The present study aimed to explore several immune mechanisms that operate in the human body, where an external, frequently consumed environmental factor, namely mTG, might drive chronic diseases. The potential role of the microbial enzyme in CD induction 8,9,50,51, 40–44,46–48 and other autoimmune and neurodegenerative diseases was recently extensively described 6,7,22, 26–28,39,46. Various deleterious effects were attributed to this enzymatic food additive and corresponding pathogenic mechanisms were suggested 6,7,46,8,9,22, 26–28,44,45.
Six pairs of similar immunogenic sequences were detected between human endogenous antigens, derived from cross-reactive antibodies, and between mTG immune epitopes (Table 1). All of them showed a strong binding affinity to at least one of the HLA-I and HLA-II alleles and play a crucial role in cellular functions and body homeostasis (Table 2).
Reviewing those six similar pairs of proteins, a functional relationship to the mTG can be suggested:
1. The fibrinogen alpha chain is part of the coagulation system that joins factor XIII to establish an efficient clot. Factor XIII and mTG are integral members of the TG family 67, both having the capacity to deamidate or transamidate acyl donors and acceptors molecules. There is no knowledge yet of on circulating mTG, nor its ability to coagulate, however, its intra-enterocytic transport and sub-epithelial deposition was documented 46 and its relative resilience to oxidative compounds was recently reported 51. Furthermore, restructured meat contains mTG and fibrinogen 68, and fibrin gels crosslinked by a mTG are used in the industry, where the mTG reactions are comparable to those of factor XIII and tTG 69. The potential pro-coagulant capacity of mTG is still an enigma.
2. Histone H1.2 plays a pivotal role in chromatin and nucleosomes stability and functionality. Interestingly, cross-linking of histone by transglutaminase is well documented. Being a universal protein condenser, transglutaminase can modify core histone and regulate chromatin condensation, thus, impacting gene expression 70–73. The cross-linking might result in free histone deprivation. In fact, epigenetic is a major pathway in ADs initiation and development, including in CD evolvement 72,73.
The direct mTG action on histone 1.2 deserves more studies. The question arises whether during the intra-enterocytic transport, can mTG impact the gene expression of the human enterocyte?
3. Dihydrolipoyllysine-residue acetyltransferase component of pyruvate dehydrogenase complex, mitochondrial is an essential enzyme in mitochondrial energy metabolism and preservation. It appears that TG2 is important in mitochondrial functions and dysfunctions 74. Upon activation, the enzyme can change the assembly of respiratory chain complexes and modulate the transcription of critical mitochondrial genes. In general, the bacterial enzyme imitates the functions of the human one; however, the impact of mTG on the mitochondrial energetic homeostasis remains to be disclosed.
4. Creatine kinase S-type, mitochondria. Creatine kinases represent a large family of isoenzymes that participate in intracellular energy homeostasis. Mitochondrial creatine kinase is responsible for the transfer of high energy phosphate to the cytosolic carrier, creatine. Creatine kinase S-type is a family member that plays a role in the mitochondrial energy metabolism and production, in organs with large, fluctuating energy demands, such as heart, skeletal muscle and brain 75. Indeed, mitochondrial creatine kinase dysfunction was reported in heart, muscle and neurodegenerative conditions 76. The observation that creatine reduces transglutaminase-catalyzed protein aggregation 77 may connect various neurodegenerative diseases, like Alzheimer's, Parkinson's, and Huntington's diseases to creatine kinase dysfunction, reducing tissue creatine level, resulting in higher cross-linking activity of the local tTG 78. Notably, mTG can functionally imitate the posttranslational modification executed by its family member, the tTG. However, the impact of mTG on those tissues is not yet known. Interestingly, abnormal energy metabolism was described in RA and T1DM 79,80 (Table 2). In parallel, transglutaminase is implicated in both of the diseases. TG2 participate in synovial inflammation, bone erosion in RA, and in island cell dysfunction in T1DM 81–84. Theoretically, if mTG reaches those target organs, comparable damage might be induced.
5. Dimethyladenosine transferase 2, mitochondrial. By the transfer of methyl groups to specific adenosine residues in mitochondrial tRNAs, this enzyme is essential for the proper folding and function of the tRNAs, which are essential components in protein synthesis. In fact, mitochondrial dysfunction exists in MS 85,86 (Table 2) and in RA 79,80 (Table 2) and both diseases are affected by tTG, as mentioned above, for RA 81–83, but also in MS 87,88. The place of the tTG functional imitator, namely the mTG, remain to be explored.
6. Cytochrome c1, heme protein, mitochondrial is integral and pivotal for the mitochondrial electron transport chain, responsible for generating ATP through oxidative phosphorylation. It represents a potential clinical marker for mitochondrial and cellular damage 89. Mitochondrial failure, accompanied by inadequate energy supply and increased oxidative stress, exists in RA 79,80,90,91 (Table 2), in T1DM 80,92 (Table 2) and in AU 93 (Table 2). Moreover, the mitochondrial Cytochrome c is affected in RA 94,95, T1DN 96,97 (Table 2) and in AU 98 (Table 2). In parallel, the posttranslational modified ability of the tTG to cross-link mitochondrial protein 70–74, 77,78 and the mTG cross-linking capacity of cytochrome c, using its lysine residue as an acyl acceptor 99,100, constitutes a confirmation of the tTG and mTG capacity to regulate mitochondrial proteins, thus contributing to this organelle dysfunction.
It can be summarized that tTG is involved in the regulation of the mitochondrial energy productive and regulatory machinery. This ubiquitous enzyme can cross-link histone, control chromatin condensation, determine gene expression 70,71, affect mitochondrial functions 74, its activity is affected by creatine kinases and by free creatine 78,79 and its cross-linking activity can impact key essential mitochondrial molecules responsible for energy equilibrium in several autoimmune 81–84, 87,88 and neurodegenerative diseases 79. In addition, the tTG is important in degradation of damaged mitochondria, thus playing as a gatekeeper of the mitochondrial functional homeostasis 101.
In fact, a lot is still unknown as to whether mTG can replace tTG in all these activities. The fact that bacterial enzyme can cross the enteric epithelial lining 46,51, have the capacity to cross-link proteins that contain acyl donors (glutamine) and acceptors (lysine) 8,9,22,26,27,37,45,47, mount specific antibodies to its cross-linked complexes 7,9, 40–43,45, 47–49 and be involved in initiation and progression of ADs, is an indication of its disadvantages, being a potential public health concern, and a caveat to public well-being 9,22,26,27,45.
The current study brings, for the first time, two new potential pathogenic pathways: 1) relating the mTG enzyme to autoimmune and other chronic human conditions; 2) cross-reactive antibodies and sequence similarity between the environmental enzyme and endogenous human self-antigens. To these two pathogenic mechanisms the epitope sharing between the environmental gluten/gliadin peptides and multiple human antigens should be added. Intriguingly, gluten/gliadin structural segments are prime substrates for mTG de/transamidation 6,7, 44–46,8,9,22, 39–43. This posttranslational modification is operating in the processed food industries, in bakeries and more importantly, in the human gut lumen 8,9,22,26,27,45. It seems that the mTG-gluten-human self-epitopes axis is interactive and auto-immunogenic. Those three interrelated pathways are the basis for our current novel hypothesis, whereby, two very common environmental domains, plants and microbes, and gluten and mTG, respectively, are joining together to induce autoimmunity and other gluten-dependent inflammatory diseases 4,7,9,22,26,27,32,39,41. Interestingly, gluten avoidance was recently reported to alleviate symptoms and disease activity of non-celiac ADs 81,82, 102–106, although, gluten withdrawal is not devoid of side effects 107–109. Taken together, both external factors, the mTG and gluten-containing nutrients, can operate as the mythological Trojan horse to drive luminal and extra-intestinal ADs 29. Figure 3 presents schematically the cross-reactivity and sequence similarity between mTG-Substrate complexes and gut-antigens that are associated with ADs.
The list of side effects of the processed food additive, mTG, and its cross-linked complexes is constantly expanding 6,7,45,8,9,22,39, 41–44. Multiple mechanisms were offered for those health-targeted detrimental effects. The mTG compromises tight junctional functional integrity, enhancing a leaky gut syndrome 9,22,45 and enhances enteric epithelial gliadins uptake and transportation 8,9,22,45,105,110. The foreign molecules, mTG and gliadin, are trans-enterocyticaly transported to face and challenge the sub-epithelial immune systems 46. The microbial enzyme can compromise the mechanical intestinal protective barriers by introducing resistant isopeptide bonds, thus, perturbating mucin fluidity and stability, resulting in enhanced attachment of pathogenic luminal germs or other harmful factors to the epithelial receptors 111. More so, it suppresses mucosal and systemic immune systems. Indeed, Streptococcus suis-originated mTG exerts anti-phagocytic effect, resulting in suppressing a major immune protective barrier 112–115. As a bacterial survival factor, suppressing gut immunity, the mTG is a growth factor for luminal microbiota, dysbiota and pathobionts, as was reported in Lactococcus strain 116,117. The problem is accentuated since more sophisticated bioengineered technics produce higher yield and more active mTG for industrial usage 118–120. The enzyme represents a double-edged sword, a protective bacterial factor in the gut lumen, hence, a human hostile one, compromising human health 45. In view of the active horizontal gene transfer in the gut lumen 28, a major question arises. Can the harmful mTG be laterally transferred to the physiological microbiome, as is happening for the bacterial resistant genes spread? 121,122. On the same line, recently, the trans-membranal region of mTG was suggested to participate in the recognition of host's immune signals and reciprocal bacterial communication, by binding to its corresponding ligand 123.
The cross-reactive antibodies warrant some clarification. Polyclonal antibodies contain a heterogenous mixture of antibodies produced by different clones of plasma B cells against different epitopes of a whole antigen, whereas monoclonal antibodies are a homogenous population of antibodies that are produced by a single clone of B cells. Thus, polyclonal antibodies interact with different epitopes on a single antigen, while monoclonal antibodies interact with a particular epitope on the same antigen. This may explain the reactivity of anti-mTG polyclonal antibody with 18 out of 77 autoantigens and the reactivity of anti-mTG monoclonal antibody with only 9 out of 77 human tissue antigens 124.
These are some strengths of the current study. It combines the human to the mTG epitopes, applying two methods, namely, cross-reactive antibodies and sequence similarity. It describes two members of the transglutaminase's family that shares comparable functions. The environmental mTG has a much broader substrate activity then its endogenous tTG one. So, theoretically, it might cross-react with more human antigens.
As for the study’s limitations, the major one is the lack of proof that the mTG itself or its post-translated modified proteins and cross-linked complexes can circulate systemically to reach peripheral target organs. However, the fact that when active mTG is abandoned in the gut lumen, it reaches the baso-lateral compartment of the enterocytes and its cross-linked complexes are immunogenic, strengthen the present hypothesis. In addition, the presented findings are limited to the curated epitopes that are currently found in the Immune Epitope Database (IEDB, www.iedb.org), and to 77 different human tissue antigens that were tested for cross-reactivity. Yet it provides an indication of such antigens that can potentially provoke molecular mimicry.