Early IL-10 producing B-cells and coinciding Th/Tr17 shifts during three year grass-pollen AIT

De
Early IL-10 producing B-cells and coinciding Th/Tr17 shifts during three
year grass-pollen AIT

Authors: 
Ulrich M. Zissler a,1, Constanze A. Jakwerth a,1, FerdinandM. Guertha, Lisa Pechtold a,b,
Juan Antonio Aguilar-Pimentel a, Katharina Dietz a, Kathrin Suttner a, Guido Piontek b, Bernhard Haller c, Zuzana Hajdu b, Matthias Schiemann d, Carsten B. Schmidt-Weber a, Adam M. Chaker a,b

a Center of Allergy & Environment (ZAUM), German Research Center for Environmental Health, Member of the German Center for Lung Research (DZL), Helmholtz Center Munich, Technical University of Munich (TUM), Biedersteiner Str. 29, Munich 80802, Germany
b Department of Otorhinolaryngology and Head and Neck Surgery, Medical School, Technical University of Munich, Ismaninger Str. 22, Munich 81675, Germany
c Institute of Medical Informatics, Statistics and Epidemiology, Medical School, Technical University of Munich, Grillparzerstr. 18, Munich 81675, Germany
d Department of Microbiology and Hygiene, Medical School, Technical University of Munich, Trogerstr. 30, Munich 81675, Germany

Abstract:
Background: Allergen-specific immunotherapy (AIT) is a causative treatment in allergic airway disease, comprising long-term allergen administration and requiring three years of treatment. Mechanisms and biomarkers that translate into clinical efficacy remain urgently needed.
Methods: In an exploratory observational allergy cohort we phenotyped 32 grass-pollen allergic patients with hayfever undergoing AIT for over three years and controls using local and systemic samples for ex vivo FACS, nasal transcriptomes and in vitro phleum-stimulation at critical time windows six hours after therapeutic allergen administration and during peak-season responses.
Findings: The up-dosing phase ismarked by increased IL-10+ B-cells with allergen-specific PD-L1 up-regulation, while effector Th1/Th17 cells and CCR6+IL-17+FoxP3+T-cells decrease. The conversion phase exhibits Th17 recovery in the absence of Th2 cells. The tolerance-mounting phase after three years of treatment is characterized by induction of Tregs while Th2 and phleum-specific Th17 responses decrease. Notably, high ratios of circulating Breg/Th17 following initial AIT correlate significantly with clinical improvement after three years.
Interpretation: Our exploratory data hypothezise differential shifts in the hierarchy of tolerance in three distinct phases of AIT characterized by conversion of regulatory against pro-inflammatory mechanisms, of which the Breg/Th17 ratio after initial treatment emerges as potential early prediction of AIT efficacy.

DOI:https://doi.org/10.1016/j.ebiom.2018.09.016

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