Indoles derived from intestinal microbiota act via type I interferon signaling to limit graft-versus-host disease

Alyson Swimm, Cynthia R. Giver, Zachariah DeFilipp, Sravanti Rangaraju, Akshay Sharma, Alina Ulezko Antonova, Robert Sonowal, Christopher Capaldo, Domonica Powell, Muna Qayed, Daniel Kalman and Edmund K. Waller

Key Points

  • Microbiota-derived or orally administered indoles limit GVHD but not graft-versus-leukemia.

  • Indoles act via IFN1 signaling to protect and repair the mucosal barrier from damage.

Publisher's Note: There is a Blood Commentary on this article in this issue.


The intestinal microbiota in allogeneic bone marrow transplant (allo-BMT) recipients modulates graft-versus-host disease (GVHD), a systemic inflammatory state initiated by donor T cells that leads to colitis, a key determinant of GVHD severity. Indole or indole derivatives produced by tryptophan metabolism in the intestinal microbiota limit intestinal inflammation caused by diverse stressors, so we tested their capacity to protect against GVHD in murine major histocompatibility complex–mismatched models of allo-BMT. Indole effects were assessed by colonization of allo-BMT recipient mice with tryptophanase positive or negative strains of Escherichia coli, or, alternatively, by exogenous administration of indole-3-carboxaldehyde (ICA), an indole derivative. Treatment with ICA limited gut epithelial damage, reduced transepithelial bacterial translocation, and decreased inflammatory cytokine production, reducing GVHD pathology and GVHD mortality, but did not compromise donor T-cell-mediated graft-versus-leukemia responses. ICA treatment also led to recipient-strain-specific tolerance of engrafted T cells. Transcriptional profiling and gene ontology analysis indicated that ICA administration upregulated genes associated with the type I interferon (IFN1) response, which has been shown to protect against radiation-induced intestinal damage and reduce subsequent GVHD pathology. Accordingly, protective effects of ICA following radiation exposure were abrogated in mice lacking IFN1 signaling. Taken together, these data indicate that indole metabolites produced by the intestinal microbiota act via type I IFNs to limit intestinal inflammation and damage associated with myeloablative chemotherapy or radiation exposure and acute GVHD, but preserve antitumor responses, and may provide a therapeutic option for BMT patients at risk for GVHD.

  • Submitted March 6, 2018.
  • Accepted September 19, 2018.
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