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Rivera-Correa J, Guthmiller JJ, Vijay R, Fernandez-Arias C, Pardo-Ruge MA, Gonzalez S, Butler NS, Rodriguez A. Plasmodium DNA-mediated TLR9 activation of T-bet + B cells contributes to autoimmune anaemia during malaria. Nat Commun 2017; 8:1282. [PMID: 29101363 PMCID: PMC5670202 DOI: 10.1038/s41467-017-01476-6] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 09/20/2017] [Indexed: 01/05/2023] Open
Abstract
Infectious pathogens contribute to the development of autoimmune disorders, but the mechanisms connecting these processes are incompletely understood. Here we show that Plasmodium DNA induces autoreactive responses against erythrocytes by activating a population of B cells expressing CD11c and the transcription factor T-bet, which become major producers of autoantibodies that promote malarial anaemia. Additionally, we identify parasite DNA-sensing through Toll-like receptor 9 (TLR9) along with inflammatory cytokine receptor IFN-γ receptor (IFN-γR) as essential signals that synergize to promote the development and appearance of these autoreactive T-bet+ B cells. The lack of any of these signals ameliorates malarial anaemia during infection in a mouse model. We also identify both expansion of T-bet+ B cells and production of anti-erythrocyte antibodies in ex vivo cultures of naive human peripheral blood mononuclear cells (PBMC) exposed to P. falciprum infected erythrocyte lysates. We propose that synergistic TLR9/IFN-γR activation of T-bet+ B cells is a mechanism underlying infection-induced autoimmune-like responses.
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MESH Headings
- Anemia, Hemolytic, Autoimmune/etiology
- Anemia, Hemolytic, Autoimmune/immunology
- Anemia, Hemolytic, Autoimmune/parasitology
- Animals
- Autoantibodies/biosynthesis
- B-Lymphocyte Subsets/immunology
- B-Lymphocyte Subsets/parasitology
- DNA, Protozoan/immunology
- Erythrocytes/immunology
- Erythrocytes/parasitology
- Female
- Humans
- Lymphocyte Activation
- Malaria, Falciparum/complications
- Malaria, Falciparum/immunology
- Malaria, Falciparum/parasitology
- Mice
- Mice, Inbred C57BL
- Mice, Knockout
- Plasmodium falciparum/immunology
- Plasmodium falciparum/pathogenicity
- Receptors, Interferon/deficiency
- Receptors, Interferon/genetics
- Receptors, Interferon/metabolism
- T-Box Domain Proteins/deficiency
- T-Box Domain Proteins/genetics
- T-Box Domain Proteins/metabolism
- Toll-Like Receptor 9/deficiency
- Toll-Like Receptor 9/genetics
- Toll-Like Receptor 9/metabolism
- Interferon gamma Receptor
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Affiliation(s)
- J Rivera-Correa
- Department of Microbiology, New York University School of Medicine, New York, NY, 10010, USA
| | - J J Guthmiller
- Department of Microbiology and Immunology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
| | - R Vijay
- Department of Microbiology and Immunology, University of Iowa, Iowa City, IA, 52242, USA
| | - C Fernandez-Arias
- Department of Microbiology, New York University School of Medicine, New York, NY, 10010, USA
| | - M A Pardo-Ruge
- Department of Microbiology, New York University School of Medicine, New York, NY, 10010, USA
| | - S Gonzalez
- Department of Microbiology, New York University School of Medicine, New York, NY, 10010, USA
| | - N S Butler
- Department of Microbiology and Immunology, University of Iowa, Iowa City, IA, 52242, USA
| | - A Rodriguez
- Department of Microbiology, New York University School of Medicine, New York, NY, 10010, USA.
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Abstract
Background Babesiosis, a tickborne zoonotic disease caused by intraerythrocytic protozoa of the genus babesia, is characterized by nonimmune hemolytic anemia that resolves with antimicrobial treatment and clearance of parasitemia. The development of warm-antibody autoimmune hemolytic anemia (also known as warm autoimmune hemolytic anemia [WAHA]) in patients with babesiosis has not previously been well described. Methods After the observation of sporadic cases of WAHA that occurred after treatment of patients for babesiosis, we conducted a retrospective cohort study of all the patients with babesiosis who were cared for at our center from January 2009 through June 2016. Data on covariates of interest were extracted from the medical records, including any hematologic complications that occurred within 3 months after the diagnosis and treatment of babesiosis. Results A total of 86 patients received a diagnosis of babesiosis during the 7.5-year study period; 18 of these patients were asplenic. WAHA developed in 6 patients 2 to 4 weeks after the diagnosis of babesiosis, by which time all the patients had had clinical and laboratory responses to antimicrobial treatment of babesiosis, including clearance of Babesia microti parasitemia. All 6 patients were asplenic (P<0.001) and had positive direct antiglobulin tests for IgG and complement component 3; warm autoantibodies were identified in all these patients. No alternative explanation for clinical hemolysis was found. WAHA required immunosuppressive treatment in 4 of the 6 patients. Conclusions We documented post-babesiosis WAHA in patients who did not have a history of autoimmunity; asplenic patients appeared to be particularly at risk.
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Affiliation(s)
- Ann E Woolley
- From the Divisions of Infectious Diseases (A.E.W., M.W.M., K.D., S.V., J.H.M., F.M.M.), Transfusion Medicine (W.J.S.), and Hematology (M.O.A.), Brigham and Women's Hospital, Harvard Medical School (A.E.W., M.W.M., W.J.S., M.O.A., J.H.M., F.M.M.), and Dana-Farber Cancer Institute (A.E.W., M.O.A., F.M.M.) - all in Boston
| | - Mary W Montgomery
- From the Divisions of Infectious Diseases (A.E.W., M.W.M., K.D., S.V., J.H.M., F.M.M.), Transfusion Medicine (W.J.S.), and Hematology (M.O.A.), Brigham and Women's Hospital, Harvard Medical School (A.E.W., M.W.M., W.J.S., M.O.A., J.H.M., F.M.M.), and Dana-Farber Cancer Institute (A.E.W., M.O.A., F.M.M.) - all in Boston
| | - William J Savage
- From the Divisions of Infectious Diseases (A.E.W., M.W.M., K.D., S.V., J.H.M., F.M.M.), Transfusion Medicine (W.J.S.), and Hematology (M.O.A.), Brigham and Women's Hospital, Harvard Medical School (A.E.W., M.W.M., W.J.S., M.O.A., J.H.M., F.M.M.), and Dana-Farber Cancer Institute (A.E.W., M.O.A., F.M.M.) - all in Boston
| | - Maureen O Achebe
- From the Divisions of Infectious Diseases (A.E.W., M.W.M., K.D., S.V., J.H.M., F.M.M.), Transfusion Medicine (W.J.S.), and Hematology (M.O.A.), Brigham and Women's Hospital, Harvard Medical School (A.E.W., M.W.M., W.J.S., M.O.A., J.H.M., F.M.M.), and Dana-Farber Cancer Institute (A.E.W., M.O.A., F.M.M.) - all in Boston
| | - Kathleen Dunford
- From the Divisions of Infectious Diseases (A.E.W., M.W.M., K.D., S.V., J.H.M., F.M.M.), Transfusion Medicine (W.J.S.), and Hematology (M.O.A.), Brigham and Women's Hospital, Harvard Medical School (A.E.W., M.W.M., W.J.S., M.O.A., J.H.M., F.M.M.), and Dana-Farber Cancer Institute (A.E.W., M.O.A., F.M.M.) - all in Boston
| | - Sarah Villeda
- From the Divisions of Infectious Diseases (A.E.W., M.W.M., K.D., S.V., J.H.M., F.M.M.), Transfusion Medicine (W.J.S.), and Hematology (M.O.A.), Brigham and Women's Hospital, Harvard Medical School (A.E.W., M.W.M., W.J.S., M.O.A., J.H.M., F.M.M.), and Dana-Farber Cancer Institute (A.E.W., M.O.A., F.M.M.) - all in Boston
| | - James H Maguire
- From the Divisions of Infectious Diseases (A.E.W., M.W.M., K.D., S.V., J.H.M., F.M.M.), Transfusion Medicine (W.J.S.), and Hematology (M.O.A.), Brigham and Women's Hospital, Harvard Medical School (A.E.W., M.W.M., W.J.S., M.O.A., J.H.M., F.M.M.), and Dana-Farber Cancer Institute (A.E.W., M.O.A., F.M.M.) - all in Boston
| | - Francisco M Marty
- From the Divisions of Infectious Diseases (A.E.W., M.W.M., K.D., S.V., J.H.M., F.M.M.), Transfusion Medicine (W.J.S.), and Hematology (M.O.A.), Brigham and Women's Hospital, Harvard Medical School (A.E.W., M.W.M., W.J.S., M.O.A., J.H.M., F.M.M.), and Dana-Farber Cancer Institute (A.E.W., M.O.A., F.M.M.) - all in Boston
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