Capturing the systemic immune signature of a norovirus infection: an n-of-1 case study within a clinical trial

Antony J Cutler; Joao Oliveira; Ricardo C Ferreira; Ben Challis; Neil M Walker; Sarah Caddy; Jia Lu; Helen E Stevens; Deborah J Smyth; Marcin L Pekalski; Jane Kennet; Kara M D Hunter; Ian Goodfellow; Linda S Wicker; John A Todd; Frank Waldron-Lynch

doi:10.12688/wellcomeopenres.11300.3

Capturing the systemic immune signature of a norovirus infection: an n-of-1 case study within a clinical trial

Wellcome Open Res. 2017 Oct 5:2:28. doi: 10.12688/wellcomeopenres.11300.3. eCollection 2017.

Authors

Antony J Cutler^{1

2}, Joao Oliveira², Ricardo C Ferreira^{1

2}, Ben Challis³, Neil M Walker², Sarah Caddy⁴, Jia Lu⁴, Helen E Stevens², Deborah J Smyth², Marcin L Pekalski^{1

2}, Jane Kennet², Kara M D Hunter², Ian Goodfellow⁴, Linda S Wicker^{1

2}, John A Todd^{1

2}, Frank Waldron-Lynch^{2

5

6}

Affiliations

¹ JDRF/Wellcome Trust Diabetes and Inflammation Laboratory, Wellcome Trust Center for Human Genetics, Nuffield Department of Medicine, National Institute for Health Research Oxford Biomedical Research Centre, University of Oxford, Oxford, OX3 7BN, UK.
² JDRF/Wellcome Trust Diabetes and Inflammation Laboratory, Department of Medical Genetics, National Institute for Health Research Cambridge Biomedical Research Centre, Cambridge Institute for Medical Research, University of Cambridge, Cambridge Biomedical Campus,Cambridge, CB2 0XY, UK.
³ Wellcome Trust/MRC Institute of Metabolic Science, Department of Medicine, National Institute for Health Research Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, CB2 0QQ, UK.
⁴ Division of Virology, Department of Pathology, University of Cambridge, Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK.
⁵ Experimental Medicine and Immunotherapeutics, Department of Medicine, National Institute for Health Research Cambridge Biomedical Research Centre, University of Cambridge, Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK.
⁶ National Institute for Health Research Cambridge Clinical Trials Unit, Cambridge University Hospitals NHS foundation Trust, Cambridge Biomedical Campus, University of Cambridge, Cambridge, CB2 0QQ, UK.

Abstract

Background: The infection of a participant with norovirus during the adaptive study of interleukin-2 dose on regulatory T cells in type 1 diabetes (DILT1D) allowed a detailed insight into the cellular and cytokine immune responses to this prevalent gastrointestinal pathogen.

Methods: Serial blood, serum and peripheral blood mononuclear cell (PBMC) samples were collected pre-, and post-development of the infection. To differentiate between the immune response to norovirus and to control for the administration of a single dose of aldesleukin (recombinant interleukin-2, rIL-2) alone, samples from five non-infected participants administered similar doses were analysed in parallel.

Results: Norovirus infection was self-limited and resolved within 24 hours, with the subsequent development of anti-norovirus antibodies. Serum pro- and anti-inflammatory cytokine levels, including IL-10, peaked during the symptomatic period of infection, coincident with increased frequencies of monocytes and neutrophils. At the same time, the frequency of regulatory CD4 ⁺ T cell (Treg), effector T cell (Teff) CD4 ⁺ and CD8 ⁺ subsets were dynamically reduced, rebounding to baseline levels or above at the next sampling point 24 hours later. NK cells and NKT cells transiently increased CD69 expression and classical monocytes expressed increased levels of CD40, HLA-DR and SIGLEC-1, biomarkers of an interferon response. We also observed activation and mobilisation of Teffs, where increased frequencies of CD69 ⁺ and Ki-67 ⁺ effector memory Teffs were followed by the emergence of memory CD8 ⁺ Teff expressing the mucosal tissue homing markers CD103 and β7 integrin. Treg responses were coincident with the innate cell, Teff and cytokine response. Key Treg molecules FOXP3, CTLA-4, and CD25 were upregulated following infection, alongside an increase in frequency of Tregs with the capacity to home to tissues.

Conclusions: The results illustrate the innate, adaptive and counter-regulatory immune responses to norovirus infection. Low-dose IL-2 administration induces many of the Treg responses observed during infection.

Keywords: Interleukin-2; Proleukin; T regulatory cells; aldesleukin; clinical trial; immune response; norovirus.

Grants and funding

WT_/Wellcome Trust/United Kingdom