Activation of NF-κB during infection has a profound effect on the expression of multiple targets which guide the maturation of immune responses against invading pathogens [
22]. Recently, much attention has been given to the immunomodulatory activities of the microbiota and various probiotic organisms. Studies have shown a
L. plantarum probiotic to be effective at modulating immunity through NF-κB and MAP kinase signaling in a number of cell types including mucosal epithelial cells [
23]. In this study we showed the immunomodulatory effects of a urogenital probiotic,
L. rhamnosus GR-1 on human bladder cells. In order to activate the urothelial cell defense mechanisms in a way that resembles the response during a UTI, including NF-κB and cytokine release, we challenged the cells with heat-killed
E. coli. Although only live bacteria are active in the infection process, we wanted to reduce the microbe-to-microbe signaling present between viable bacteria as well as the effects of
E. coli metabolites on cell cultures [
24]. Our results showed that bladder cells challenged with heat-killed
E. coli and subjected to stimulation with
L. rhamnosus GR-1 exhibited increased NF-κB activation and TNF release.
The finding that
L. rhamnosus does indeed have immunomodulatory properties is not new per se, but most previous experiments have been done using immune cells [
20,
25]. Adjuvant properties of
Lactobacillus species have been demonstrated in several
in vivo models. An
L. casei strain boosted immunoglobulin (Ig)A secretion in a mouse model of
Salmonella typhimurium infection [
26]. Another effectively potentiated IgG responses after subcutaneous vaccination of chickens towards Newcastle disease virus and infectious bronchitis virus [
27]. Collectively, these studies provide evidence that lactobacilli can be used for potentiating immune responses
in vivo. Nevertheless, although TNF was upregulated by
L. rhamnosus GR-1 treatment, anti-inflammatory properties of lactobacilli are well established [
25]. In our study, both IL-6 and CXCL8 were modulated differently from TNF, where both were down-regulated after lactobacilli treatment of
E. coli-challenged cells. These effects might represent an alternative influence of
L. rhamnosus GR-1 on epithelial immune function, guided by transcription factors other than NF-κB, such as MAP kinase/AP-1 pathways or post-transcriptional regulation of NF-κB-regulated genes. Another possibility is that
L. rhamnosus GR-1 produces substances that can interfere with cytokine release from the cell or cytokine stability in the extracellular space.
Probiotic health benefits have been shown to be somewhat strain specific. In this study, we showed that two strains exhibit different abilities to increase activation of NF-κB.
L. rhamnosus GG elicited a weaker potentiation of
E. coli-induced NF-κB activation than
L. rhamnosus GR-1. Heat-killed preparations of
L. rhamnosus GR-1 marginally augmented NF-κB, in a manner similar to using viable
L. rhamnosus GG (below twofold). It is possible this augmentation is due to surface-associated structures shared by both strains. Lactobacilli surface components have previously been shown to modulate NF-κB in a contact-dependent manner [
17]. T24 cells express TLR2, and can recognize lipoteichoic acid (LTA) found on the surface of lactobacilli with increased NF-κB activation as a consequence [
28]. However, since heat-killed lactobacilli only slightly induced NF-κB activation that is not a likely mechanism given that LTA is anchored to the Gram-positive cell wall. A more probable mechanism is that products released during bacterial growth are responsible for the NF-κB augmentation by
L. rhamnosus GR-1. We have previously shown that spent culture supernatant from
L. rhamnosus GR-1 can augment NF-κB activation in
E. coli-challenged T24 cells [
29]. There are no published studies on the identity of the secreted proteins from
L. rhamnosus GR-1. However
L. rhamnosus GG is known to release a small number of proteins during growth, none of which have an established immunomodulatory effect [
30]. A comparison of secretory proteins from the two strains might help explain the differences in terms of immune potentiation.
The role of TLR4 was evaluated by blocking LPS binding to the receptor using polymyxin B, which eliminated the observed NF-kB potentiation. We initially saw that expression of TLR4 at genetic and protein levels was increased during co-stimulation compared to controls, or during individual stimulation with
E. coli or lactobacilli. Although TLR4 has LPS as a natural ligand, other
E. coli components such as pili have been shown to be able to activate TLR4. However, in this study, polymyxin B completely inhibited NF-κB activation in
E. coli stimulated cells, therefore pili or other surface structures could not have contributed to this effect [
31]. We consider that an increased number of TLR4 present on the cell facilitated activation by ligands on
E. coli and lactobacilli alike.
TLRs are important in UTI disease progression, as shown in C3H/HeJ mice with a mutation in the
Tlr4 gene. After an
E. coli infection, these mutant mice have problems removing the pathogens from their urinary tract [
32]. A recent study scoring TLR4 expression levels in healthy control subjects and UTI patients showed that the latter have a lower TLR4 expression than healthy controls [
9]. This important feature of TLR4 is consistent with the effect that certain
E. coli strains expressing immunomodulatory compounds have on TLR signaling and NF-κB activation. The effect of lactobacilli on NF-κB, TNF and TLR4 represents one possibility that increases the urothelial immune cell responses. This augmentation might facilitate early detection and clearance of pathogens.
As defined by FAO/WHO, probiotic microbes must be alive when administered in order to confer health benefits [
33]. The
in vitro effects on NF-κB augmentation has been reported to be dependent on lactobacilli viability, since after heat-killing they only had a marginal effect on NF-κB activation in co-stimulation experiments with
E. coli. This supports modulation of NF-κB as a potential probiotic mechanism. The ability of probiotic lactobacilli to interfere with UPEC colonization in the vagina, and thereby the pathogens' ascension into the bladder, could therefore involve immunomodulatory activity, specifically via NF-κB activation.