Abstract
Background: IL-17 has been thought to be pathogenic in IBD. However, a recent clinical trial using IL-17 blockade unexpectedly worsened IBD (Hueber, et al. Gut. 2012). A proportion of trial patients who responded to IL-17 blockade were found to carry a risk TL1A IBD polymorphism that predicted elevated expression of TL1A. The mechanism of IL-17 and its interaction with TL1A on mucosal inflammation has not been found. Aim: To determine the mechanism of TL1A mediated differential effects of IL-17 on mucosal inflammation Methods: Naive (CD4+CD45RBhi) T-cells were isolated from WT, Tl1a-Tg, Il-17a-/-, and Tl1a-Tg with deficiency in Il-17a (Tl1a-Tg/Il-17a-/-) mice and adoptively transferred into Rag-/mice. Naive (CD4+CD25loCD44loCD62hi) T-cells were differentiated in vitro into T helper (Th) effector cells. Intestinal inflammation was evaluated by disease activity index (DAI) and histological analyses. Flow cytometry was used to determine CD4+ T-cell infiltration, activation, and cytokine expression in the LPMC from the colon. Results: Consistent with the human IL-17 trial, we found that mice that received Il-17a-/Naive cells had worsened colitis (increased DAI scores and cecal inflammation) as compared to WT. Comparable results were seen with Tl1a-Tg Naive cells. Similar to the human IL-17 trial, Il-17a deficiency under Tl1a driven conditions (Tl1a-Tg/Il-17a-/-) ameliorated colitis (reduced DAI and cecal inflammation). Mucosal CD4+ T-cell infiltration and activation (CD69 and CD44) were increased in both Il-17a-/and Tl1a-Tg, but reduced with Tl1a-Tg/Il-17a-/-. Analysis of Th effector pathways demonstrated a shift towards Th-1 (increased Ifn-γ) and Th-9 (increased Il-9), and reduced regulatory cytokine Il-10 production with both Il-17a-/and Tl1a-Tg. In contrast, Il-17 deficiency under Tl1a driven conditions (Tl1a-Tg/Il-17a-/-) had a reduction in Th1 (reduced Ifn-γ) and Th9 (reduced Il-9) responses, and increased regulatory responses (increased Il-10). To assess whether intrinsic cellular differences exist in Naive T-cells between WT, Il-17a-/-, Tl1a-Tg, and Tl1a-Tg/Il-17a-/-, in vitro differentiation assays were performed. Consistently, in vitro differentiated Naive Il-17a-/and Tl1a-Tg T-cells expressed increased Ifn-γ and Il-9, whereas Tl1a-Tg/Il17a-/T-cells expressed lower Il-9 but higher Il-10 levels. Conclusion: IL-17 blockade induces mucosal inflammation by enhancing Th1 and Th9 effector pathways and reducing regulatory response. However under TL1A driven conditions, inhibiting IL-17 may be beneficial by reducing Th1 and Th9 effector responses and enhancing regulatory responses. This may be one mechanism of why the subset of IBD patients with TL1A polymorphisms improved with IL-17 blockade, while most trial patients did not. This highlights the importance of understanding pathway-pathway interactions in designing clinical trials. Table 1: Inflammatory Markers
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