Originally published as JHC exPRESS on November 26, 2007. doi:10.1369/jhc.7A7303.2007
Volume 56 (3): 267-274, 2008 Copyright ©The Histochemical Society, Inc. Expression of Toll-like Receptor 2 (TLR2), TLR4, and CD14 in Biopsy Samples of Patients With Inflammatory Bowel Diseases: Upregulated Expression of TLR2 in Terminal Ileum of Patients With Ulcerative Colitis
Department of Immunology and Gnotobiology, Institute of Microbiology, Academy of Sciences of the Czech Republic, Prague, Czech Republic (LF,PR,KK,HT-H), and Institute of Clinical and Experimental Medicine, Prague, Czech Republic (PD) Correspondence to: Prof. Helena Tlaskalova-Hogenova, Department of Immunology and Gnotobiology, Institute of Microbiology, Academy of Sciences of the Czech Republic, Videnska 1083, 142 20 Prague 4, Czech Republic. E-mail: tlaskalo{at}biomed.cas.cz
Dysregulation of innate and adaptive intestinal immune responses to bacterial microbiota is supposed to be involved in pathogenetic mechanisms of inflammatory bowel diseases (IBDs). We investigated expression of Toll-like receptor 2 (TLR2), TLR4, and their transmembrane coreceptor CD14 in biopsy samples from patients with IBD and in non-inflamed gut mucosa from controls. Small intestine and colon samples were obtained by colonoscopy from patients with Crohn's disease (CD), ulcerative colitis (UC), and controls. Immunohistochemical analysis of cryostat sections using polyclonal and monoclonal antibodies specific for TLR2, TLR4, and CD14 showed a significant increase in TLR2 expression in the terminal ileum of patients with inactive and active UC against controls. Significant upregulation of TLR4 expression relative to controls was found in the terminal ileum and rectum of UC patients in remission and in the terminal ileum of CD patients with active disease. CD14 expression was upregulated in the terminal ileum of CD patients in remission and with active disease, in the cecum of UC patients in remission and with active disease, and in rectum of UC patients with active disease. Hence, dysregulation of TLR2, TLR4, and CD14 expression in different parts of the intestinal mucosa may be crucial in IBD pathogenesis. (J Histochem Cytochem 56:267–274, 2008)
Key Words: toll-like receptors gut mucosa intestinal inflammation CD14 gut Crohn's disease mucosal immunity
INFLAMMATORY BOWEL DISEASES (IBD), Crohn's disease (CD), and ulcerative colitis (UC) are severe chronic disorders affecting 0.2% of humans. IBD occurs worldwide, although it is more common in northern Europe and North America. The major incidence of IBD usually occurs between 15 and 30 years of age, but both younger and older individuals may be affected (Brandtzaeg 2001
Dysregulation of the intestinal immune response to bacterial flora is suggested to play a crucial role in the development of IBD with loss of normal physiological regulatory mechanisms of the local immune system. Perhaps a breakdown of oral tolerance to environmental antigens/commensal gut bacteria may be involved in the pathogenic mechanisms (Duchmann et al. 1995
Characteristic, highly conserved bacterial components, e.g., lipopolysaccharides (LPS), are recognized by innate immunity cells through pattern recognition receptors (PRRs) (TLRs, NODs, NaLPs, etc.). Toll-like receptors (TLRs) are molecules identifying selective bacterial patterns. The TLR family comprises human homologs of the Drosophila Toll protein, which play an essential role in the immune response to microbial infection. TLR2 has been shown to signal the presence of bacterial lipoproteins, lipoteichoic acids, peptidoglycan, and zymosan. Moreover, evidence suggested that human TLR2 interacts with CD14 and forms a LPS receptor complex. TLR4 is the predominant receptor for LPS from gram-negative organisms. MD2 protein has been shown to form a complex with TLR4 and is required for surface expression and LPS-regulated activation of TLR4. LPS is opsonized by lipopolysaccharide-binding protein (LBP) and recognized by CD14 on the macrophage. CD14 is a glycosylphosphatidyl inositol (GPI)-anchored receptor, which is not capable of generating a transmembrane signal. Nascent LPS–LBP–CD14 complex activates TLR4, which signals through adaptor protein MyD88 and serine kinase IL-1R-associated kinase 4 (IRAK4) and another adaptor protein TNF receptor-associated factor 6 (TRAF6). This finally results in activation of NF-
There are few papers mentioning the expression levels of TLR2 and TLR4 in terminal ileum of patients with IBD (Cario and Podolsky 2000
Patients and Tissue Samples A total of 155 intestinal tissue samples from 59 different patients undergoing colonoscopy were obtained for our study at the Institute of Clinical and Experimental Medicine (IKEM), Prague, Czech Republic (Table 1 ). Informed consent was obtained from all patients, and the protocol was approved by the Human Studies Committee of the IKEM. Each patient had a confirmed diagnosis by standard endoscopic and histological criteria, and disease activity was graded according to the Harvey–Bradshaw index (HBI) or Mayo score (Best 2006
Immunohistochemistry Fresh tissue samples were frozen in liquid nitrogen and stored at –80C until further processing. Cryostat sections (6 µm) were extracted with ice-cold acetone for 5 min and eluted with PBS with Tween. TLR2 and TLR4 expression was detected using rabbit polyclonal IgG and goat polyclonal IgG antibodies (Abs) [diluted 1:10 in human serum albumin (HSA); Santa Cruz Biotechnology, Heidelberg, Germany] for 1 hr at room temperature. Specificity of these Abs was confirmed by Medvedev et al. (2002) For fluorescence microscopy, FITC-labeled CD14 mouse anti-human MAb (Dako) was applied. CD68 epitope was detected by two-step immunofluorescence with the TR-labeled goat anti-mouse IgG (Jackson ImmunoResearch Laboratories; West Grove, PA). Confocal microscope was used for detection (SPE; Leica, Wetzlar, Germany). Digitized images were then revised using Adobe Photoshop 6 (Adobe Systems; Mountain View, CA). Pathologists regularly analyzed at least two sections per sample. Degree of expression of TLR2, TLR4, and CD14 in the specimens was blindly evaluated by a pathologist, independently confirmed by a second examiner, and graded microscopically as follows: for TLR2 and TLR4: 0, the same as background; 0.5, close to background; 1, well-marked positivity; 1.5, focally enhanced; 2, strong positivity; 2.5, very strong positivity; for CD14: 0, no cells presented; 0.5, sporadic single cells; 1, scattered single cells; 1.5, scattered cells with discrete clusters; 2, large groups or clusters of cells; 2.5, dense dissemination. Data are expressed as mean ± SD of the total of about gained values (Table 2 ). Statistical analyses were performed using Kruskal–Wallis and Mann-–Whitney tests. Differences were considered significant when p<0.05.
TLR 2 Expression Control samples of normal mucosa were only weakly positive for TLR2 except cecum, where the presence of positive epithelial cells was comparable with that in IBD patients. In the specimens obtained from patients with inflamed mucosa, TLR2-positive epithelial cells were accumulated on the mucosal surface rather than in the crypts (Figure 1A ). The lamina propria (LP) remained negative or rarely displayed sporadic single cells. Both macroscopically inflamed and non-inflamed areas of mucosa from the cecum and rectum as well as terminal ileum showed cells positive for TLR2. It is noteworthy that statistically significant upregulation of TLR2 protein expression was observed in the ileal epithelium from UC patients with inactive (p=0.0256) and active disease (p=0.0078) as compared with the normal intestine (Table 2; Figures 1A–1C).
TLR4 Expression Epithelial TLR4 cell expression was usually stronger than TLR2 expression. It was abundantly positive in colonic epithelium of all UC and CD patients (often but not always stronger on the surface than in the depth of crypts), whereas in the terminal ileum the expression was less evident. In both TLR2 and TLR4, expression was more apparent in the surface epithelium, mainly in samples with weaker positivity. In a case with strong positivity, crypts were equally or more involved. TLR4-positive epithelial cells were also detected in non-IBD colonic mucosa (Figure 1L), whereas minimally positive cells were found in the terminal ilea of controls. LP was close to negative as in TLR2. Differences were processed and reached statistical significance in the terminal ileum (p=0.0228) and rectum (p=0.0087) of UC patients in remission (Table 2; Figures 1G–1J) and in the terminal ileum (p=0.0106) of CD patients with active disease (Table 2; Figure 1D).
CD14 Expression
Interestingly, in our study the extent of colitis in UC and the distribution of inflammation in CD have no influence on expression of TLRs and CD14. Only two cases from IBD did not match the mean expression. Infiltration of CD14-positive macrophages in the LP was significantly more intense in the ileal samples of active CD, which differed from the higher density in the cecum and rectum of UC.
In the present study we describe an unexpected finding of a significant increase of TLR2 expression present in the non-impaired (by inflammation) part of the gut, in the terminal ileum of patients with UC, as compared with controls. Statistically significant upregulation of TLR4 expression was observed in the terminal ileum and rectum of UC patients and in the terminal ileum of CD patients as compared with healthy controls. CD14 expression was upregulated in the terminal ileum of CD patients and in the cecum and rectum of UC patients when compared with controls. Cario et al. affirm that IECs of normal non-diseased mucosa constitutively express TLR3 and TLR5. On the other hand, in their study TLR2 and TLR4 were described to be present with low intensity. We focused our interest on three different parts of the bowel, which can play different roles in the development of disease and expression of TLRs. We have demonstrated low levels of TLR2 protein expression in the non-diseased sections of terminal ileum and rectum of controls. However, TLR2-positive cells were found in samples of healthy cecum in numbers comparable to those from the cecum of IBD patients. We may explain this discrepancy by the fact that healthy cecum is a part of the human bowel containing a high density of bacteria combined with low motility (peristalsis) (Savage 1999 Interestingly, TLR2- and TLR4-positive IECs were found in the terminal ileum in the area of the gut not usually affected by inflammation in these patients. Moreover, TLR2 expression is significantly increased, regardless of whether assessed in active or inactive disease of UC patients, and TLR4 expression is detected in UC patients in remission. A possible explanation of this unexpected finding could be that this upregulation reflects the activation of innate immunity cells by bacterial components, until now unknown, present also in the proximal part of the gut of UC patients. Another explanation is that immunosuppression may influence bacterial colonization or bowel peristalsis in the terminal ileum. Thus, it seems that the terminal ileum can sensitively react to "potentially pathogenic" but still undiscovered components of microbiota by immunological mechanisms impairing homeostasis in the distant part of the gut, i.e., colonic tissues.
Moreover, we found statistically significant upregulation of TLR4 expression in biopsy samples from the ileum and rectum of UC patients in remission and in the terminal ileum of CD patients with active disease. Recent studies (Cario and Podolsky 2000
Monocytes recruited to normal intestinal mucosa are characterized by downregulation of the proinflammatory phenotype and functional profile. On the other hand, monocytes recruited to the inflamed mucosa do not undergo such stringent downregulation and retain their proinflammatory potential (Smith et al. 2005
In conclusion, there is increasing evidence that intestinal microflora play a crucial role in induction and maintenance of inflammation in patients with IBD. IECs form the first line of contact between the host and the normal microbiota and provide a connection with the immune system via cells in the LP. Moreover, the intestinal epithelium is an active participant in the mucosal immune response through its expression of proinflammatory genes, secretion of inflammatory cytokines, and recruitment of inflammatory cells operative against pathogenic bacteria and their products (Autschbach et al. 2002
IBD is the result of concerted actions of innate immune signals such as the binding of LPS to TLR4, as well as adaptive immune signals such as INF-
This work was supported by the Czech Science Foundation (projects no. #310/03/H147 and #303060974); Grant Agency of Academy of Sciences (project #S500200572); Ministry of Education, Youth and Sports of the Czech Republic (project #2B06155); and Institute of Microbiology (project #AV0Z50200510).
Received for publication July 4, 2007; accepted November 8, 2007
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