Advanced Course in Basic & Clinical Immunology February 20, Mucosal Immunology

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1 Mucosal Immunology Cathryn Nagler University of Chicago Department of Pathology/Committee on Immunology Mucosal surfaces are the major portals of entry for antigen Largest area of contact of the immune system with the environment. Largest accumulation of lymphoid tissue in the body: 6 x antibody forming cells in mucosal tissues vs 2.5 x in lymphoid organs. The gut associated lymphoid tissue (GALT) contains more lymphocytes than all of the secondary lymphoid organs combined! Secretory IgA is produced at a rate of mg/kg/day. 1

2 Antigens enter through mucosal surfaces From Nagler-Anderson, Nat.Rev. Immunol. 2001, 1:59 Lymphoid cells protect epithelial barriers at mucosal surfaces From Gerald Pier, Channing Labs, HMS 2

3 The gut-associated lymphoid tissue contains both inductive and effector sites Peyer s patch (inductive) Villus epithelium and lamina propria (effector) (effector) From Nagler-Anderson, Nat.Rev. Immunol. 2001, 1:59 The intestinal epithelium is self-renewing Small intestine Colon Barker, N., Nat. Rev. Mol. Cell Bio. 2014, 15: 19 3

4 Specialized protective adaptations of the intestinal epithelial barrier 1. Mucus 2. Anti-Microbial Peptides 3. Intercellular tight junctions that restrict the passage of even very small (2kD) molecules between cells 4. Secretory IgA Mucus layers in the small intestine and colon Johansson MEV and Hansson, GC Nat. Rev. Immunol. 2016, 16: 639 4

5 Anti-microbial peptides protect the intestinal epithelial barrier Gallo, RL & LV Hooper Nat. Rev. Immunol. 2012, 12: 503 Anatomy of the mucosal barrier: the intestinal epithelial junctional complex Turner, J.R. Nat. Rev., Immunol. 2009, 9:799 5

6 Clayburgh, DR, Shen, L & Turner JR. Lab Invest. 2004, 84: 282 The epithelial tight junction regulates mucosal homeostasis Turner, J.R. Nat. Rev., Immunol. 2009, 9:799 6

7 Secretory IgA J chain joins IgA monomers IgA (not IgG) is the major isotype of Ig synthesized by the body! At least 80% of all plasma cells are located in the intestinal lamina propria and together produce more IgA than all other Ig isotypes combined. Class switching to IgA is regulated by TGF-. Secretory component (SC) prevents proteolytic damage to secretory IgA in the harsh luminal microenvironment. From Gerald Pier, Channing Labs, HMS 7

8 Transport of secretory IgA to the luminal surface IgA binds to the polymeric Ig receptor (pigr, also known as transmembrane SC) on the basolateral surface and is transported to the apical surface. The portion of the pigr attached to the Fc region of IgA is then enzymatically cleaved and stays bound to dimeric IgA as secretory component. From Gerald Pier, Channing Labs, HMS Secretory IgA has several functions at epithelial surfaces 8

9 Mechanisms of antigen sampling in the small intestine APC (DC or macrophage) Schulz, O & Pabst. O Trends Immunol 2013, 34: 155 Lymphocyte recruitment requires specific chemokine recognition and appropriate adhesion/homing receptor engagement IgA ASCs induced in small intestine can enter all mucosal sites. ASCs induced in the respiratory tract lack 4 7 and CCR9 and are restricted to nonintestinal mucosal tissues and the bone marrow. From Kunkel and Butcher, Nat. Rev. Immunol. 2003, 3: 822 9

10 Chemokine/receptor pairs regulate tissue specific migration The chemokine CCL25 (also called thymus expressed chemokine, TECK) is secreted only by epithelial cells in the thymus and the small intestine, and attracts developing CCR9+ T cells to these sites. The dual expression of the intestinal homing receptor 4 7 (an integrin which binds the mucosal vascular addressin MADCAM-1) and CCR9 allows for the selective homing of memory T cells to the intestinal lamina propria. From Cheroutre and Madakamutil, Nat. Rev. Immunol. 2004, 4: 290 Enzymatically converted vitamins control lymphocyte migration in the skin and the gut Dendritic cells (DCs) in the GALT express enzymes required for converting dietary vitamin A to retinoic acid (RA). T cell activation in the presence of retinoic acid induces the expression of the gut homing receptors CCR9 and 4 7. DCs in the skin convert sunlight induced vitamin D3 to its active form 1,25(OH) 2 D 3, which induces the expression of CCR10 on activated T cells, allowing their migration into the epidermis. From Mebius, Nat. Immunol 2007, 8:

11 Memory T cells accumulate in the GALT Memory T effector cells accumulate in the intestinal lamina propria, enabling the GALT to respond quickly and effectively to challenge with enteric pathogens. Antigen challenge redistributes memory T effector cells to man the barrier for strategic mucosal defense Intestinal intraepithelial lymphocytes Atypical populations of T cells that reside between enterocytes above the basement membrane. Express CD8 as a CD8 homodimer (rather than the CD8 heterodimer expressed by CD8 + T cells at other sites) Many IEL are constitutively cytolytic directly ex vivo. A large proportion of IEL bear (as opposed to ) T cell receptors. From Karen Edelblum, U. Chicago 11

12 IEL act as sentinels to detect and repair damaged epithelium lumen T cell nuclei -TCR + From Cheroutre and Madakamutil, Nat. Rev. Immunol. 2004, 4: 290 Edelblum et al PNAS 2012, 109: 7097 How does the gut associated lymphoid tissue distinguish innocuous dietary antigens and commensal bacteria from pathogenic microbes.and mount an appropriate response to each? 12

13 Oral tolerance- induction of mucosal and systemic nonresponsiveness to orallyadministered antigens Orally administered antigen ameliorates disease in a large variety of experimental models Weiner, H. et al Immuno. Rev. 2011; 241:241 13

14 A multistep model of oral tolerance to dietary antigens I. Antigen loaded CD103 + DC migrate to MLN II. RA produced by DC and stromal cells in MLN induce homing receptors and favor TGF- dependent conversion of Foxp3 + Tregs III. Committed Tregs home back to LP IV. Tregs expand under the influence of IL-10 produced by CX3CR1 hi macrophages V. Some Tregs exit mucosa via lymph or bloodstream to promote systemic tolerance Pabst and Mowat, Mucosal Immunology 2012, 5: 232 Tolerance to dietary antigen requires the induction of a bacteria-induced barrier protective response Stefka, Feehley et al PNAS 2014, 111;

15 Mucosal Vaccines Mucosal (oral/nasal) vaccines are the preferred method for vaccination in the developing world. Mucosal vaccines are easily administered (needle-free), non-invasive and costeffective. Only mucosal vaccination elicits a protective secretory IgA response. Mucosal vaccination routes and compartmentalization of effector functions Lycke, N. Nat. Rev. Immunol. 2012, 12;

16 Currently licensed mucosal vaccines Kim, S.-H. and Jang, Y.-S. Clin. Exp. Vaccine Res 2017, 6: 15 Intranasal vaccination stimulate immune responses in the nasopharynx-associated lymphoid tissue Lycke, N. Nat. Rev. Immunol. 2012, 12;

17 Mucosal adjuvants Adjuvants that are effective parenterally are generally toxic or unstable when given orally. The tendency of the GALT to induce tolerance to soluble antigens has made identification of effective mucosal adjuvants difficult. Microbial products such as cholera toxin, E. coli heat-labile toxin and oligodeoxynucleotides containing a bacterial CpG motif can act as effective mucosal adjuvants and induce both mucosal and systemic immune responses to co-administered protein antigens. Pattern recognition receptors and their cellular location 17

18 Bacterial TLR ligands Capsule Pathogenic bacteria use various strategies to trigger a proinflammatory program in intestinal epithelial cells From Sansonetti, Nat. Rev.Immunol. 2004, 12:953 18

19 Commensal bacteria populate our skin and mucosal surfaces and profoundly influence our health 1.2E trillion human cells 20,000 genes 100 trillion bacterial cells 2-20,000,000 genes 0 Human cells Bacterial cells There are as many E. coli in our gut as there are people on earth! We exist in a dynamic interrelationship with our commensal microbiome! Healthy individuals tolerate their intestinal microbiota but are also constantly receiving signals from the microbiome that have a profound impact on both systemic and mucosal immunity. 19

20 The commensal microbiota confers many health benefits to the host Culture independent methods of analysis have transformed our understanding of the composition of the microbiome The 16S rrna gene is highly conserved among bacterial species. Universal primers target conserved regions of this gene and allow for amplification and sequencing of species specific hypervariable regions for bacterial classification. Structure of 16S ribosomal RNA 20

21 The composition of the microbiota varies by anatomical site Cho, I. & Blaser, M.J. Nat. Rev. Genetics 2012; 13: 260 The gastrointestinal microbiota changes throughout life Dominguez-Bello, MG et al, Gastroenterology 2011; 140:

22 The atopic march 22

23 Allergic responses to food can be diverse and can include lifethreatening anaphylactic shock (respiratory/cardiovascular collapse) The prevalence of eosinophilic esophagitis (EoE), a food related disease is also increasing 23

24 Antibiotic use Diseases of Western Society Western high fat, low fiber diet Elimination of enteropathogens (H. pylori, helminths) Vaccination/reduced exposure to infectious disease Alteration of commensal microbiota dysbiosis genetically susceptible individual Inflammatory Bowel Disease Obesity Food Allergy Diabetes Autism Asthma Caesarean birth/formula feeding Feehley et al Seminars in Immunopathology 2012, 34; 671 Germ free mice are a powerful tool to examine the role of the commensal microbiota in the regulation of health and disease 24

25 Protection against allergic sensitization to food requires the induction of a bacteria-induced barrier protective response Stefka, Feehley et al PNAS 2014, 111; Can we develop novel strategies to modulate the composition of the microbiota to prevent or treat food allergies? 25

26 Evaluation of dietary management of cow s milk allergy Visit 1 Visit 2 6 months Visit 3 12 months Full anamnestic and clinical evaluation SPT and APT Oral food challenge (OFC) Full clinical evaluation Full clinical evaluation SPT and APT Oral food challenge (OFC) Berni Canani R, et al. The Journal of Pediatrics 2013, 163; 771 Supplementation of extensively hydrolyzed casein formula (EHCF) with Lactobacillus GG accelerates acquisition of tolerance in children with cow s milk allergy % of children acquiring tolerance after 12 months P<0.001 P<0.001 P<0.001 P<0.001 EHCF EHCF + LGG RHF SF AAF Berni Canani R, et al. The Journal of Pediatrics 2013, 163;

27 The cow s milk allergic (CMA) infant microbiome exhibits significantly increased diversity Berni Canani, Sangwan, Stefka et al ISMEJ 2016, 10; 742 The composition of the fecal microbiota is altered in cow s milk allergic (CMA) infants Healthy Cow's Milk Allergic Clostridiales Lactobacillales Bifidobacteriales Enterobacteriales Bacteroidales Burkholderiales Pasteurellales Other n=20 n=20 Berni Canani, Sangwan, Stefka et al ISMEJ 2016, 10;

28 Treatment with LGG supplemented formula changes microbial community structure to enhance production of of fecal butyric acid and promote tolerance to CMA Tolerance to CMA at 12 months EHCF 0/7 EHCF + LGG 5/12* Berni Canani, Sangwan, Stefka et al ISMEJ 2016, 10; 742 food IL-22 modified from M. Velasquez-Manoff, Nature 2015, 518: S4 28

29 Are mice colonized with a healthy microbiota protected against an allergic response to food? Healthy infant microbiota Non-allergic Sensitize with lactoglobulin (BLG)/CT Cow s milk allergic (CMA) infant microbiota Allergic Transfer of a healthy infant microbiota protects against an anaphylactic response to sensitization with BLG+CT T C Healthy Colonized Allergic Colonized * * * * * * Time (min.) =3 BLG-specific IgE (ng/ml) * Healthy CMA 50mg BLG gavage 50mg BLG gavage Feehley, Plunkett et al, 2018, in revision 29

30 Developing microbiomemodulating therapeutics to prevent or treat food allergy Healthy infant microbiota Non-allergic Drug formulations from microbial metabolites Cow s milk allergic (CMA) infant microbiota Sensitize with lactoglobulin (BLG)/CT Allergic 30