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*
Division of Infection and Immunity, Institute of Biomedical and Life Sciences, and
Department of Immunology and Bacteriology, University of Glasgow, Glasgow, United Kingdom
| Abstract |
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| Introduction |
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Reactive nitrogen intermediates including NO have been identified as
important effector molecules that can restrict pathogen growth in
infected hosts while also playing a role in immunoregulation and
pathology (5, 6, 7, 8, 9, 10, 11, 12, 13). Expression of inducible NO synthase
(iNOS,3
NOS2) is elicited in a wide variety of cell types by
pro-inflammatory cytokines or bacterial products such as LPS, and
results in high level production of NO from
L-arginine substrate (5, 6, 7, 8). A
number of studies have indicated that NO produced by cytokine-activated
macrophages is important in immune responses against bacterial, fungal,
helminth, and protozoan infectious agents (9, 10, 11, 12, 13).
Furthermore, the immunomodulatory activity of NO is manifested in
potent immunosuppression and in influencing Th cell development
(5, 6, 14, 15). Production of excessive amounts of NO,
however, has been implicated in a number of pathological conditions,
appearing to play a crucial role in diabetes mellitus, graft-vs-host
disease, rheumatoid arthritis, and inflammatory bowel disease (IBD)
(5, 16, 17, 18, 19). Intestinal pathology in a number of
immunologically mediated enteropathies such as graft-vs-host disease,
IBD, and the spontaneous gut lesions that develop in certain cytokine
knock out mice is usually associated with Th1 type responses and
TNF-
(19, 20, 21, 22), and iNOS induced by inflammatory
cytokines is thought to play an important role in these situations.
However, it has recently been demonstrated that other models of IBD
could also be associated with Th2 responses (23, 24, 25).
Many studies have analyzed the protective role of NO during Th1-inducing infections, but few have analyzed the effects of this mediator in the context of a Th2-stimulating infection such as with helminth parasites. Although the gross enteropathy associated with the immune expulsion of intestinal helminths mirrors that associated with many Th1 responses, both the pathology and parasite loss are Th2-dependent phenomena. Indeed, we have recently shown that expulsion proceeds in the absence of pathology in mice defective for the TNF signaling system, demonstrating that pro-inflammatory cytokines appear to be under the control of Th2 responses in this case, and that pathology is not obligatory for parasite loss (4). These findings have implications for vaccine development and the control of idiopathic IBDs, yet the downstream/direct mediators of enteropathy in Th2-mediated events such as in helminth infections remain to be identified.
In this paper we provide evidence that NO is an important mediator of enteropathy in infection with the intestinal nematode T. spiralis, and propose that iNOS production is under the control of TNF in such circumstances. Our findings reinforce the concept that enteropathy is not required for the removal of nematode parasites. Furthermore, the identification of NO as a crucial mediator provides a more amenable target for intervention than manipulation of cytokines in the control of enteropathy in infections or idiopathic conditions. If NO is indeed the end point mediator of enteropathy, regardless of aetiology, then the new generation of inhibitors and scavengers of NO will be useful therapeutic agents (26).
| Materials and Methods |
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The maintenance, infection, and recovery of T. spiralis were essentially as described previously (4). Mice were infected with 400 T. spiralis larvae on day 0 and killed at various times postinfection (p.i.) as detailed. C57BL/6 mice purchased from Harlan-Olac (Oxford, U.K.) were maintained under standard laboratory conditions. MF-1 x 129 mice with a homozygous disruption of the iNOS gene (iNOS-/-) and heterozygous littermates (iNOS-/+) were bred and maintained in the Joint Animal Facility, University of Glasgow. The homozygous and heterozygous mice thus generated were backcrossed with MF-1 mice for three generations. Heterozygous mice have previously been shown to be phenotypically identical to wild-type MF-1 mice (13, 27).
Quantitation of intestinal pathology
After weighing the entire small intestine, mucosal architecture, and epithelial cell mitotic activity were assessed in samples of jejunum taken 10 cm from the pylorus, as described previously (4). Samples were fixed in 25% acetic acid/75% ethanol and stained with Schiff reagent (Sigma, Poole, U.K.). Specimens were microdissected and villus and crypt lengths measured using an eyepiece micrometer. The number of mitotic figures per crypt were also counted. Ten villi and crypts were measured for each sample. Consecutive samples of jejunum were fixed in Carnoys fixative and processed using standard histological techniques. Sections were stained with 0.5% toluidine blue (pH 0.3) for visualization of mast cells. The numbers of mucosal mast cells were counted per 25 villus crypt units (VCU) and data expressed per VCU.
Lymphocyte culture and cytokine responses
Single cell suspensions of mesenteric lymph nodes (MLN) were
prepared and incubated in the presence of T. spiralis larval
homogenate (50 µg/ml protein). Culture supernatants were harvested
after 24 h, and IL-2, IL-4, IL-5, and IFN-
levels measured by
ELISA using paired Abs as described previously (4).
TNF-
levels were determined in serum by ELISA according to the
manufacturers instructions (PharMingen, Oxford, U.K.).
Measurement of Ab responses
Parasite-specific IgG1 and IgG2a and total IgE levels were determined as described previously (4). T. spiralis larval homogenate was used as a target Ag at 10 µg/ml in ELISA, and sera were diluted 1/100. IgG1 and IgG2a were detected using biotinylated anti-mouse IgG1 or IgG2a (PharMingen) at 2 µg/ml each, followed by streptavidin-peroxidase (SAPU, Carluke, U.K.). Total serum IgE levels were measured by ELISA, anti-mouse IgE was used as capture Ab, and IgE was detected using biotinylated anti-mouse IgE (PharMingen). An IgE mAb specific for TNP (PharMingen) was used as standard.
Measurement of NO
Total nitrate and nitrite concentrations in sera were estimated by the conversion of nitrate into nitrite. Total nitrite content was then measured by the Greiss reaction using NaNO2 as standard with detection limit of 1 µM (28). Briefly, 30 µl of each sample was incubated for 1 h at 37°C with 5 µl Aspergillus nitrate reductase (5 U/ml; Sigma) and 15 µl of NADPH (1.25 mg/ml; Sigma). After incubation, 100 µl of Greiss reagent (1% sulfanilamide/0.1% naphthylethylene diamine dihydrochloride/2.5% H3PO4) and 100 µl trichloroacetic acid (10% aqueous solution) were added and incubated at room temperature for 10 min. Protein precipitates were removed by centrifugation at 13,000 x g for 5 min. Supernatants (100 µl) were transferred in duplicate to a 96-well flat-bottom plate. Absorbance at 570 nm was measured, and NO concentrations were estimated against a sodium nitrate standard curve.
Statistics
Results are expressed as means ± 1 SEM. Statistical differences (p = 0.05) between experimental groups were determined using the Mann-Whitney U test.
| Results |
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NO in T. spiralis infection
To investigate whether NO was produced during infection of mice with T. spiralis, C57BL/6 mice were infected with 400 muscle larvae, and concentrations of nitrite and nitrate were measured in the serum. Production of NO by T. spiralis infected C57BL/6 mice was significantly increased; levels rose from 11.2 ± 1.6 µM to 23.2 ± 1.9 µM (p < 0.05). This confirmed studies of T. spiralis infection in rats (29). We next investigated the role of NO in protection and pathology using iNOS-deficient mice.
T. spiralis-associated pathology is diminished in iNOS-deficient mice despite normal expulsion of the parasite
The kinetics of parasite expulsion from heterozygous
(iNOS-/+) or homozygous
(iNOS-/-) mice infected with T.
spiralis were identical to those seen in wild-type mice (Fig. 1
). There was no significant difference
in the establishment (day 6 p.i.) or the expulsion (day 13
p.i.) of the parasite from iNOS-/- mice. To
determine whether expulsion may have occurred earlier in
iNOS-/- mice, animals were also examined at day
10 p.i., but again there was no significant difference between the
two groups at this time (data not shown).
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To investigate the role of T helper subsets during infection of
iNOS-deficient mice with T. spiralis, we determined levels
of IL-2, IFN-
, IL-4, IL-5, and TNF-
produced by these animals
(Table I
). There was a significant
increase in Th2 cytokines in iNOS-/+ mice during
infection but little increase in IFN-
. In contrast,
iNOS-/- mice showed increased production of
both IL-2 and IFN-
with little or no change in the levels of IL-4 or
IL-5 following infection. Importantly, while serum TNF-
levels in
iNOS-/- mice did not increase, those in
iNOS-/- mice were significantly elevated.
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Isotype-specific anti-Trichinella Ag Abs were also
measured as an indicator of Th activity. High IgG1 and IgE levels and
low IgG2a levels were observed in heterozygous mice (Table II
). Although levels of IgG1 and IgE
produced by iNOS-deficient mice were still significantly elevated with
respect to control animals, they were significantly less than those
observed in infected heterozygous animals. Conversely, while levels of
IgG2a did not increase significantly in infected heterozygous mice,
they were significantly elevated in the iNOS-deficient animals.
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Numerous studies have indicated that mast cells play an important
role in the expulsion of T. spiralis, and they have also
been implicated in the mediation of intestinal pathology in other
disease models, and NO has been demonstrated to play a role in the
activation of mast cells (32, 33, 34). Although a mucosal
mastocytosis was apparent in iNOS-deficient mice infected with T.
spiralis, it was substantially lower than that observed in the
heterozygous animals (Fig. 4
).
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It has been suggested that a change in intestinal fluid dynamics
that favors fluid accumulation in the gut lumen and an increase in the
small intestine smooth muscle contractility results in the expulsion of
loosely attached parasites (35). Additionally, NO is
involved in the induction of vascular leak syndromes that lead to fluid
accumulation in intestinal tissues (36). Although there
was a significant increase in the wet weight of the small intestine in
both groups of animals, the weights of the intestines from
iNOS-/- mice were significantly lower than
those from iNOS-/+ mice (Fig. 5
). Fluid accumulation in the gut lumen
of infected mice, mediated by NO, is therefore unlikely to play a role
in the expulsion of T. spiralis.
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| Discussion |
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It has been well documented that protection against Th1-inducing infections is associated with the production of NO via iNOS up-regulation, and NO has also been implicated in many Th1-mediated enteropathies (10, 11, 12, 13, 14, 17, 18, 19). However, the pathology observed during infection with the highly pathogenic gastrointestinal (GI) parasite T. spiralis is mediated by a Th2 response (4). At present, little work has been conducted on the role of NO in Th2-inducing infections, so we aimed to establish the role of iNOS in the induction of protection and pathology in a Th2-polarizing infection. The observations were consistent with our previous studies in showing that intestinal pathology is not required for the expulsion of GI nematode parasites. Moreover, while NO does not appear to be important in protection against helminths, it is crucial for the pathology induced. Recent studies have also suggested that NO plays a dual role in inducing protective and pathological responses in other systems. Inhibition of iNOS during a number of infections, including viruses, bacteria, and protozoan parasites, could greatly improve survival despite an increase in pathogen numbers. (37, 38, 39). Importantly, NO may now be considered as an end point mediator of pathology induced by either Th1 or Th2 polarized responses.
Like earlier studies in rats infected with T. spiralis (30), we show an increase NO levels in the serum of T. spiralis-infected mice. Although NO appears to be directly toxic to some helminths in vitro (40, 41, 42), our study now shows that NO synthesized by iNOS is not essential for the expulsion of T. spiralis from mice. The results presented here also demonstrate that iNOS plays a crucial role in the induction of the Th2-mediated enteropathy that accompanies GI nematode infections. This contrasts with some models of IBD where NO is associated with excessive production of Th1 cytokines, and where the use of NO inhibitors and iNOS-deficient mice have clearly demonstrated a central role for NO in the induction of enteropathy (17, 18, 19). Interestingly, it has recently been shown that Th2-type responses may also mediate intestinal inflammation in other models of enteropathy, although the role of NO in these pathologies is unknown (23, 24, 25).
The source of NO in enteropathy has not been identified but a number of cells including epithelial cells, macrophages, and mast cells have been implicated (9, 43, 44, 45). Epithelial cells are the first point of host contact for invasive intestinal pathogens and may initiate mucosal inflammatory responses via production of pro-inflammatory cytokines and mediators including NO (8, 43). T. spiralis occupies an intramulticellular niche in small intestinal epithelium and infected epithelial cells have been shown to respond by synthesizing cytokines (46). It is therefore possible that the perturbation of the epithelium by invasion of T. spiralis results in the development of an aberrant mucosal immune response mediated by iNOS and the subsequent compromise of intestinal integrity.
A cardinal role for mast cells in host protection against certain GI nematode infections (T. spiralis in particular) has been shown in numerous studies (47, 48). Mast cells have also been shown to induce intestinal pathology by a number of mechanisms including the release of mediators such as cytokines, histamine, and NO (32, 33, 34, 49). There is also evidence that mast cells have the ability to synthesize and release NO derivatives through their own expression of iNOS induced by IgE immune complexes (44). Furthermore, iNOS has been shown to be crucial in allergic inflammatory processes by regulating the activation and degranulation of mast cells (50). However, it has also been suggested that mast cells normally serve to inhibit increased mucosal permeability induced by iNOS activity in the gut (33, 34). We find that mast cell numbers were decreased in T. spiralis-infected iNOS-deficient mice, so even if they are involved in parasite expulsion in this context, then they do so without the concomitant pathology.
NO may also exert its effects in enteropathy and parasite infection through its immunomodulatory role in Th cell polarization. It was observed that although iNOS-deficient mice infected with T. spiralis exhibited a decreased Th2 response compared with heterozygous mice, this was nevertheless sufficient to induce expulsion of the parasite. Similarly, iNOS-deficient mice infected with Leishmania major, Schistosoma mansoni, or Staphylococcus aureus have been demonstrated to have enhanced Th1 responses compared with wild-type mice (7, 13, 51). The mechanism by which NO influences immunoregulation is unknown at present but it has been suggested that NO could preferentially regulate the production of Th1/Th2 cytokines through modification of gene transcription, through the induction of apoptosis in Th1 cells, and/or by down-regulating selectin-dependent Th1 cell accumulation at sites of inflammation (14, 15, 30, 52, 53).
The production of TNF-
in T. spiralis-infected
iNOS-deficient mice was decreased in comparison to heterozygous mice.
In contrast, it has been shown that iNOS-deficient mice infected
with S. aureus had increased production of TNF-
compared with heterozygotes, and it was concluded that the increased
levels of TNF-
were the result of the exaggerated Th1 polarization
induced in these animals (7). However, NO has also been
shown to enhance the induction of TNF-
synthesis both in vivo and in
vitro (15). The reduced levels of TNF-
in
iNOS-deficient mice infected with T. spiralis may instead be
due to its induction by a Th2 response rather than a Th1 response. More
recently, expulsion of Trichuris muris from TNF-R
gene-deficient mice was prevented, and it was proposed that TNF-
mediated its protective effects by regulating the Th2 cytokine response
in the intestine (54).
Other NO-dependent functions (including alterations in vasodilation, endothelial integrity, vascular adhesion, emigration of inflammatory cells, increased mucin secretion by goblet cells, altered intestinal smooth muscle function, and intestinal fluid secretion) may also play a role in the enteropathy accompanying parasite expulsion (29, 50, 53, 55, 56, 57). It has been suggested that a change in intestinal smooth muscle and fluid dynamics, which favors increased propulsion and fluid accumulation in the gut lumen, leads to the expulsion of loosely attached parasites (35). However, fluid accumulation in the gut lumen of infected mice is unlikely to play a role in the expulsion of T. spiralis because the wet weights of the small intestines from iNOS-deficient mice were significantly lower than those of heterozygous mice. Furthermore, these parasites are embedded in the intestinal epithelium and so would be less susceptible to peristaltic removal.
It is possible that the villus atrophy observed in T.
spiralis infection, similar to that described following
administration of IL-12, IFN-
, or TNF-
(56), may be
induced by NO either through direct cellular injury via peroxynitrite
or indirectly via apoptosis of villus epithelial cells. Although villus
atrophy was ablated in iNOS-deficient mice, crypt hyperplasia was also
reduced, suggesting that NO is playing a greater role in inducing
intestinal inflammation than merely causing the death of epithelial
cells. Thus, iNOS may induce intestinal pathology in T.
spiralis infection in a number of ways which could include
induction of inflammatory cytokines such as TNF, activation of mast
cells, immunomodulation, alterations in intestinal physiology, or by
the induction of apoptosis of villus epithelial cells.
In conclusion, we have demonstrated that NO is an important component of the pathological response accompanying the expulsion of a GI nematode parasite. In the absence of high output NO synthesis, mice did not develop the severe enteropathy which usually accompanies infection with T. spiralis, but this did not inhibit the ability of the animals to expel the parasite. Thus, iNOS may promote parasite expulsion by down-regulating the induction of Th1 responses, thereby promoting a Th2 response. However, limitation of excessive NO production and the resulting tissue damage is no doubt of general benefit to the host. These results provide insights into the interplay of the protective and pathological responses associated with the expulsion of GI parasites. Importantly, they further suggest that Th2 responses can induce NO-mediated pathology. Hence, selective inhibitors of iNOS, currently under consideration for the treatment of IBDs, may prove beneficial for both Th1 and Th2-mediated enteropathies without compromising Th2 protective responses (26). It is now important to establish the exact mechanism by which iNOS is induced and exerts its pathological influence in intestinal inflammation.
| Footnotes |
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2 Address correspondence and reprint requests to Dr. Catherine E. Lawrence, Division of Infection and Immunity, Institute of Biomedical and Life Sciences, Joseph Black Building, University of Glasgow, Glasgow, G12 8QQ, U.K. ![]()
3 Abbreviations used in this paper: iNOS, inducible NO synthase; GI, gastrointestinal; IBD, inflammatory bowel disease; MLN, mesenteric lymph node; p.i., postinfection. ![]()
Received for publication November 8, 1999. Accepted for publication February 8, 2000.
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