Baomei Wang1, Jong-Hyung Lim2, Tetsuhiro Kajikawa2, Xiaofei Li2, Bruce A Vallance3, Niki M Moutsopoulos4, Triantafyllos Chavakis5, George Hajishengallis6. 1. Department of Microbiology, University of Pennsylvania School of Dental Medicine, Philadelphia, PA 19104, USA. Electronic address: baomei.wang@pennmedicine.upenn.edu. 2. Department of Microbiology, University of Pennsylvania School of Dental Medicine, Philadelphia, PA 19104, USA. 3. Department of Pediatrics, Division of Gastroenterology, University of British Columbia, Vancouver, BC V6H 3N1, Canada. 4. Oral Immunity and Inflammation Unit, NIDCR, NIH, Bethesda, MD 20892, USA. 5. Faculty of Medicine, Institute for Clinical Chemistry and Laboratory Medicine, Technische Universität Dresden, 01307 Dresden, Germany. 6. Department of Microbiology, University of Pennsylvania School of Dental Medicine, Philadelphia, PA 19104, USA. Electronic address: geoh@upenn.edu.
Abstract
β2-integrins promote neutrophil recruitment to infected tissues and are crucial for host defense. Neutrophil recruitment is defective in leukocyte adhesion deficiency type-1 (LAD1), a condition caused by mutations in the CD18 (β2-integrin) gene. Using a model of Citrobacter rodentium (CR)-induced colitis, we show that CD18-/- mice display increased intestinal damage and systemic bacterial burden, compared to littermate controls, ultimately succumbing to infection. This phenotype is not attributed to defective neutrophil recruitment, as it is shared by CXCR2-/- mice that survive CR infection. CR-infected CD18-/- mice feature prominent upregulation of IL-17 and downregulation of IL-22. Exogenous IL-22 administration, but not endogenous IL-17 neutralization, protects CD18-/- mice from lethal colitis. β2-integrin expression on macrophages is mechanistically linked to Rac1/ROS-mediated induction of noncanonical-NLRP3 (nucleotide-binding domain, leucine-rich-containing family, pyrin domain-containing-3) inflammasome-dependent IL-1β production, which promotes ILC3-derived IL-22. Therefore, β2-integrins are required for protective IL-1β-dependent IL-22 responses in colitis, and the identified mechanism may underlie the association of human LAD1 with colitis.
β2-integrins promote neutrophil recruitment to infected tissues and are crucial for host defense. Neutrophil recruitment is defective in leukocyte adhesion deficiency type-1 (LAD1), a condition caused by mutations in the CD18 (β2-integrin) gene. Using a model of Citrobacter rodentium (CR)-induced colitis, we show that CD18-/- mice display increased intestinal damage and systemic bacterial burden, compared to littermate controls, ultimately succumbing to infection. This phenotype is not attributed to defective neutrophil recruitment, as it is shared by CXCR2-/- mice that survive CRinfection. CR-infected CD18-/- mice feature prominent upregulation of IL-17 and downregulation of IL-22. Exogenous IL-22 administration, but not endogenous IL-17 neutralization, protects CD18-/- mice from lethal colitis. β2-integrin expression on macrophages is mechanistically linked to Rac1/ROS-mediated induction of noncanonical-NLRP3 (nucleotide-binding domain, leucine-rich-containing family, pyrin domain-containing-3) inflammasome-dependent IL-1β production, which promotes ILC3-derived IL-22. Therefore, β2-integrins are required for protective IL-1β-dependent IL-22 responses in colitis, and the identified mechanism may underlie the association of human LAD1 with colitis.
Leukocyte adhesion deficiency type 1 (LAD1) is an autosomal recessive primary
immunodeficiency caused by mutations in the ITGB2 gene that encodes
the common CD18 subunit of β2-integrins. As β2-integrins are required
for firm endothelial adhesion and subsequent transmigration of neutrophils to sites
of infection or inflammation, the absence or diminished expression of CD18 in
affected individuals results in few or no neutrophils in peripheral tissues (Moutsopoulos et al., 2014; Schmidt et al., 2013). LAD1 patients typically display
recurrent bacterial infections and pathological inflammation, primarily in the skin
and mucosal surfaces (Hanna and Etzioni,
2012; Moutsopoulos et al., 2014).
Gastrointestinal complications and colitis have also been reported in a subset of
LAD1 patients (D’Agata et al., 1996;
Hawkins et al., 1992; Uzel et al., 2001). However, the mechanism or mechanisms
by which β2-integrin deficiency may predispose to LAD1-associated colitis
remain uncertain, as does the ability of LAD1 patients to cope with gastrointestinal
pathogens.Similar to human LAD1 patients (Hanna and
Etzioni, 2012; Moutsopoulos et al.,
2014, 2017), mice with a null
mutation in CD18 (CD18−/−) have defective neutrophil
adhesion and extravasation, have exaggerated interleukin (IL)-17 production in
peripheral tissues, and develop skin ulcerations (Scharffetter-Kochanek et al., 1998; Stark et al., 2005). In this study, we used
CD18−/− mice in a model of Citrobacter
rodentium-induced colitis (Koroleva et
al., 2015) to gain insights into the potential connection between
β2-integrin expression and control of intestinal infection and colitis.
C. rodentium is a natural Gram-negative enteric pathogen of
mice and has been used to model several humanintestinal disorders, including Crohn
disease and ulcerative colitis (Koroleva et al.,
2015). In this regard, C. rodentium breaches the
intestinal epithelial barrier, leading to a vigorous inflammatory response and
colitis. C. rodentium-induced colitis is tolerated and resolved in
immunocompetent hosts (e.g., wild-type C57BL/6 mice), whereas specific
immune-deficiencies lead to varying degrees of susceptibility (Koroleva et al., 2015). For instance, IL-22-deficient
(IL-22−/−) mice are extremely sensitive and die of
C. rodentiuminfection (Zheng
et al., 2008). In this regard, early induction of colonic IL-22 upon
C. rodentium challenge is critical for host protection, and
group 3 innate lymphoid cells (ILC3s) are a major source of this protective cytokine
(Cella et al., 2009; Sonnenberg et al., 2011; Zheng et al., 2008). Macrophage-derived IL-1β and dendritic
cell-derived IL-23 are key cytokines that support the ILC3 expression of IL-22 in
the colon (Longman et al., 2014; Manta et al., 2013; Seo et al., 2015).Here, we show that β2-integrins are required for protection against
C. rodentium-induced colitis and mortality through a mechanism
that is largely independent of defective neutrophil recruitment. Specifically, our
findings indicate a role for macrophage β2-integrins in promoting
IL-1β release, which subsequently regulates protective ILC3 function. Unlike
β2-integrin-sufficient littermates (CD18+/+ and
CD18+/−), CD18−/− mice succumbed to
C. rodentium-induced colitis in concert with the pronounced
upregulation of IL-17 and downregulation of IL-22 as compared to littermate
controls. Administration of exogenous IL-22, but not neutralization of endogenous
IL-17, protected CD18−/− mice from C.
rodentium-induced lethal colitis. Mechanistic studies established a
role for β2-integrins in macrophages for Rho-family guanosine triphosphatase
(GTPase) Rac1 activation, reactive oxygen species (ROS) production, and subsequent
induction of noncanonical NLRP3 (nucleotide-binding domain,
leucine-rich–containing family, pyrin domain–containing-3)
inflammasome-dependent IL-1β release, which in turn promoted a protective
ILC3-mediated IL-22 response. In conclusion, we established a transcellular
β2 integrin-IL-1β–IL-22 pathway, which mediates protection
against C. rodentium-induced colitis in mice and suggests a
potential link between human LAD1 and susceptibility to colitogenic bacteria.
RESULTS
CD18−/− Mice Are Highly Susceptible to C.
rodentium-Induced Colitis
The contribution of β2-integrins to gut homeostasis and immunity
is poorly characterized, although CD18 deficiency upregulates IL-17 in the
intestine and mesenteric lymph nodes (MLNs) in the absence of infection (Stark et al., 2005). However, whether the
dysregulated IL-17 response associated with LAD1 causes immunopathology in the
gut (as is the case with oral mucosal or skin tissue [Moutsopoulos et al., 2014, 2017]) has not been addressed. Examination of
8-week-old CD18−/− mice showed that they maintain
normal weight and colon length (Figures S1A and S1B), although they
exhibit splenomegaly relative to CD18-sufficient (CD18+/+ and
CD18+/−) littermates (Figure S1C), as reported earlier
(Scharffetter-Kochanek et al., 1998).
Histological examination of the CD18−/− colon and cecum
revealed normal tissue morphology as compared with that of littermate controls
(Figures S1D and
S1E). Similarly, when examined at 18 weeks of age,
CD18−/− mice were still found to maintain normal
colon length and had no signs of colitis (Figures S1F and S1G).We next addressed whether CD18 deficiency causes increased
susceptibility to C. rodentium-induced colitis (Koroleva et al., 2015). To this end,
CD18−/− mice and littermate controls were orally
gavaged with 5 × 108 colony-forming units (CFUs) of C.
rodentium. CD18+/+ and CD18+/−
littermates were able to survive the infection (Figure 1A) without significant changes in body weight (Figure 1B). In stark contrast,
CD18−/− mice suffered a significant drop in body
weight from day 5 onward (Figure 1B) and
rapidly succumbed to infection, starting at day 8 and leading to 100% mortality
by day 12 (Figure 1A). Fluorescence
in situ hybridization showed that as early as day 5
post-infection, CD18−/− mice exhibited markedly
elevated C. rodentium burdens (as compared to
CD18+/− mice) within the distal colon adjacent to or
associated with the intestinal epithelial cells (Figure 1C). In the same time interval,
CD18−/− mice displayed a marked dissemination of
C. rodentium to peripheral organs, including MLNs, spleens,
and livers, whereas in CD18+/− controls, C.
rodentium bacteria were barely detectable in these organs, despite
their abundance in the feces (Figure 1D).
Moreover, the pronounced susceptibility of CD18−/− mice
was associated with a significant reduction in colon length (a marker of
colitis) at day 8 post-infection (Figure
1E) and with concomitantly increased C. rodentium
bacterial burdens in the spleens and livers (Figure 1F), as compared to CD18-sufficient littermates. In addition,
histological analysis revealed cecal and colonic mucosa hyperplasia and
ulceration in C. rodentium-infected
CD18−/− mice (Figure
1G), thereby resulting in significantly higher cecal and colonic
histopathology scores relative to their CD18-sufficient littermate controls
(Figure 1H). Therefore, in the setting
of CD18 deficiency, C. rodentium causes increased intestinal
epithelial damage, systemic pathogen burdens, and mortality in mice during
infection with C. rodentium.
Figure 1.
CD18 Deficiency Renders Mice Highly Susceptible to C.
rodentium-Induced Colitis
(A and B) Survival rates (A) and average weight changes (B) at the
indicated time points in CD18−/−,
CD18+/−, and CD18+/+ littermates orally
inoculated with C. rodentium at the age of 8 weeks.
(C and D) CD18−/− and CD18+/–
mice were orally inoculated with GFP-expressing and antibiotic-resistant
C. rodentium, and after 5 days, tissues were harvested to
visualize bacteria by fluorescence in situ hybridization (FISH)
and determine bacterial load.
(C) Colon sections from CD18−/− and
CD18+/− littermates were stained with a universal probe
that targets the 16S rRNA gene of all bacteria (red) and anti-GFP antibody
(green). Sections were counterstained with DAPI to visualize nuclei. Scale bars,
50 μm. Dotted line indicates basement membrane and arrowheads indicate
bacteria associated with the distal colonic epithelium.
(D) Log10 CFU of C. rodentium in MLNs,
spleens, livers, and feces.
(E–H) CD18−/−, CD18+/−
and CD18+/+ mice were orally inoculated with C.
rodentium, and after 8 days, tissues were harvested to determine
(E) colon length and (F) log10 CFU of C. rodentium
in spleen and liver. (G) H&E-stained cecum and colon sections (scale bars,
100 μm) and (H) histopathology scores of cecum and colon sections at day
8 post-infection.
Numerical data are means ± SDs and are pooled from 4 independent
experiments with 7–8 mice/group in each experiment, for a total of 29
mice/group (A); are from 2 independent experiments with 3 mice/group, for a
total of 6 mice/group (B and F); are from 2 independent experiments with
4–5 mice/group, for a total of 8–9 mice/group (D and E); or are
from 2 independent experiments with 3 mice/group, for a total of 6 mice/group
(H). Images are representative of 2 independent experiments with 3–4
mice/group (C and G). **p < 0.01, ***p < 0.001, and ****p <
0.0001 (B: 2-way ANOVA with repeated-measures and Dunnett’s
multiple-comparisons test; D: 2-tailed Student’s t test; E, F, and H: or
1-way ANOVA with Tukey’s multiple-comparisons test). NS,
non-significant.
Differential Regulation of IL-17 and IL-22 in
CD18−/− Large Intestine after C.
rodentium Infection
Neutrophils in CD18−/− mice show defective
extravasation and recruitment to sites of infection or inflammation (Scharffetter-Kochanek et al., 1998).
Consistent with this, flow cytometric analysis revealed significantly reduced
neutrophil infiltration on day 8 post-infection in the colonic lamina propria of
CD18−/− mice as compared to their
CD18+/− littermate controls (Figure S2A). As β2-integrins
mediate multiple functions besides neutrophil recruitment, we used mice
deficient in C-X-C motif chemokine receptor 2
(CXCR2−/−) to determine the importance of recruited
neutrophils in C. rodentium-induced colitis. CXCR2 is a major
chemokine receptor expressed on neutrophils, and
CXCR2−/− mice display few or no neutrophils in the
colon and other sites of infection due to defective neutrophil chemotaxis (Spehlmann et al., 2009; Zenobia et al., 2013), as also confirmed in our study
(Figure S2B). Upon
oral gavage with C. rodentium, all
CXCR2−/− mice survived the infection, whereas all
CD18−/− mice (infected in a side-by-side
experiment) died by day 12 (Figure S2C). CXCR2−/− mice maintained
normal body weight and colon length (Figures S2D and S2E), although they
exhibited modestly increased bacterial loads within systemic tissues as compared
to CXCR2+/+ littermate controls (differences reached statistical
significance in spleens but not in livers; Figure S2F). Histologically,
CXCR2−/− mice displayed increased colonic
inflammation, edema, and epithelial damage (Figure S2G) and modestly higher
colonic pathology scores relative to CXCR2+/+ controls (Figure S2H). These data
suggest that the lethal C. rodentium-induced colitis seen in
CD18−/− mice during the second week post-infection
cannot be adequately explained by defects in neutrophil recruitment.We thus next investigated alternative mechanisms underlying the
increased susceptibility of CD18−/− mice to C.
rodentium-induced colitis. To this end, we examined their colonic
cytokine expression profile at day 5 post-infection—in other words, just
before the time that CD18−/− mice started losing
significant weight and began to succumb to infection. Similar to the
IL-17-dominated gene expression signature seen in human and murineoral mucosal
tissues in the setting of LAD1-associated periodontitis (Moutsopoulos et al., 2014, 2017), C. rodentiuminfection of
CD18−/− mice elicited significantly higher mRNA
expression of IL-17 (although not of tumor necrosis factor [TNF] or IL-6) as
compared to the CD18-sufficient (CD18+/−) littermate controls,
which also showed elevated IL-17 mRNA expression relative to pre-infection
baseline levels (Figure 2A). In stark
contrast to IL-17, the mRNA expression of IL-22 and of IL-22-dependent
antimicrobial genes (Reg3β and Reg3γ) was markedly reduced
(compared to littermate controls) in the CD18−/− colon
(Figure 2A). The differentially
regulated expression of IL-17 and IL-22 in the C.
rodentium-infected CD18−/− colon was confirmed
at the protein level (Figure 2B). These
data suggest that colonic IL-22 expression is under β2-integrin
regulation.
Figure 2.
Differential Regulation of IL-17 and IL-22 in
CD18−/− Colon after C. rodentium
Infection
(A and B) Eight-week-old CD18−/− mice and
CD18-sufficient littermate controls (CD18+/− and/or
CD18+/+) were orally inoculated with C.
rodentium. On day 5, colonic tissue was harvested, and expression
of the indicated cytokines was determined (A) at the mRNA level by quantitative
real-time PCR and (B) at the protein level by ex vivo colon
culture ELISA.
(C and D) On day 5 post-infection, LPMCs were isolated from the large
intestine of CD18−/− or CD18+/− mice
and analyzed by flow cytometry for IL-22+ ILC3 cells (shown are
representative fluorescence-activated cell sorting [FACS] plots [left] and
absolute numbers [right] of IL-22-expressing RORγt+ ILCs
[gated on
CD3−CD5−B220−NK1.1−F4/80−Gr-1−CD127+CD90.2+RORγt+])
(C) and for total number of ILC3 cells (D).
Data are means ± SDs and are pooled from 2 independent
experiments with 3 mice/group in each experiment, for a total of 6 mice/group (A
and B); are from 2 independent experiments with 3 mice/group in one experiment
and 4 mice/group in the second experiment, for a total of 7 mice/group (C); or
are from 3 independent experiments with 3 mice/group in each experiment, for a
total of 9 mice/group (D). *p < 0.05, **p < 0.01, ***p <
0.001, and ****p < 0.0001 (A, C, and D: 2-tailed Student’s t test;
B: or 1-way ANOVA with Tukey’s multiple-comparisons test). NS,
non-significant.
Compared to their littermate controls, C.
rodentium-infected CD18−/− mice exhibited
markedly increased numbers of γδT cells in the lamina propria of
the large intestine, MLNs, and spleens (Figure S3A) and a significantly
higher frequency of IL-17-expressing γδT cells in the same tissues
(Figure S3B). As
ILC3s constitute the predominant source of IL-22 in the early stage of
C. rodentiuminfection (Sonnenberg and Artis, 2015), we examined the numbers of
IL-22-expressing ILC3s in the large intestinal lamina propria on day 5
post-infection. The analysis revealed a significant reduction in the numbers of
IL-22+ ILC3s in CD18−/− mice as compared
to those in CD18+/− littermate controls (Figures 2C and S4A). In contrast, there were no
significant differences between CD18−/− and
CD18+/− mice regarding the total number of ILC3 cells
(Figure 2D). Therefore, the reduced
numbers of IL-22+ ILC3 cells was not the result of a reduction in the
total ILC3 cell numbers, but is likely attributable to the defective regulation
of IL-22 induction in ILC3s. These findings collectively indicate that in the
absence of β2-integrin expression, C. rodentium causes a
pronounced dysregulation of intestinal IL-17 and IL-22 responses.Although IL-22-expressing CD4 T cells are important for immunity against
C. rodentium at later stages of infection (mice lacking T
cells start dying after the second week of infection) (Basu et al., 2012; Sonnenberg et al., 2011; Vallance et
al., 2002), we examined whether CD18 deficiency could also affect
IL-22 production by T cells at a relatively early stage that is relevant to our
study model. On day 8 post-infection, we isolated total lamina propria
mononuclear cells (LPMCs) from the colons of C.
rodentium-infected CD18−/− and
CD18+/− mice and quantified the numbers of IL-22-producing
CD4 T cells by flow cytometry. Although T cell-derived IL-17 could be readily
detected at this time point, T cell-derived IL-22 was not detectable in the
colons of C. rodentium-infected
CD18−/− or CD18+/− mice (Figure S4B). Thus, the
IL-22 defect underlying the pronounced susceptibility of
CD18−/− mice to C. rodentiuminfection involves ILC3s and not CD4 T cells.
RoleofIL-17andIL-22intheProtectionofCD18−/−Mice
against C. rodentium Infection
Despite the marked dysregulation of IL-17 and IL-22 due to CD18
deficiency, it was uncertain whether the observed susceptibility to C.
rodentium-induced colitis of the CD18−/−
mice was mediated by their exaggerated IL-17 response, their diminished IL-22
response, or both. Under certain conditions, IL-17 can inhibit the expression of
IL-22 and, moreover, may determine the balance between its tissue-protective and
its pathological effects (Sonnenberg et al.,
2010). To determine the role of IL-17 during C.
rodentium-induced colitis in the context of β2-integrin
deficiency, CD18−/− mice and CD18+/+
littermate controls were systemically administered anti-IL-17 neutralizing
monoclonal antibody (mAb) or immunoglobulin G1 (IgG1) isotype control, as
previously described (Xiong et al.,
2016). The anti-IL-17 treatment had no influence on the survival of
either genotype (Figure 3A), although, as
expected, it reduced the granulocyte-colony-stimulating factor (G-CSF) levels in
the blood of treated animals (Figure S4C). Moreover, the inability of anti-IL-17 treatment to
extend the survival of CD18−/− mice was associated with
the failure to upregulate IL-22 expression by ILC3s in the large intestine
(Figure 3B). Furthermore, we induced
colitis in CD18−/− mice and
CD18−/−/γδT−/−
mice to determine whether depletion of γδT cells, a major cellular
source of intestinal lL-17 in CD18−/− mice (Figures S3A and S3B),
would influence the outcome of C. rodentium-induced colitis.
Similar to the anti-IL-17 treatment, depletion of γδT cells failed
to improve or otherwise affect mouse survival (Figure 3C) or IL-22 production by ILC3s (Figure 3D).
Figure 3.
Role of IL-17 and IL-17+γδT Cells in C.
rodentium Infection of CD18−/−
Mice
(A and B) Eight-week-old CD18−/− and
CD18+/+ littermates were injected intravenously (i.v.) with
either anti-IL-17 antibody or isotype control IgG (IC) on a daily basis for 7
days starting 1 day before C. rodentium infection.
(A) Survival rates at the indicated time points.
(B) On day 5 post-infection, LPMCs were isolated from the large
intestine of the indicated mouse groups and analyzed by flow cytometry; shown
are representative FACS plots (left) and absolute numbers (right) of
IL-22-expressing RORγt+ ILCs (gated on
CD3−CD5−B220−NK1.1−F4/80−Gr-1−CD127+CD90.2+RORγt+).
(C and D) Eight-week-old
CD18−/−/γδT−/−
mice and CD18−/−/γδT+/+
littermates (as well as CD18-sufficient mice with or without γδT
cell deficiency) were orally inoculated with C. rodentium.
(C) Survival rates at the indicated time points.
(D) On day 5 post-infection, LPMCs were isolated from the large
intestine of the indicated mouse groups and analyzed by flow cytometry; shown
are representative FACS plots (left) and absolute numbers (right) of
IL-22-expressing RORγt+ ILCs (gated on on
CD3−CD5−B220−NK1.1−F4/80−Gr-1−CD127+CD90.2+RORγt+).
Data are means ± SDs and are pooled from 2 independent
experiments with 5 mice/group in each experiment, for a total of 10 mice/group
(A and C); or are from 2 independent experiments with 3 mice/group, for a total
of 6 mice/group (B and D). ***p < 0.001 (B and D: 1-way ANOVA with
Tukey’s multiple-comparisons test). NS, non-significant.
To determine whether the diminished IL-22 production in the colon of
CD18−/− mice underlies their marked susceptibility
to C. rodentiuminfection, we treated C.
rodentium-infected CD18−/− mice with
recombinant IL-22-Fc or IgG control using a previously established approach
(Ota et al., 2011). In contrast to
control-treated CD18−/− mice that succumbed to
infection by day 13 and experienced significant body weight loss from day 6
onward, IL-22-Fc-treated CD18−/− mice were rescued from
infection-induced weight loss and lethality (Figures 4A and 4B). Moreover, in comparison to the control
treatment, IL-22-Fc treatment significantly reduced the systemic spread of
bacteria to the livers and spleens of CD18−/− mice,
leaving them with CFU values that are comparable to those of CD18+/+
mice (Figure 4C). Histological analysis of
the colon consistently showed that the IL-22 treatment reduced epithelial cell
damage and clinical scores (Figures 4D and
4E). β2-Integrin deficiency is thus associated with increased
numbers of IL-17-producing γδT cells and reduced numbers of
IL-22-expressing ILC3s in the gut, although only the latter is associated with
impaired host protection against C. rodentium-induced
colitis.
Figure 4.
Exogenous IL-22 Protects CD18−/− Mice from
C. rodentium-Induced Lethality
Eight-week-old CD18−/− and CD18+/+
littermates were given i.v. IL-22-Fc or control IgG every 3 days starting on the
same day as bacteria inoculation.
(A and B) Survival rates (A) and average weight changes (B) at indicated
time points.
(C–E) At day 8 post-infection, tissues were harvested to
determine log10 CFU of C. rodentium bacteria in
spleen and liver (C), perform H&E staining of colon sections (scale bars,
100 μm) (D), and determine histopathology scores of colon sections
(E).
Data are means ± SDs and are pooled from 2 independent
experiments with 5 mice/group in each experiment, for a total of 10 mice/group
(A); are from 2 independent experiments with 4 mice/group, for a total of 8
mice/group (B); or are representative of 2 independent experiments with 3
mice/group, for a total of 6 mice/group (C and E). *p < 0.05, **p
< 0.01, ***p < 0.001, and ****p < 0.0001 (B: 2-way ANOVA
with repeated-measures and Bonferroni’s multiple-comparisons test; C and
E: 1-way ANOVA with Tukey’s multiple-comparisons test).
Reduced IL-1β Secretion in CD18−/−
Macrophages in Response to C. rodentium Infection Impairs ILC3
Production of IL-22
We next examined the possible mechanisms linking β2-integrin
deficiency to defective ILC3 production of IL-22. To determine the possibility
of cell-intrinsic effects, we compared IL-22 production between
CD18−/− and CD18+/− ILC3s after
stimulation with IL-1β, IL-23, or both. Our analysis did not reveal
inherent defects in CD18−/− ILC3s, as they were able to
produce IL-22 and IL-17 at levels similar to those seen in
β2-integrin-sufficient (CD18+/−) controls (Figure 5A). We thus next investigated
potential ILC3-extrinsic factors that were responsible for the impaired
production of IL-22 in the CD18−/−colon (Figure 2), such as defective activation of ILC3s by
bystander β2-integrin-deficient leukocytes. Specifically, we hypothesized
that the impaired production of IL-22 by CD18−/− ILC3s
could be attributed to decreased levels of IL-1β and/or IL-23, which are
key macrophage- and dendritic cell-derived cytokines supporting ILC3 expression
of IL-22 (Longman et al., 2014; Manta et al., 2013; Seo et al., 2015). To this end, we measured these
cytokines in colon tissue homogenates on day 5 post-C.
rodentium infection. The production of IL-23 protein in the colon
of CD18−/− mice was not decreased (rather, modestly
increased) as compared to that of CD18+/− littermate controls
(Figure 5B, left). The production of
IL-1b was significantly decreased, thus correlating with the reduced production
of IL-22 in the CD18−/− colon (Figure 5B, center and right, respectively). The
production of IL-1β was also significantly diminished in ex
vivo cultures of total LPMCs isolated from the colon of C.
rodentium-infected CD18−/− mice, as
compared to LPMCs from the colons of infected CD18+/− control
mice (Figure 5C, left). Therefore,
β2-integrins appear to be required for optimal production of
leukocyte-derived IL-1β in the colon, although not of leukocyte-derived
IL-6 since CD18−/− and CD18+/− LPMCs
produced similar amounts of IL-6 (Figure
5C, center). Consistent with the in vivo tissue
findings, the reduced IL-1β production by
CD18−/− LPMCs correlated with the decreased
production of IL-22 in the same cultures (relative to their
CD18+/− counterparts; Figure
5C, right).
Figure 5.
β2-Integrins Regulate Macrophage Production of IL-1β in
Response to C. rodentium Infection
(A) ILCs
(CD3−CD5−B220−NK1.1−F4/80−Gr-1−CD90+CD127+CD25+KLRG1−)
were sort-purified from the intestines of naive CD18+/− or
CD18−/− littermates. Sorted ILCs were cultured in
96-well plates in the presence of 20 ng/mL IL-1β, 20 ng/mL IL-23, both
IL-1β and IL-23, or in medium only for 72 h. The release of IL-22 (left)
and IL-17 (right) in culture supernatants was determined by ELISA.
(B and C) Eight-week-old CD18−/− mice and
CD18+/− littermate controls were orally inoculated with
C. rodentium. On day 5, colons were harvested, and
production of the indicated cytokines was determined by ELISA of (B) colonic
tissue homogenates and (C) supernatants from ex vivo cultures
of total large intestinal lamina propria mononuclear cells (LPMCs).
(D) Bone marrow-derived macrophages (BMDMs) were generated from
CD18+/− and CD18−/− mice and
stimulated with C. rodentium (C. rod) (MOI
20:1) for 1 h without antibiotics and then cultured for another 17 h with
gentamicin (50 μg/mL).
(E) Eight-week-old CD18−/− mice and
CD18+/− littermate controls were orally inoculated with
C. rodentium. On day 5 post-infection, LPMCs were isolated
from the large intestine and analyzed by flow cytometry; shown are
representative FACS plots (left) and absolute numbers (right) of
F4/80+CX3CR1+ macrophages (gated on
CD45+CD3−B220−NK1.1−Ly6G−).
(F)ILCs
(CD3−CD5−B220−NK1.1−F4/80−Gr-1−CD90+CD127+CD25+KLRG1−)
were sort-purified from the intestine of naive CD18−/−
mice. Sorted ILCs and BMDMs from naive CD18+/− or
CD18−/− mice were cultured alone or co-cultured,
with or without stimulation with C. rodentium (MOI 20:1) for 24
h, in the presence of neutralizing antibody to IL-1β or isotype control
(IC). The indicated cytokines were measured by ELISA of culture
supernatants.
Data are means ± SDs and are pooled from 3 independent
experiments performed in duplicate, for a total of 6 replicates/group (A); are
from 3 independent experiments with 2 mice/group in 2 experiments and 3
mice/group in another, for a total of 7 mice/group (B); are from 2 independent
experiments with 3–4 mice/group, for a total of 6–8 mice/group
(C); are from 2 independent experiments with 3 mice/group in one experiment and
4 mice/group in the other experiment, for a total of 7 mice/group (E); or are
from 3 independent experiments performed in triplicate, for a total of 9
mice/group (D and F). **p < 0.01 and ***p < 0.001 (2-tailed
Student’s t test). NS, non-significant.
Given that the macrophages in the intestinal lamina propria constitute a
major cellular source of IL-1β (Seo et
al., 2015), we next investigated whether β2-integrin
deficiency could affect the macrophage IL-1β response. To this end, bone
marrow-derived macrophages (BMDMs) were stimulated with C.
rodentium, and cytokine production was measured in culture
supernatants. CD18−/− macrophages exhibited
significantly decreased production of IL-1β in response to C.
rodentium, although their ability to produce IL-6 or TNF was
similar to that of CD18+/− controls (Figure 5D). Therefore, β2-integrin deficiency
selectively impairs IL-1β production in C.
rodentium-challenged macrophages. We also showed that the numbers of
F4/80+CX3CR1+ macrophages in the colons of
CD18−/− and CD18-sufficient
(CD18+/−) mice were comparable (Figure 5E), thus ruling out the possibility that the
reduced production of colonic IL-1β in CD18−/−
mice could be attributed, at least in part, to the low abundance of
macrophages.To obtain direct evidence that macrophage CD18deficiency impairsIL-22
production by CD18−/− ILC3s in an
IL-1β-dependent manner, BMDMs and ILC3s were cultured separately or
together in the presence or absence of C. rodentium. IL-22
production was induced only in the presence of both cell types and concomitant
stimulation by C. rodentium (Figure 5F). ILC3s produced significantly lower IL-22 when
co-cultured with CD18−/− as compared to
CD18+/− BMDMs (Figure
5F). However, the ability of CD18+/− BMDMs to
support IL-22 production in the co-culture system was significantly inhibited in
the presence of neutralizing antibody to IL-1β (Figure 5F). A similar observation was made for
co-cultures containing CD18−/− BMDMs, the ability of
which to support IL-22 production was reduced even further by anti-IL-1β.
In a similar experiment, combined anti-IL-1β and anti-IL-23 treatment did
not reduce IL-22 production more than anti-IL-1β treatment alone did
(Figure S5),
suggesting that IL-23 is not endogenously produced in the system at levels
sufficient to influence IL-22 production. These data indicate that ILC3
production of IL-22 is regulated by β2-integrins on macrophages in a
paracrine manner involving macrophage-derived IL-1β secretion.
β2-Integrins Mediate the Activation of the ROS-Noncanonical
NLRP3-IL-1β Axis
The production and release of bioactive IL-1β is a multistep,
tightly controlled process. It includes pattern recognition receptor-induced
mRNA expression and protein synthesis of pro-IL-1β, which is subsequently
cleaved by inflammasome-induced caspase-1 into the active and secreted forms of
IL-1β (Lamkanfi and Dixit, 2014;
Sharma and Kanneganti, 2016). Upon
challenge with C. rodentium, CD18+/− and
CD18−/− BMDMs expressed similar levels of
IL-1β mRNA at 8 and 18 h post-challenge (Figure 6A), suggesting that β2-integrins do not regulate
macrophage IL-1β mRNA expression in response to this pathogen. We next
investigated whether the reduced IL-1β production in C.
rodentium-challenged CD18−/− BMDMs
involved defective inflammasome function. In this regard, Gram-negative enteric
pathogens such as C. rodentium selectively activate the
noncanonical pathway of the NLRP3 inflammasome, which entails the upstream
activation of caspase-11 that is crucial for caspase-1 activation and
IL-1β production in macrophages (Kayagaki
et al., 2011; Rathinam et al.,
2012). We confirmed that the inhibition of caspase-11 (with
wedelolactone), NLRP3 (with glyburide), or caspase-1 (with
N-acetyl-tyrosyl-valyl-alanyl-aspartyl chloromethyl ketone [Ac-YVAD-CMK])
resulted in significantly reduced IL-1β (but not TNF) responses in
C. rodentium-challenged CD18+/− BMDMs and
further diminished the IL-1β levels in CD18−/−
BMDMs (without affecting their TNF response) (Figure 6B). The findings that IL-1β production by C.
rodentium-stimulated BMDMs is regulated by CD18 and the
inflamma-some pathway were reproduced using similarly treated
CD18+/− and CD18−/− intestinal
macrophages
(CD45+Lin(CD3NK1.1B220Ly6G)F4/80+CX3CR1+)
(Figure S6A). These
results validated our in vitro BMDM system as biologically
relevant for further mechanistic investigations.
Figure 6.
β2-Integrins Promote Rac1-Dependent ROS Production and Noncanonical
Inflammasome Activation
(A) CD18+/− and CD18−/− BMDMs
were infected with C. rodentium at an MOI of 20:1, and
IL-1β mRNA expression was determined at 8 and 18 h post-infection by
quantitative real-time PCR.
(B) CD18+/− and CD18−/− BMDMs
were pre-treated for 1 h with the indicated inhibitors and then infected with
C. rodentium for 18 h. Supernatants were harvested and
analyzed for IL-1β and TNF release by ELISA.
(C) CD18+/− and CD18−/− BMDMs
were stimulated with C. rodentium (MOI = 20:1), stained with
H2DCFDA, and analyzed by flow cytometry; shown are representative FACS plots
(left) and data analysis (fold increase over unstimulated control) at the
indicated times (right).
(D and E) CD18+/− and CD18−/−
BMDMs were pre-treated with 20 mM NAC for 1 h and then infected with C.
rodentium (MOI = 20:1).
(D) At 16 h post infection, cell lysates were harvested and analyzed by
immunoblotting with anti-mouse-caspase-11 antibody (left) and densitometry
(right).
(E) At 18 h post infection, supernatants were harvested and analyzed for
IL-1β and TNF release by ELISA.
(F) CD18+/− and CD18−/− BMDMs
were stimulated with C. rodentium (MOI = 20:1), and Rac1
activity was determined using the Rac1 G-LISA activation assay and expressed as
fold increase over unstimulated control.
(G and H) CD18+/− and CD18−/−
BMDMs were pre-treated with Rac1 inhibitor (NSC23766; 100 μM) for 1 h and
then infected with C. rodentium (MOI = 20:1).
(G) At 6 h post-infection, cells were stained with H2DCFDA and analyzed
by flow cytometry; shown are representative FACS plots (left) and data analysis
(right).
(H) At 18 h post-infection, supernatants were harvested and analyzed for
IL-1β release by ELISA.
Data are means ± SDs and are pooled from 2 independent
experiments performed in triplicate for a total of 6 replicates/group
(A–C); are from 3 independent experiments with 2 or 3 replicates/group
for a total of 6–7 replicates/group (D); are from 3 independent
experiments performed in triplicate in 2 experiments and in duplicate in 1
experiment, for a total of 8 replicates/group (E); or are from 3 independent
experiments performed in triplicate, for a total of 9 replicates/group
(F–H). *p < 0.05, **p < 0.01, ***p < 0.001, and
****p < 0.0001 (B: 1-way ANOVA with Dunnett’s multiple comparisons
test; F: 2-way ANOVA with Sidak’s multiple comparisons test; A,
C–E, G, and H: 2-tailed Student’s t test). NS,
non-significant.
Since ROS upregulates caspase-11 expression of the noncanonical NLRP3
inflammasome and promotes IL-1β production in response to C.
rodentium infection (Lupfer et al.,
2014), we examined whether the defect in IL-1β production by
C. rodentium-infected CD18−/−
BMDMs could be attributed to reduced ROS production. C.
rodentium-challenged CD18−/− BMDMs
elicited significantly reduced ROS production relative to similarly treated
CD18+/− BMDMs as shown by H2DCFDA staining (Figure 6C), indicating that C.
rodentium-induced ROS generation is largely dependent on the
presence of β2-integrins. Moreover, caspase-11 expression in
CD18−/− BMDMs in response to C.
rodentium was significantly lower than in CD18+/−
BMDMs (Figure 6D). The importance of ROS
generation for noncanonical NLRP3-dependent IL-1β production in our
system was substantiated by showing that treatment of C.
rodentium-challenged CD18+/− or
CD18−/− BMDMs with the ROS scavenger
N-acetyl-L-cysteine (NAC) significantly reduced caspase-11
expression (Figure 6D) and IL-1β
(but not TNF) production (Figure 6E). To
further substantiate that the impaired caspase-11 expression in C.
rodentium-challenged CD18−/− BMDMs results
from the reduced generation of ROS, we supplemented the cells with an exogenous
source of ROS (H2O2). The H2O2
treatment restored caspase-11 expression in CD18−/−
BMDMs to levels that are comparable to those of untreated (i.e., not given
H2O2) C. rodentium-challenged
CD18+/− BMDMs (Figure S6B).The Rho-family GTPase Rac1 acts downstream of integrins (Nurmi et al., 2007) and is a crucial mediator of ROS
production (Heasman and Ridley, 2008). To
determine whether the decreased ROS production in
CD18−/− BMDMs (Figure
6C) is linked to defective Rac1 activation, we assessed Rac1 activity
in C. rodentium-infected CD18−/− and
CD18+/− BMDMs. CD18−/− BMDMs
exhibited significantly reduced levels of Rac1 activity upon C.
rodentium infection as compared to CD18+/− BMDMs
(Figure 6F). Moreover, the ability of
CD18+/ BMDMs to produce ROS in response to C.
rodentium was significantly decreased in the presence of a Rac1
inhibitor (Figure 6G). Therefore, in
C. rodentium-challenged macrophages, Rac1 appears to link
β2-integrins to ROS production, in turn suggesting that Rac1 may also
regulate IL-1β. Rac1 inhibition with NSC23766 significantly decreased
IL-1β secretion in C. rodentium-challenged
CD18+/– BMDMs and in intestinal
F4/80+CX3CR1+ macrophages, and further diminished
IL-1β levels in similarly challenged CD18−/−
cells (Figures 6H and S6A). These data indicate that Rac1
functions downstream of β2-integrin and promotes ROS generation. It is
likely that CD18−/− macrophages have additional
defects, such as impaired opsonophagocytosis of C. rodentium, a
notion that we confirmed (Figure S6C). However, CD11b−/− mice, which
lack complement receptor 3 (CD11b/CD18) that mediates complement-dependent
opsonophagocytosis, do not exhibit lethal C. rodentium-induced
colitis as seen in CD18−/− mice (data not shown).Our data collectively indicate that β2-integrins promote
IL-1β production in macrophages via Rac1-dependent ROS production, which
in turn regulates caspase-11. These mechanistic findings, in combination with
the IL-1β requirement for efficient IL-22 production in macrophage-ILC3
co-cultures (Figure 5F), are consistent
with our in vivo observations for defective production of
IL-1β, and hence IL-22, in the colon of C.
rodentium-infected CD18−/− mice.
DISCUSSION
Our study shows that β2-integrins are required for optimal IL-22
responses by intestinal ILC3s and protection from C.
rodentium-induced colitis. Mechanistically, β2-integrin deficiency
did not affect ILC3s in a cell-intrinsic manner, but through defective production of
paracrine IL-1β, a macrophage-derived cytokine that promotes IL-22 production
by ILC3s (Longman et al., 2014; Seo et al., 2015). Our findings thus reveal a
connection between β2-integrins and Rac1-dependent, ROS-mediated activation
of the noncanonical NLRP3 inflammasome-IL-1β axis. Given the importance of
IL-22 in intestinal homeostasis and immunity (Cella
et al., 2009; Zenewicz et al.,
2008; Zheng et al., 2008), the
functional link between β2-integrins and IL-22 provides a mechanistic
understanding of the marked susceptibility of LAD1
(CD18−/−) mice to colitis, which was reversed by exogenous
administration of IL-22-Fc.Caspase-11 functions both as a sensor of Gram-negative bacterial infections,
such as by C. rodentium, and as a trigger of NLRP3 inflammasome
assembly in the noncanonical pathway, thus acting upstream of caspase-1 (Kayagaki et al., 2013; Sharma and Kanneganti, 2016). In C.
rodentium-challenged macrophages, induction of ROS upregulates
caspase-11 expression and promotes noncanonical NLRP3 inflammasome activation (Lupfer et al., 2014). Here, we found that
C. rodentium-challenged macrophages are defective in Rac1
activation and hence in ROS production in the absence of b2-integrin expression. The
ability of β2-integrins to upregulate ROS production renders them an
important regulator of noncanonical NLRP3 inflammasome-dependent release of
IL-1β. Although C. rodentium-challenged
CD18−/− macrophages exhibited impaired IL-1β
release, they expressed normal levels of IL-1β mRNA and elicited TNF and IL-6
protein responses similar to those of CD18-sufficient macrophages, suggesting a
selective defect of β2-integrin deficiency in inflammasome activation. It
should be noted that IL-1β production is not the only defect expected in
CD18−/− macrophages, and in this regard, other
β2-integrin-dependent functions in macrophages include phagocytosis of
microbes opsonized with C3 activation fragments, adhesion to extracellular matrix
components such as fibrinogen, and podosome formation (Erdei et al., 2019). Although
CD18−/− macrophages display impaired C.
rodentium opsonophagocytosis in vitro, which may
contribute to the CD18−/− phenotype in the C.
rodentium infection model, CD11b−/− mice do
not develop lethal C. rodentium-induced colitis as
CD18−/− mice do. Thus, defective phagocytosis may not
necessarily be a crucial defect in this regard, although complement receptor 4
(CD11c/CD18) may compensate for the lack of complement receptor 3 (CD11b/CD18) in
CD11b−/− mice.Our findings that the colons of C. rodentium-infected
CD18−/− mice and CD18-sufficient
(CD18+/−) controls contain comparable numbers of
F4/80+CX3CR1+ macrophages lend further support to the
concept that the reduced production of colonic IL-1β in
CD18−/− mice arises from cell-intrinsic defects in the
macrophages (owing to their CD18 deficiency), as it cannot be attributed to the
reduced abundance of macrophages in these mice. That
CD18−/− monocytes or macrophages may exhibit normal
transmigration in some cases is consistent with observations that other integrins,
such as very late antigen-4 (VLA-4), can also mediate macrophage accumulation in an
inflamed tissue (Chung et al., 2017; Meerschaert and Furie, 1995). Whereas CD18 has
been implicated in multiple pathologies predominantly as a recruitment receptor
(Palmen et al., 1995; Suchard et al., 2010; Vedder et al., 1988; Wallace et al.,
1992), our study has clearly distinguished the recruitment function of
CD18 from its immune activation function in intestinal macrophages.An earlier study investigated CD18−/− mice in
dextran sodium sulfate (DSS)-induced colitis and found that they were less
susceptible to DSS than were wild-type mice (Abdelbaqi et al., 2006). As DSS-induced colitis is largely due to
excessive neutrophil recruitment, the authors attributed the protective effect of
CD18 deficiency to the diminished numbers of recruited neutrophils in the intestines
of the CD18−/− mice. Because the model we used is driven by
infection, and thus host immunity plays a central role, the importance of CD18 for
maximal activation of the ROS-noncanonical NLRP3-IL-1β pathway has led to the
pronounced susceptibility of the CD18−/− mice, as compared
to their wild-type littermate controls. The use of different models (likely
addressing distinct functions of CD18) may explain the seemingly disparate results
in the two studies.IL-22−/− mice (Zheng et al., 2008) and CD18−/− mice (the
present study) succumb within the second week after inoculation of C.
rodentium (“early stage of infection”), whereas mice
lacking adaptive immunity (recombinase activating gene-1-deficient
[Rag1−/−] mice) start dying after the
second week of infection (Vallance et al.,
2002). ILC3s constitute the dominant source of IL-22 in the early stage
of C. rodentiuminfection (Cella et
al., 2009; Seo et al., 2015; Sonnenberg et al., 2011; Zheng et al., 2008), whereas at later time points,
IL-22-producing CD4+ T cells assume a leading role in protection against
C. rodentium-induced colitis (Basu et al., 2012). Consistent with these findings, all of the
C. rodentium-infected IL-22−/− mice
administered IL-22+/+ CD4+ T cells succumbed to infection
within the second week, whereas 50% of IL-22−/− mice given
IL-22+/+ ILC3s survived beyond day 20 (Sonnenberg et al., 2011). In line with these studies,
IL-22-producing T cells were not detectable in the colons of C.
rodentium-infected CD18−/− mice or their
CD18-sufficient (CD18+/−) littermate controls at day 8
post-infection. Therefore, the IL-22 defect underlying the pronounced susceptibility
of CD18−/− mice to C. rodentiuminfection
involves ILC3s and not other potential cellular sources of this cytokine, such as
CD4 T cells. Overall, ILC3-derived IL-22 is critical for intestinal innate immunity
to C. rodentiuminfection before adaptive immunity can fully
develop.Consistent with the protective function of IL-22 in mouse models of colitis
(Sugimoto et al., 2008; Zenewicz et al., 2008), the secreted IL-22-binding
protein (IL-22BP) exacerbates experimental colitis by blocking the binding of IL-22
to its receptor (Pelczar et al., 2016). In
humans with inflammatory bowel disease (IBD), anti-TNF therapy inhibited the
expression of IL-22BP in patients who responded to therapy, suggesting a protective
role for IL-22 in humancolitis (Pelczar et al.,
2016), perhaps through its ability to induce antimicrobial molecules and
mucus production and to promote mucosal healing and barrier integrity (Hernandez et al., 2018; Sabat et al., 2014). Consistent with these findings,
IL-22-related molecules (e.g., IL-10R2 and signal transducer and activator of
transcription 3 [STAT3]) are encoded by inflammatory bowel disease susceptibility
genes (Glocker et al., 2009; Silverberg et al., 2009). Moreover, the frequency of
IL-22-secreting ILCs in the intestinal lamina propria is markedly decreased in
patients with Crohn disease (Takayama et al.,
2010). However, the exact role of IL-22 in colitis requires further
investigation (Sabat et al., 2014). Whereas
colitis in an LAD1 patient was completely resolved after bone marrow transplantation
(D’Agata et al., 1996), patients
for whom transplantation is not an option may benefit from therapies that promote
intestinal immunity and homeostasis.We have recently shown that the association of LAD1 with the oral
inflammatory disease periodontitis is driven by microbe-induced hyperinflammatory
responses involving the IL-23-IL-17 immune pathway (Moutsopoulos et al., 2014). Accordingly, antibody-mediated inhibition of
IL-23 or IL-17 diminished inflammation and bone loss in a mouse model of LAD1
periodontitis (Moutsopoulos et al., 2014).
Moreover, systemic administration of ustekinumab (which targets the common p40
subunit of IL-23 and IL-12) in a human LAD1 patient resulted in the inhibition of
IL-17 expression, resolution of inflammatory periodontal lesions, and healing of a
severe sacral wound that also featured abundant IL-17 expression (Moutsopoulos et al., 2017). Although
CD18–/– mice displayed dysregulated overexpression of
IL-17 in the gut upon C. rodentium challenge, neutralization of
this cytokine failed to change the disease course and to increase IL-22 production,
suggesting that the IL-23-IL-17 axis may drive the pathogenesis of some (e.g.,
periodontal lesions, skin lesions) but not all conditions associated with LAD1.We found that, unlike CD18–/– mice,
CXCR2–/– mice survive infection with C.
rodentium despite tissue inflammation and reduced bacterial clearance,
and these findings are consistent with an earlier report (Spehlmann et al., 2009). That study showed that the
defective recruitment of neutrophils to the colon of
CXCR2–/– mice results in increased tissue pathology and
bacterial load (as compared to wild-type controls) in the colons, livers, and
spleens at the “early stage of infection,” specifically 2 weeks
post-infection. However, the same study showed that C.
rodentium-infected CXCR2–/– mice did not die and
eventually cleared the bacteria after 4 weeks (Spehlmann et al., 2009). In contrast, neutrophil-deficient
LysMcreMcl1fl/fl mice succumb to C.
rodentium infection by day 14 (Kamada
et al., 2015). However, the defect in these mice does not simply involve
the scarcity of neutrophils from peripheral tissues such as the colon, but
neutrophils are globally absent (including from the circulation, where both
CXCR2–/–and CD18–/– mice
exhibit neutrophilia [Mei et al., 2012; Scharffetter-Kochanek et al., 1998; Stark et al., 2005]). Thus, mortality in the
LysMcreMcl1fl/fl mouse model may, at least in part, result
from systemic dissemination of bacteria to vital organs in the absence of systemic
neutrophil defense. These findings collectively suggest that the protection
conferred by β2 integrins in the early stage of C. rodentiuminfection is unlikely to be primarily attributed to their capacity to mediate
neutrophil recruitment; rather, it may be associated with the induction of Rac1- and
ROS-mediated noncanonical NLRP3 inflammasome-dependent IL-1β production. This
in turn promotes ILC3-derived IL-22 production and protection against lethal
C. rodentium-induced colitis, as shown in the present
study.The association of β2-integrins with inflammatory diseases, including
colitis, often involves their ability to mediate pathologic infiltration of
inflammatory leukocytes to infected or inflamed tissues (Kourtzelis et al., 2017; Palmen et al., 1995; Rothhammer et al.,
2011; Suchard et al., 2010; Vedder et al., 1988; Wallace et al., 1992). Here, in contrast, we established
a protective function for β2-integrins in promoting IL-1β-dependent
IL-22 responses that inhibit C. rodentium-induced colitis. Our
study therefore suggests a plausible link between LAD1 and susceptibility to
colitogenic bacteria. Our findings that β2-integrins promote intestinal
immunity should be considered in the context of β2-integrin targeting
strategies to control the leukocyte adhesion cascade as a potential therapy in
inflammatory bowel disease (Bamias et al.,
2013).
STAR⋆METHODS
CONTACT FOR REAGENT AND RESOURCE SHARING
Further information and requests for resources and reagents should be
directed to and will be fulfilled by the Lead Contact, G. Hajishengallis
(geoh@upenn.edu).
EXPERIMENTAL MODEL AND SUBJECT DETAILS
Mice
Mice genetically deficient in all β2 integrins
(CD18−),
CXCR2 (CXCR2−),
or in γδTCR
(Tcrδ−/−) were
purchased from the Jackson Laboratories. These mice were crossed with
wild-type C57BL/6J mice (Jackson Laboratories) to generate gene-deficient
(homozygotes and heterozygotes) mice and wild-type littermate controls for
use in experiments. Mice deficient in both CD18 and γδTCR
(CD18−/−/γδT−/−)
were generated by breeding the two parental knockout mouse strains. Groups
of mice within the same experiment were sex- and age-matched. Male or female
mice were used in infection experiments with C. rodentium
at the age of 8 weeks. As there were no significant differences in the
results obtained with males and females (e.g., CD18
deficiency resulted in similar susceptibility to infection regardless of
sex), their respective data were pooled. All animal procedures were
performed according to protocols reviewed and approved by the Institutional
Animal Care and Use Committee of the University of Pennsylvania.
METHOD DETAILS
C. rodentium infection and in vivo
treatments
Mice were orally gavaged with either 5 × 108
colony-forming units (CFU) of C. rodentium strain DBS100
(ATCC 51459; American Type Culture Collection) or GFP-expressing and
chloramphenicol-resistant C. rodentium (GFP-C.
rodentium) as described (Bergstrom et al., 2010; Zheng et
al., 2008). To determine bacterial CFU in the stool, feces were
collected, weighed, and homogenized in 5 mL of phosphate-buffered saline
(PBS). To enumerate bacterial CFU in MLN, liver and spleen, each organ was
homogenized in 2 mL of PBS. Serial dilutions of tissue homogenates were
plated onto MacConkey agar (Acumedia; Neogen) or LB agar plate containing
chloramphenicol (30μg/ml) and incubated for 24h at 37°C.
C. rodentium colonies were identified by their
characteristic pink center surrounded by a white rim. For in
vivo neutralization of IL-17, anti-IL-17 monoclonal antibody
(200 mg, clone 17F3; BioXcell) and an equal amount of isotype control IgG
(IgG1, clone MOPC-21; BioXcell) were administered i.v. on a
daily basis for 7 days starting 1 day before infection, as previously
established (Xiong et al., 2016). To
confirm the biological activity of anti-IL-17, blood was obtained by
retro-orbital bleeding of CD18−/− and
CD18+/− littermates on day 0 and day 4 post-C.
rodentium infection and the levels of G-CSF in the serum were
measured using an ELISA kit (RayBiotech, Inc.). For treatment with IL-22,
the mice were i.v. injected with 100 μg recombinant
IL-22-Fc (IL-22-mIgG2a fusion protein, PRO312045; kindly provided by
Genentech) or an equal amount of control IgG (mIgG2a, clone C1.18.4;
BioXcell) every three days starting at the day of bacteria inoculation, as
previously established (Ota et al.,
2011).
Fluorescence in situ hybridization (FISH)
Colons from GFP-C. rodentium-infected mice were
excised and fixed overnight at 4°C in freshly made non-aqueous
methacarn solution as previously described (Caballero et al., 2015). Tissues were washed in 70% ethanol,
processed with tissue embedding system (KD-BMII) and paraffin-embedded by
standard techniques. Sections at 5-μm thickness were baked at
56°C for 1 h prior to staining. Briefly, tissue sections were
deparaffinized with xylene and rehydrated through an ethanol gradient to
water. Sections were then incubated at 45°C for 2.5 h with a
universal bacterial probe EUB338 (Cy3-GCTGCCTCCCGTAGGAGT-Cy3) directed
against the 16S rRNA gene. Subsequently, tissue sections were washed twice
and stained with anti-GFP antibody (Abcam) overnight at 4°C. Finally,
the sections were further rinsed and counterstained with DAPI (Abcam) and
images were captured on a Nikon C2 confocal microscope.
Histology
Large intestines were fixed in 4% paraformaldehyde and then embedded
in paraffin. Tissue samples were sectioned at 5-μm thickness and
stained with hematoxylin and eosin (H&E) or alcian blue. For
histological scoring, tissue sections were blindly graded on a 0–5
scale for each of three parameters (epithelial lesions; inflammation; and
edema, hence with an overall maximal histopathology score of 15) as
previously described (Giacomin et al.,
2015).
Cell isolation and flow cytometry
Spleen and MLNs were harvested and single-cell suspensions were
prepared at necropsy (Sonnenberg et al.,
2011). Lamina propria mononuclear cells (LPMCs) from intestine
were isolated as previously described (Hepworth et al., 2015; Wang et
al., 2014). Briefly, intestines were isolated, attached fat was
removed and luminal contents were flushed out using PBS. Tissues were cut
into 4-cm fragments, everted, gently scraped at the edge of the Petri dish
to remove mucus and then rinsed in cold PBS three times. Intraepithelial
lymphocytes and epithelial cells were removed by shaking tissue in RPMI-1640
containing penicillin/streptomycin, 0.02 mol/L HEPES, 2% FBS and 2mM EDTA
for 30 min at 37°C. LPMCs were isolated by digesting the remaining
tissue in 1 mg/ml collagenase type IV (Worthington Biomedical), 1 mg/ml
collagenase type VIII and 20 μg/ml DNase I (both from
Sigma-Aldrich-Aldrich) for 30min at 37°C. For flow cytometric
analysis, cells were stained with monoclonal antibodies (mAbs) against the
following surface markers (mAb clone in parenthesis): CD3e
(145–2C11), CD5 (53–7.3), CD90.2 (30-H12), Ly6G (1A8), KLRG1
(2F1), B220 (RA3–6B2), CD127 (A7R34), CD25 (PC61), CD45(30-F11),
NK1.1 (PK136), F4/80 (BM8), Gr-1(RB6–8C5), RORγt (AFKJS-9),
CX3CR1 (SA011F11) and γδT (GL3). All mAbs were purchased from
Biolegend. For intracellular detection of cytokines in T cells, the cells
were stimulated for 4h with phorbol myristate acetate (50 ng/ml) and
ionomycin (750 ng/ml) in the presence of 10 μg/ml brefeldin A (all
from Sigma-Aldrich-Aldrich). For intracellular detection of cytokines in
ILC3s, cells were first cultured in the presence of mouse recombinant
IL-1β and IL-23 each at a concentration of 20 ng/ml for 2h
(Biolegend) and then stimulated with phorbol myristate acetate, ionomycin
and brefeldin A for 4h, as previously described (Withers et al., 2016). The cells were then fixed
and permeabilized using an intracellular fixation and permeabilization kit
(ThermoFisher) and stained using antibodies against IL-17
(TC11–18H10.1), IFN-γ (XMG1.2) or IL-22 (1H8PWSR). Flow
cytometry data were acquired on LSRII or Accuri (BD Biosciences) and
analyzed with FlowJo software (Tree Star Inc.).
Quantitative real-time PCR
Total RNA was extracted from cells or organs using Trizol
(ThermoFisher) and quantified by spectrometry at 260 and 280 nm. The RNA was
reverse-transcribed using the High Capacity RNA-to-cDNA Kit (ThermoFisher)
and real-time PCR with cDNA was performed using the Applied Biosystems 7500
Fast Real-Time PCR System according to the manufacturer’s protocol
(ThermoFisher). Data were analyzed using the comparative
(ΔΔCt) method. TaqMan probes, sense primers, and antisense
primers for detection and quantification of genes investigated in this paper
were purchased from ThermoFisher. GAPDH was included as an internal control.
Samples were normalized to GAPDH and displayed as fold induction over
wild-type controls unless otherwise stated.
ELISA of ex vivo cytokine responses
For analysis of colon cytokine expression, the distal 3 cm of
colonic tissue was excised, cleaned off feces and attached adipose tissue,
washed three times with PBS containing fungizone-amphotericin B, penicillin
and streptomycin (Wang et al., 2014).
Colon segments were further cut into 1-mm pieces and cultured in 1 mL of
RPMI-1640 medium supplemented with 10% FBS and 1% amphotericin
B-penicilin-streptomycin (ThermoFisher) for 24 h at 37°C with 5% CO2.
Supernatants were harvested and the concentration of cytokines was
determined by ELISA using specific kits (ThermoFisher). Alternatively, the
whole colon was removed, cleaned off fecal material and attached adipose
tissue and homogenized in PBS supplemented with proteinase inhibitors
(ThermoFisher). The homogenates were then immediately assayed for cytokine
production using ELISA kits (ThermoFisher).
In vitro stimulation of macrophages and ILC3s
BM-derived macrophages were generated as described previously (Seo et al., 2015) and cultured for 5
days in DMEM containing 20% L929 supernatant and then re-plated into 24-well
plates with antibiotic-free DMEM supplemented with 20 ng/ml of M-CSF. BMDMs
were infected with C. rodentium at MOI 20:1 for 1h followed
by additional incubation, as specified below, in the presence of gentamicin
(50 μg/ml) to prevent bacterial overgrowth (Seo et al., 2015). At 8h and 18h post-infection,
cells were harvested and processed for quantitative real-time PCR as
described above. Culture supernatants were harvested at 18h post-infection
and cytokines were measured using ELISA kits (ThermoFisher). Cell lysates
were collected at 16h post-infection and analyzed by immunoblotting with
anti-mouse-caspase-11 antibody (17D9; Novus Biologicals) (Broz and Monack, 2013). Images were captured
using a FluorChem M imaging system (ProteinSimple). Densitometry was
performed using the AlphaView software and the data were normalized against
GAPDH. In some experiments, BMDMs were pre-treated with various
pharmacological inhibitors for 1h at 37°C prior to infection. For
inflammasome inhibition, BMDM were treated with the caspase-1 inhibitor
Ac-YVAD-CMK (25μM; Invivogen), caspase-11 inhibitor wedelolactone (30
μM; Santa Cruz Biotechnology) or the NLRP3 inhibitor glyburide
(200μM; Sigma-Aldrich). To inhibit Rac1 activation or ROS production,
BMDMs were treated with the Rac1 inhibitor NSC23766 (100μM;
Selleckchem) or the ROS scavenger N-acetyl-L-cysteine (NAC, 20mM;
Sigma-Aldrich), respectively. In other experiments, BMDMs were supplied with
50 μM H2O2 as a ROS source 6h after infection
with C. rodentium (Lupfer
et al., 2014) and cell lysates were collected 2.5h later to
determine caspase-11 expression by immunoblotting, as described above. To
assay cytokine production by intestinal macrophages
(CD45+CD3−NK1.1−B220−Ly6G−F4/80+CX3CR1+),
these cells were sorting-purified from large intestine of C.
rodentium infected CD18+/− or
CD18−/− littermates using a FACS Aria (BD
Bioscience). Intestinal macrophages were pre-treated with various
pharmacological inhibitors for 1h at 37°C and then stimulated with
C. rodentium (MOI 20:1) for 24h. Culture supernatants
were harvested for cytokine analysis by ELISA. To assay cytokine responses
in ILCs
(CD3−CD5−B220−NK1.1−F4/80−Gr-1−
CD90+CD127+CD25+KLRG1−),
these cells were sort-purified from intestine and MLN of naive
CD18+/− or CD18−/−
littermates using a FACS Aria (BD Bioscience). Sorted ILCs at 1 ×
105/ml were resuspended in DMEM containing 10 ng/ml IL-7 and
10 ng/ml IL-15. ILCs were either incubated in the presence of 20 ng/ml
IL-1β and/or 20 ng/ml IL-23, or in medium alone for 72h. In other
experiments, sorted ILCs were co-cultured with BMDMs (both cell types atat 2
× 105/ml) with or without C. rodentium
(MOI 20:1) for 24h in the presence of neutralizing antibody to IL-1β
(10 μg/ml; B122, Leinco Technologies) or an equal concentration of
isotype control (Armenian HamsterIgG isotype control monoclonal antibody,
PIP, Leinco Technologies). Culture supernatants were harvested and the
concentration of cytokines was determined by ELISA using specific kits
(ThermoFisher).
ROS measurement
BMDM were plated on non-tissue-culture-treated 12-well plates and
stimulated with C. rodentium (MOI 20:1) in antibiotic-free
medium. At 2, 4 or 6h after infection (West
et al., 2011), culture medium was removed and, after washing with
PBS, the cells were incubated for 10 min at 37°C in PBS containing 10
μM H2DCFDA (to measure total cellular H2O2)
(ThermoFisher). Subsequently, the cells were removed from the plate, washed
and analyzed immediately by flow cytometry. To control for baseline dye
fluorescence, samples were left unstimulated but stained according to the
above procedure. Mean fluorescence intensity values were calculated by
dividing C. rodentium-stimulated by unstimulated
values.
Rac1 activation assay
BMDMs were plated in 12-well plates and stimulated with C.
rodentium (MOI 20:1) in antibiotic-free medium. Cell lysates
were harvested at different time points (specified in figure legend) and
analyzed for Rac1 activity using the Rac1 G-LISA activation assay kit
(Cytoskeleton).
Opsonophagocytosis
For opsonization, GFP-C. rodentium bacteria in
Hanks’ balanced salt solution (containing CaCl2 and
MgCl2) were incubated with 50% blood serum obtained from
C57BL/6 wild-type mice with end-over-end mixing at 37°C for 30 mins
followed by washing. BMDMs were then infected with serum-opsonized
GFP-C. rodentium (MOI 20:1) at 37°C for 30 mins
to allow uptake of bacteria. Cells were treated with gentamycin to kill
non-phagocytosed bacteria and harvested by trypsinization, stained with
anti-mouse F4/80 antibody (clone BM8, Biolegend), and phagocytic activity (%
cells positive for GFP-C. rodentium) was determined by flow
cytometric analysis.
QUANTIFICATION AND STATISTICAL ANALYSIS
Statistical analysis
Comparison of mean values between groups was evaluated by two-tailed
unpaired Student’s t test, one-way ANOVA or two-way ANOVA, with
repeated-measures as appropriate. The latter two tests were followed by a
multiple-comparison post-test, as specified in the figure legends.
Statistical analysis was performed using Prism 7.0c (GraphPad Software) and
significance was set at p < 0.05.
KEY RESOURCES TABLE
REAGENT or RESOURCE
SOURCE
IDENTIFIER
Antibodies
Armenian Hamster anti-mouse CD3e (FITC)
BioLegend
Cat# 100306; RRID: AB_312671
Armenian Hamster anti-mouse CD3e
(APC/Cy7)
BioLegend
Cat# 100330; RRID: AB_1877170
Rat anti-mouse CD45
BioLegend
Cat# 103130; RRID: AB_893339
Rat anti-mouse CD5
BioLegend
Cat# 100606; RRID: AB_312735
Rat anti-mouse CD90.2
BioLegend
Cat# 105322; RRID: AB_893453
Rat anti-mouse Ly6G
BioLegend
Cat# 127608; RRID: AB_1186099
Syrian hamster anti-mouse KLRG1
BioLegend
Cat# 138426; RRID: AB_2566554
Rat anti-mouse B220 (FITC)
BioLegend
Cat# 103206; RRID: AB_312991
Rat anti-mouse B220 (Brilliant Violet
421)
BioLegend
Cat# 103240; RRID:AB_11203896
Rat anti-mouse CD127
ThermoFisher
Cat# 25–1271–82; RRID:
AB_469649
Rat anti-mouse CD25
BioLegend
Cat# 102012; RRID: AB_312861
Mouse anti-mouse NK1.1
BioLegend
Cat# 108732; RRID: AB_2562218
Rat anti-mouse F4/80
BioLegend
Cat# 123108; RRID: AB_893502
Rat anti-mouse Ly-6G/Ly-6C (Gr-1)
BioLegend
Cat# 108406; RRID: AB_313371
Armenian Hamster anti-mouse TCR
γ/δ (FITC)
BioLegend
Cat# 118106; RRID: AB_313830
Armenian Hamster anti-mouse TCR
γ/δ (APC)
BioLegend
Cat# 118116; RRID: AB_1731813
Rat anti-mouse IL-17
BioLegend
Cat# 506944; RRID: AB_2566153
Rat anti-mouse IFN-γ
ThermoFisher
Cat# 14–7311–81; RRID:
AB_468467
Rat anti-mouse IL-22
ThermoFisher
Cat# 12–7221–82; RRID:
AB_10597428
Rat anti-mouse RORγt
ThermoFisher
Cat# 17–6988–82; RRID:
AB_10609207
Mouse anti-mouse CX3CR1
BioLegend
Cat# 149007 RRID: AB_2564491
Rat anti-mouse Caspase-11
Novus Biologicals
Cat# NB120–10454
Rabbit anti-mouse GAPDH
Cell Signaling Technology
Cat# 8884S
Rabbit anti- GFP
Abcam
Cat# ab6556
Armenian Hamster anti-mouse IL-1β
Leinco Technologies
Cat# I-437
Armenian Hamster IgG isotype control
Leinco Technologies
Cat# I-140
Rat anti-mouse IL-23 p19
ThermoFisher
Cat# 16–7232–81 RRID:
AB_842742
Rat IgG1 kappa Isotype
Control
ThermoFisher
Cat# 16–4301–81
InVivoMAb mouse IgG2a isotype control
BioXcell
Cat# BE0085; RRID: AB_1107771
InvivoMAb anti-mouse IL-17A
BioXcell
Cat# BE0173; RRID: AB_10950102
InVivomAb mouse IgG1 isotype
control
BioXcell
Cat# BE0083; RRID: AB_1107784
Chemicals, Peptides, and Recombinant
Proteins
Chloramphenicol sodium succinate
Acros Organics
Cat# 459530050
Gentamicin
ThermoFisher
Cat# 15750060
Ac-YVAD-cmk
InvivoGen
Cat# inh-yvad
Brefeldin A
Sigma-Aldrich
Cat# B7651
Wedelolactone
Santa Cruz Biotechnology
Cat# sc-200648
Glyburide
Sigma-Aldrich
Cat# G2539
NSC 23766
Selleckchem
Cat# S8031
N-Acetyl-L-cysteine
Sigma-Aldrich
Cat# A9165
Hydrogen peroxide
MilliporeSigma
Cat# 107209
H2DCFDA
ThermoFisher
Cat# D399
Collagenase type IV
Worthington Biochemical Corporation
Cat# LS004188
Collagenase type VIII
Sigma-Aldrich
Cat# C2139
DNase I
Sigma-Aldrich
Cat# 10104159001
Ionomycin
Sigma-Aldrich
Cat# I0634
Phorbol 12-myristate 13-acetate
Sigma-Aldrich
Cat# P8139
Protease Inhibitor Cocktail
ThermoFisher
Cat# 87785
IL-22-Fc
Genentech
PRO312045
Recombinant Murine IL-1β
Biolegend
Cat# 575106
Recombinant Murine IL-23
Biolegend
Cat# 589004
Recombinant Murine M-CSF
Biolegend
Cat# 576408
Recombinant Murine IL-7
Biolegend
Cat# 577806
Recombinant Murine IL-15
Biolegend
Cat# 566302
Critical Commercial Assays
Foxp3/Transcription Factor Buffer Set
ThermoFisher
Cat# 00–5523–00
Mouse G-CSF ELISA
RayBiotech
Cat# ELM-GCSF
Mouse IL-17A ELISA
ThermoFisher
Cat# 88–7371–22
Mouse IL-22 ELISA
ThermoFisher
Cat# 88–7422–22
Mouse IL-1β ELISA
ThermoFisher
Cat# 88–7013–22
Mouse IL-23 ELISA
ThermoFisher
Cat# 88–7230–22
Mouse TNF alpha ELISA
ThermoFisher
Cat# 88–7324–22
Mouse IL-6 ELISA
ThermoFisher
Cat# 88–7064–22
Rac1 G-LISA Activation Assay Kit
Cytoskeleton
Cat# BK128
Trizol
ThermoFisher
Cat# 15596018
High-Capacity RNA-to-cDNA Kit
ThermoFisher
Cat# 4387406
TaqMan Fast Advanced Master Mix
ThermoFisher
Cat# 4444964
Experimental Models: Organisms/Strains
Mouse:
CD18−/−
The Jackson Laboratory
Stock# 002128
Mouse:
CXCR2−/−
The Jackson Laboratory
Stock# 006848
Mouse:
TCRδ−/−
The Jackson Laboratory
Stock# 002120
Bacterial and Virus Strains
Citrobacter rodentium strain
DBS100
ATCC
Stock# 51459
GFP-expressing and chloramphenicol-resistant
Citrobacter rodentium
Authors: Nobuhiko Kayagaki; Michael T Wong; Irma B Stowe; Sree Ranjani Ramani; Lino C Gonzalez; Sachiko Akashi-Takamura; Kensuke Miyake; Juan Zhang; Wyne P Lee; Artur Muszyński; Lennart S Forsberg; Russell W Carlson; Vishva M Dixit Journal: Science Date: 2013-07-25 Impact factor: 47.728
Authors: Suzanne J Suchard; Dawn K Stetsko; Patricia M Davis; Stacey Skala; Dominique Potin; Michele Launay; T G Murali Dhar; Joel C Barrish; Vojkan Susulic; David J Shuster; Kim W McIntyre; Murray McKinnon; Luisa Salter-Cid Journal: J Immunol Date: 2010-02-26 Impact factor: 5.422
Authors: Gregory F Sonnenberg; Meera G Nair; Thomas J Kirn; Colby Zaph; Lynette A Fouser; David Artis Journal: J Exp Med Date: 2010-05-24 Impact factor: 14.307
Authors: Maisoun Abdelbaqi; John H Chidlow; Kametra M Matthews; Kevin P Pavlick; Shayne C Barlow; Andrea J Linscott; Matthew B Grisham; Marjorie R Fowler; Christopher G Kevil Journal: Lab Invest Date: 2006-04 Impact factor: 5.662
Authors: Erik-Oliver Glocker; Daniel Kotlarz; Kaan Boztug; E Michael Gertz; Alejandro A Schäffer; Fatih Noyan; Mario Perro; Jana Diestelhorst; Anna Allroth; Dhaarini Murugan; Nadine Hätscher; Dietmar Pfeifer; Karl-Walter Sykora; Martin Sauer; Hans Kreipe; Martin Lacher; Rainer Nustede; Cristina Woellner; Ulrich Baumann; Ulrich Salzer; Sibylle Koletzko; Neil Shah; Anthony W Segal; Axel Sauerbrey; Stephan Buderus; Scott B Snapper; Bodo Grimbacher; Christoph Klein Journal: N Engl J Med Date: 2009-11-04 Impact factor: 91.245
Authors: Marina Cella; Anja Fuchs; William Vermi; Fabio Facchetti; Karel Otero; Jochen K M Lennerz; Jason M Doherty; Jason C Mills; Marco Colonna Journal: Nature Date: 2008-11-02 Impact factor: 49.962
Authors: Alexander A Boucher; Leah Rosenfeldt; Duaa Mureb; Jessica Shafer; Bal Krishan Sharma; Adam Lane; Rebecca R Crowther; Melanie C McKell; Jordan Whitt; Theresa Alenghat; Joseph Qualls; Silvio Antoniak; Nigel Mackman; Matthew J Flick; Kris A Steinbrecher; Joseph S Palumbo Journal: J Thromb Haemost Date: 2019-10-11 Impact factor: 5.824
Authors: Wan-Jung H Wu; Myunghoo Kim; Lin-Chun Chang; Adrien Assie; Fatima B Saldana-Morales; Daniel F Zegarra-Ruiz; Kendra Norwood; Buck S Samuel; Gretchen E Diehl Journal: Gut Microbes Date: 2022 Jan-Dec