Claudia Macaubas

Development of allergen-specific T-cell memory in atopic and normal children

BACKGROUND In the past 20-30 years, there has been an increase in prevalence of allergic respiratory diseases, particularly amongst children. This study is a prospective analysis of the postnatal maturation of T-helper cell (Th) responses to aeroallergens in atopic and non-atopic infants. METHODS We measured mononuclear-cell proliferative and cytokine responses to specific allergens and tetanus toxoid in blood samples from atopic and non-atopic infants every 6 months from birth to 2 years of age. Cytokine analyses of responses to housedust-mite allergen used ELISA and reverse-transcriptase PCR. We also measured responses to Fel d1 (cat allergen) and tetanus toxoid. FINDINGS Samples from 18 atopic and 13 non-atopic infants showed low-level Th2-skewed allergen-specific responses at birth, with little accompanying specific interferon-gamma production. Neonatal Th2 responses were lower in the atopic group than in the non-atopic group; the differences were significant for interleukin-4 (mRNA: beta-actin ratio 0.48 [SE 0.15] vs 0.15 [0.06], p=0.049), interleukin-6 (4750 [48] vs 1352 [51] pg/mL culture fluid, p=0.003), interleukin-10 (1162 [228] vs 485 [89], p=0.015), and interleukin-13 (7.1 [0.9] vs 0.9 [0.3], p=0.008). There was rapid suppression of Th2 responses during the first year of life in non-atopic children, but there was consolidation of responses in atopic children, associated with defective neonatal interferon-gamma production. INTERPRETATION The continuation of fetal allergen-specific Th2 responses during infancy is a defining feature of the inductive phase of atopic disease, and is associated with decreased capacity for production of the Th1 cytokine interferon y by atopic neonates. These findings provide a plausible mechanism for persistence of the fetal Th2 responses during early childhood in atopic individuals and subsequent expression of disease.

Asthma: an epidemic of dysregulated immunity

The remarkable increase in asthma prevalence that has occurred over the last two decades is thought to be caused by changes in the environment due to improved hygiene and fewer childhood infections. However, the specific infections that limit T helper type 2 (TH2)-biased inflammation and asthma are not fully known. Infectious organisms, including commensal bacteria in the gastrointestinal tract and hepatitis A virus, may normally induce the development of regulatory T (TR) cells and protective immunity that limit airway inflammation and promote tolerance to respiratory allergens. In the absence of such infections, TH2 cells—which are developmentally related to TR cells—develop instead and coordinate the development of asthmatic inflammation.

The role of allergy in the development of asthma

Recent studies have shown that initial sensitization to airborne environmental allergens occurs typically in early childhood, but subsequent progression to persistent atopic asthma, which may not manifest for several years, is restricted to only a subset of atopics. The key to establishing the link between atopy and asthma lies in the development of persistent inflammation in the airway wall, resulting in structural and functional changes in local tissues which are responsible for the symptoms of the disease. This review summarizes recent findings on the nature of the cellular and molecular mechanisms underlying this process, and addresses the issue of why the intensity and duration of these tissue-damaging responses in the airway wall apparently exceeds the critical threshold required for development of persistent asthma in only a minority of allergy sufferers.

TH2-polarized immunological memory to inhalant allergens in atopics is established during infancy and early childhood

Background There is increasing evidence that the T‐cell reactivity to environmental allergens underlying expression of allergic disease in adulthood, develops initially during childhood. However, there is little information available on the kinetics of these early responses, or on the patterns of cytokine production during this period.

Immunology : hepatitis A virus link to atopic disease

Atopic diseases, including asthma, allergic rhinitis and atopic dermatitis, are caused by both environmental and genetic factors. Here we show that infection by hepatitis A virus (HAV) may protect individuals from atopy if they carry a particular variant of the gene that encodes TIM-1 (also known as HAVcr-1) — the cell-surface receptor used by HAV to infect human cells. Exposure to HAV is associated with poor hygiene, large family size and attendance at day-care centres, all factors that are also inversely associated with atopy. Our discovery indicates that interaction between HAV and TIM-1 genotype may contribute to the aetiology of atopic diseases, and provides a mechanism to account for the hygiene hypothesis.

Regulation of T-helper cell responses to inhalant allergen during early childhood

Recent evidence suggests that preschool children manifest patterns of allergen‐specific skin prick test (SPT) reactivity and in vitro T‐cell cytokine production which are similar to that of either atopic or nonatopic adults. However, published studies on this age group involve small sample sizes and a restricted number of cytokines, usually in response to polyclonal stimuli.

Reciprocal age-related patterns of allergen-specific T-cell immunity in normal vs. atopic infants.

By adulthood there is almost universal immunological memory to aeroallergens, and the presence of allergic disease appears to be related to the nature of the underlying T‐helper (Th) cell cytokine responses. The hypothesis of this study is that adult patterns of allergen specific Th‐cell memory (Th‐2 polarized in atopics vs. Th1 in non‐atopics) can be determined in early infancy.

Antigen-specific responses to diphtheria-tetanus-acellular pertussis vaccine in human infants are initially Th2 polarized

ABSTRACT Immune responses to exogenous antigens in infant experimental animals display various degrees of Th2 polarization. Preliminary evidence from small human studies suggest a similar age-dependent response pattern to vaccines, but detailed investigations on vaccine immunity during infancy have not yet been undertaken. We report below the results of a comprehensive prospective study on responses to the tetanus component of the diphtheria, tetanus, acellular pertussis (DTaP) vaccine in a cohort of 55 healthy children, employing peripheral blood mononuclear cells (PBMC) collected at the 2-, 4-, and 6-month vaccinations and at 12 months. Antigen-specific production of interleukin-4 (IL-4), IL-5, IL-6, IL-9, IL-10, IL-13, and gamma interferon (IFN-γ) was determined at each sample point, in parallel with polyclonal (phytohemagglutinin PHA-induced) cytokine responses. Our results indicate early and persistent Th2 responses to the vaccine, in contrast to a more delayed and transient pattern of IFN-γ production. This initial disparity between the Th1 and Th2 components of the vaccine response was mirrored by patterns of polyclonally induced cytokine production, suggesting that the delayed maturation of the Th1 component of the vaccine response during infancy is secondary to developmental processes occurring within the overall Th cell system.

Developing Patterns of T Cell Memory to Environmental Allergens in the First Two Years of Life

Several recent studies have demonstrated cord blood mononuclear cell (CBMC) proliferation in response to food and inhalant allergens, suggesting that initial T-cell-priming may occur in utero. The findings below from an ongoing prospective study on 60 subjects provide initial information on the nature of accompanying T cell cytokine responses. We demonstrate CBMC proliferation following culture with house dust mite and ovalbumin (OVA) in 47 and 42% of subjects, respectively, compared to an overall rate of 3% for tetanus toxoid; the frequencies of these responses were comparable in neonates with and without atopic family history (FH). With the exception of IL-10, analysis of cytokine responses in allergen-stimulated cultures of CBMCs required the use of semiquantitative RT-PCR, which revealed low-level IL-4 and/or IL-5 mRNA production, in particular a 50% IL-5 response rate to OVA in FH-positive neonates. IFN-gamma responses were less frequent and required higher PCR cycle numbers for detection. Preliminary analysis of culture supernatants from a subgroup of CBMCs indicate high-level allergen-specific IL-10 responses in both FH-negative and -positive subjects, detectable by ELISA. Parallel PCR studies on MCs from 27 children (mean age 18 months) indicated a clear segregation at this age on the basis of FH, with Th0-like or mixed Th1/Th2 responses (IL-5 plus IFN-gamma) which were mainly restricted to the FH-positive group.

CD4+ T Cell Autoimmunity to Hypocretin/Orexin and Cross-Reactivity to a 2009 H1N1 Influenza A Epitope in Narcolepsy

Patients with narcolepsy carry CD4+ T cells that react to peptides from both the sleep-regulating neuropeptide hypocretin and a 2009 H1N1 influenza A protein. New Clues About Narcolepsy Most adults long for more sleep, but patients with narcolepsy would rather be free of their excessive sleepiness. Some things about narcolepsy are clear: It is caused by the loss of the peptide hypocretin from neurons that control wakefulness, and it has a remarkably strong association with a particular human leukocyte antigen (HLA) molecule (DQ0602), suggesting that there is an immune contribution to the disease. Other things are not so clear: We do not know what triggers the disease, and there is no way to prevent it. The neurons that are destroyed in narcolepsy contain the body’s only store of hypocretin, so an immune response against hypocretin could conceivably be responsible for the disease. Although no antibodies to hypocretin have been found in patients, now De la Herrán-Arita et al. have identified CD4+ T cells that react against several peptides derived from hypocretin when they are presented by HLA DQ0602. The two 13–amino acid peptides, corresponding to the N-terminal ends of the mature, secreted forms of hypocretin, triggered responses in T cells from 23 patients with narcolepsy but not in matched DQ0602-positive healthy control subjects. Similarly, in pairs of twins discordant for narcolepsy, the twin with disease carried cells that were activated by hypocretin peptides, whereas the healthy twin did not. Clues about environmental factors that might contribute to narcolepsy have come from epidemiology studies that associate Streptococcus, influenza, and other infections with the disease. In Scandinavia, a particular flu vaccine was associated with increased narcolepsy risk. To investigate these associations further, the authors searched for epitopes in proteins from the flu virus that might activate the same T cells that responded to the hypocretin peptides. Within the flu protein hemagglutinin, they found a small segment that had this effect, amino acids 275 to 287. When cells from patients were incubated with this peptide presented by DQ0602, there was an increase in the number of cells reactive to both the hemagglutinin peptide and the hypocretin peptides, suggesting cross-reactivity between these epitopes. Although more research is necessary to understand the effects of the hypocretin-reactive cells in patients, these results point to a possible molecular mimicry between epitopes on hypocretin and the influenza hemagglutinin protein. Narcolepsy, a disorder strongly associated with human leukocyte antigen (HLA)–DQA1*01:02/DQB1*06:02 (DQ0602), is characterized by excessive daytime sleepiness, cataplexy, and rapid eye movement sleep abnormalities. It is caused by the loss of ~70,000 posterior hypothalamic neurons that produce the wake-promoting neuropeptide hypocretin (HCRT) (orexin). We identified two DQ0602-binding HCRT epitopes, HCRT56–68 and HCRT87–99, that activated a subpopulation of CD4+ T cells in narcolepsy patients but not in DQ0602-positive healthy control subjects. Because of the established association of narcolepsy with the 2009 H1N1 influenza A strain (pH1N1), we administered a seasonal influenza vaccine (containing pH1N1) to patients with narcolepsy and found an increased frequency of circulating HCRT56–68– and HCRT87–99–reactive T cells. We also identified a hemagglutinin (HA) pHA1 epitope specific to the 2009 H1N1 strain, pHA1275–287, with homology to HCRT56–68 and HCRT87–99. In vitro stimulation of narcolepsy CD4+ T cells with pH1N1 proteins or pHA1275–287 increased the frequency of HCRT56–68– and HCRT87–99–reactive T cells. Our data indicate the presence of CD4+ T cells that are reactive to HCRT in narcolepsy patients and possible molecular mimicry between HCRT and a similar epitope in influenza pH1N1, pHA1275–287.