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The interplay between alterations in esophageal microbiota associated with Th17 immune response and impaired LC20 phosphorylation in achalasia

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Abstract

Background

Achalasia is an esophageal motility disorder with an unknown etiology. We aimed to determine the pathogenesis of achalasia by studying alterations in esophageal smooth muscle contraction and the associated inflammatory response, and evaluate the role of esophageal microbiota in achalasia development.

Methods

We analyzed esophageal mucosa and lower esophageal sphincter (LES) samples, obtained from patients with type II achalasia who underwent peroral endoscopic myotomy. Esophageal conditioned media obtained from patients were transferred into the mouse esophagus to determine whether the esophageal intraluminal environment is associated with achalasia.

Results

Approximately 30% of 20-kDa myosin light chains (LC20) was phosphorylated in LES from the control group under resting and stimulated conditions, whereas less than 10% of LC20 phosphorylation was detected in achalasia under all conditions. The hypophosphorylation of LC20 in achalasia was associated with the downregulation of the myosin phosphatase-inhibitor protein CPI-17. Th17-related cytokines, including IL-17A, IL-17F, IL-22, and IL-23A, were significantly upregulated in achalasia. α-Diversity index of esophageal microbiota and the proportion of several microbes, including Actinomyces and Dialister, increased in achalasia. Actinomyces levels positively correlated with IL-23A levels, whereas Dialister levels were positively associated with IL-17A, IL-17F, and IL-22 levels. Esophageal IL-17F levels increased in mice after oral administration of the conditioned media.

Conclusions

In LES of patients with achalasia, hypophosphorylation of LC20, a possible cause of impaired contractility, was associated with CPI-17 downregulation and an increased Th17-related immune response. The esophageal intraluminal environment, represented by the esophageal microbiota, could be associated with the development and exacerbation of achalasia.

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Acknowledgements

This study was supported in part by the Japan Society for the Promotion of Science KAKENHI (20K08334, 22K19530, 23K07440) and the Japan Agency for Medical Research and Development (AMED) (21lk0201144h001, 22lk0201144h002, and 23lk0201144h003).

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Authors and Affiliations

  1. Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka-shi, Fukuoka, 812-8582, Japan

    Hiroko Ikeda, Eikichi Ihara, Koji Mukai, Yoshitaka Hata, Xiaopeng Bai, Yoshimasa Tanaka & Yoshihiro Ogawa

  2. Faculty of Veterinary Medicine, Okayama University of Science, Ehime, Japan

    Kosuke Takeya, Fumiyo Saito & Masumi Eto

  3. Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan

    Manabu Onimaru & Haruhiro Inoue

  4. Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

    Kenoki Ouchida & Masafumi Nakamura

  5. Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

    Taisuke Sasaki & Yoshinao Oda

  6. Laboratory of Microbial Technology, Division of Systems Bioengineering, Department of Bioscience and Biotechnology, Faculty of Agriculture, Graduate School, Kyushu University, Fukuoka, Japan

    Jiro Nakayama

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  1. Hiroko Ikeda
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  2. Eikichi Ihara
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Contributions

Conceptualization: HI, EI, KT, KM, and MO; Methodology: HI, EI, KT, KO, YH, TS, FS, ME, JN, and YO; Formal analysis and investigation: HI, KT, KM, XB, YT, TS, FS, and ME; Writing-original draft preparation: HI, EI, and KT; Writing-review and editing: ME, JN, YO, MN, HI, and YO; Funding acquisition: EI and YO; Resources: EI and YO; Supervision: HI and YO. All authors have read and approved the final manuscript.

Corresponding author

Correspondence to Eikichi Ihara.

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Conflict of interest

The authors declare no conflicts of interest related to this study.  E.I. belongs to an endowed course supported by companies including Miyarisan Pharmaceutical Co., Ltd., Fujifilm Medical Co., Ltd., Terumo Corporation, FANCL Corporation and Muta Hospital. E.I. received a lecture honorarium from EA Pharma Co., Ltd., Viatris Inc. and Takeda Pharmaceutical Company. Y.O. conducted collaborative research with Fujifilm Medical Co., Ltd. and the FANCL Corporation. The other authors have no other conflicts of interest to declare in relation to this study.

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Ikeda, H., Ihara, E., Takeya, K. et al. The interplay between alterations in esophageal microbiota associated with Th17 immune response and impaired LC20 phosphorylation in achalasia. J Gastroenterol 59, 361–375 (2024). https://doi.org/10.1007/s00535-024-02088-w

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