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Inflammation-Induced IL-6 Functions As a Natural Brake On BASIC RESEARCH www.jasn.org Inflammation-Induced IL-6 Functions as a Natural Brake on Macrophages and Limits GN Michael Luig,* Malte A. Kluger,* Boeren Goerke,* Matthias Meyer,* Anna Nosko,* † ‡ † Isabell Yan, Jürgen Scheller, Hans-Willi Mittrücker, Stefan Rose-John,§ Rolf A.K. Stahl,* Ulf Panzer,* and Oliver M. Steinmetz* *Medical Clinic III and †Immunology Institute, Hamburg University Medical Center, Hamburg, Germany; ‡Institute of Biochemistry and Molecular Biology II, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany; and §Institute of Biochemistry, Christian-Albrechts-University, Kiel, Germany ABSTRACT IL-6 can mediate proinflammatory effects, and IL-6 receptor (IL-6R) blockade as a treatment for in- flammatory diseases has entered clinical practice. However, opposing effects of IL-6 have been observed in models of GN. Although IL-6 is proinflammatory in murine lupus nephritis, protective effects have been observed for IL-6 in the nephrotoxic nephritis (NTN) model of acute crescentic GN. In light of the potential dangers of IL-6–directed treatment, we studied the mechanisms underlying the contradictory findings in GN. IL-6 can signal through the membrane-bound IL-6R, which is expressed only on hepatocytes and certain leukocytes (classic), or through the soluble IL-6R, which binds the ubiquitously expressed gp130 (alternative). Preemptive treatment of mice with anti-IL-6R or anti-IL-6 worsened NTN, whereas selective blockade of alternative IL-6 signaling by the fusion protein sgp130Fc did not. FACS analysis of mouse spleen cells revealed proinflammatory macrophages express the highest levels of IL-6Ra,andin vitro treatment with IL-6 blocked macrophage proliferation. Furthermore, proinflammatory macrophages were 2 2 expanded during inflammation in IL-6 / mice. Late application of anti-IL-6 after establishment of adaptive nephritogenic immunity was sufficient to aggravate NTN within 2.5 days, a period when macrophages are active. Finally, NTN was aggravated in mice with macrophage-specific impairment of IL-6 classic signaling, coincident with enhanced macrophage proliferation and accumulation in the kidney. Our data thus reveal a novel mechanism in which IL-6–mediated dampening of macrophage activation protects tissues from overshooting immune responses. This finding has important implications for potential IL-6–directed ther- apies and supports the careful choice of recipient patients and timing. J Am Soc Nephrol 26: 1597–1607, 2015. doi: 10.1681/ASN.2014060620 IL-6 is a pleiotropic cytokine that is involved in hepatocytes and a number of distinct leukocyte multiple pathways such as regulation of acute phase subsets.4 Thus classic signaling can only occur on responses, cell growth and differentiation, as well these definedcelltypes.However,inadditionto as metabolic processes.1 Importantly, IL-6 has this restricted signaling pathway, an alternative emerged as a potent regulator of immune responses and inflammation.2,3 Given these multiple func- Received June 27, 2014. Accepted September 15, 2014. tions, it is not surprising that signaling of IL-6 is complex and can occur via two different pathways. M.L. and M.A.K. contributed equally to this work. In the so-called classic IL-6 signaling pathway, IL-6 Published online ahead of print. Publication date available at binds to the membrane-bound IL-6 receptor (IL-6R) www.jasn.org. which consists of two different subunits: the IL-6Ra Correspondence: Dr. Oliver M. Steinmetz, Division of Nephrology, chain to which IL-6 binds directly, and the signal- Medical Clinic III, Hamburg University Medical Center, Martinistrasse transducing membrane glycoprotein gp130. The IL-6Ra 52, 20246 Hamburg, Germany. Email: [email protected] chain is exclusively expressed on the surface of Copyright © 2015 by the American Society of Nephrology J Am Soc Nephrol 26: 1597–1607, 2015 ISSN : 1046-6673/2607-1597 1597 BASIC RESEARCH www.jasn.org IL-6 signaling pathway exists which was termed IL-6 trans- effects of recombinant IL-6.35,36 Both the mechanisms under- signaling.5,6 Here, IL-6 forms a complex with a soluble IL-6 lying IL-6–mediated protection from nephritis and the respon- receptor a chain (sIL-6Ra) that binds to the ubiquitously sible IL-6 signaling pathway (classic versus trans) remained expressed gp130. Therefore, in contrast with classic signaling, unclear. Injury in the NTN model develops independently IL-6 trans-signaling can occur on all cells of the body. The of antibodies37 but highly depends on Th1 and Th17 cell re- complex role of IL-6 and the relative contribution of each sponses38–41 as well as macrophages.42 Therefore, it is very signaling pathway in immunologically mediated disease has likely that the observed effects were mediated by these highly been the focus of many studies from the past few years.7 In this IL-6–responsive leukocyte subpopulations. In addition to the respect, IL-6 was initially identified as a B-cell differentiation anti-inflammatory role of IL-6 in NTN, a more recent study factor.8 However, subsequent studies have also revealed ef- found protective effects of IL-6 trans-signaling in AKI.43 fects on multiple other cells of the immune system such as Regarding the situation in humans, IL-6 secretion from neutrophils (PMNs), macrophages, dendritic cells (DCs), and PBMCs correlated with renal disease activity in lupus nephritis.44 T-helper (Th) cells. The discovery of IL-6 as a key cytokine Urinary IL-6 has also been suggested as a marker for renal in- required for development of the highly proinflammatory flammation in different forms of GN. Definite proof for a path- Th17 response has especially gained much attention.9,10 To- ogenic role of IL-6 in human inflammatory renal disease is, gether with TGF-b, IL-6 initiates cellular events leading to however, still lacking. Few case reports from the literature de- programming of Th17 differentiation.11,12 Many studies in scribe successful treatment of renal disease by the IL-6R antibody Th17-mediated experimental models of immune-mediated tocilizumab,45 including one patient with pANCA-associated diseases such as encephalitis, colitis, and arthritis have proven refractory GN.46 In addition, one pilot study assessed the effects the proinflammatory effects of IL-6.13–15 As a consequence, of tocilizumab in patients with mild lupus nephritis.47 Although IL-6–directed therapy has been introduced into clinical prac- arthritis in these patients improved significantly, improvement tice. The mAb tocilizumab, which is directed against the hu- of renal function was less evident. Nevertheless, given the pos- man IL-6R, is successfully used to treat rheumatoid arthritis itive results in animal studies of SLE and the paucity of effective and Still’s disease.16–18 However, some significant caveats re- therapeutic options for human lupus and ANCA-associated ne- main. Besides its proinflammatory role, IL-6 signaling has also phritis, it would be very tempting to initiate randomized clinical been shown to exert strong anti-inflammatory effects. Studies trials of IL-6R blockade in GN. However, for such studies to be from the pre-Th17 era predominantly declared IL-6 to be an launched, it is crucial to better understand which mechanisms anti-inflammatory cytokine with IL-10–like properties.19–22 underlie the strong anti-inflammatory and tissue-protective ef- These effects include downregulation of macrophage prolifera- fects of IL-6. This study therefore aimed to (1) assess the effect of tion and activation23–25 as well as inhibition of DC maturation.26 IL-6 pathway blockade on the clinical course of NTN, (2)iden- Most importantly, IL-6R blockade in humans has also been tify the differential IL-6 signaling pathways that are involved reported to cause inflammatory eye disease,27 psoriasis,28 as (classic versus trans-signaling), and (3) identify which cell pop- well as crescentic immune complex GN.29 Generally, the anti- ulations mediate the effects of IL-6 in NTN. inflammatory actions of IL-6 stillremainvery ill defined. This is also the case regarding inflammatory renal disease where conflicting data have been reported. Several studies have been RESULTS performed in rodent models of SLE. Pioneering work by Kiberd showed an anti-inflammatory role of an IL-6R antibody in IL-6R Blockade Aggravates NTN the Mrl/lpr model of lupus nephritis.30 Much later, a study in NTN was induced in C57BL/6 mice and one group was treated IL-6–deficient mice confirmed these findings in the same with anti-IL-6R antibody,48 whereas controls were injected model.31 In a second model of SLE, three studies supported with control IgG. Analyses of kidneys at day 10 after NTN proinflammatory effects of IL-6. First, recombinant IL-6 induction revealed significantly aggravated disease in anti- aggravated pathogenic immune responses and the clinical course IL-6R–treated mice in terms of histologic and functional dam- of SLE in NZW3NZB mice.32 Application of anti–IL-6R as well age (Figure 1A). Renal leukocyte influx was significantly as anti–IL-6 antibodies were subsequently shown to ameliorate increased (Figure 1B) and renal Th1 and Th17 responses re- disease by two independent groups.33,34 Mechanistically, the del- mained intact (Figure 1C). Analyses of systemic T- and B-cell eterious effects of IL-6 were largely ascribed to production of immune responses showed multiple effects. Antigen-specific pathogenic antibodies. Some authors also suspected IL-6 effects antibody production was impaired, confirming effective on T-cell activation; however, this was not addressed any further blockade of IL-6 signaling (Supplemental Figure 1A). Spleen and effects on Th17 responses have not yet been studied. cell numbers were significantly reduced but regulatory T-cell Although these data are in line with and clearly indicate a percentages remained unchanged (Supplemental Figure 1, B proinflammatory role for IL-6 in lupus and lupus nephritis, and C).
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