1. Introduction
Interleukin (IL)-18 is a proinflammatory cytokine produced by antigen-presenting cells (APCs) and T cells such as macrophages, dendritic cells (DCs) and CD4
+ T cells. The IL-18 receptor (IL-18R) is a heterodimer comprised of a signaling IL-18Rβ subunit (also called IL-1RAcPL and IL-1R7) and a ligand-binding IL-18Rα subunit. Downstream from IL-18R, the signaling activates interleukin-1 receptor-associated kinase 4 (IRAK4) and the adaptor molecule MyD88, in a scenario similar to that of other IL-1 and Toll-like receptors (TLRs) [
1,
2,
3].
An infection or the exposure to a pathogen such as a bacterium, virus, parasite or fungus can trigger the production of IL-18 by APCs and T cells [
4]. IL-18 is used as an early marker of renal tubular damage in acute kidney injury (AKI) in humans [
5], and in a mouse model, IL-18 treatment worsened acute tubular necrosis [
6,
7]. It was demonstrated that IL-18 is also an interferon-gamma (IFN)-γ- and tumor necrosis factor (TNF)-inducing factor based on to its ability to induce the production of TNF and IFN-γ in APCs, T cells and monocytes [
8]. We hypothesized that if an injured kidney becomes hyper-responsive to lipopolysaccharide (LPS), which is a component of Gram-negative bacteria, it may increase the levels of circulating inflammatory cytokines such as TNF and IFN-γ and result in a worsening of the AKI, resulting in further damage to renal function.
The reported incidence of AKI ranges from 5% in all hospitalized patients to 30–50% in intensive care units [
9]. Infiltrating cells have been indicated to play important roles in the initiation and progress of tubule dysfunction and structural injury in AKI [
10] by inhibiting infiltrations by lymphocytes [
11] or macrophages [
12], leading to decreased tubule damage. In the repair of epithelial cells that occurs in response to an AKI, the differentiation, migration and proliferation of surviving tubular cells is essential for the restoration of tissue integrity [
13,
14].
We demonstrate herein that when IL-18Rα knockout (KO) mice experienced an LPS-induced AKI, they had markedly ameliorated renal function. The renal status of the IL-18Rα KO mice was also ameliorated by the downregulation of inflammatory cytokines after LPS injection. The expressions of mRNA and protein Toll-like receptor 4 (TLR4) in IL-18Rα KO mice did not differ significantly between before and after they were injected with LPS. Our results indicate that in the LPS-induced AKI model mice, IL-18Rα has a crucial and direct signaling pathway in CD4+ T cells in APCs and not via a TLR4 signaling pathway.
3. Discussion
We have published several studies about IL-18Rα. For example, we showed that MRL- Fas
lprmice (well known as lupus model) cross-bred with mice deficient in IL-18Rα had a better survival rate and lessened nephritis due to reduced levels of autoantibodies [
20]. We then observed that IL-18Rα may mediate anti-inflammatory responses through suppressors of cytokine signaling-1 and/or -3 in cisplatin-induced AKI [
21]. Our later investigation showed that IL-18Rα also mediates apoptosis in ischemia/reperfusion injury model mice [
7]. It remains unknown how APCs such as macrophages and DCs affect the immune response in the acute advanced and recovery phases. Our present findings demonstrate that the numbers of inflammatory cells in the kidney were decreased and the renal function was ameliorated in IL-18Rα-deficient mice after LPS injection.
Studies from 1997 and 200 demonstrated that the AKI induced by LPS or by other toxins results in the release of inflammatory mediators, even without lowering blood pressure [
22,
23]. In the present study, the blood pressure values of the mice as measured by a tail cuff were not significantly lower post-LPS injection (
Supplementary Table S1). We have sought to determine the mechanisms underlying the activation of IL-18Rα and IL-18Rα signaling in the immune system’s response to LPS-induced AKI. To gain a better understanding of these issues, we thus investigated the effects of the inflammatory cytokines and TLR4 expression, which is accompanied by the influx into the kidney of monocytes such as APCs and CD4
+ T cells in the acute advanced and recovery phases.
Honda et al. showed that CD4
+ T cells express surface TCRs (T-cell receptors) that identify foreign antigenic peptides bound to MHC (major histocompatibility complex) molecules on the surface of APCs in the lymph nodes [
24]. These naive T cells are induced to proliferate rapidly by signaling via the TCR and then integrate additional signals that allow them to differentiate into Th1, Th2 or Th17 phenotypes [
23,
25,
26]. Of particular interest is the report that Th1 cells can gain the capacity to secrete IFN-γ (which is a key cytokine in the activation of macrophages and host protection against intracellular pathogens) and IL-18 [
27,
28]. After effector CD4
+ T cells recognize peptide/MHC complexes displayed on tissue APCs [
29,
30], they can secrete cytokines, and the inflammatory cytokine production is thus targeted locally to the precise anatomical site of infection. Notably, IFN-γ and IL-18 elicited from Th1 cells can also activate neighboring macrophages [
22,
31], providing some nonspecific defense in the area around the Th1 stimulation.
Calvani et al. noted that IL-18 apparently mediates inflammation by initiating and expanding Th1 responses and by its direct effects on lymphocytes and macrophages [
27]. IL-18 is nephritogenic; it recruits IL-18R-positive DCs to the kidneys, enhancing the immune-mediated renal damage [
32,
33]. When IL-18 binds to its specific receptor IL-18R, recruiting the adaptor molecule MyD88 to the Toll/IL-1R domain of IL-18R, IL-18 can thereby induce the production of other inflammatory cytokines (e.g., IFN-γ, TNF-α, IL-6 and IL-1β) [
34]. There are several cytokine-deficient mouse strains that are resistant to the lethal actions of LPS [
35]. For example, Okamura et al. reported that IFN-γR KO mice displayed enhanced resistance to LPS, and the severity of the clinical changes caused by LPS (e.g., liver injury, weight loss) was greatly decreased in the mice [
36].
However, IFN-γ production can itself be modulated by regulatory cytokines such as IL-12 and -18. IL-12 can both induce IFN-γ production and act synergistically with IL-18 [
37]. IFN-γ production by B cells and macrophages occurred only after simultaneous treatment with IL-12 and -18 [
38,
39], whereas it was reported that T cells and natural killer (NK) cells do not require either IL-12 or IL-18 to produce IFN-γ [
29,
40]. Unusually high levels of IL-18 (which can induce IFN-γ production) and TNF-α have been described in humans [
41]. Such IL-18 levels are associated with an imbalance between the natural inhibitor of IL-18 (i.e., IL-18 binding protein [IL-18BP]) and IL-18 that is followed by an excess of free IL-18 [
42]. The IL-18BP promoter has an element that is responsive to IFN-γ, and IFN-γ can effectively induce the production of IL-18BP [
43].
Using a murine model of hemophagocytic lymphohistiocytosis treated with IL-18BP, Chiossone et al. reported that this treatment decreased hemophagocytosis and reversed both liver and spleen damage in the mice [
44]. In addition, treating the mice with IL-18BP reduced the production of both IFN-γ and TNF-α by CD8
+ T cells and NK cells, and it reduced the expression of Fas ligand on the surfaces of NK cells. In the present study, we investigated the effects of inflammatory cytokines and TLR4 expression (which is accompanied by an influx of monocytes including CD4
+ T cells and APCs) in IL-18Rα-deficient mice after LPS injection, and we observed that the survival rate and renal function were improved by suppressing serum inflammatory cytokines and the renal cytokine mRNA expressions (especially those of IL-18, IFN-γ, TNF and IL-6) and an accumulation of CD4
+ T cells in IL-18Rα KO mice. It is possible that the administration of IL-18BP may eventually be revealed to have potential in the therapy of AKI in endotoxemia.
To understand the mechanisms underlying the IL-18R signaling pathway when mice are exposed to LPS-induced AKI, we used IL-18Rα-deficient mice in this study. Specific cell-surface receptors mediate the binding of IL-18 to its target cells; this is similar to the IL-1R mechanism. An α-chain (IL-18Rα) [
45,
46] and a β-chain (IL-18Rβ or AcPL) comprise the receptor of IL-18 [
47]. Born et al. proposed that IL-18Rβ does not itself interact directly with IL-18; they also suggested that IL-18Rα is responsible for the IL-18 binding. We investigated whether an IL-18Rβ signaling pathway contributes to decreased renal function. We treated WT mice with an anti-IL-18Rβ antibody in a cisplatin-induced renal injury model [
21], and we found that this treatment reduced the renal function. The involvement of an IL-18Rβ signaling pathway in the immune systems in AKI model mice remains unknown. Further studies of IL-18Rβ-deficient mice with LPS-induced AKI may clarify this mechanism.
At this time, our data suggest that an IL-18Rα-mediated signaling pathway, not via a TLR4 signaling pathway, in CD4+ T cells and APCs plays a major part in the immune response to LPS-induced AKI in the acute advanced phase. In the recovery phase, the IL-18Rα-mediated signaling pathway in APCs, especially macrophages, has a critical role in the recovery of the damaged kidney tissue by the clearance of debris in response to LPS-induced AKI. Our present findings also demonstrated that the expressions of IL-18 and IL-18Rα mRNA in CD4+ T cells and the IL-18R1+ in CD4+ T cells and CD11c+ T cells peaked at 18 h as the acute advanced phase. Moreover, the survival rate and renal function were ameliorated by suppressing the serum inflammatory cytokines and the renal cytokine mRNA expressions (especially those of IL-18, IFN-γ, TNF and IL-6) and by the suppression of an accumulation of CD4+ T cells in IL-18Rα KO mice at 18 h.
Conversely, F4/80+, CD69+ and CD11c+ cells as APCs still showed increased infiltrations regardless of the renal function, and the levels of inflammatory cytokines were normal at 120 h in the recovery phase. These data suggest that F4/80+, CD69+ and CD11c+ cells might have important roles in the internalization and the clearance of apoptotic cells. The necrotic debris in the recovery phase was highlighted by splenocytes’ adoptive transfer from wild-type mice to IL-18Rα KO mice.
In summary, our results demonstrated that an IL-18Rα-mediated signaling pathway plays a critical role in CD4+ T cells and APCs and was faster at responding to IFN-γ and IL-18 than TLR4 stimulation in the pathogenesis of LPS-induced AKI. We conclude that as the pathological mechanism, mainly CD4+ T cells and APCs in the advanced phase have the critical role in the immune response to LPS-induced AKI.
In summary, our results demonstrated that IL-18Rα-mediated signaling plays critical roles in CD4+ T-cells and APCs and was markedly faster at responding to IFN-γ and IL-18 than TLR4 stimulation in the pathogenesis of LPS-induced acute kidney injury. We conclude that mainly CD4+ T-cells and APCs in the advanced phase play a direct and critical role in the immune response to the pathological mechanism in LPS-induced acute kidney injury.