Colonization of the gastric mucosa by
H. pylori in most individuals is associated with a chronic inflammatory and immune response that on the one hand probably accounts for the diseases caused by
H. pylori, but on the other hand does not clear the infection. The lifelong adaptation of
H. pylori, which is noninvasive or minimally invasive (
17,
18,
32,
38) with the host inflammatory and immune response (
6,
7,
14,
38) is distinctly different from invasive enteric pathogens, such as
Salmonella and
Shigella species, that are usually associated with self-limited infection and generation of protective immunity (
42,
47). Interestingly, both invasive enteric pathogens and
H. pylori generate innate immune responses characterized by intense inflammation and immunity (
6,
7,
14,
38,
42,
47) dominated by Th1 cytokine (such as IFN-γ and IL-12) production (
2,
11,
20,
36,
37,
42). This raises the question as to whether the persistence of
H. pylori is primarily due to inaccessibility of the intraluminal bacteria to mucosal immune effector mechanisms or is due to other qualitative or quantitative differences in the inflammatory and immune response that favor persistent bacterial colonization. Although enterocytes likely contribute critical signals in the response, such as IL-8 production (
10), the innate and adaptive immune response to
H. pylori most likely includes interaction of bacteria with intramucosal cells, including cells of macrophage and lymphoid lineage due to translocation of bacterial products across the epithelium (
17,
18,
32). Therefore, the primary focus of this investigation was to evaluate the potential for different
H. pylori products to elicit innate immune responses, and, in particular, cytokine responses that could play an important role in modulating adaptive immunity.
The initial experiments comparing three distinctly different
H. pylori preparations—intact bacteria, a crude whole-bacterial-cell lysate, and recombinant enzymatically inactive urease—demonstrated dose-dependent induction of IL-10, IL-12p40, and IFN-γ secretion by PBMCs, but no significant induction of IL-2 or IL-5. These observations are confirmatory of the observations of previous studies which have demonstrated induction of IFN-γ, IL-10, and IL-12 in naïve PBMC cultures with several different types of bacterial preparations (
2,
13,
16). It is interesting that there were no major differences in the cytokine-inducing activities of the three different preparations used, suggesting broad recognition of
H. pylori products by innate mechanisms. Since IL-12 is thought to be a critical regulatory cytokine for IFN-γ production (
2,
13,
16), we examined the effect of blocking anti-IL-12 antibodies and observed only modest effects on IFN-γ production. This suggests that the stimulatory effect of
H. pylori products on their target cells, which are not defined, is largely independent of IL-12. The direct activation of IFN-γ and IL-12 production by
H. pylori products suggests that this is a possible mechanism for the observed in vivo predominance of Th1 cytokine (IFN-γ)-expressing cells in the gastric mucosa of
H. pylori-infected patients (
1,
16,
41,
46) and the in vitro increased production of IL-10 and IL-12 in gastric biopsies from infected patients (
2). Furthermore, based on studies of IFN-γ (−/−) mice, the presence of this cytokine is critical not only for inflammation, but also for downregulation of bacterial colonization (
41). The biological effects of increased IL-10 production in
H. pylori gastritis are unknown, but based on the observation of more severe gastritis in
H. felis-infected IL-10
(−/−) mice compared to controls (
3), IL-10 may contribute to a protective response.
We simultaneously carried out experiments to evaluate the potential for the same three
H. pylori preparations to modulate cytokine responses by adding them to mitogen-stimulated cultures. These experiments revealed inhibition of high-output mitogen-stimulated IL-5, IL-10, IL-12, and IFN-γ production only at very high doses of bacteria or bacterial protein. In contrast, dose-dependent inhibition of mitogen-stimulated IL-2 production was observed at lower concentrations of bacterial preparations. The effect of
H. pylori products on inhibition of IL-2 production may be a direct effect on T cells, rather than an indirect effect mediated through other cell types, since we also observed direct inhibition of IL-2 production by a Jurkat T-cell line. We have previously shown that other bacterial products, isolated from enteropathogenic
Escherichia coli, directly inhibit cytokine production by T cells (
24,
25,
33). It is presently unknown whether
H. pylori gastritis is associated with inhibition of IL-2 production in vivo or whether IL-2 plays an important role in disease pathogenesis, as might be determined by study of IL-2
(−/−) mice.
If
H. pylori products limit expression of IL-2 in vivo, then there are a number of possible implications of this finding. First, IL-2 is one critical cytokine necessary for expansion of immune responses, and thus, inhibition of IL-2 could limit the magnitude of the overall immune response. Second, cell proliferation is required for activation of IL-4 gene expression from naïve lymphocytes (
39), and thus inhibition of IL-2 could limit expansion of a Th2 cytokine response. Our results clearly demonstrate that
H. pylori products not only inhibit IL-2 production, but also inhibit mitogen-stimulated proliferation of PBMCs and Jurkat T cells. However, the inhibitory effect on cell proliferation was only observed for intact
H. pylori bacteria or lysate, but not for urease, while inhibition of IL-2 production was observed with all three products. This observation suggests that inhibition of IL-2 by
H. pylori products is not sufficient for inhibition of proliferation.
The natures of the factors present in intact bacteria and bacterial lysates that both induce and inhibit cytokine production are unknown. In preliminary experiments, we found that the factor or factors that inhibit IL-2 production are heat and protease sensitive, suggesting that bacterial proteins mediate the inhibitory activity. This observation is consistent with the observations of Knipp et al. (
29) showing that a protein preparation of
H. pylori inhibits proliferation. In addition, it has previously been shown that recombinant CagA protein inhibits proliferation of PBMCs (
40). Our observation that recombinant urease also inhibits IL-2 production suggests that multiple different
H. pylori proteins may have immunomodulatory activity.
In addition to bacterial proteins, there has been recent interest in the ability of bacterial DNA motifs to elicit innate immune responses in murine cells, including increases in NK activity, B- and T-cell activation, and production of multiple cytokines, including IL-6, IL-12, and IFN-γ, but not IL-5 or IL-10 (
21,
26,
27,
31,
35,
44,
45,
49). Surprisingly, previous studies have demonstrated that the effects of bacterial DNA on innate immune cell activation may be greater than that of bacterial lipopolysaccharide (
27). Our data demonstrate that
H. pylori DNA also has the potential to activate IFN-γ and IL-12 production by human PBMCs. The concentrations of
H. pylori DNA required to elicit increased cytokine responses were high and much greater than the estimated DNA concentrations in the bacterial lysates and intact bacterial preparations used in this study. Nonetheless, it remains possible that bacterial DNA released by cell death might achieve a sufficiently high concentration in proximity of immune cells to result in activation in vivo.
In summary, the results of these studies demonstrate that different products of H. pylori, including recombinant urease, crude protein preparations, intact bacteria, and bacterial DNA, all have the capacity to modulate innate immunity. In particular, the marked upregulation of IFN-γ and IL-12 production and inhibition of IL-2 production and proliferation by activated cells may contribute to Th1 polarization of the immune response observed in vivo. The capacity of a variety of different H. pylori products to elicit innate immune responses may significantly influence their potential to elicit protective immunity when used as vaccines.