Background
The genetic determinants of the human innate immune response are poorly understood. Apolipoprotein (apo)E, a lipid-trafficking protein that impacts inflammation, has well-described ‘wild type’ (ε3) and disease-associated (ε2, ε4) alleles, but its connection to human innate immunity is undefined.
Objective
To define the relationship of APOε4 to the human innate immune response.
Methods
We evaluated APOε4 in several functional models of the human innate immune response including intravenous lipopolysaccharide challenge in human subjects, and assessed APOε4 association to organ injury in human severe sepsis, a disease driven by dysregulated innate immunity.
Results
Whole blood from healthy APOε3/APOε4 volunteers induced higher cytokines upon ex vivo stimulation with Toll like Receptor (TLR)2, TLR4, or TLR5 ligands than blood from APOε3/APOε3 subjects, whereas TLR7/8 responses were similar. This was associated with increased lipid rafts in APOε3/APOε4 monocytes. By contrast, APOε3/APOε3 and APOε3/APOε4 serum neutralized lipopolysaccharide equivalently and supported similar lipopolysaccharide responses in Apoe-deficient macrophages, arguing against a differential role for secretory APOE4 protein. After intravenous lipopolysaccharide, APOε3/APOε4 human subjects had higher hyperthermia and plasma TNFα and earlier plasma IL-6 than APOε3/APOε3 subjects. APOE4-targeted replacement mice displayed enhanced hypothermia, plasma cytokines, and hepatic injury, and altered splenic lymphocyte apoptosis after systemic lipopolysaccharide compared with APOE3 counterparts. In a cohort of 828 severe sepsis patients, APOε4 was associated with increased coagulation system failure among European American subjects.
Conclusions
APOε4 is a determinant of the human innate immune response to multiple TLR ligands, and associates with altered patterns of organ injury in human sepsis.