Therapeutical implication of regulatory cells and cytokines in celiac disease

Transcription

1 Institute of Food Sciences, CNR Avellino, Italy Therapeutical implication of regulatory cells and cytokines in celiac disease Carmen Gianfrani Mastering the coeliac condition: from medicine to social sciences and food technology Florence, Congress Palace, March 2012

2 Oral Tolerance In healthy jejunal mucosa food antigens and commensal flora are beneficial and tolerated food antigens commensal bacteria Mowat, Nat Rev Immunol 2003 Oral Tolerance is a tightly controlled immune phenomenon. The intestinal immune system has to discriminate between harmful and beneficial luminal antigens Key role of Regulatory T cells and cytokines IL 10 and TGFβ in OT Weiner Immunol Rev Powrie, Immunol Rev. 2006

3 Abnormal immune response to gluten occurs in in celiac mucosa but not in healthy gut IFN-γ SFC/1x10 6 cells Gianfrani, J Immunol 2003 Gianfrani, J Immunol 2006 Mazzarella, Gastroenterology non-cd CD Lundin, J Exp Med 1993 Molberg, Scand J Immunol 2006 Is oral tolerance broken in CD?

4 Both pro inflammatory and regulatory cytokines are upregulated in celiac mucosa

5 T REGULATORY (Tr) CELLS CD4-8 - CD4 + NK-T CD8 + Tr1 cells (IL-10 +, TGF-beta +, IFN- +, IL-4 -, IL-2 low/- ) Th3 cells (IL-10+, TGF-beta+) CD4+CD25+Foxp3+ (IL-10+, TGF-beta+)

6 IL 10 and TGF beta are key cytokines in controlling immune response to gluten in celiacs 60 3-H-TdR (cpmx10 3 ) IFN (pg/ml) cells gliadin gliadin + ail10r gliadin + atgf gliadin + both cells + ail10r cells + atgf cells gliadin gliadin + ail10r gliadin + atgf gliadin + both cells + ail10r cells + atgf Gianfrani C. et al J Immunol 2006

7 IL 10 and TGF β control T cell response to gliadin in children at high risk to develop CD (PreventCD EU FP FOOD4B) IFN-γ (Fold Increase) PrCD with atrophic mucosa N=6 P = PrCD with normal mucosa N=6 p= gliadin gliadin + a-il-10r + a-tgfbeta gliadin+tg gliadin+tg + a-il-10r + a-tgfbeta 0 gliadin gliadin + a-il-10r + a-tgfbeta gliadin+tg gliadin+tg + a-il-10r + a-tgfbeta Gianfrani et al unpublished see poster #26 for details

8 Immune response to gliadin at early CD state PreventCD EU FP FOOD4B) PrCD AGA ttg(iga) Marsh grade CD3 γδ CD25 IgA deposit 40,2 0,1 M1 36 2,3 5 Absent IFN- (pg/ml) medium gliadin gliadin gliadin+tg + a-il-10r + a-tgfbeta gliadin+tg + a-il-10r + a-tgfbeta First biopsy: normal mucosa Gianfrani et al unpublished see poster #26 for details Second biopsy after 30 months: atrophy, ttg 100U/ml

9 IL 10 and TGFβ producing Treg (Tr1) cells are present in celiac mucosa and suppress immune response to gliadin IL-10 net pg/ml Tr1.7 Tr1 phenotype CD3+CD4+ TCR a/b+ B7 integrin+ CD103 neg CD45RO TCC Tr1.9 IL-4 TGF- IL-2 -IFN 7 Stimulation index Th.6 (R) Tr1.7 (S) R:5x10 4 S:5x10 4 S:R 2:1 S:R 1:1 11 S:R 0.2:1 15 S:R 0.1: R + S R +R Gianfrani C. et al J Immunol 2006

10 No IL 10 and TGFβ producing Treg (Tr1) cells in nonceliac, healthy subjects IFN- -SFC/1x10 6 cells gliadin gliadin + -IL-10R and -TGF PHA T1D T1D T1D T1D T1D Gianfrani C. et al J Immunol 2006 Gianfrani C unpublished

11 No defect in the presence and suppressive function of IL 10 and TGFβ T regulatory cells in CD No evidence of Tr1 cell reactive to gliadin in healthy mucosa In DQ2 Tg mice tolerance to deamidated gliadin is mantained by regulatory IL 10+Tr1 cells (Du Pre MF Gastroenterology 2011)

12 Increased CD4+Foxp3+ T regs in celiac mucosa Control mucosa Untreated mucosa Foxp3+; CD4+ Zanzi, Am J Gastr 2011

13 Intraepithelial CD8 + cells have a regulatory function in CD Baghat et al, J Clin Invest 2008

14 No defect in the presence and suppressive function of CD4+CD25+Foxp3+ and CD8+TCRγδ+ Treg In normal condition gluten seems to be ignored by the gut immune system

15 Standpoint: activation of both pro inflammatory and regulatory pathways in CD mucosa gluten gluten Regulatory Immune response IL10+TGF + Tr1 CD4+CD25+Foxp3+ Inflammatory Response Immune Regulation Treg based therapy

16 Very low rate of in vitro expansion of gliadin reactive Treg from biopsy Gliadin (± ttg) Biopsy (3-5 mm) INF γ, IL 2, IL 21 Proliferation Gliadin-Th cells Gianfrani, Gastroenterology 2007 Camarca, J Immunol 2009 Rizzello, App Env Microb 2007 Bergamo, Mol Nutr Food Res Maglio, Scand J Gastroenterol Gliadin-Treg cells IL 10, TGFbeta Proliferation

17 Gliadin IL 10+ T cells in the blood of celiac and not in healthy donors IL-10-SFC/1x10 6 PBMC p<0.009 ns p< Control donors Celiacs gliadin gliadin-tg LPS PHA Camarca et al unpublished

18 Is Treg based therapy suitable in celiac disease? Possible strategies: i. In vitro induction/expansion of gut homing Tr1 and delivery into patients. ii. Orally administration of genetically modified bacteria (IL 10/gliadin secreting lactococcus lactis), to in vivo induce or expand Tr1 cells iii. Gluten peptide vaccination: in vivo induction of specific IL 10+Tr1 cells?

19 Adoptive Transfer of Treg in Clinical Trials Reviewed by Gregori S. Frontiers in Immunology. Feb 2012

20 Contributes Institute of Food Sciences, CNR, Avellino, Italy Carmen Gianfrani Giuseppe Mazzarella Alessandra Camarca Stefania Picascia Rosita Stefanile Department of Pediatrics University Federico II, Naples, Italy Salvatore Auricchio Riccardo Troncone Luigi Greco Virginia Salvati Delia Zanzi Thanks to AIC & Celiac People