First Department of Medicine, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
Institute of Pathology, Klinikum Bayreuth, Bayreuth, Germany.
Gastroenterology. 2019 Mar;156(4):1082-1097.e11. doi: 10.1053/j.gastro.2018.11.029. Epub 2018 Nov 16.
BACKGROUND & AIMS: Intestinal fibrosis is a long-term complication in inflammatory bowel diseases (IBD) that frequently results in functional damage, bowel obstruction, and surgery. Interleukin (IL) 36 is a group of cytokines in the IL1 family with inflammatory effects. We studied the expression of IL36 and its receptor, interleukin 1 receptor like 2 (IL1RL2 or IL36R) in the development of intestinal fibrosis in human tissues and mice. METHODS: We obtained intestinal tissues from 92 patients with Crohn's disease (CD), 48 patients with ulcerative colitis, and 26 patients without inflammatory bowel diseases (control individuals). Tissues were analyzed by histology to detect fibrosis and by immunohistochemistry to determine the distribution of fibroblasts and levels of IL36R ligands. Human and mouse fibroblasts were incubated with IL36 or control medium, and transcriptome-wide RNA sequences were analyzed. Mice were given neutralizing antibodies against IL36R, and we studied intestinal tissues from Il1rl2 mice; colitis and fibrosis were induced in mice by repetitive administration of DSS or TNBS. Bone marrow cells were transplanted from Il1rl2 to irradiated wild-type mice and intestinal tissues were analyzed. Antibodies against IL36R were applied to mice with established chronic colitis and fibrosis and intestinal tissues were studied. RESULTS: Mucosal and submucosal tissue from patients with CD or ulcerative colitis had higher levels of collagens, including type VI collagen, compared with tissue from control individuals. In tissues from patients with fibrostenotic CD, significantly higher levels of IL36A were noted, which correlated with high numbers of activated fibroblasts that expressed α-smooth muscle actin. IL36R activation of mouse and human fibroblasts resulted in expression of genes that regulate fibrosis and tissue remodeling, as well as expression of collagen type VI. Il1rl2 mice and mice given injections of an antibody against IL36R developed less severe colitis and fibrosis after administration of DSS or TNBS, but bone marrow cells from Il1rl2 mice did not prevent induction of colitis and fibrosis. Injection of antibodies against IL36R significantly reduced established fibrosis in mice with chronic intestinal inflammation. CONCLUSION: We found higher levels of IL36A in fibrotic intestinal tissues from patients with IBD compared with control individuals. IL36 induced expression of genes that regulate fibrogenesis in fibroblasts. Inhibition or knockout of the IL36R gene in mice reduces chronic colitis and intestinal fibrosis. Agents designed to block IL36R signaling could be developed for prevention and treatment of intestinal fibrosis in patients with IBD.
背景与目的:肠纤维化是炎症性肠病(IBD)的一种长期并发症,常导致功能损害、肠梗阻和手术。白细胞介素(IL)36 是白细胞介素 1 家族中的一组具有炎症作用的细胞因子。我们研究了 IL36 及其受体白细胞介素 1 受体样 2(IL1RL2 或 IL36R)在人类组织和小鼠中肠纤维化发展中的表达。 方法:我们从 92 例克罗恩病(CD)患者、48 例溃疡性结肠炎患者和 26 例无炎症性肠病患者(对照组)获得肠组织。通过组织学分析检测纤维化,并通过免疫组织化学检测成纤维细胞的分布和 IL36R 配体的水平。用 IL36 或对照培养基孵育人源和鼠源成纤维细胞,并进行转录组全序列 RNA 分析。用中和抗 IL36R 抗体处理小鼠,研究 Il1rl2 小鼠的肠组织;通过重复给予 DSS 或 TNBS 诱导小鼠结肠炎和纤维化。将骨髓细胞从 Il1rl2 移植到照射的野生型小鼠中,并分析肠组织。将抗 IL36R 抗体应用于已建立的慢性结肠炎和纤维化的小鼠,并研究肠组织。 结果:与对照组相比,CD 或溃疡性结肠炎患者的黏膜和黏膜下组织中胶原,包括 VI 型胶原水平更高。在纤维性 CD 患者的组织中,IL36A 水平明显升高,与表达α-平滑肌肌动蛋白的活化成纤维细胞数量增加相关。IL36R 激活小鼠和人源成纤维细胞导致调节纤维化和组织重塑以及胶原 VI 型表达的基因表达。在给予 DSS 或 TNBS 后,Il1rl2 小鼠和给予抗 IL36R 抗体的小鼠的结肠炎和纤维化程度较轻,但 Il1rl2 小鼠的骨髓细胞不能预防结肠炎和纤维化的诱导。注射抗 IL36R 抗体可显著减少慢性肠道炎症小鼠已建立的纤维化。 结论:与对照组相比,我们在 IBD 患者的纤维化肠道组织中发现了更高水平的 IL36A。IL36 诱导成纤维细胞中调节纤维化发生的基因表达。在小鼠中抑制或敲除 IL36R 基因可减少慢性结肠炎和肠纤维化。设计用于阻断 IL36R 信号的药物可用于预防和治疗 IBD 患者的肠纤维化。
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