Insights Into Mucosal Innate Immune Responses in House Dust Mite-Mediated Allergic Asthma
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REVIEW published: 07 December 2020 doi: 10.3389/fimmu.2020.534501 Insights Into Mucosal Innate Immune Responses in House Dust Mite-Mediated Allergic Asthma Arwa Abu Khweek 1,2,3, Eunsoo Kim 3, Marisa R. Joldrichsen 3, Amal O. Amer 2,4* and Prosper N. Boyaka 2,3,4* 1 Department of Biology and Biochemistry, Birzeit University, Birzeit, Palestine, 2 Department of Microbial Infection and Immunity, The Ohio State University, Columbus, OH, United States, 3 Department of Veterinary Biosciences, The Ohio State University, Columbus, OH, United States, 4 The Infectious Diseases Institute, The Ohio State University, Columbus, OH, United States The prevalence of asthma has been rising steadily for several decades, and continues to be a major public health and global economic burden due to both direct and indirect costs. Asthma is defined as chronic heterogeneous inflammatory diseases characterized by airway obstruction, mucus production and bronchospasm. Different endotypes of asthma are being recognized based on the distinct pathophysiology, genetic predisposition, age, prognosis, and response to remedies. Mucosal innate Edited by: response to environmental triggers such as pollen, cigarette smoke, fragrances, viral Eric Cox, infection, and house dust mite (HDM) are now recognized to play an important role Ghent University, Belgium in allergic asthma. HDM are the most pervasive allergens that co-habitat with us, as Reviewed by: they are ubiquitous in-house dusts, mattress and bedsheets, and feed on a diet of Wayne Robert Thomas, University of Western exfoliated human skin flakes. Dermatophagoides pteronyssinus, is one among several Australia, Australia HDM identified up to date. During the last decade, extensive studies have been Stewart J. Levine, National Heart, Lung, and Blood fundamental in elucidating the interactions between HDM allergens, the host immune Institute (NHLBI), United States systems and airways. Moreover, the paradigm in the field of HDM-mediated allergy has *Correspondence: been shifted away from being solely a Th2-geared to a complex response orchestrated Prosper N. Boyaka via extensive crosstalk between the epithelium, professional antigen presenting cells [email protected] Amal O. Amer (APCs) and components of the adaptive immunity. In fact, HDM have several lessons [email protected] to teach us about their allergenicity, the complex interactions that stimulate innate immunity in initiating and perpetuating the lung inflammation. Herein, we review main Specialty section: This article was submitted to allergens of Dermatophagoides pteronyssinus and their interactions with immunological Mucosal Immunity, sentinels that promote allergic sensitization and activation of innate immunity, which is a section of the journal Frontiers in Immunology critical for the development of the Th2 biased adaptive immunity to HDM allergens and Received: 12 February 2020 development of allergic asthma. Accepted: 01 September 2020 Keywords: mucosal, innate immunity, asthma, house dust mite, allergy Published: 07 December 2020 Citation: Abu Khweek A, Kim E, INTRODUCTION Joldrichsen MR, Amer AO and Boyaka PN (2020) Insights Into Mucosal Innate Immune Responses in Asthma is a chronic lung disease characterized by airway obstruction, mucus production and House Dust Mite-Mediated Allergic bronchospasm that affects approximately 339 million people worldwide (1). It is a cause of Asthma. Front. Immunol. 11:534501. both premature death and reduced quality of life in individuals of all ages in all parts of the doi: 10.3389/fimmu.2020.534501 world. Not only the prevalence of asthma is increasing, but it continues to be a major public Frontiers in Immunology | www.frontiersin.org 1 December 2020 | Volume 11 | Article 534501 Abu Khweek et al. Innate Regulation of Mites-Induced Asthma health and global economic burden due to both direct and have less clinical relevance (21–23). More recently, Der p 23, indirect costs (2). The definition of asthma has evolved over the a peritrophin-like protein, has been identified as another major last three decades as our understanding of the pathophysiology HDM allergen of D. pteronyssinus (24–27). Although Der p 23 is and different clinical presentation has developed. During the only present in low amounts in house dust and in HDM extracts, twentieth century, researchers recognized constriction of airway it was shown to induce IgE-dependent basophil activation which smooth muscles and excessive sensitivity of the airway to indicated a high allergenic activity (28). A recent study analyzed external stimuli (hyper-responsiveness) as the key features the profile of sensitization to HDM major components. The of asthma. In the 1980s, it was established that airway authors found that most individuals in the pediatric population inflammation was an essential feature, with structural changes with respiratory allergy disease with mite allergy are sensitized in the airways (remodeling) present early in the development and contained IgE specific to Der p 1, Der p 2, and Der p 23 of the disease. Currently, it is well-accepted that asthma is major allergens (29). The clinical relevance Der p 23 was further a heterogeneous inflammatory disease associated with airways established by the fact that 5% of this population was mono- narrowing, swelling and excessive mucus production. It is sensitized to Der p 23 and presented clinical symptoms of HDM also defined by the history of respiratory symptoms such allergy (29). as intermittent attacks of breathlessness, bronchoconstriction, Nowadays, the complexity of HDM components and their coughing, wheezing, dyspnea, and airway inflammation (3–5). mechanism of action led to an updated classification that matches their biological activity and regulatory effects on the epithelial cells, and cells of the innate and adaptive HOUSE DUST MITE ALLERGENS AND immune systems. D. pteronyssinus have allergens that exhibit THEIR ROLES IN ASTHMA proteolytic activity, homology with the lipopolysaccharide- binding component of Toll-like receptor 4, homology with House dust mites are small yet, extremely complex organisms other invertebrate tropomyosins, and chitin-cleaving and chitin- that belong to the group of arthropods and thrive in humid binding activity (30, 31). The major allergens of D. pteronyssinus indoor environment. They come in contact with humans mainly are listed in Table 1. through mattresses and bedsheets, and live on a diet of skin scales and bio-debris accumulated in house dust. Hypersensitivity AIRWAY EPITHELIUM: THE INITIATOR AND to HDM such as Dermatophagoides pteronyssinus aeroallergens contribute to atopic sensitization in 50–85% of asthmatics, and REGULATOR OF HDM-MEDIATED are strong inducers of allergenicity worldwide (6–8). In addition ALLERGIC ASTHMA to genetic predisposition, mite sensitization, and exposure are important determinants of the subsequent development Initial interactions with immunological sentinels start when of asthma (3–5). Thus, patients with asthma and dust mite HDM allergens reach and interact with the airway epithelial sensitivity show worsened bronchospasm and bronchial hyper- reactivity following exposure to mite allergen, while reduced symptoms are noted in a mite-free environment (3). The link TABLE 1 | HDM allergens derived from Dermatophagoides pteronyssinus. between HDM and asthma is further supported by the fact Allergens Biological functions that the levels of HDM exposure and sensitization are strong predictors for asthma in clinics (9, 10). Furthermore, the Der p 1 Cysteine protease synergy between mite sensitization, exposure and respiratory Der p 2 Lipid binding viral infection enhances the severity of the disease, and is the Der p 3 Serine protease (trypsin) leading cause of acute wheezing or hospitalization (11–13). Other Der p 4 Amylase pieces of evidence that link HDM and asthma include the fact Der p 5 Lipid binding that inhalation of HDM allergens induces the proliferation of Der p 6 Serine protease (chymotrypsin) bronchial smooth muscle (14), and that HDM-specific IgE were Der p 7 Lipid binding detected in the sputum of asthmatics (15). Der p 8 Glutathione transferase The high percentage of HDM-mediated allergy encouraged Der p 9 Serine protease (collagenase) extensive research on HDM allergens. An array of at least 30 Der p 10 Muscle tropomyosin allergen have now been identified for D. pteronyssinus (16, Der p 11 High molecular weight muscle paramyosin 17). They are classified according to a Linnaean system for Der p 12 Homology to chitin nomenclature based upon their genus, species, and the order Der p 13 Lipid transfer they were discovered (18). For example, Der p 1 was the first Der p 14 Lipid transport discovered allergen from the genus Dermatophagoides, species Der p 15 Chitinase pteronyssinus (19). Originally, HDM allergens were classified into Der p 16 Gelsolin major and minor groups based on their allergenicity and strict Der p 17 EF hand protein IgE reactivity. The major group allergen Der p 1 and Der p 2, Der p 18 chitin-binding protein and minor group allergen Der p 4, Der p 5 and Der p 7 account Der p 20 Arginine kinase for ∼50 and 30% of HDM-specific IgE, respectively (17). Thus, Der p 21 Putative fatty acid binding these major groups are serodominant (19, 20), while other groups Der p 23 Peritrophin, chitin binding Frontiers in Immunology | www.frontiersin.org 2 December 2020 | Volume 11 | Article 534501 Abu Khweek et al. Innate Regulation of Mites-Induced Asthma FIGURE 1 | Overview of mucosal immune cells, molecules, and pathways targeted