It is becoming increasingly clear that impaired intestinal barrier integrity is a major pathophysiological feature of ageing that contributes to the decline of organismal health. Whilst recent publications have demonstrated a significant role for microbial translocation in driving chronic immune cell activation and inflammageing [5, 6], the potential links between age-related intestinal barrier dysfunction and immunesenescence are still largely unknown. In this study, we demonstrate that older adults with higher levels of intestinal barrier leakage are more likely to display hallmarks of T cell ageing, contributing to high IMM-AGE scores in these individuals. Importantly, aged germ-free mice that display reduced intestinal membrane permeability and bacterial translocation preserve their thymic architecture and have an unaltered thymic microenvironment, possibly driving high thymic output in old age (Fig. 8). These novel findings take us a step further in understanding the age-related changes in the microbiome-immune axis and provide evidence for therapeutic restoration of intestinal barrier homeostasis to preserve immune function in aged individuals.
To the best of our knowledge, this study is the first to report an age-associated increase in intestinal membrane permeability and systemic microbial translocation in healthy aged individuals in line with findings from non-human primate studies [38, 39]. Dietary components play an integral role in modulating intestinal barrier integrity. For instance, there is mounting evidence that excessive consumption of dietary fats enhances intestinal membrane permeability [40], predisposing individuals to local and systemic inflammation. Interestingly, high adherence to the MedDiet and consumption of a high-quality diet were inversely correlated with intestinal barrier dysfunction in this study, possibly due to the anti-inflammatory and health-promoting properties of dietary fibre [41, 42]. This is supported by a study that reported improvements in intestinal barrier integrity in middle-aged women following high adherence to the MedDiet [43]. Furthermore, high intake of dietary fibre and omega-3 polyunsaturated fatty acids (both enriched in MedDiet foods like fruits, vegetables, fish and nuts) has been shown to restore gut barrier function in non-obese diabetic mice, thereby restoring intestinal immune homeostasis (i.e. reduced gut inflammation, expansion of IL10-producing Tregs, decline in pro-inflammatory Th17 cells) [44]. However, these beneficial effects on the immune system have yet to be confirmed in aged humans.
Changes in gut microbiota composition with age are also closely linked with the onset of intestinal barrier leakage in mice [6]. Accordingly, intestinal barrier leakage was correlated with higher relative abundances of pro-inflammatory Escherichia-Shigella, Peptostreptococcaceae and Paraprevotella in stool. On the other hand, robust intestinal barrier integrity was positively associated with high faecal levels of propionate and GDCA, both of which exert immunomodulatory and anti-inflammatory effects on the immune system. These results suggest a possible role of age-related microbial dysbiosis in promoting increased gut permeability through inflammation-induced epithelial damage.
In this study, we propose that age-related microbial translocation induces a state of persistent T-cell activation. These results are supported by an earlier study that reported loss of gut mucosa homeostasis and increased bacterial translocation in HIV patients, resulting in chronic immune system activation and systemic inflammation [45]. Therefore, we hypothesise that persistent stimulation caused by microbial translocation promotes the terminal differentiation of T cells and induces cellular senescence in aged T cells, together accelerating immune ageing. These observations are in line with those from another study reporting close links between microbial translocation and memory T cell expansion in adult mice [46]. Furthermore, in vitro studies have confirmed that gut microbial secretory factors induce cellular senescence via the activation of cell cycle inhibitors (p16INK4a, p21WAF1 and p53) and the DNA damage response, resulting in the development of a senescence-associated secretory phenotype (SASP) [47, 48].
In agreement with other ageing studies [19, 49], we observed an age-related increase in the percentage of Tregs that was correlated with increased gut permeability. There is emerging evidence of a potential link between the expansion of senescent T cells and Tregs, with studies demonstrating that Tregs trigger DNA damage in effector T cells via metabolic competition during cross-talk, resulting in cellular senescence and functional exhaustion [50]. Thus, we propose that increased microbe recognition caused by enhanced bacterial translocation might contribute to dysregulated ROS production and altered glucose metabolism in aged Tregs, promoting aberrant Treg interactions and senescent cell accumulation.
Consistent with the findings discussed above, we identified several hallmarks of ageing in circulating immune cells, including upregulation of pro-inflammatory signalling markers (HMBG1), defective autophagy processes (ATG7 and LAMP), reduced DNA damage repair (ATM), increased cellular senescence (gain of KLRG1 and loss of CD28), enhanced apoptosis (BCL2, CASP3 and CASP8), loss of proliferation regulators (DUSP4 and DUSP6) and upregulation of cell-cycle arrest regulators (TXNIP), that were only present in older adults with high microbial translocation. These results are in line with those from a study that demonstrated that microbial products disrupt autophagosome formation and trigger mitochondrial dysfunction by interfering with Rab1A signalling and reducing mitochondrial coupling [51, 52].
T cells are continuously produced by the thymus throughout life. However, the thymus undergoes accelerated atrophy with advancing age, resulting in a reduced thymic output of naïve T cells that limits the host’s ability to respond to neoantigens [15, 53]. In this study, we report a significant age-related loss of RTEs in older adults with high MT, supporting our hypothesis that circulating bacterial products have deleterious effects on thymopoiesis. To confirm that microbial products contribute towards age-related thymic involution, we used aged germ-free mice which are protected from loss of intestinal barrier function. Here, we demonstrate for the first time that ageing is accompanied by increased thymic translocation of E. coli in wild-type mice but not in germ-free mice. Importantly, hallmarks of thymic involution, including the loss of functional thymic niches due to the depletion of TECs, adipocyte infiltration and senescent cell accumulation, were less pronounced in aged germ-free mice.
In vitro analysis reveals that LPS, found on the surface of gram-negative bacteria such as E. coli, promotes the accumulation of lipid droplets in endothelial cells [54], induces cellular senescence and enhances the SASP of senescent cells [55, 56]. Thus, elevated circulating levels of microbes and microbial products, like LPS, could promote increased thymic adiposity and cellular senescence in aged hosts. Accumulation of senescent cells and adipocytes during ageing is believed to hinder thymic function through increased secretion of pro-inflammatory cytokines, such as IL6 and TNFα [36, 38]. In this study, ageing was accompanied by increased thymic expression of IL6 in wild-type mice. However, aged germ-free mice exhibited comparable IL6 expression levels to those in young wild-type mice, indicating a role for microbial translocation in the age-dependent upregulation of thymopoiesis-suppressing cytokines. Indeed, LPS treatment and E. coli enterotoxin cause thymic atrophy, leading to the loss of single positive (CD4− veCD8+ve and CD4+ veCD8−ve) thymocytes as well as double positive (CD4+ veCD8+ve) and double negative (CD4− veCD8−ve) thymocytes [57, 58]. One mechanism by which this occurs is through LPS-induced apoptosis of thymocytes [59]. Supporting this, thymic expression of the apoptotic gene BAX increased with age in wild-type mice, whereas aged germ-free mice were unaffected.
Although therapeutic manipulation of the gut microbiota might improve health in aged hosts, it remains unclear how restoring intestinal barrier function possibly by targeting microbiome dysbiosis could reverse features of immune ageing. For instance, studies have reported links between microbial composition, intestinal membrane permeability and circulating cytokine levels in aged hosts, but have not investigated their impact on immune health [60]. Our data demonstrates that transferring healthy gut microbiota into Clostridium difficile infected older adults is sufficient to improve intestinal barrier integrity. Moreover, faecal microbiota transplantation promotes the expansion of peripheral naïve T cells and reduces the senescent T cell burden in recipients, suggesting potential anti-immunesenescence effects [61]. Microbial dysbiosis in HIV patients, characterised by the loss of beneficial Bifidobacterium and the overrepresentation of Clostridium clusters, is also alleviated in response to probiotic administration, resulting in reduced microbial translocation and improved immune cell function [62]. The appearance of opportunistic microbial communities in the aged gut is related to dietary changes, such as low consumption of fibre-rich fruits and vegetables and increased consumption of meats and processed foods [60]. Moreover, studies have reported rebalancing of the gut flora, reduced systemic inflammation and improved health status in older adults who consume a MedDiet [63, 64]. Therefore, high adherence to a MedDiet rich in fibre, polyunsaturated fats, minerals and vitamins could strengthen gut barrier function and improve immune function in the elderly.
This study has a few limitations, the first being that the exact mechanisms linking intestinal membrane permeability to immune ageing remain to be fully elucidated. Secondly, although we report an increase in microbial translocation with age, we do not know the nature of these microbial products. Thus, further work is required to determine the impact of individual bacterial products on immune ageing.
Like all research studies, ours has a few limitations that should be noted. Firstly, our use of strict inclusion criteria excluded older adults with any underlying comorbidities, immune-mediated diseases and gastrointestinal disorders. Our cohort of older adults, who were interested in biogerontology research and keen to partake in our study, are all extremely healthy, consume a high-quality diet rich in dietary fibres and engage in regular physical activity (only one individual was sedentary). Unfortunately, this might not be a true representation of the ageing population, which is considered to be malnourished, largely sedentary and ridden with multimorbidity. However, this strategy dissected the intrinsic effects of ageing and highlighted the novel interactions that we observed are features of intestinal barrier dysfunction and T-cell ageing. However, in a current ongoing study, we are addressing this by recruiting older individuals with underlying comorbidities to identify immune-intestinal barrier signatures and interactions that differ between individuals on healthy vs unhealthy ageing trajectories. Another key limitation is that our results are based on a cohort of Caucasian participants, and we would like to validate our findings in a larger study (enabling us to dissect sex differences) conducted on older adults with more ethically and geographically diverse backgrounds.
In conclusion, age-related thymic involution is a known hallmark of T cell ageing that contributes significantly toward immunesenescence. Although we have made progress in understanding the molecular mechanisms that instigate thymic involution, the detailed molecular regulation network is still unclear. Nevertheless, we suggest that systemic microbial translocation due to increased intestinal barrier leakage contributes towards a reduced thymic output and the emergence of T cell ageing features Thus, our findings advocate for targeting intestinal barrier integrity as a novel strategy for promoting thymic rejuvenation and combating T cell ageing in the elderly. Exploiting the restoration ability of these targets provides new opportunities to cope with lagging health span developments of individualised dietary, probiotic and postbiotic interventions.