Review Article

Intestinal Immune Imbalance is an Alarm in the Development of IBD

Table 1

Physiological function of immune cells in the intestinal tract and the pathophysiological function of inflammatory bowel disease (IBD).

Immune cellPhysiological functions in the intestinal tractThe pathophysiological role in IBD

MacrophagesAssist Treg cells’ expansion and production of IL-10 [21, 22].Secretion of large amounts of pro-inflammatory cytokines such as IL-23 and TNF-α [29, 30].
ILCsControlling tissue homeostasis [34, 35].ILC1 can release IFN-γ [36, 37, 41]; LC2 can produce IL-5 and IL-13 cytokines [40]; patients with IBD express ILC3 genes (IL17A, IL22, and IL23R) [44].
NKT cellsResponse to infectious pathogens, prevention of autoimmune diseases, and maintenance of self-tolerance [57].NKT cells are sources of IL-13 [60]. The expression of IL-13 was significantly increased in UC [60, 61].
IECsDefend against intestinal luminal bacteria and pathogen-associated molecular patterns [64].TLR5 recognizes flagellin, whose activation stimulates the NF-κB, which induces the secretion of chemokines IL-8 and MIP3 [67, 68]. ISG15 expression was increased and ISG15 could enhance IL-12-induced IFN-γ release [71, 73, 74].
Th1 cellsProtective immunity against microbial pathogens and tumors [75].In CD, Th1 cell responses are associated with an increased expression of IL-12 [7981].
Th2 cellsPromote antihelminth immunity, suppress type 1-driven autoimmune disease and maintain metabolic homeostasis [88].UC is characterized by Th2-related cytokines (IL-5 and IL-13) [60, 61, 95, 96].
Th17 cellsMaintaining symbiotic populations at important barrier sites [99].The mucosa of patients with IBD can detect high levels of IL-17A [78, 105, 106], IL-17C [102], and IL-21 [82, 107].
Treg cellsTregs act as the key regulators of intestinal homeostasis [108, 109].Tregs may differentiate into Th17 cells, resulting in the IL-17+ and FoxP3+ subsets of T cells [48].

IL, interleukin; TNF-α, tumor necrosis factor-alpha; ILC, innate lymphocyte; IFN, interferon; NKT, natural killer T; IEC, intestinal epithelial cell; UC, ulcerative colitis; TLR, Toll-like receptor; NF, nuclear factor; ISG15, IFN-stimulated gene 15; MIP3, macrophage inflammatory protein 3; CD, Crohn’s disease; Treg, regulatory T.