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. 2020 May 20:11:844.
doi: 10.3389/fimmu.2020.00844. eCollection 2020.

Role of Small Intestine and Gut Microbiome in Plant-Based Oral Tolerance for Hemophilia

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Role of Small Intestine and Gut Microbiome in Plant-Based Oral Tolerance for Hemophilia

Sandeep R P Kumar et al. Front Immunol. .

Abstract

Fusion proteins, which consist of factor VIII or factor IX and the transmucosal carrier cholera toxin subunit B, expressed in chloroplasts and bioencapsulated within plant cells, initiate tolerogenic immune responses in the intestine when administered orally. This approach induces regulatory T cells (Treg), which suppress inhibitory antibody formation directed at hemophilia proteins induced by intravenous replacement therapy in hemophilia A and B mice. Further analyses of Treg CD4+ lymphocyte sub-populations in hemophilia B mice reveal a marked increase in the frequency of CD4+CD25-FoxP3-LAP+ T cells (but not of CD4+CD25+FoxP3+ T cells) in the lamina propria of the small but not large intestine. The adoptive transfer of very small numbers of CD4+CD25-LAP+ Treg isolated from the spleen of tolerized mice was superior in suppression of antibodies directed against FIX when compared to CD4+CD25+ T cells. Thus, tolerance induction by oral delivery of antigens bioencapsulated in plant cells occurs via the unique immune system of the small intestine, and suppression of antibody formation is primarily carried out by induced latency-associated peptide (LAP) expressing Treg that likely migrate to the spleen. Tolerogenic antigen presentation in the small intestine requires partial enzymatic degradation of plant cell wall by commensal bacteria in order to release the antigen. Microbiome analysis of hemophilia B mice showed marked differences between small and large intestine. Remarkably, bacterial species known to produce a broad spectrum of enzymes involved in degradation of plant cell wall components were found in the small intestine, in particular in the duodenum. These were highly distinct from populations of cell wall degrading bacteria found in the large intestine. Therefore, FIX antigen presentation and Treg induction by the immune system of the small intestine relies on activity of a distinct microbiome that can potentially be augmented to further enhance this approach.

Keywords: factor IX; hemophilia; oral tolerance; regulatory T (Treg) cell; transgenic plant.

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Figures

Figure 1
Figure 1
Suppression of antibody formation against FIX after adoptive transfer of Treg. (A) Experimental outline of oral tolerance with bioencapsulated CTB-FIX/intravenous treatment with FIX, T cell isolation, adoptive transfer, and immunization. Donor hemophilia B mice had been treated in this manner or were naïve control mice. Flow cytometry plots show results from purification of splenic CD4+CD25+ T cells and CD4+CD25LAP+ T cells by flow sorting. (B) FIX-specific IgG titers in mice that received either CD4+CD25+ T cells or CD4+CD25LAP+ T cells after immunization with FIX. Results are average ±SD (n = 5/group). * indicates P < 0.05.
Figure 2
Figure 2
Analysis of Treg subsets in intraepithelial lymphocyte (IEL) and lamina propria lymphocyte (LPL) populations of small and large intestine of hemophilia B mice using flow cytometry. (A) Time course of oral tolerance regimen with CTB-FIX expressing plant cells and treatment by intravenous injection of recombinant FIX protein. (B) Gating scheme and examples of flow cytometry results. Examples of small intestine (“small”) and large intestine (“large”) results are shown for CD4+CD25+FoxP3+ T cells and CD4+CD25LAP+ T cells. Control mice had not received any treatment.
Figure 3
Figure 3
Frequencies of (A) CD4+CD25+FoxP3+ T cells and (B) CD4+CD25LAP+ T cells among IEL and LPL populations of small and large intestines of orally tolerized and naïve control hemophilia B mice. Results are average ±SD (n = 5/group).
Figure 4
Figure 4
Relative frequencies of bacterial orders in duodenum, jejunum/ileum, and small intestine of hemophilia B mice (n = 4) as determined by bioinformatic analysis of NGS data. The example shown here is for data obtained from amplification of variable region v3v4.
Figure 5
Figure 5
Species relative frequencies of bacteria producing the following enzymes in duodenum, jejunum/ileum, and large intestine of hemophilia B mice as predicted by PICRUSt2 on different 16S rRNA variable region taxonomic profiles. Results are shown for six variable regions analyzed by NGS (Statistical method t-test was used, asterisks represent significance level of a pairwise t-test with P-values i.e., ‘****' ≤ 1e-04, ‘***' ≤ 0.001, ‘**' ≤ 0.01, ‘*' ≤ 0.05, ns > 0.05 (not significant). (A) Triacylglycerol lipase. (B) Carboxylesterase. (C) 6-phospho-β-glucosidase. (D) β-N-acetylhexosaminidase. (E) Cellulase (β-1,4-endoglucan hydrolase). (F) Amino-acid N-acetyltransferase. (G) β-glucosidase. (H) Xylan 1,4-β-xylosidase. (I) Mannan endo-1,4-β-mannosidase. (J) Pectinesterase. (K) Endo-1,4-β-xylanase.
Figure 6
Figure 6
Relative abundance of bacterial orders producing enzymes that degrade plant cell wall components were identified in the duodenum, jejunum, and large intestine of hemophilia B mice. Results are shown as highest abundance of each enzyme from the tested amplicon regions in duodenum, jejunum/ileum, and large intestine of the hemophilia B mice. (A) Carboxylesterase. (B) Triacylglycerol lipase. (C) Amino-acid N-acetyltransferase. (D) Pectinesterase. (E) β-glucosidase. (F) Xylan 1,4-β-xylosidase. (G) β-N-acetylhexosaminidase. (H) Cellulase (β-1,4-endoglucan hydrolase). (I) 6-phospho-β-glucosidase.

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