CTLA-4 mediates oral immunotolerance against systemic allergic sensitization to environmental allergens

Introduction/Rationale: Environmental exposure to food allergens (e.g. peanut antigens) through the skin or airways increases the risk of developing food allergy (e.g. peanut allergy). In contrast, oral antigen exposure (e.g., consumption of peanut products) early in life reduces the risk. The objective of this study was to investigate the immunologic mechanisms by which oral antigen exposure provides systemic immunotolerance and protection from food allergy development using murine models.

Methods: Naive mice were administered ovalbumin (OVA) through their drinking water to promote oral immunotolerance. Mice were subsequently exposed intranasally (i.n.) to OVA plus peanut flour, as an allergic adjuvant. CD4+ T cells from lung draining lymph nodes (dLNs) were assessed by single-cell RNA sequencing, MHC-II tetramer staining, and flow cytometry.

Results: Following i.n. exposure to OVA plus peanut flour, mice developed OVA-specific IgE (OVA-IgE) and showed symptoms of acute anaphylaxis upon intraperitoneal OVA challenge. Oral OVA feeding prior to i.n. OVA exposure reduced OVA-IgE and protected mice from anaphylaxis. Protection was associated with suppression of OVA-specific T follicular helper (Tfh) and germinal center B cells in dLNs. Tolerance was reversed by administration of anti-CTLA-4 blocking antibody but was not affected by deletion of Foxp3+Bcl6+ T follicular regulatory (Tfr) cells. Accordingly, conventional Foxp3+T regulatory (Treg) cells were not increased in dLNs of OVA-fed mice. Rather, protection was associated with the emergence of OVA-specific Foxp3-CTLA4+ cells expressing markers of stemness.

Conclusion: Oral antigen exposure suppresses the development of antigen-specific Tfh cells in remote dLNs thereby preventing systemic allergic sensitization. Systemic oral tolerance is dependent on CTLA-4 and unlikely requires conventional Foxp3+ Treg cells.