Introduction
Antimicrobial peptide (AMPs), also known as host defense peptides (HDPs), act as natural broad-spectrum antibiotics and play essential roles in regulating host defense and immunity [
1,
2]. More than hundred human AMPs have been identified from various tissues and epithelial surfaces [
3]. Nevertheless most human AMPs belong to two major families: the Defensins and the Cathelicidins [
4]. Members of theCathelicidins family of AMPs share a conserved N-terminal Cathelin domain [
5]. Cathelicidins were first identified in bone marrow myeloid cells, therefore they were referred to as”myeloid antimicrobial peptides” (MAP) [
6,
7]. In humans, the only Cathelicidin is the 37 amino acid peptide LL-37. This peptide is expressedin many immune cells such as neutrophils, monocytes/macrophages and lymphocytes [
5]. LL-37 is also expressed in epithelial cells of the intestine, airways, skin, and the urogenital tract [
8‐
10]. Cathelicidin is stored inside cellular granules in an inactive precursor form and is activated upon secretion by proteolitic cleavage of the conserved cathelin domain from the active C-terminal region [
6].
LL-37 has broad-spectrum antimicrobial activity against Gram-positive and Gram-negative bacteria, as well as against fungi and enveloped viruses [
11]. The anti-infective properties of LL-37 depend on its direct microbicidal and immunomodulatory activities. The direct microbicidal activity of LL-37 is predominantly mediated by disrupting the integrity of microbial membranes, due to its inherent cationic and amphipathic nature [
12]. Additionally, a multi-hit mechanism in which the peptide translocates through the bacterial inner membrane to interacts with several intracellular targets appears to enhance direct microbicidal activity [
13]. For example in
Escherechia coli intracellular LL-37 induced the production of reactive oxygen species (ROS), increased the permeability of the membrane and affected the transcription of genes related to energy production and carbohydrates metabolism with the net result of inhibiting bacterial growth [
14].
Despite its direct microbicidal action, several line of evidence have shown that the anti-infective activity of LL-37 in vivo is mainly dependent on its ability to modulate the immune response [
15]. LL-37 boosts immune-activating functions such as chemokine production, leukocyte recruitment, immune cell activation, T-cell polarization and angiogenesis [
16,
17]. Also, LL-37 induces autophagy-mediated killing which provides protection against infection with intracellular organisms such as
Mycobacterium tuberculosis [
18].
The non-microbicidal, immunomodulatory actions of Cathelicidins have attracted increasing attention and have been associated with several autoimmune diseases; such as psoriasis [
19], systemic lupus erythematous [
20], arthritis [
21], atherosclerosis [
22,
23], and type 1 diabetes [
24]. Interestingly a study showed that the gut microbiota via short-chain fatty acids promoted the production of mCRAMP (mouse cathelicidin-related antimicrobial peptide), the only cathelicidin in rats and mice, by pancreatic endocrine cells, which provided protection against autoimmune diabetes by inducing regulatory immune cells in the pancreas [
24].
Induction of endogenous CRAMP/LL-37 expression has emerged as a novel approach in combating infectious diseases through alternative therapy.
Short-chain fatty acids, butyrate in particular, were found to be strong inducers of LL-37 gene expression [
25]. Sodium phenyl-butyrate (PBA) is a registered drug used for the treatment of urea cycle disease [
26]. Earlier studies have shown that treatment with PBA enhanced cathelicidin expression in a colonic epithelia cell line and in colonic epithelium in a rabbit model of shigellosis, which resulted in rapid clinical recovery and a concomitant decline in bacterial load in stool [
27,
28]. Similarly, studies in rabbit model of shigellosis have further shown that PBA treatment overcome Shigella mediated down regulation of Cathelicidin expression in in a bronchial epithelial cells [
29,
30].
An in vitro study showed that PBA induced cellular production of LL-37and inhibited the growth of
Mycobacterium tuberculosis (Mtb) in human macrophages [
31]. Furthermore, an in vivo study showed that oral intake of PBA up regulates LL-37 in human macrophages and lymphocytes, and induced intracellular killing of Mtb [
32]. In a randomized controlled trial oral PBA together with vitD,which is also known to induce LL-37 expression, demonstrated beneficial effects toward clinical recovery in tuberculosis patients [
33]. .
Gum Arabic (GA) is derived from the exudates of
Acacia senegal or
Acacia seyal trees. It consists of a mixture of polysaccharides (major component) plus oligosaccharides and glycoproteins [
34,
35]. Oral intake of GA has been shown to provide several health benefits [
36]. GA significantly increases
Bifidobacteria, Lactobacteria, and Bacteriodes in the gut and is considered to have prebiotic actions [
37]. GA is claimed to have anti-cancer [
38], anti-malarial [
39] immune-modulatory [
38,
39] and antioxidant effects [
37,
40]. GA treatment has been shown to favorably influence clinical and laboratory results in rats with adenine-induced chronic renal failure (CRF) and in humans diagnosed with renal failure [
40‐
42]. It also increased Erythropoietin level in two separate studies and ameliorated anemia induced by adenine administration [
43,
44]. Very recently GA was found to have a novel effect on fetal hemoglobin production [
45]. Also, Gum Arabic ingestion resulted in decreased inflammatory markers and disease severity score among Rheumatoid Arthritis Patients [
46].
Regarding Cathelicidin expression, several studies showed that GA ingestion increases serum short chain fatty acid concentration, mainly butyrate and propionate [
47,
48].. Many of the health beneficial effects of GA mentioned above was related to increased serum butyrate concentration following regular GA intake [
33]. Increasing Cathelicidin expression is beneficial in treatment of diseases such as shigellosis and tuberculosis in which Cathelicidin expression is down regulated as discussed earlier [
28,
33]. Also Cathelicidin through its immunomodulatory functions was involved in several autoimmune diseases and cardiovascular diseases [
22‐
24]. And since butyrate is a potent inducer of Cathelicidin expression, we were interested in investigating the effect of regular GA intake on Cathelicidin expression by immune cells.
Discussion
Several cell types including macrophage are known to express Cathelicidin [
3,
7]. The aim of the study was to evaluate the effect of GA supplementation on Cathelicidin expression in mice MDMs. We administrated GA to two groups of healthy mice in two different concentrations: 15 and 30% w/v for 28 days. The expression of CRAMP in MDM cellswas assessed using Quantitative real time PCR. Our results showed that there was a significant increase in RNA expression of Cathelicidin among the groups supplemented with GA in a concentration of 15% (
P = 0.023) in comparison with the control group. These results were expected since GA has been shown to increase circulating butyrate concentration. Matsumoto’set. al, showed that ingestion of 25 g of GA daily doubled serum butyrate level [
47]. Butyrate is known to increase cathelicidin production in immune cells [
31]. It has been shown that the downregulation of the rabbit cathelicidin (CAP-18) in the colonic and lung epithelium can be opposed by oral treatment with sodium butyrate or its analogue, PBA, in experimental model of shigellosis [
28,
30]. Both butyrate and PBA induced LL-37 expression in human lung epithelial and colonic epithelial lines [
29].
Studies have shown that butyrate affects LL-37 expression mainly at the transcriptional level and that LL-37 mRNA expression was directly correlated with LL-37 protein synthesis and antimicrobial activity both in vitro and in vivo [
50]. Hyperacetylation of core histones is considered to be the major mechanism of butyrate-induced LL-37 expression [
51]. Nevertheless, it has been shown that MAP kinase signaling pathway is also involved in butyrate- induced CAMP gene expression [
51].
Cathelicidin RNA expression in MDMs obtained from mice receiving high concentrations of GA (30% w/v.) was higher when compared to the control group, but the difference was not statistically significant Fig.
1). This indicates that butyrate induced CRAMP expression was dose dependent, and the stimulatory effect of butyrate is lost in higher butyrate concentrations [
52]. As reported by Soliman et al. butyrate up-regulated leptin expression within physiological levels (1 mM) but the high doses inhibited gene expression of Leptin. It is uncertain why high doses of butyrate exert this inhibitory effect.
In conclusion, the study demonstrated a novel effect of GA, as an inducer for cathelicidin expression. Being able to induce the expression of cathelicidin, regular consumption of GA can therefore enhance the innate immunity against bacterial, viral, and fungal infections. Hence the study asserts that GA is a promising candidate as an adjuvant treatment in infectious diseases. Effect of GA supplementation in Cathelicidine expression in humans should be investigated.
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