Although the gut microflora is essential to the development of the immune system, it can also be detrimental to the host. Inflammatory bowel disease (IBD) is associated with uncontrolled inflammatory CD4
+ T cell responses to bacteria in the gastrointestinal tract (
50,
51). Inflammatory responses resulting in IBD are frequently directed against specific subtypes of bacteria, including
Helicobacter, Clostridium, and
Enterococcus. It is interesting that these bacterial subtypes can be abundant members of the gut microflora of healthy individuals (
7,
52). The mechanisms behind initiating and maintaining an inflammatory immune response to commensal bacteria are largely unknown.
Symptoms of IBD are reduced if bacterial numbers in the intestine are decreased by means of antibiotic treatment (
53,
54). Moreover, in rodent models, maintenance in a GF environment can protect animals genetically susceptible to IBD from intestinal inflammation (
55–
59). Consequently, it has been hypothesized that IBD can result from an imbalance among different types bacteria in the intestine (
7,
60). In some IBD patients, entire classes of bacteria are lost from the gut flora (
61). It may be that some bacteria in the gut minimize the pathogenic potential of other bacteria commonly associated with IBD. Recent research has demonstrated that PSA produced by
B. fragilis in the gut may be capable of preventing IBD induced by the presence of bacterial agents of this disease (
11).
As discussed above, the lymphocyte populations in the spleens of GF mice contain a reduced proportion of CD4
+ T cells. However, colonization of GF mice with
B. fragilis restores the CD4
+ population to that found in conventional colonized mice (
10). Further characterization of the CD4
+ T cell population in the spleen reveals that GF mice have a lower proportion of CD4
+CD45Rb
low T cells than conventionally colonized mice. CD45Rb
low T cells, which are thought to be antigen experienced, have anti-inflammatory properties that can provide protection in animal models of IBD (
62). Remarkably, colonization of GF mice with
B. fragilis increases the proportion of CD4
+CD45Rb
low cells in the spleen to conventional levels. This effect is PSA dependent; colonization of the GF mice with a strain of
B. fragilis lacking PSA has no impact (
11).
Furthermore, PSA can protect mice in an experimental model of colitis. Mice lacking recombination-activating genes (Rag
−/−) have no T or B cells. If CD4
+CD45Rb
high T cells are transferred into Rag
−/− mice and the animals are colonized with
Helicobacter hepaticus, colitis develops within 2 months (
63). The intestinal pathology of these mice is marked by a high degree of inflammation, colonic hyperplasia, and expression of pro-inflammatory cytokines. The mice also exhibit significant weight loss. If, at the time of colonization with
H. hepaticus, the mice are co-colonized with a PSA-producing strain of
B. fragilis, they are protected from disease and from the associated production of pro-inflammatory cytokines. However, if the mice are co-colonized with a
B. fragilis mutant deficient in PSA production rather than with the wild-type strain, they develop full-blown colitis. Levels of colonization by all bacterial species remained constant; therefore, this protection is not due to differences in bacterial clearance. In addition, oral administration of purified PSA during
H. hepaticus colonization almost completely protects mice against
H. hepaticus–induced colitis by eliminating leukocyte infiltration and the resulting colonic hyperplasia (
11). Thus, the presence of a single molecule produced by a single organism is sufficient to prevent colitis induced by colonization with a commensal bacterium that has pathogenic potential.
8.1. Repression of pro-inflammatory cytokines associated with the Th17 lineage
The protective effects of
B. fragilis PSA in experimental models of colitis do not appear to be related directly to the role of the organism in establishing a Th1/Th2 balance in GF mice. Instead, PSA appears to dampen the pro-inflammatory response that leads to colitis by repressing Th17 cells (
11). Classically, CD4
+ T helper cells were thought to differentiate into only two lineages: Th1 and Th2. However, research has now shown that CD4
+ T cells can also differentiate into Th17 cells, which are characterized by the production of IL-17 and not of IFN-gamma or IL-4 (
36,
64). Because IL-17 is a potent chemoattractant for neutrophils, Th17 cells are key mediators of inflammation (
39). Increased levels of IL-17 have been found in the inflamed mucosa and sera from patients with IBD (
65). Th17 cells have a different developmental program and produce different cytokines than Th1 or Th2 cells. The induction of Th17 differentiation is independent of IL-12 or IL-4; rather, IL-6 and transforming growth factor-beta 1 (TGF-beta1) (in mice) and IL-1 (in humans) mediate Th17 differentiation from naive CD4
+ T cells. IL-23 is necessary for the expansion and maintenance of the Th17 lineage. In addition to IL-17, Th17 cells produce the pro-inflammatory cytokines IL-21 and TNF-alpha (
36).
Protection against colitis mediated by
B. fragilis PSA results from modulation of cytokine production. Levels of cytokines critical in the Th17 lineage—i.e., IL-1beta, IL-23, and TNF-alpha are elevated in the colons of Rag
−/− mice colonized with
H. hepaticus. Colonization with
B. fragilis in conjunction with
H. hepaticus reduces levels of the pro-inflammatory cytokines to those found in SPF Rag
−/− mice. In addition, documented decreases in levels of TNF-alpha and IL-23 in the spleens of co-colonized mice demonstrate that immune modulation in the intestinal compartment can affect the systemic immune system (
11).
PSA has been given therapeutically to decrease pro-inflammatory cytokine production in an experimental model of colonic irritation (
66). The cytokines induced by rectal administration of trinitrobenzene sulfonic acid (TNBS) mimic those found in the
H. hepaticus colitis model. CD4
+ T cells from the spleens and MLNs of TNBS-treated animals produce elevated levels of IL-23, TNF-alpha, and IL-17. Therapeutic administration of PSA to TNBS-treated animals significantly reduces levels of these pro-inflammatory cytokines. In addition, PSA treatment decreases the expression of RORgamma-t, the transcription factor that directs the Th17 differentiation pathway (
11,
67).
8.2. IL-10 is required for the PSA mediated anti-inflammatory response
PSA suppression of the inflammatory immune response is dependent on IL-10, one of the most potent anti-inflammatory cytokines in the immune system. IL-10 plays a critical role in protection against inflammation in several animal models, including the
H. hepaticus model of colitis (
68,
69). Several experimental approaches support the assertion that IL-10 produced by CD4
+ T cells is required for protection against inflammation by PSA in both TNBS and
H. hepaticus models. First, mice that lack IL-10 (IL-10
−/−) and are treated with TNBS develop symptoms of intestinal inflammation even in the presence of PSA. Second, if IL-10
−/− mice are colonized either with
H. hepaticus (to induce inflammation) or with
H. hepaticus and
B. fragilis together, the presence of
B. fragilis does not decrease the levels of TNF-alpha or IL-17 produced by MLN cells stimulated in culture with
H. hepaticus antigen. The level of IL-17 is actually higher in co-colonized mice than in mice colonized with
H. hepaticus alone. Finally, if, in addition to PSA, an antibody to IL-10 is administered to Rag
−/− mice after transfer of CD4
+CD45Rb
high cells, the polysaccharide no longer protects the mice from developing colitis during colonization with
H. hepaticus. In addition, PSA cannot protect mice from colitis if the CD4
+CD45Rb
high cells used to induce experimental colitis are isolated from an IL-10
−/− mouse (
11). To date, PSA is the only bacterial molecule known to be sufficient to stimulate anti-inflammatory responses that can counteract the pro-inflammatory responses induced by commensals with pathogenic potential.