[HTML][HTML] Repeated TLR9 stimulation results in macrophage activation syndrome–like disease in mice

EM Behrens, SW Canna, K Slade… - The Journal of …, 2011 - Am Soc Clin Investig
EM Behrens, SW Canna, K Slade, S Rao, PA Kreiger, M Paessler, T Kambayashi…
The Journal of clinical investigation, 2011Am Soc Clin Investig
Hemophagocytic lymphohistiocytosis (HLH) and macrophage activation syndrome (MAS)
are 2 similar diseases characterized by a cytokine storm, overwhelming inflammation,
multiorgan dysfunction, and death. Animal models of HLH suggest that disease is driven by
IFN-γ produced by CD8+ lymphocytes stimulated by persistent antigen exposure. In these
models and patients with “primary” HLH, the antigen persists due to genetic defects,
resulting in ineffective cytotoxic responses by CD8+ T cells and poor pathogen clearance …
Hemophagocytic lymphohistiocytosis (HLH) and macrophage activation syndrome (MAS) are 2 similar diseases characterized by a cytokine storm, overwhelming inflammation, multiorgan dysfunction, and death. Animal models of HLH suggest that disease is driven by IFN-γ produced by CD8+ lymphocytes stimulated by persistent antigen exposure. In these models and patients with “primary” HLH, the antigen persists due to genetic defects, resulting in ineffective cytotoxic responses by CD8+ T cells and poor pathogen clearance. However, infectious triggers are often not identified in patients with MAS, and some patients with HLH or MAS lack defects in cytotoxic T cell killing. Herein, we show that repeated stimulation of TLR9 produced an HLH/MAS-like syndrome on a normal genetic background, without exogenous antigen. Like previous HLH models, TLR9-induced MAS was IFN-γ dependent; however, unlike other models, disease did not require lymphocytes. We further showed that IL-10 played a protective role in this model and that blocking IL-10 signaling led to the development of hemophagocytosis. IL-10 may therefore be an important target for the development of effective therapeutics for MAS. Our data provide insight into MAS-like syndromes in patients with inflammatory diseases in which there is chronic innate immune activation but no genetic defects in cytotoxic cell function.
The Journal of Clinical Investigation