Analysis of the Human Mucosal Response to Cholera Reveals Sustained Activation of Innate Immune Signaling Pathways
ABSTRACTTo better understand the innate immune response toVibrio choleraeinfection, we tracked gene expression in the duodenal mucosa of 11 Bangladeshi adults with cholera, using biopsy specimens obtained immediately after rehydration and 30 and 180 days later. We identified differentially expressed genes and performed an analysis to predict differentially regulated pathways and upstream regulators. During acute cholera, there was a broad increase in the expression of genes associated with innate immunity, including activation of the NF-κB, mitogen-activated protein kinase (MAPK), and Toll-like receptor (TLR)-mediated signaling pathways, which, unexpectedly, persisted even 30 days after infection. Focusing on early differences in gene expression, we identified 37 genes that were differentially expressed on days 2 and 30 across the 11 participants. These genes included the endosomal Toll-like receptor geneTLR8, which was expressed in lamina propria cells. Underscoring a potential role for endosomal TLR-mediated signalingin vivo, our pathway analysis found that interferon regulatory factor 7 and beta 1 and alpha 2 interferons were among the top upstream regulators activated during cholera. Among the innate immune effectors, we found that the gene for DUOX2, an NADPH oxidase involved in the maintenance of intestinal homeostasis, was upregulated in intestinal epithelial cells during cholera. Notably, the observed increases inDUOX2andTLR8expression were also modeledin vitrowhen Caco-2 or THP-1 cells, respectively, were stimulated with liveV. choleraebut not with heat-killed organisms or cholera toxin alone. These previously unidentified features of the innate immune response toV. choleraeextend our understanding of the mucosal immune signaling pathways and effectors activatedin vivofollowing cholera.