Inhaled corticosteroid suppression of cathelicidin drives dysbiosis and bacterial infection in chronic obstructive pulmonary disease
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Accepted version
Author(s)
Type
Journal Article
Abstract
Bacterial infection commonly complicates inflammatory airway diseases such as chronic obstructive pulmonary disease (COPD). The mechanisms of increased infection susceptibility and how use of the commonly prescribed therapy inhaled corticosteroids (ICS) accentuates pneumonia risk in COPD are poorly understood. Here, using analysis of samples from patients with COPD, we show that ICS use is associated with lung microbiota disruption leading to proliferation of streptococcal genera, an effect that could be recapitulated in ICS-treated mice. To study mechanisms underlying this effect, we used cellular and mouse models of streptococcal expansion with Streptococcus pneumoniae, an important pathogen in COPD, to demonstrate that ICS impairs pulmonary clearance of bacteria through suppression of the antimicrobial peptide cathelicidin. ICS impairment of pulmonary immunity was dependent on suppression of cathelicidin because ICS had no effect on bacterial loads in mice lacking cathelicidin (Camp-/-) and exogenous cathelicidin prevented ICS-mediated expansion of streptococci within the microbiota and improved bacterial clearance. Suppression of pulmonary immunity by ICS was mediated by augmentation of the protease cathepsin D. Collectively, these data suggest a central role for cathepsin D/cathelicidin in the suppression of antibacterial host defense by ICS in COPD. Therapeutic restoration of cathelicidin to boost antibacterial immunity and beneficially modulate the lung microbiota might be an effective strategy in COPD.
Date Issued
2019-08-28
Date Acceptance
2019-07-23
Citation
Science Translational Medicine, 2019, 11 (507), pp.1-13
ISSN
1946-6234
Publisher
American Association for the Advancement of Science
Start Page
1
End Page
13
Journal / Book Title
Science Translational Medicine
Volume
11
Issue
507
Copyright Statement
© 2019 The Authors, some rights reserved; exclusive licensee American Association for the Advancement of Science. No claim to original U.S. Government Works http://www.sciencemag.org/about/science-licenses-journal-article-reuse.
Sponsor
Wellcome Trust
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/31462509
PII: 11/507/eaav3879
Grant Number
107660/Z/15/Z
Subjects
Science & Technology
Life Sciences & Biomedicine
Cell Biology
Medicine, Research & Experimental
Research & Experimental Medicine
ANTIMICROBIAL PEPTIDE
COPD PATIENTS
CATHEPSIN-D
SALMETEROL/FLUTICASONE PROPIONATE
RHINOVIRUS INFECTION
RECEPTOR EXPRESSION
EPITHELIAL-CELLS
GENE-EXPRESSION
HOST-DEFENSE
IN-VITRO
11 Medical and Health Sciences
06 Biological Sciences
Publication Status
Published
Coverage Spatial
United States
Date Publish Online
2019-08-28