for its prevention and treatment. Recent studies indicated that the methods of exercise differed in improving cardiorespiratory fitness, endothelial function, etc.

METHODS

In the present study, we compared the effects of high-intensity intermittent exercise and moderate-intensity continuous exercise on the blood pressure, plasma CRAMP level and living quality of hypertensive patients. We measured the basic characteristics of all the individuals and made intermittent/continuous exercise plans according to each of their conditions.

RESULTS

The whole training lasted for 16 weeks and the CRAMP level of each patient was recorded by blood sampling and ELISA test. The patients' quality of life (QoL) was also surveyed to determine their physical and psychological health. Our result suggested that the intermittent exercise significantly reduced the blood pressure and the CRAMP level of the hypertensive patients. Although the physical pain and social function were not improved by either exercises training, the other six dimensions of QoL, including physical function, physical role, general health condition, vitality, emotional role and mental health, were significant improved by exercises, especially by intermittent exercises.

CONCLUSIONS

To sum up, the high-intensity intermittent exercise and moderate-intensity continuous exercise could both improve the living quality of hypertensive patients, but the effect of intermittent exercise was more obvious that it reduced the blood pressure and the CRAMP level of hypertensive patients and improve the living quality in a higher level.

No evidence of pathogenic involvement of cathelicidins in patient cohorts and mouse models of lupus and arthritis

Apart from their role in the immune defence against pathogens evidence of a role of antimicrobial peptides (AMPs) in autoimmune diseases has accumulated in the past years. The aim of this project was to examine the functional impact of the human cathelicidin LL-37 and the mouse cathelicidin-related AMP (CRAMP) on the pathogenesis of lupus and arthritis. Serum LL-37 and anti-LL-37 levels were measured by ELISA in healthy donors and patients with Systemic Lupus Erythematosus (SLE) and Rheumatoid arthritis (RA). Pristane-induced lupus was induced in female wild type (WT) and cathelicidin-deficient (CRAMP-/-) mice. Serum levels of anti-Sm/RNP, anti-dsDNA, and anti-histone were determined via ELISA, cytokines in sera and peritoneal lavages were measured via Multiplex. Expression of Interferon I stimulated genes (ISG) was determined by real-time PCR. Collagen-induced arthritis (CIA) was induced in male WT and CRAMP-/- mice and arthritis severity was visually scored and analysed histomorphometrically by OsteoMeasure software. Serum levels of anti-LL-37 were higher in SLE-patients compared to healthy donors or patients with RA. However, no correlation to markers of disease activity or organ involvement was observed. No significant differences of autoantibody or cytokine/chemokine levels, or of expression of ISGs were observed between WT and CRAMP-/- mice after pristane-injection. Furthermore, lung and kidney pathology did not differ in the absence of CRAMP. Incidence and severity of CIA and histological parameters (inflammation, cartilage degradation, and bone erosion) were not different in WT and CRAMP-/- mice. Although cathelicidins are upregulated in mouse models of lupus and arthritis, cathelicidin-deficiency did not persistently affect the diseases. Also in patients with SLE, autoantibodies against cathelicidins did not correlate with disease manifestation. Reactivity against cathelicidins in lupus and arthritis could thus be an epiphenomenon caused by extensive overexpression in blood and affected tissues. In addition, other cationic AMPs could functionally compensate for the deficiency of cathelicidins.

Increased serum leucine, leucine-37 levels in psoriasis: positive and negative feedback loops of leucine, leucine-37 and pro- or anti-inflammatory cytokines

Expression of leucine, leucine-37 (LL-37) is enhanced in keratinocytes of skin lesions with psoriasis. We examined serum LL-37 levels in patients with psoriasis vulgaris. Serum LL-37 levels in patients were higher than in normal controls, and were reduced after cyclosporine A treatment. In both groups, LL-37 and interleukin (IL)-17 levels inversely correlated. In patients, LL-37 levels correlated with interferon (IFN)-γ and IL-10 levels. In controls, LL-37 levels inversely correlated with tumor necrosis factor (TNF)-α, IL-6, IL-1β, and IL-22 levels. IFN-γ, IL-17, IL-22, TNF-α, IL-6, and IL-1β enhanced, and IL-10, IL-4, IL-13, and cyclosporine A suppressed, LL-37 secretion from keratinocytes and neutrophils. LL-37 enhanced IFN-γ, IL-4, IL-13, and TNF-α secretion from CD3/CD28-stimulated T cells, suppressed TNF-α, IL-1β, IL-6, and IL-10 secretion from lipopolysaccharide-stimulated monocytes, and IL-17, IL-22, IL-1β, IL-6, and IL-10 secretion from CD3/CD28-stimulated T cells. LL-37 may sustain its production by enhancing IFN-γ or reducing IL-10 production, while suppressing its production by reducing IL-17, IL-22, TNF-α, IL-1β, or IL-6 and enhancing IL-4 or IL-13 production. In patients, systemic LL-37 production is enhanced, and an IFN-γ/LL-37-positive feedback loop may exist. In controls, negative feedback by LL-37 on TNF-α, IL-1β, IL-22, and IL-6 may exist. In both groups, negative feedback by LL-37 on IL-17 may exist. LL-37 may act as an effector and regulator.

Maternal plasma level of antimicrobial peptide LL37 is a major determinant factor of neonatal plasma LL37 level

AIM

To determine cathelicidin antimicrobial peptide LL37subcellular distribution in cord neutrophils and normal plasma LL37 levels in mothers and neonates, relate them to delivery mode and relevant biochemical markers, including 25-OHvitamin D [25(OH)D] as this molecules increases cathelicidin gene expression.

METHODS

A total of 115 infants were included, n = 68 with normal delivery and n = 47 with elective Caesarean section (C-section), a subset of these being 50 mother-infant pairs. Biomarkers were determined in maternal and cord blood. Subcellular peptide LL37 distribution was analysed with immunoelectron microscopy.

RESULTS

Cord plasma LL37 levels were three-times higher after normal delivery compared with C-section. A highly significant correlation was observed between maternal and cord plasma LL37 levels, regardless of delivery mode. No relationship was found between LL37 and 25(OH)D levels. Neutrophils from cord blood after normal delivery contained 10-times more cytoplasmatic cathelicidin peptide compared with corresponding cells after C-section where a strict granular localization was found.

CONCLUSION

These data are consistent with a placental transfer of LL37 and identifies maternal stores as the critical factor determining neonatal plasma LL37 level. An additional enhancement of neonatal cathelicidin mobilization and release is connected to normal delivery stress.

Association of human cathelicidin (hCAP-18/LL-37) gene expression with cardiovascular disease risk factors

BACKGROUND AND AIMS

Antimicrobial peptides (AMPs) are components of the innate immune system. In addition, evidence suggests that these peptides are associated with various inflammatory diseases. We examined whether expression of the cathelicidin LL-37 in peripheral blood mononuclear cells (PBMCs) is associated with cardiovascular risk factors.

METHODS AND RESULTS

A total of 90 men and 87 women selected from STANISLAS cohort were studied. Expression of LL-37 mRNA isolated from PBMCs of these subjects was quantified by quantitative RT-PCR. Anthropometric measurements and biochemical profiles were assessed for each individual. In women, LL-37 mRNA expression was significantly and positively correlated with body mass index (BMI) (p<or=0.001); waist circumference (WC) (p<or=0.01); systolic blood pressure (SBP) (p<or=0.05) and triglycerides (TG) level (p<or=0.05) and negatively with plasma levels of HDL-C (p<or=0.05). In men however, LL-37 was positively associated with waist to hip ratio (WHR) (p<or=0.05); SBP (p<or=0.001); TG (p<or=0.05); fasting glucose levels (p<or=0.01); alanine aminotransferase (ALT) activity (p<or=0.01); neutrophils counts (p<or=0.01) and negatively with lymphocyte counts (p<or=0.001); serum HDL-C (p<or=0.001) and apoA-I (p<or=0.05) levels. After adjustment for WC and BMI, multiple regression analysis showed that LL-37 remained significantly associated with SBP; HDL-C; fasting glucose level; ALT activity; neutrophil and lymphocyte counts (p<or=0.001 to p<or=0.05) in men.

CONCLUSION

Our results suggest that LL-37 gene expression may be closely associated with cardiovascular risk factors independently of BMI and WC. However, functional studies are required to confirm these data.

Antimicrobial fragments of the pro-region of cathelicidins and other immune peptides

In addition to the numerous cathelicidin peptides that are associated with the antimicrobial activity exhibited by a crude extract from ovine blood, a further three peptides with antimicrobial activity have been identified. These were part of the precursor cathelin domain of cathelicidins, a large fragment of platelet factor 4 and a small peptide similar to signal peptide of the T-cell glycoprotein CD4 precursor. Fragments of proteins that are involved in protecting the host from infection may have a secondary purpose as antimicrobial agents once they have carried out their primary purpose and are cleaved the main protein.