Crohn's disease typically involves the distal ileum and in its most severe form is characterized by pathological changes including transmural acute and chronic inflammation. CD is associated with increased expression of immunoregulatory cytokines including leptin
4 and adiponectin
5. Multiple genetic factors predispose to CD, but the specific relationship between the function of these genes and the diverse pathologies observed in CD is not well understood. One CD susceptibility allele is in the predicted autophagy gene
ATG16L1 6,7,8,9. Autophagy is an evolutionarily conserved process that recycles cellular components via delivery of double membrane-bound vesicles containing cytoplasm and cytoplasmic organelles to the lysosome
10. Autophagy has an important role in cell and tissue homeostasis, and has been implicated in a range of human diseases
10. The mammalian Atg16L1 protein contains an N-terminal domain that is homologous to yeast Atg16
2 which functions in autophagy as part of a complex with autophagy proteins Atg5 and Atg12
2,11. Atg16 is responsible, in both yeast and mammalian cells, for proper sub-cellular localization of the autophagy machinery
12,8,11.
To determine the role of Atg16L1 and autophagy in the intestine, we generated two mouse lines with gene trap-mediated disruptions of
Atg16L1 and a third line lacking
Atg5 in intestinal epithelial cells. Gene trap vectors introduce a false splice acceptor into an intron, and can inhibit expression of intact mRNA
13 (). This can result in decreased expression of a protein, potentially generating viable mice when full disruption of a gene is lethal. This approach is attractive since Atg5 is part of the Atg16L1 complex and full disruption of
Atg5 is lethal
14,2. Mouse lines homozygous for gene trap mutations were generated from commercially available ES cells carrying gene trap mutations in the intron 3’ to either exon 6 or exon 10 of
Atg16L113.
Atg16L1 mutant murine embryo fibroblasts (MEFs) expressed low levels of Atg16L1 protein () indicating that both mouse lines, Atg16L1
HM1 and Atg16L1
HM2, are hypomorphic (HM) for expression of Atg16L1 protein. Atg16L1
HM mice were born at Mendelian ratios (
Supplementary Fig. 1a), and survive to adulthood; the characteristics of the two Atg16L1
HM lines
in vivo were similar across all experiments.
To determine if Atg16L1 is an autophagy protein, we studied low-passage and transformed MEFs from Atg16L1
HM mice compared to MEFs lacking the essential autophagy protein Atg5
14. Rapamycin-induced and autophagy-dependent
15 degradation of the adapter protein p62 was diminished in Atg16L1
HM and Atg5
−/− cells (). Decreased degradation of p62 in Atg16L1
HM cells was restored by expressing Atg16L1 (
Supplementary Fig. 1b, c). Atg16L1
HM MEFs also showed diminished rapamycin-induced production of LC3-II, the phosphatidylethanolamine-conjugated form of Atg8/LC3-I generated during autophagy
10 (). The induction of autophagosomes, as measured by LC3-positive dot formation after rapamycin treatment or starvation, was also decreased in Atg16L1
HM MEFs (
Supplementary Fig. 2), although the defect of Atg16L1
HM2 cells was more subtle in starved cells; this was confirmed in cells transfected with GFP-LC3 (
Supplementary Fig. 3). Mammalian Atg16L1 is therefore an autophagy protein.
We next determined if markers of autophagy were abnormal in the distal small intestine (ileum, a common site of CD) of Atg16L1
HM mice by measuring the expression of Atg16L1, LC3, and p62 proteins in ileal lysates (). Atg16L1 mRNA is expressed throughout the crypt-villus axis (
Supplementary Fig. 4). Atg16L1
HM mice expressed 23−37% of the expected level of Atg16L1 protein (). Consistent with a role for Atg16L1 in ileal autophagy, both the ratio of LC3-I to LC3-II, and the total amount of LC3-I and p62 were increased in lysates from Atg16L1
HM mice (). To validate these results, we studied ileal lysates from mice generated by breeding
Atg5flox/flox mice
16 to mice expressing the Cre recombinase under the control of the intestinal epithelium-specific
villin promoter (
Atg5flox/floxvillin-Cre mice)
17. Atg5 expression was significantly diminished in ileal lysates of
Atg5flox/floxvillin-Cre mice, and these mice exhibited changes in expression of LC3 and p62 similar to those observed in Atg16L1
HM mice (
Supplementary Fig. 5). These data are consistent with a role for Atg16L1 and Atg5 in ileal autophagy.
Deficiency in Atg16L1 had no effect on the overall morphology of the ileum or colon as measured by analysis of crypt height or villus length (data not shown). However, there were obvious abnormalities in Paneth cells, leading us to focus our studies on these critically important intestinal innate immune cells. Paneth cells are ileal epithelial cells thought to play a role in control of intestinal microbiota via secretion of granule contents including antimicrobial peptides and lysozyme
18. Staining of whole mounts of ileum revealed the expected colocalization of lysozyme and mucus (). However, there was a striking lack of lysozyme staining in the mucus of Atg16L1
HM mice, suggesting an abnormality of Paneth cell secretion (). We examined PAS/alcian blue stained sections and found extraordinary abnormalities in Paneth cells including aberrant, disorganized granules as well as decreased granule numbers (, and not shown). Blinded analysis of these sections from 16 control and 30 mutant mice revealed a 100% concordance between Atg16L1
HM genotype and abnormal Paneth cell morphology. We quantified these Paneth granule abnormalities by staining sections for lysozyme which is normally packaged efficiently in the granules
18 (). In these sections, we observed a striking population of Atg16L1
HM cells with diffuse lysozyme staining (). We also observed the presence of intact granules in the crypt lumen of whole mounts of ileum from Atg16L1
HM mice (
Supplementary Fig. 6a-c), a finding confirmed by EM (
Supplementary Figure 6d, e), potentially explaining the absence of lysozyme staining in the mucus layer of the ileum (). These observations indicate that Atg16L1 is required for maintaining the integrity of the Paneth cell granule exocytosis pathway. Based on these data, and the published role for Nod2 in resistance to infection
19, we orally challenged Atg16L1
HM mice with
Listeria monocytogenes. We found no change in
L. monocytogenes titers in spleen, liver, and mesenteric lymph nodes (
Supplementary Fig. 7), indicating that the striking changes in release of granules in ATG16L1
HM mice did not affect
L. monocytogenes resistance. This argues that the phenotypes of mutations analyzed to date in Atg16L1 and Nod 2 are distinct.
Despite these profound alterations in the granule exocytosis pathway, we found no evidence of increased epithelial cell death or proliferation as determined by quantification of apoptotic bodies and M-phase cells (not shown). Importantly, deletion of
Atg5 in the intestinal epithelium in
Atg5flox/floxvillin-Cre mice led to Paneth cell and granule abnormalities similar to those observed in Atg16L1
HM mice ( and
Supplementary Fig. 8), while other epithelial cells appeared normal. This indicates that, within the intestinal epithelium, Paneth cells have a unique sensitivity to autophagy gene disruption.
To better characterize the effects of Atg16L1 deficiency in Paneth cells, we used transmission electron microscopy (EM). We observed degenerating mitochondria, loss of granules, and the frequent absence of apical microvilli in Atg16L1
HM Paneth cells (;
Supplementary Fig. 6d, e). EM also showed Atg16L1
HM Paneth cells with marked increases in cytoplasmic vesicles (); a similar abnormality has been reported in Paneth cells from a CD patient
20. Importantly, such dramatic findings were not present in epithelial progenitors or enterocytes ( and
Supplementary Fig. 9), confirming that Atg16L1 deficiency selectively affects Paneth cells within the intestinal epithelium. We next performed transcriptional profiling of Paneth cell RNA procured by laser capture microdissection (LCM)
21 (see methods and analysis in
Supplementary Figure 10). Consistent with a lack of cell death or degeneration as detected by EM, microarray analysis revealed that less than 1.5% of probe sets detected changes in RNA levels using low stringency criteria (≥ 1.3-fold difference;
Supplementary Table 1 and
Supplementary Fig. 11). Cluster analysis of significantly enriched transcripts in Atg16L1 deficient Paneth cells revealed a striking signature of genes involved in PPAR pathways, adipocytokine signaling, and aspects of lipid metabolism ( and
Supplementary Fig. 12). Additionally, transcripts for several acute phase reactants including serum amyloid A1, haptoglobin, and complement factors D and I were elevated (). Of particular interest was the observation that the adipocytokines leptin and adiponectin, previously reported to be increased in CD patients
5,4, were amongst the most highly enriched transcripts (). To determine if these transcriptional changes are unique to Atg16L1 deficient Paneth cells, we examined a second primary cell type from Atg16L1
HM mice. Autophagy is important in the function of T cells
22. Thymocytes from Atg16L1
HM mice were normal in number but expressed low levels of Atg16L1 and exhibited decreased conversion of LC3I to LC3II (
Supplementary Fig. 13) demonstrating that Atg16L1 is important for autophagy in thymocytes. Microarray analysis of these cells revealed that, in striking contrast to Paneth cells, expression of only 27 genes was altered more than 1.3 fold (
Supplementary Fig. 14). There was no significant change in expression of the most significant clusters of transcripts altered in Atg16L1
HM Paneth cells, and only one gene altered in thymocytes was also altered in Paneth cells (). Therefore the transcriptional signature of Atg16L1 deficiency is specific to Paneth cells, again emphasizing the unique effects of Atg16L1 deficiency on these cells. Taken together with the extensive morphologic abnormalities documented above, we conclude that Atg16L1 deficiency is associated with profound alterations in the specialized properties of Paneth cells including defective granule exocytosis and unexpected increases in expression of genes involved in regulating injury responses.
Given the importance of Atg16L1 and Atg5 in Paneth cells in mice, we examined the role of the human
ATG16L1 CD risk allele via a retrospective analysis of ileocolic resection specimens from patients with CD. We studied tissue sections from the uninvolved proximal margins, containing little or no inflammation, from 10 CD patients homozygous for the
ATG16L1 risk allele compared to 7 CD controls without the risk allele. All 17 patients lacked the three major
NOD2 risk alleles and the protective IL23R allele for CD
7,23. Independent blinded examination by T.S.S. and E.M.B. revealed that 100% of at risk patients and 0% of controls contained abnormal Paneth cells similar to those in Atg16L1
HM mice (). We quantified lysozyme staining in CD patient specimens, and like Atg16L1
HM mice, found that patients carrying the
ATG16L1 risk allele contained an increased proportion of Paneth cells with disorganized or diminished granules or exhibiting diffuse cytoplasmic lysozyme staining (). Moreover, consistent with transcriptional analysis in mice, 19% of Paneth cells from at risk patients that exhibited diffuse lysozyme staining also stained positive for leptin protein compared to only 2% of controls (p<0.05) (). These findings demonstrate a remarkable concordance between the pathology and transcriptional profile of Paneth cells from Atg16L1
HM mice and Paneth cell abnormalities observed in CD patients with the risk allele of
ATG16L1. These data provide the first indication that Atg16L1 has a specific role in humans and mice in regulating the specialized properties of Paneth cells, and provide a novel and relevant mouse model that emulates one of the many diverse pathological hallmarks of human CD. We show that Atg16L1 and a second autophagy protein Atg5 are critically important for the known role of Paneth cells in secretion of granule contents that may alter the intestinal microbiota. In addition, we demonstrate a previously unknown role of Atg16L1 in the regulation of Paneth cell expression of adipocytokines previously associated with CD. Within the intestinal epithelium, the dramatic effect of autophagy protein deficiency on Paneth cells, but not enterocytes which share a common progenitor, indicates that autophagy can contribute to disease pathogenesis via a highly specific role within a single cell lineage. Indeed, the effects of hypomorphic expression of Atg16L1 were specific to Paneth cells and not seen in Atg16L1-deficient thymocytes. An important implication of this type of ‘within-lineage’ specificity is that future studies will need to focus on how Atg16L1 polymorphisms affect the function of differentiated Paneth cells. Since both environment and genotype play a role in human CD pathogenesis
7, it will be interesting to determine whether environmental triggers including agents that damage the intestine or pathogens alter the pathological features associated with compromised Atg16L1 function.