Cell proliferation
Cell proliferation is an early event in antigen-specific immune responses, and determining the percent proliferation is important for assessing the functional activity of immune cells and proliferation induced by
S. mansoni antigens [
6,
11,
25‐
27]. In patients during the chronic intestinal phase of schistosomiasis, cell proliferation is reduced in SEA-stimulated PBMCs compared to uninfected individuals [
3]. Our previous findings [
24] showed no difference between T cell proliferation in the XTO, NI and BD groups after both SEA and SWAP stimulation. However, the proliferation profile in this study is consistent with the findings of most other studies [
3,
4,
27,
28] that show lower CD4
+ and CD8
+ T cell proliferation in the XTO group than the BD group after SEA stimulation (Figure
2C and 2D). There was also decreased proliferation of CD8
+ T cells after SWAP stimulation in the XTO group compared to the BD group (Figure
2F). The fact that the PBMCs from the NI and XTO patients were obtained from two distinct endemic areas may explain the differences between our studies. The population living in endemic areas is heterogeneous, and the immunological profile of each individual is a result of re-infection, delayed hypersensitivity and severity of the disease [
5].
Moreover, the NI group showed reduced proliferation of CD8
+ T cells after SWAP (Figure
2F) stimulation in the unstimulated cultures compared to the BD group (Figure
2B). The lower proliferation rate in the presence of SWAP in the NI group may be associated with increased synthesis of IL-4 and IL-5, which is caused by SWAP stimulation [
10].
Cytokine response to S. mansoniantigens
The mechanisms involved in the induction of Th1 and Th2 responses to schistosomiasis have not yet been fully elucidated, and the mechanisms that induce both responses are still under discussion. Some studies in murine models show that the eggs are responsible for a predominantly Th2 response. This finding is in contrast to the adult worms that appear to be weak Th2-inducers [
29,
30].
Our results showed that in the XTO group, SEA stimulation induced higher production of TNF-α, IL-2, IL-4 and IL-5 compared to the unstimulated cultures. SEA stimulation of the XTO group also decreased production of IFN-y compared to the SWAP-stimulated cultures (Figure
3). Compared to the unstimulated cultures, SWAP stimulation induced an increase of all the type 1 and type 2 cytokines analyzed in the supernatant of the PBMC cultures from subjects in the XTO group (Figure
3). A comparison between the SEA and SWAP-stimulated groups shows an increase in IFN-γ, which is consistent with the literature [
12], and an increase in TNF-α, IL-2 and IL-5 levels. We suggest that in the XTO group either SWAP or SEA stimulation elicited a mixed immune response. These findings are in agreement with data previously published by our group showing that most of the chronic patients displayed a mixed type (type 1/type 2) immune profile [
11,
16,
31].
Identification and characterization of
S. mansoni antigens that can provide protective immunity is crucial for understanding the complex immunoregulatory events that modulate the immune response in schistosomiasis. In the chronic phase of schistosomiasis, TNF-α production was described as an important stimulator of nitric oxide production in response to the PIII-fraction of the soluble antigen of
S. mansoni adult worms. NO induces a modulatory effect upon
in vitro and
in vivo granuloma formation. This finding suggests a protective effect related to immune response modulation [
32,
33]. Our data are consistent with the literature showing increased production of TNF-α after stimulation with SWAP in the supernatant of cultures from the XTO group (Figure
3A and 3F).
For the inter-group comparisons, the XTO group showed more IL-4, IL-5 and IL-10 secretion after SEA and SWAP stimulation compared to the BD group (Figure
3). These data are consistent with those previously published in which these cytokines may be related to the modulation of proliferation to
Schistosoma antigens [
10,
11,
34]. However, in the NI group, there was an increase in IL-2 and IFN-γ secretion compared to the BD group after SEA stimulation (Figure
3). Indeed, high levels of IFN-γ have been associated with resistance to schistosomiasis in individuals known as “endemic normal” [
35‐
37]. High IFN-γ levels are also associated with resistance to infection after treatment [
31]. These data may explain the increase in IFN-γ observed in the NI and BD groups. It has previously been shown that PBMC from blood donors produce high levels of IFN-γ concomitant with low levels of IL-10 after in vitro SEA stimulation, similar to what is observed during the acute phase of infection. Only after the second recall event, the immune response was polarized toward a strong Th2-like response [
38].
We observed that the NI and XTO cells secreted significantly greater amounts of IL-10 compared to the BD group, in the unstimulated cultures and the SEA- and SWAP-stimulated cultures (Figure
3F). This may be an attempt to control the immune system through the production of other inflammatory cytokines. In fact, IL-10 is involved in the regulation of the human immune response during
S. mansoni infection and has been associated with morbidity control [
10,
11,
14,
16,
39‐
41]. In addition, the literature indicates that high IL-10 production is associated with the cellular response of patients during the asymptomatic chronic phase, whereas IL-10 production reduces the cellular response of patients during the hepatosplenic and acute phase [
10]. More recently, it was demonstrated that in the presence of SEA, PBMCs from patients suffering from a chronic infection produce high amounts of IL-10 and secrete significantly lower levels of IFN-γ than uninfected individuals [
12,
28].
When we compared the synthesis of IL-10 in the NI and XTO groups, we observed an increase in IL-10 production independent of the stimuli, and the results were similar to those reported in the literature [
42]. IL-10 can inhibit antigen presentation by dendritic cells. The mechanism of this response appears to be through blockade of certain cytokines, such as IFN-γ, IL-2 and TNF-α, modulation of the co-stimulatory molecules CD80, CD86 and MHC II and secretion of chemokines. In addition, the presence of IL-10 has a suppressive effect and limits the magnitude of activation [
43].
Cytokines play an important role in cellular proliferation. In the comparisons between the different study groups, the XTO group showed less proliferation of both CD4+ and CD8+ T cells after SEA stimulation compared to the BD group. This may be associated with increased IL-10 production and reduced IFN-γ and IL-2 production in the XTO group. After SWAP stimulation, cell proliferation was lower for the CD8+ T cells, despite an increase in IL-2 and TNF-α and an increase in the secretion of IL-4, IL-5 and IL-10 compared to the database. Because the results of the proliferation and cytokine assays did not have any statistical correlation, further functional studies are needed to clarify the reduction in proliferation. Our data suggest that even though priming and culture conditions can skew a T-cell population toward the increased expression of some cytokines and the decreased expression of other cytokines, the expression of each cytokine can be regulated independently.
Effects of SEA and SWAP on ERK1/2 and Akt phosphorylation
Few studies have sought to elucidate the molecular mechanisms involved in regulating the immune response in individuals infected with
S. mansoni. [
44]. ERK1/2 is involved in the cytotoxic activity of CD8
+ T cells [
45,
46]. During T cell activation, anergic clones fail to activate ERK1/2; however, there is also evidence that inhibition of ERK1/2 alone cannot act on this unresponsive state known as clonal anergy [
47].
In this study, ERK1/2 phosphorylation status may be associated with phenotypic results when there was no PBMC activation
in vitro. Stimulation and co-stimulation promotes T cell proliferation, cytokine production, cell survival, and cellular metabolism through the activation of signaling pathways that send information to the nucleus [
17]. If there was no surface receptor activation after SEA and SWAP stimulation, activation of the ERK1/2 signaling pathway activation may have been compromised.
Almeida et al. (2001) [
44] have shown that after SWAP stimulation, the phosphorylation levels of Lck and Shc were more pronounced in the SWAP- than in the SEA-stimulated PBMCs. These data suggest that SEA and SWAP induce proliferation of lymphocytes both selectively and separately. Our results show that there was decreased phosphorylated ERK1/2 in the cells from individuals in the XTO group after SWAP stimulation (Figure
4B). Compared to that study, we hypothesize that the decrease in phosphorylated ERK1/2 may have occurred because of the involvement of Lck and Shc.
Phosphorylation analyses were performed
in vitro after 120 hours of culture. The culture time was tested pre-viously by others [
3,
7], who showed that 120 hours of culture is necessary to observe the effect of the antigens on PBMCs. However, it is known that the duration of ERK1/2 activation depends on the type of stimuli [
48‐
50]. It has been demonstrated in fibroblasts that a correlation exists between the signal intensity and duration of mitogen activation of ERK1/2. Furthermore, no mitogenic factors induce transient (15 minutes) activation of ERK1/2 that do not also induce cell cycle progression, whereas mitogen stimulation induces long-term activation of ERK1/2 (approximately 6 hours) [
51,
52]. Therefore, the stimulation time, the number of patients per group in the phosphorylation assay and the fact that SEA and the SWAP are not mitogenic stimuli may have influenced the phosphorylation state of ERK1/2.
There are currently no studies that have investigated the involvement of Akt in the immunomodulation of granulomas or the immune response in schistosomiasis. The similarity of Akt phosphorylation in the BD, NI and XTO groups may have occurred because of the low in vitro activation of CD28 after 120 hours of culture (data not shown). Phosphorylation of Akt may have followed the same pattern of CD28 activation.
All normal immune responses decrease with time, cau-sing the activation of regulatory mechanisms that are triggered by CTLA-4 expression [
53]. Therefore, after 120 hours of culture, CD28 expression may have increased the expression of CTLA-4, which, in turn, may have generated a signal that does not increase Akt activation. This hypothesis should be confirmed by experiments that evaluate the expression of CTLA-4 under the same conditions
in vitro.
We conclude that SEA and SWAP exert distinct effects on cell proliferation and cytokine production in the PBMCs of infected and egg-negative individuals living in the same endemic area. Infected individuals (XTO) present with reduced CD4+ T cell proliferation after SEA stimulation only. By contrast, CD8+ T cells do not seem to be significantly influenced by either the SEA or SWAP antigens because their proliferation was reduced in the unstimulated cultures in both the XTO and NI groups. The low CD4+ proliferation rate after SEA stimulation may be related to low secretion of IFN-γ and IL-2 and higher production of IL-10 in the XTO group compared to the BD group.
The influence of SWAP is clearly observed in the comparisons between the XTO and BD groups with regard to proliferation and cytokine production. In the BD group, there is low production of TNF, IL-2, IL-4, IL-5 and IL-10 as well as greater proliferation. The opposite is observed in the infected patients group. In this group, there is higher secretion of TNF, IL-2, IL-4, IL-5 and IL-10 and reduced proliferation compared to the blood donors group.
We also observed the influence of SWAP on ERK1/2 phosphorylation in the XTO group. It may be that in the first few hours of culture, ERK1/2, Akt or both may have been phosphorylated, which would influence cell proliferation. We are interested in determining the long-term significance of T cell hyporesponsiveness, with a particular focus on the relationship between the expression of surface regulatory markers and molecular activation.