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Centre National de la Recherche Scientifique, Unité de Recherche Associée 1854, Institut de Biologie de Lille, Lille, France;
Institut National de la Santé et de la Recherche Médicale, Unité 167, Physiopathologie des Affections Neurodégénératives Transmissibles, Institut Pasteur, Lille, France;
Institut National de la Santé et de la Recherche Médicale, Unité 167, Institut Pasteur, Lille, France;
§
Laboratoire de SOR, European Special Program for Operational and Integrated Research, Saint Louis, Sénégal;
¶
Service de Chirurgie Plastique et Reconstructive, Hôpital Roger Salengro, Lille, France; and
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Université de Lille II, Lille, France
| Abstract |
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| Introduction |
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), increased IL-2R
expression on T
lymphocytes, and activation of mature T lymphocytes and monocytes (see
Refs. 1 and 4 for review). More recently, the pivotal role of IL-7 in
the skin has been highlighted (5). Several authors described the
involvement of IL-7 in human skin pathology. In Mycobacterium
leprae infection, IL-7 produced at the site of lesion facilitates
the cellular infectious responses in potentiating Ag-specific T cells.
The authors postulated that the dysregulation of IL-7 production might
contribute to the hosts inability to control infection (6). Bonifati
et al. (7) described an increase in IL-7 concentrations in lesional
skin and in the sera of patients with plaque-type psoriasis. Increased
IL-7 mRNA synthesis was also demonstrated in skin of patients with
atopic dermatitis. Indeed, IL-7 is supposed to amplify inflammation,
acting principally as a growth factor for in vivo primed Ag-specific T
cells and enhancing their proliferation in the skin (8). Apart from these studies, the role of IL-7 produced in the skin of Schistosoma mansoni-infected mice has only been recently reported (9). Indeed, this parasite infects its definitive host by an obligatory penetration through the skin. The larvae that are responsible for schistosomiasis, a parasitic disease affecting over 200 million individuals worldwide (10), remain in cutaneous tissue for 3 to 4 days, almost exclusively in the deep epidermal layers in close contact with keratinocytes. Subsequently, they reach dermal vessels (11), then are passively carried by the bloodstream to the lungs where they remain a few days. Finally, via the systemic circulation, they enter the hepatic portal system, where they mature into egg-producing adult worms at the mesenteric vein level (12). During the penetration and shortly thereafter, the cutaneous cells could play an active role in the initiation of the immune response through processing and presentation of the Ag to the competent cells of skin draining lymphoid compartments. By itself, the skin presents all the characteristics which suggest that it can function as an autonomous immunologic organ (13). We recently reported the early immunologic cutaneous events occurring during murine S. mansoni infection and their importance to the fate of the late immune response. Indeed, we were able to show that IL-7 expression was detectable in the skin of infected mice, between days 1 and 21 following infection. In addition, intradermal injection of exogenous IL-7, before the penetration of the cercariae, led to a more severe liver pathology and to an increased number of surviving adult parasites, thus favoring the parasite rather than its host (9).
The growing body of information on the important role of IL-7 in immunologic and pathologic cutaneous reactions and our own demonstration of its participation in cutaneous reactions in the murine experimental system (9) prompted us to assess the involvement of this cytokine in human S. mansoni, particularly at cutaneous level, in the first days of infection. Recently, human skin grafts were performed on SCID mice. This system was extensively used to investigate fundamental and pathologic dermatology (14, 15, 16, 17, 18). Subsequent injection with human peripheral blood leukocytes led to the SCID-hu-PBL/skin mouse model, allowing human cutaneous immunologic assays (46). We thus decided to use SCID-hu-PBL/skin mice to infect human skin with S. mansoni and analyzed, on the one hand, the unknown localization of schistosomula in human skin and, on the other hand, the onset of early immunologic events (6 days after infection), such as human cell recruitment and human cytokine production. Interestingly, we observed a cutaneous infiltration of lymphocytes and detected IL-7 production in the epidermal layers and the dermal vascular endothelium. We also demonstrate the direct effect of larvae on human dermal endothelial cells in vitro. In addition to its cutaneous production we finally documented the presence of IL-7 in plasma of S. mansoni-infected patients from a highly endemic focus.
| Materials and Methods |
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Six-week-old homozygous scid/scid C57BL/6 (SCID) mice were obtained from the specific pathogen-free animal breeding facility at the Pasteur Institute (Lille, France) and kept in isolators under barrier-sustained conditions, without prophylactic administration of antibiotic.
Skin transplantation and hu-SCID mice reconstitution
The protocol of skin transplantation was performed as previously
described by Yan et al. (14). Animals were anesthetized by i.p.
injection of a mixture of Imalgene 1000 (80 mg/kg; Rhône
Mêrieux, Lyon, France) and valium (2.5 mg/kg; Roche Products,
Neuilly-sur-Seine, France). Human skin (
1.5 x 2 x 0.2
cm) was grafted onto a full skin excisional field of the shaved back of
the SCID mice and fixed with nonadsorbable 4-0 Ethibond Excel sutures
(Ethicon, Neuilly-sur-Seine, France). After applying a sterile
Vaseline-impregnated gauze, the graft was protected from self injury
with compressive dressing. Dressings were kept in place, and the wounds
resolved spontaneously within 4 to 6 wk. Human skin consisted of
biopsies from reconstructive surgery (Roger Salengro Hospital, Lille,
France) after obtaining informed consent from the patient. Blood
samples from skin donor were collected 4 wk after surgery. Mononuclear
cells were isolated using Ficoll-Paque density gradient centrifugation
(Pharmacia Biotech, Uppsala, Sweden). Skin-grafted SCID mice were
injected i.v. with 23 x 106 human peripheral blood
leukocytes per mouse.
Parasites and infection protocols
The S. mansoni (Puerto Rican strain) life cycle was maintained at the Pasteur Institute of Lille using the Biomphalaria glabrata snail as the intermediate host and the Mesocricetus auratus hamster as the definitive host. For infection of human skin-grafted SCID mice, animals were anesthetized with pentobarbital (30 mg/kg; Sanofi, Libourne, France). The human skin graft site was then exposed to 60 furcocercariae (1600 cercariae were used for histologic studies, see below), according to the method first described by Smithers et al. (19). Control mice were anesthetized in the same way, and the infectious furcocercariae solution was replaced by water without parasite.
Histologic analysis
Histology. Human skin graft infected with 1600 furcocercariae was aseptically harvested 1 h postinfection (p.i.)3 then fixed overnight in Bouins solution and paraffin embedded. Sections of 6 µm were dewaxed in xylene then, rehydrated, and stained with Massons trichrome (Sigma, St. Louis, MO) before being mounted with Entellan resin (Labonord, Villeneuve dAscq, France) for histologic observations.
Immunohistochemistry. Six days p.i., a punch biopsy was performed on human skin graft from two infected mice (60 furcocercariae) and two noninfected mice as control. Biopsies were split and snap-frozen into liquid nitrogen for subsequent RNA extraction (see above) and immunohistochemical analysis, using a standard immunoperoxidase staining protocol (LSAB-II Kit, Dako, Trappes, France). We chose the 3-amino-9-ethyl-carbazol as red substrate for peroxidase to discriminate between specific staining and the natural brown color of melanin. Negative controls were performed by omission of the primary Abs. Sections were counterstained with Mayers hematoxylin (Merck, Darmstadt, Germany) and then mounted in Glycergel (Sigma).
RNA isolation, cDNA synthesis, and PCR
Total RNA was isolated from punch biopsies using 1 ml of
RNAzol/100 mg of snap-frozen skin samples. The quality of the RNA was
checked on an 1% agarose gel. cDNA were synthesized from equal amounts
of oligo(dT)-primed RNA (1 µg) by incubation at 42°C with 200 U of
Moloney murine leukemia virus reverse transcriptase (Life Technologies,
Eragny, France). PCR amplification was performed using primers specific
for human ß-actin (5'-GGG TCA GAA GGA TTC CTA TG-3' and 5'-GGT CTC
AAA CAT GAT CTG GG-3'), IL-4 (5'-TGC CTC CAA GAA CAC AAC TG-3' and
5'-AAC GTA CTC TGG TTG GCT TC-3'), and IFN-
(5'-GCA GAG CCA AAT TGT
CTC CT-3' and 5'-ATG CTC TTC GAC CTC GAA AC-3'). Samples of cDNA were
amplified for 40 cycles (for ß-actin and IL-4) or for 33 cycles (for
IFN-
) at an annealing temperature of 55°C using a Perkin-Elmer DNA
thermal cycler (Perkin-Elmer/Cetus, Saint-Quentin, France). For each
cDNA preparation, a control synthesis reaction was performed without
cDNA synthesis to ensure that there was no contaminating genomic DNA.
PCR products were analyzed in 1.5% agarose gel in 1x TBE containing
ethidium bromide (25 µg/50 ml gel; Interchim, Montluçon,
France).
Immunologic reagents and cells
Monoclonal Abs. mAbs specific for human CD4 (Th
lymphocytes; MT310, Dako, Trappes, France), CD8 (CTL; B9.11,
Immunotech, Marseille, France), CD22 (B lymphocytes; 4KB128, Dako),
IL-7 (B-N18, Diaclone, Besançon, France), IFN-
(B-B1,
Diaclone), and IL-4 (provided by Sandoz, Basel, Switzerland) were used.
The anti-human IL-7 mAb do not cross-react with another human
cytokine or with murine IL-7 as indicated by the manufacturer.
Endothelial cells, keratinocytes, and schistosomula coculture. Human dermal microvascular endothelial cells (HMVEC-d) and human keratinocytes were purchased from Boehringer Ingelheim Bioproducts (Gagny, France) and grown according to the recommendations of the manufacturer (passages 35). S. mansoni schistosomula were prepared from furcocercariae by the skin penetration procedure (20) and resuspended in culture medium at 37°C in 5% CO2 humidified atmosphere until use. For determination of IL-7 concentration, HMVEC-d and keratinocytes were cultured to confluence in six-well plates (Polylabo, Strasbourg, France), and the medium was renewed 1 h before addition of parasites. Aliquots of schistosomula (100 parasites/10-µl aliquot) were added to each well and incubated at 37°C for various periods of time (duplicate samples were harvested for each time point). During the course of the experiment (120 h), parasites remained alive, and no proliferation of endothelial cells was observed in our culture conditions. Culture supernatants were centrifuged at 4000 x g for 5 min to eliminate residual cells and parasites and were frozen at -70°C until use.
Study area and population of infected human
A human population was drawn from Guidakhar village, located along the Senegal River in Richard-Toll district. All age groups presented the same history of exposure. Indeed, Guidakhar village, where schistosomiasis began in 1987 is highly endemic for S. mansoni infection (21) with a prevalence reaching almost 100% (Schistosoma haematobium is absent (22)). Fecal samples were obtained from each individual, and the diagnostic of S. mansoni infection was assessed using the Kato-Katz technique (23). Results were expressed as the number of eggs per gram of feces (EPG), taken as the mean of countings performed on 5 consecutive days. A cohort was selected from 8 to 60 yr of age, after stratification by age in positive population for S. mansoni infection. Plasma was collected from 187 positive individuals and was selected before chemotherapy by praziquantel. Twenty uninfected Africans resident in St. Louis, a nonendemic region, and 104 healthy European individuals were chosen with the same age class distribution and studied as controls. Infected and uninfected populations consisted of equal numbers of males and females.
ELISA for IL-7 determination
IL-7 concentrations were determined in plasma from S. mansoni-infected or uninfected humans and in endothelial cell-schistosomulum coculture supernatants using a highly sensitive test (R & D Systems, Oxon, U.K.; detection level, 0.025 pg/ml for a 200-µl sample). Assays were performed strictly following the manufacturers instructions. A multichannel spectrophotometer, Labsystems, Helsinki, Finland were used to measure the absorbance at 492 nm.
| Results |
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Five to six weeks after engraftment, macroscopic examination of
the human skin revealed a classical aspect as defined by a normal
pigmentation and by the absence of inflammation and skin breakdown.
Histologic observations of biopsies corresponding to the connective
zone between human and murine skins showed a continuous junction (Fig. 1
). An usual aspect of the different
cutaneous components, such as epidermis, dermis, annexa, and blood
vessels, could be observed without cellular alterations. As the human
engrafted skin appeared macroscopically and microscopically intact, we
performed an infection with S. mansoni cercariae (as
described in Materials and Methods).
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The skin was described as a unique immunologic environment that contains many of the cellular constituents needed for the initiation, modulation, and elicitation of the immune response (25). Immunologic events occurring immediately after penetration of cercariae in human skin were not extensively studied in previous reports for obvious ethical reasons. In our model of SCID-hu-PBL/skin mice, a functional humanized immune response to schistosomulum transcutaneous penetration could potentially occur.
The anatomo-pathologic analysis of the infected human skin sections (6
days p.i.) showed a moderate intradermal infiltration of human
lymphocytes. Immunohistochemistry analysis confirmed the infiltration
of human CD4+ Th lymphocytes, exclusively in the dermis
with a perivascular predominance (Fig. 3
A). No CD4+ T
cells were detected in control noninfected SCID-hu-PBL/skin mice (Fig. 3
B). Few human CD8+ T lymphocytes were present
in the basal epidermis, but no differences could be observed between
control and infected skin. No CD22+ B lymphocytes were
found in any biopsies whether infected or not (data not shown).
|
In earlier work we reported that IL-4, IL-7, and IFN-
are
produced in murine infected skin within the first days after parasite
penetration (9). Thus, we investigated cytokine production following
penetration of the parasite through the human skin graft.
Immunohistochemical stainings were conducted on skin sections (6 days
p.i.), and a strong increase of IL-7 was revealed in human skin
following infection (Fig. 4
A;
noninfected control is shown in Fig. 4
B). A diffuse staining
in the total epidermis and at the vascular level in the dermis was
observed. At higher magnification, a well-defined staining surrounding
the endothelial cells was apparent (Fig. 4
C), suggesting a
possible synthesis of IL-7 by the dermal vascular cells. In contrast,
neither IL-4 nor IFN-
was detected by immunohistochemistry at the
protein level (data not shown). These findings were confirmed using
RT-PCR method. Indeed, IL-4 mRNA and IFN-
mRNA were not detectable
in either human infected skin or human uninfected skin (Fig. 5
).
|
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To determine whether the parasite could be directly responsible
for the IL-7 endothelial production and to exclude a possible diffusion
from keratinocytes, we conducted cocultures of schistosomula with
dermal human microvascular endothelial cells. At different time points,
culture supernatants were harvested, and IL-7 accumulation was
measured. As shown in Figure 6
, a
continuous constitutive synthesis of IL-7 by HMVEC-d was observed in
the absence of parasite. Cocultures with schistosomula showed a
significantly higher synthesis at 72 h compared with that in the
control culture. This was confirmed after 120 h, with 2.5-fold
increased production.
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Highly S. mansoni-infected patients show high IL-7 levels in plasma
Considering these results, we questioned whether the local
(epidermal and endothelial) IL-7 production in S.
mansoni-infected human skin could be extended to detectable IL-7
levels in the plasma of infected individuals. The results presented in
Figure 7
B show the
distribution of IL-7 concentrations in the different age classes in the
infected population (with comparable numbers of individuals for each
class). The youngest individuals exhibited the highest IL-7
concentrations, whereas the oldest displayed the lowest levels. Several
population studies in major schistosomiasis endemic areas highlighted a
negative correlation between age and infection intensity (determined by
EPG) (26, 27, 28, 29). It was then crucial to check whether this was the case
in our chosen population and subsequently to test potential correlation
between IL-7 and age. To validate statistical tests, we conducted
logarithmic transformations of EPG values and IL-7 values to obtain a
normal distribution of these parameters. Therefore, correlation
coefficients (r) were calculated between EPG and age and
between IL-7 and age. On the one hand, the highly significant negative
correlation (r = 0.252; p < 0.0005)
between EPG and age was confirmed. On the other hand, we showed a
strong negative correlation (r = 0.371;
p < 0.0001) between IL-7 and age (Fig. 7
C).
Therefore, IL-7 concentrations and EPG are displaying the same
age-dependent evolution (the highest IL-7 levels and EPG values in the
lowest age class). Moreover, identical analysis of the African and
European uninfected control populations revealed comparable IL-7 plasma
concentrations in the whole populations (Fig. 7
A). Any
difference between the amount of IL-7 in each age group could be
observed, and statistical analysis for each of these populations did
not single out any significant correlation between IL-7 levels and age.
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| Discussion |
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S. mansoni is a topical endovascular parasite; from host penetration through the skin, to migration via the lungs to the liver and mesenteric vein, S. mansoni is in close contact with the endothelial compartment at each maturation step. In a previous work (9) we detected IL-7 mRNA synthesis in murine infected skin and demonstrated that parasite migration at least in part depends on this cytokine. Indeed, mice infected 12 h after intradermal injection of rIL-7 show a different migration and/or localization of the parasites at the very early stages of infection. In addition, this single injection before infection leads to an increased worm burden and to a more severe pathology associated with S. mansoni infection. Furthermore, in IL-7-deficient mice (36) infected with S. mansoni, the worm burden is decreased, and the clinical status of the infected host is ameliorated. In addition, and interestingly, worms never develop to full sexual maturity in infected IL-7-deficient mice, implying an important role of IL-7 in schistosome growth and maturation (I. Wolowczuk, manuscript in preparation).
Therefore, our demonstration of increased IL-7 endothelial
production in human infected skin triggered by the parasite could be to
its own benefit. Whether others auto-, para-, and/or intracrine
molecular activities are involved is still unknown, and the molecular
identity and the mechanism of action of parasitic factors
involved in this stimulation remain to be determined. Among
others cytokines potentially produced by endothelial cells, IL-7
appears to be uniquely expressed in response to the parasite (F.
Trottein, unpublished observation). Beyond IL-7 production by
dermal endothelial cells, IL-7 synthesis by lung endothelium was
investigated in vitro subsequent to parasite entry, using human
pulmonary endothelial cells. Coculture assays showed high baseline
levels of IL-7 production, which were not modulated by the presence of
parasites (data not shown). Therefore, the parasite-dependent increase
in IL-7 synthesis might be limited to the cutaneous environment. We
also noticed increased production of IL-7 in the epidermis (in vivo)
probably produced by keratinocytes (37). Moreover, IL-7 was not
observed in the epidermis of SCID-hu-skin mice not injected with
autologous PBL and was undetectable in keratinocyte-schistosomulum
cocultures (data not shown). Taken together, these observations could
mean that keratinocytes need additional factors present in the S.
mansoni-infected skin to produce IL-7, in contrast to endothelial
cells. We are investigating the potential increase in IL-7 production
due to the parasite using cytokines added to coculture medium, such as
IFN-
, which is known to activate keratinocytes (6). Therefore, from
these observations we could postulate that IL-7 would be available for
the parasite, at least from skin to lung.
In our study we reported a perivascular recruitment of CD4+
T cells in the dermis of S. mansoni-infected human skin.
That seems to be specific to parasite penetration, and the absence of
CD8+ T lymphocytes could not be due to limitation of
cellular reconstitution of the mice. Indeed, using the same
experimental system, Delhem et al. observed a cutaneous infiltration of
CD8+ T lymphocytes after injection of virus in human skin
(see Footnote 3). Recently, IL-7 was described as an inducer of T cell
adhesion to endothelial cell (38, 39). Particularly, this cytokine
increase VLA-4 and LFA-1 expression on activated CD4+
CD23+ T cells subsets (40). Therefore, we could hypothesize
that IL-7 produced by dermal endothelial cells may promote the observed
CD4+ T cell recruitment. In addition, IL-7 could probably
act as a costimulus (coreceptor and/or cytokine) to induce human
resting peripheral blood T lymphocytes to proliferate within the skin
(41). In murine skin, IL-7 overexpression by keratinocytes from
transgenic mice causes a large expansion of
ß and 
TCR cells
in the skin (42). Finally, IL-7 regulates TCR usage and T cell
proliferation in HIV-1 infection (43). Therefore, it seems pertinent to
hypothesize a role for endothelium- and/or keratinocyte-derived IL-7
not only for increasing T cell adhesiveness but also for final
peripheral activation and proliferation of dermal recruited T cells. T
cells of the cutaneous infiltrate are presently being cloned to
determine their specificity, effector role, and particularly the
presence of the cutaneous leukocyte antigen, a unique skin homing
receptor expressed by memory T cells (44). Finally, double-graft
experiments would be performed to determine whether T cell infiltration
is restricted to the infection site or is systemic, within the
uninfected fragment of human skin.
We have demonstrated that IL-7 is not only locally produced in the skin but that IL-7 concentrations are also increased in the plasma of the youngest infected patients. Monocytes (6) and platelets (45) from peripheral blood might be the principal sources of this secretion. Moreover, we established a significant negative correlation between IL-7 and age, whereas no such link was found in African and European uninfected populations. Nevertheless, we cannot reach a conclusion about the role of IL-7 in the level of infectivity in humans. The fact that IL-7 can be detected in human sera re-enforces the validity of the observation made in the model of SCID-hu-PBL/skin mice and justifies further analysis of human infected populations.
IL-7 has a very pleiotropic action; it is thus difficult to hypothesize a single specific role in schistosomiasis or in other parasite diseases. Our results provide evidence that keratinocytes and dermal endothelial cells synthesize increased amounts of IL-7 upon penetration of S. mansoni larvae. These findings were relevant in the field, since high IL-7 levels could be measured in the plasma of infected individuals. Finally, this first demonstration of IL-7 production by dermal endothelial cells, the first cells encountered by infiltrating T cells, provides a new view of the T cell proliferation responsible for the most common cutaneous diseases, such as psoriasis (7) or atopic dermatitis (8). To conclude, the effect of IL-7 concomitantly exerted on the parasite and on the immune response could be very intricate and reflects the complex relationships between host and parasite.
| Acknowledgments |
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| Footnotes |
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2 Address correspondence and reprint requests to Dr. Olivier Roye, Immunopathologie Cellulaire des Maladies Infectieuses, Centre National de la Recherche Scientifique, Unité de Recherche Associée 1854, Institut de Biologie de Lille, 1 rue du Pr. Calmette, BP 447, F-59021 Lille Cedex, France. ![]()
3 Abbreviations used in this paper: p.i., postinfection; HMVEC-d, dermal human microvascular endothelial cells; EPG, number of eggs per gram of feces. ![]()
Received for publication April 6, 1998. Accepted for publication June 17, 1998.
| References |
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production and leads to an aggravation of the disease. Immunology 91:35.[Medline]
This article has been cited by other articles:
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I. Wolowczuk, S. Nutten, O. Roye, M. Delacre, M. Capron, R. M. Murray, F. Trottein, and C. Auriault Infection of Mice Lacking Interleukin-7 (IL-7) Reveals an Unexpected Role for IL-7 in the Development of the Parasite Schistosoma mansoni Infect. Immun., August 1, 1999; 67(8): 4183 - 4190. [Abstract] [Full Text] [PDF] |
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