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Objective: In acute pancreatitis (AP), bacterial translocation and subsequent infection of pancreatic necrosis are the main risk factors for severe disease and late death. Understanding how immunological host defence mechanisms fail to protect the intestinal barrier is of great importance in reducing the mortality risk of the disease. Here, we studied the role of the Treg/Th17 balance for maintaining the intestinal barrier function in a mouse model of severe AP.
Design: AP was induced by partial duct ligation in C57Bl/6 or DEREG mice, in which regulatory T-cells (Treg) were depleted by intraperitoneal injection of diphtheria toxin. By flow cytometry, functional suppression assays and transcriptional profiling we analysed Treg activation and characterised T-cells of the lamina propria as well as intraepithelial lymphocytes (IELs) regarding their activation and differentiation. Microbiota composition was examined in intestinal samples as well as in murine and human pancreatic necrosis by 16S rRNA gene sequencing.
Results: The prophylactic Treg-depletion enhanced the proinflammatory response in an experimental mouse model of AP but stabilised the intestinal immunological barrier function of Th17 cells and CD8+/γδTCR+ IELs. Treg depleted animals developed less bacterial translocation to the pancreas. Duodenal overgrowth of the facultative pathogenic taxa Escherichia/Shigella which associates with severe disease and infected necrosis was diminished in Treg depleted animals.
Conclusion: Tregs play a crucial role in the counterbalance against systemic inflammatory response syndrome. In AP, Treg-activation disturbs the duodenal barrier function and permits translocation of commensal bacteria into pancreatic necrosis. Targeting Tregs in AP may help to ameliorate the disease course.
Acute pancreatitis (AP), which is characterized by self-digestion of the pancreas by its own prematurely activated digestive proteases, is a major reason for hospitalization. The autodigestive process causes necrotic cell death of pancreatic acinar cells and the release of damage associated molecular pattern which activate macrophages and drive the secretion of pro-inflammatory cytokines. The MYD88/IRAK signaling pathway plays an important role for the induction of inflammatory responses. Interleukin-1 receptor associated kinase-3 (IRAK3) is a counter-regulator of this pathway. In this study, we investigated the role of MYD88/IRAK using Irak3−/− mice in two experimental animal models of mild and severe AP. IRAK3 is expressed in macrophages as well as pancreatic acinar cells where it restrains NFκB activation. Deletion of IRAK3 enhanced the migration of CCR2+ monocytes into the pancreas and triggered a pro-inflammatory type 1 immune response characterized by significantly increased serum levels of TNFα, IL-6, and IL-12p70. Unexpectedly, in a mild AP model this enhanced pro-inflammatory response resulted in decreased pancreatic damage, whereas in a severe AP model, induced by partial pancreatic duct ligation, the increased pro-inflammatory response drives a severe systemic inflammatory response syndrome (SIRS) and is associated with an increased local and systemic damage. Our results indicate that complex immune regulation mechanism control the course of AP, where moderate pro-inflammation not necessarily associates with increased disease severity but also drives tissue regenerative processes through a more effective clearance of necrotic acinar cells. Only when the pro-inflammation exceeds a certain systemic level, it fuels SIRS and increases disease severity.
Chronic pancreatitis (CP) is characterized by chronic inflammation and the progressive fibrotic replacement of exocrine and endocrine pancreatic tissue. We identify Treg cells as central regulators of the fibroinflammatory reaction by a selective depletion of FOXP3-positive cells in a transgenic mouse model (DEREG-mice) of experimental CP. In Treg-depleted DEREG-mice, the induction of CP results in a significantly increased stroma deposition, the development of exocrine insufficiency and significant weight loss starting from day 14 after disease onset. In CP, FOXP3+CD25+ Treg cells suppress the type-2 immune response by a repression of GATA3+ T helper cells (Th2), GATA3+ innate lymphoid cells type 2 (ILC2) and CD206+ M2-macrophages. A suspected pathomechanism behind the fibrotic tissue replacement may involve an observed dysbalance of Activin A expression in macrophages and of its counter regulator follistatin. Our study identified Treg cells as key regulators of the type-2 immune response and of organ remodeling during CP. The Treg/Th2 axis could be a therapeutic target to prevent fibrosis and preserve functional pancreatic tissue.
Objective
Acute pancreatitis (AP) is an inflammatory disorder, the severe form of which is burdened with multi-organ dysfunction and high mortality. The pathogenesis of life –threatening organ complications, such as respiratory and renal failure, is unknown.
Design
Organ dysfunction was investigated in a mouse model of AP. The influence of monocytes and neutrophils on multi organ dysfunction syndrome (MODS) was investigated in vivo by antibody depletion. Using real-time-fluorescence and deformability-cytometry (RT-DC) analysis we determined the mechanical properties of neutrophils and monocytes during AP. Furthermore, blood samples of pancreatitis patients were used to characterize severity-dependent chemokine profiles according to the revised Atlanta classification.
Results
Similar to AP in humans, severe disease in the mouse model associates with organ dysfunction mainly of lung and kidney, which is triggered by a mobilisation of Ly6g-/CD11b+/Ly6c hi monocytes, but not of Ly6g+/CD11b+ neutrophils. Monocyte depletion by anti-CCR2 antibody treatment ameliorated lung function (oxygen consumption) without interfering with the systemic immune response. RT-DC analysis of circulation monocytes showed a significant increase in cell size during SAP, but without a compensatory increase in elasticity. Patient chemokine profiles show a correlation of AP severity with monocyte attracting chemokines like MCP-1 or MIG and with leukocyte mobilisation.
Conclusion
In AP, the physical properties of mobilized monocytes, especially their large size, result in an obstruction of the fine capillary systems of the lung and of the kidney glomeruli. A selective depletion of monocytes may represent a treatment strategy for pancreatitis as well as for other inflammation-related disorders.
Die akute Pankreatitis ist eine der häufigsten nicht malignen gastrointestinalen Erkrankungen, die zu Krankenhausaufenthalten führt. Sie ist als Selbstverdau des Pankreas durch seine eigenen Proteasen wie z.B. Trypsin, Elastase und Chymotrypsin definiert. Als Ursprung der Erkrankung wird die frühzeitige intrazelluläre Aktivierung dieser Verdauungsenzyme angesehen. Dies führt zum Zelltod der Azinuszellen und zur Schädigung des Gewebes.
Während der akuten Pankreatitis kommt es in 20% der Fälle zu einem schweren Verlauf der Erkrankung, der mit Organversagen in der Lunge und den Nieren assoziiert ist. Es ist bekannt, dass es zu einer Entzündungsreaktion kommt, bei der große Mengen an Zytokinen ausgeschüttet werden. Leukozyten infiltrieren das Pankreas und verstärken den Gewebeschaden. Es kommt zur Freisetzung von DAMPs, die das angeborene und adaptive Immunsystem aktivieren. Bislang ist nicht gut untersucht, wie das Immunsystem den schweren Verlauf der akuten Pankreatitis beeinflusst und es gibt wenig Theorien über den Organschaden in der Lunge und den Nieren.
In dieser Arbeit lag der Fokus auf dem Organschaden in Lunge und Niere und die Wirkung von Interleukin 33 (IL33) auf die Zellen des angeborenen Immunsystems und deren Einwanderung in verschiedene Organe während der schweren akuten Pankreatitis im Mausmodell. Die schwere akute Pankreatitis wurde mittels Gangligatur und einmaliger Gabe von Caerulein an Tag 2 nach Gangligatur induziert. An Tag 3 nach Induktion wurden die Mäuse getötet und die Organe wurden für weitere Analysen entnommen.
Am dritten Tag nach Induktion der Pankreatitis kam es zu einem Organschaden in der Lunge und den Nieren. In der Lunge fand sich eine Verdickung der Alveolarsepten und eine Verdichtung des Gewebes sowie eine Infiltration von Leukozyten und ein Ödem. In der Niere waren ebenfalls strukturelle Veränderungen zu finden und eine Infiltration von Leukozyten war zu beobachten. In durchflusszytometrischen Analysen der Lunge konnte beobachtet werden, dass CD11b+CD62L+ Monozyten während der akuten Pankreatitis signifikant anstiegen. Mittels RT-DC wurde gezeigt, dass diese Monozyten an Tag 3 signifikant an Größe zugenommen hatten. Mit einer CD11b Färbungen von Lungen und Nieren konnte die Infiltration durch Monozyten bestätigt werden. Unter einer Blockade von Monozyten durch systemische Gabe von anti-CCR2-Antikörpern verringerte sich die Schädigung in Lunge und Niere während der Pankreatitis signifikant.
Diese Daten legen nahe, dass der Organschaden in der schweren akuten Pankreatitis durch infiltrierende Monozyten verursacht wird, die über CD62L (L-Selektin) an die Gefäßwände binden und über ihre Größe Gefäße verstopfen, was in den Kapillaren zur Ischämie führt.
In vitro sezernierten Makrophagen, die mit CCK stimulierten Azinuszellen co-inkubiert wurden, IL33. Im Mausmodell wurde IL33 mittels sST2 blockiert, was die Schädigung des Pankreas in der Pankreatitis reduzierte. In IL33-depletierten Tieren fand sich im Vergleich zum Wildtyp ein geringerer Lungenschaden aber eine unveränderte Nierenschädigung. Somit scheint IL33 eine Rolle bei der Monozyten-vermittelten Organschädigung in der Pankreatitis zu spielen, die sich auf Grund von kompensatorischen Regulationsmechanismen im globalen IL33 Knock-out weniger gut belegen lässt als nach IL33 Inhibition. Die Hemmung von IL33 zur Behandlung der akuten Pankreatitis stellt somit ein vielversprechendes Therapieprinzip dar.