The presence of eosinophils in general has been considered an end-stage effect of Th2 polarization, but it can now be alternatively viewed as immunoregulatory, itself tilting T cell polarization toward a Th2 response. IL-5 is known as a Th2 cell product, but it is also a potent autocrine growth and survival cytokine produced by eosinophils themselves [
52–
55]. IL-5 is produced by eosinophils in a wide variety of pathologic settings in human disease [
56–
58]. In a mouse model of respiratory syncytial virus infection, inhibiting eosinophil chemotaxis by blocking eotaxin reduced both CD4
+ T cell influx into the lungs and production of IL-5 [
59].
Critical to making the case that eosinophils are able to cause Th2 polarization is the observation that eosinophils produce IL-4, a key Th2-polarizing cytokine [
60,
61]. Sabin et al. [
60] showed in a murine model of
Schistosoma infection, a known potent Th2 stimulus, that there was a non-T cell population responsible for IL-4 production. They went on to demonstrate that in this model, IL-5 was produced and caused eosinophil recruitment. Eosinophils recruited to the i.p. site of
Schistosoma egg injection proved to be responsible for local IL-4 production, suggesting that eosinophils are the primary early drivers of Th2 polarization in the immune response to murine schistosomiasis [
61]. There appears to be an additional amplification effect of IL-4 as well; IL-4 itself recruits antigen-specific IL-4 producing eosinophils to the airways in a murine OVA-challenge system [
62]. The recruited eosinophils had increased expression of IL-4 than local CD4
+ T cells, suggesting that eosinophils are the dominant source of this Th2 cytokine [
62]. Zhu et al. [
63] observed that bone marrow progenitor cells stimulated with IL-5 differentiated into IL-4 producing cells, the majority of which were eosinophils.
Studies utilizing bicistronic IL-4 reporter mice, known as 4get mice, have also been important in establishing IL-4 production by eosinophils [
64]. 4get mice infected with
Nippostrongylus brasiliensis demonstrate recruitment of IL-4 producing eosinophils to infected lung tissue [
65,
66]. Additionally, eosinophils from 4get mice constitutively express IL-4 and IL-13 transcripts, which are able to facilitate rapid cytokine production in response to stimulation [
67]. Though further data from 4get mice infected with
N. brasiliensis indicate a non-eosinophil, IL-4 producing innate immune cell is required for Th2 cell recruitment, the demonstration of IL-4 production by eosinophils furthers the case for important immunoregulatory function of eosinophils in Th2 polarization [
68].
As noted previously, the presence of eosinophils promotes the production of Th2-associated cytokines from sensitized CD4
+ T cells and from already polarized Th2 cells, pointing toward a regulatory role of eosinophils in amplifying and perpetuating allergic inflammation [
25,
35]. Antigen-exposed eosinophils from a murine airways inflammation model are able to promote the production of IL-4, IL-13, and IL-5 by Th2 cells in co-culture [
25]; the same group of cytokines is similarly produced by sensitized CD4
+ T cells in co-culture with eosinophils [
35]. Through these three cytokines respectively, eosinophils act as immunoregulators via CD4
+ T cells to amplify Th2-polarization, amplify downstream Th2-mediated inflammation, and promote their own survival. The ability of eosinophils to affect Th2 responses via IL-4, IL-13, and IL-5
in vivo has been observed as well [
35,
69]. Eosinophils that were transferred intratracheally from OVA-challenged mice to sensitized mice trafficked to draining paratracheal lymph nodes, where they promoted IL-4, IL-13, and IL-5 production by Th2 cells [
35]. Significantly, this ability was dependent on CD80 and CD86 on eosinophils, providing a link between the antigen-presenting and Th2 polarization immunoregulatory roles of eosinophils in allergic inflammation [
35]. A similar effect is seen with mice subjected to ragweed challenge, with airways eosinophils expressing IL-4, IL-5, and the Th2 transcription factor GATA-3 [
70]. The demonstration of Th2 cytokine production in airways inflammation has been mirrored in murine schistosomiasis, in which eosinophils are an important source of IL-2, IL-4, and IL-5 in the schistosome granuloma [
71].
It has been demonstrated that IL-4 is rapidly released in a vesicle-mediated fashion from human eosinophils in response to eotaxin and RANTES (regulated on activation, normal T cell expressed and secreted) [
72]. Additionally, the rapid release of IL-4 that is stimulated by eotaxin is enhanced in the presence of IL-5, with the entire process being mediated by CCR3 receptors to eotaxin [
72]. The eosinophil chemoattractant cytokine IL-16 promotes release of preformed IL-4 preferentially to the Th1-polarizing cytokine IL-12 via autocrine mechanisms acting on CCR3 receptors on eosinophils [
73]. The fact that IL-4 is able to be released in such a manner provides a mechanism by which eosinophils are able to rapidly modulate T cell responses toward a Th2 phenotype.
New evidence indicates that eosinophils also regulate Th2 responses via secretion of IL-25 [
74]. Eosinophils have now been found to secrete IL-25, and, in turn, promote amplification of the Th2 response by memory Th2 cells that have been stimulated by thymic stromic lymphopoietin-activated DCs [
74]. The Th2 cells exposed to eosinophil-derived IL-25 have increased Th2 cytokine production, and Th2 cells exposed to exogenous IL-25 have increased proliferation and Th2 polarization; the effect of IL-25 is independent of IL-4 [
74].
Eosinophils may act to promote Th2 polarization through inhibition of the Th1 pathway [
75]. DCs transfected to produce indoleamine 2,3 dioxygenase (IDO), which breaks down tryptophan, have been noted in the past to have cytotoxic effects to T cells, presumably through the action of tryptophan metabolites [
76]. Odemuyiwa et al. [
75] demonstrated that human eosinophils express IDO and that IDO is upregulated by IFN-γ. An IFN-γ producing T cell line had decreased proliferation and increased apoptosis when co-cultured with eosinophils, while an IL-4 producing T cell line did not show the same effect [
75]. These data suggest that eosinophils can mediate Th1 cell apoptosis via IDO when exposed to IFN-γ, causing polarization to tilt away from Th1 and toward Th2 [
75]. Similarly, Jung et al. [
77] have recently confirmed the finding that human eosinophils, both from peripheral blood and from an eosinophil cell line, can be stimulated to express IDO when stimulated with IFN-γ, IL-3, and GM-CSF.
Despite several lines of evidence that are in support of eosinophils actively regulating the Th2 response, there is evidence that suggests eosinophils may not be absolutely necessary to initiate and perpetuate Th2 inflammation. IL-5 knockout mice, which are eosinophil deficient (but not eosinophil devoid), continue to have an intact Th2 response after injection of antigen from the parasite
Nippostrongylus [
78]. Hypereosinophilic mice produced via an IL-5 gene-containing plasmid actually have reduced antigen-specific allergic inflammation when the gene is delivered before sensitization to allergen [
79]. Furthermore, this effect appeared to be mediated by TGF-β produced by the eosinophils themselves [
79]. However, a recent study by Jacobsen et al. [
80] provides the most convincing evidence to date that eosinophils play a central and essential immunoregulatory function in the Th2 response characteristic of allergic pulmonary inflammation. They demonstrated that
PHIL mice, which are lacking in eosinophils, have deficient recruitment of CD4
+ T cells to the lung and airways in response to antigen challenge, as well as reduced levels of Th2-cytokines (IL-4, IL-5, and IL-13) and Th2-chemokines (CCL 17 and CCL22) [
80]. These findings support prior data from another eosinophil-deficient strain (ΔdblGATA) and a strain deficient in eosinophil recruitment (CCR3 knockout) that both had decreased airway IL-4 and IL-13 in response to airways challenge [
81]. Perhaps more significantly, Jacobsen et al. [
80] also found that adoptive transfer of antigen-specific Th2-polarized T cells alone was not sufficient to generate a Th2 response to airways challenge in
PHIL mice; adoptive transfer of eosinophils was needed as well to provoke Th2 inflammation. This finding strongly suggests that eosinophils are a requirement for Th2 polarization in allergic airways inflammation.
Though eosinophils have long been recognized as a component of allergic inflammation, the evidence reviewed in this section provides a basis for recognizing them as true regulators of the Th2 response, rather than as bystanders or simply end-stage effectors.