Summary

This presentation details the roles of various immune cells and processes in the gut, including IgA production, and the development of different immunological responses.

Full Transcript

Barrier Immunology in the Gut Part 2 Text: Kuby’s Immunology, 8th ed. BMS 150 Week 12 Chapter 13 IgA and Intestinal Immunity IgA is secreted from plasma cells from 3 major sources: ILFs and Peyer’s patches – most of the IgA secreted in the lumen is from these...

Barrier Immunology in the Gut Part 2 Text: Kuby’s Immunology, 8th ed. BMS 150 Week 12 Chapter 13 IgA and Intestinal Immunity IgA is secreted from plasma cells from 3 major sources: ILFs and Peyer’s patches – most of the IgA secreted in the lumen is from these two sources Plasma cells in the mesenteric lymph nodes located around the abdominal aorta ▪ After the B cell is activated, it travels back to the mucosa to secrete IgA IgA and Intestinal Immunity IgA class switching: ▪ T-dependent – follicular T cells (Tfh) induce IgA class switching in B-cells via TGF- beta, and CD40L/iCOS interactions – RA plays a role but is not secreted by follicular T cells This is a long process, and can involve somatic hypermutation – takes at least 7 days It will result in the production of ONE or A FEW specific antibodies IgA and Intestinal Immunity IgA class switching: ▪ T-independent – BAFF and APRIL are secreted by mucosal dendritic cells and enterocytes Low-affinity antibodies that are produced very quickly MANY different types of antibodies produced Much more likely to be produced in a tolerogenic environment ILC3 and Th17 in the Gut Initially Th17 cells and ILC3 cells were thought to be most clinically relevant in situations where they were pro- inflammatory However, they play a major role in tolerance and normal development of the intestinal immune system ▪ There are quite a few ILC3 cells and Th17 cells in a healthy gut… not so many ILC2/ILC1 or Th1/Th2 cells Human ILC3 cells seem to respond: ▪ Directly to microbes via TLRs (this does not happen in mice) ▪ To RA and IL-23 released from innate immune cells and enterocytes ILC3 and Th17 in the Gut When activated, ILC3 cells: ▪ Secrete IL-22 & IL-17, which leads to increased production of AMPs by enterocytes and Paneth cells ▪ Secrete factors that induce the full development of Peyer’s patches and ILFs and IgA production These factors are still being elucidated ▪ Amplify the Th17 response in the gut This can be tolerogenic or pathogenic, depending on the presence of pro- or anti- inflammatory cytokines ILC3 and Th17 in the Gut Interestingly, Th17 cells can be induced to become either: ▪ Tfh cells → assist antibody production in follicles and lymph nodes ▪ Treg cells → anti-inflammatory cytokine production, downregulation of APCs So, although Th17 and ILC3 are strongly implicated in autoimmunity and inflammatory disease, they are also crucial for tolerance Comparison – Large and Small Intestines Small intestine: ▪ Much smaller and less diverse microbial community ▪ Many Paneth cells, fewer goblet cells ▪ More prevalent M cells, Peyer’s patches present, fewer ILFs Large intestine: ▪ Huge microbial community (1,000 – 1,000,000 times more than the small intestine) ▪ Lots of goblet cells, very thick layer of mucous ▪ Lots of ILFs, no Paneth cells, fewer M cells The full impact of these differences is still being researched ▪ Different microbes invade the small and large intestines ▪ Excess large intestinal bacteria in the small intestine is known as small intestinal bacterial overgrowth ▪ Different autoimmune disorders affect the large vs. the small intestine Immune Tolerance and the Microbiome Commensals tend to: Stimulate the development and accumulation of Tregs ▪ Firmicutes, Actinobacteria, Bacteroidetes ▪ Can be through secretion of short-chain fatty acids (SCFA) SCFAs influence dendritic cells → induction of regulatory T-cells Aid the development of MALT ▪ Can be through TLR signaling Human ILC3s can detect commensals via TLR signaling → IL-17, IL-22 and secretion of MALT-developing signals Firmicutes (segmented and filamentous bacteria) enhance IgA production and Th17 development Immune Tolerance and the Microbiome Failure of Tolerance – Celiac Disease Gluten “messes with” our intestinal immune in a complex and multi-step way: 1. A degradation product known as alpha-gliadin is resistant to proteolytic degradation by pancreatic enzymes 2. Gliadin binds to a chemokine receptor – CXCR3 → production and release of zonulin extracellularly ▪ Zonulin binds to its receptor → disassembly of ZO proteins → disassembly of tight junctions 3. Gliadin ALSO causes production of IL-15 by enterocytes ▪ This causes intra-epithelial lymphocytes to express NK cell “activating receptors” that bind to stress proteins on the enterocyte Failure of Tolerance – Celiac Disease Gluten “messes with” our intestinal immune in a complex and multi-step way: 4. Gliadin – and other pro-inflammatory molecules, likely – leaks through the damaged tight junctions 5. APCs phagocytose gliadin and some individuals will express HLA-2 molecules that present gliadin in a way that activates Th cells (usually Th1 or Th17) Step 5 is the “kiss of death” – this type of HLA molecule (either HLA-DQ2 or HLA-DQ8) seems to be the necessary factor to perpetuate inflammation and destruction of villi HLA-DQ2 or DQ8 expression is strongly linked to development of celiac disease ▪ Though many with this HLA-type do not develop celiac disease – still being studied Pathogenetic model – celiac disease A combination of enterocyte destruction by intra-epithelial lymphocytes (NKG2D recognizes stress proteins), loss of tight junction integrity, and ongoing inflammation driven by recognition of gliadin as an antigen leads to: ▪ Development of self-antibodies – in particular tissue- transglutaminase antibodies ▪ Destruction of villi, crypt hyperplasia ▪ Migration of immune cells into the crypts and lamina propria Robbins Pathologic Basis of Disease, fig. 17.26 Celiac disease – Clinical Presentation Adults and children often present differently: Adult presentation (becoming more commonly detected) ▪ Anemia, chronic diarrhea ▪ Bloating, fatigue ▪ Deficiencies in B12 and iron Pediatric presentation: ▪ Irritability, anorexia, chronic diarrhea, weight loss muscle wasting (malabsorption) ▪ Some present with abdominal pain, nausea, vomiting, bloating, or constipation These children appear less nutrient deprived Celiac disease – Clinical Presentation Extra-intestinal manifestations are very common In all ages: ▪ include arthritis or joint pain, aphthous stomatitis, iron deficiency anemia ▪ Dermatitis herpetiformis – up to 10% of patients Itchy, erythematous, blistering macular- vesicular lesion Often on torso, can present in a variety of areas In children: ▪ seizure disorders ▪ pubertal delay and short stature Celiac disease – Diagnosis, Prognosis Diagnosis: ▪ Anti-tissue transglutaminase antibodies have a >95% specificity and sensitivity Most labs detect IgA tTG – if IgA deficiency, then need to look for IgG ▪ Duodenal biopsy is the gold diagnostic standard Prognosis: ▪ Very good prognosis if gluten can be avoided ▪ Continual exposure to gluten will result in intestinal and extra-intestinal manifestations In a minority, can result in the development of a B-cell lymphoma

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