XIAP Regulates Paneth Cell Homeostasis and the Susceptibility to Microbial Triggers of Intestinal Inflammation

SummaryInflammatory bowel disease (IBD) is characterized by inappropriate immune responses to the microbiota in genetically susceptible hosts, but pathways that link individual genetic alterations to microbiota-dependent inflammation remain to be identified. Here, we show that loss of X-linked inhibitor of apoptosis protein (XIAP), a gene associated with Mendelian IBD, renders Paneth cells sensitive to microbiota-, tumor-necrosis factor (TNF)- and receptor-interacting protein kinase 3 (RIPK3)-dependent cell death. This is associated with deficiency in Paneth cell-derived antimicrobial peptides and alterations in the stratification and composition of the microbiota. Loss of XIAP is not sufficient to elicit intestinal inflammation, but provides susceptibility to pathobionts able to promote granulomatous ileitis in hosts deficient in XIAP, which can be prevented by administration of a Paneth cell-derived antimicrobial peptide. These data reveal a pathway critical for host-microbial cross-talk, which is required for intestinal homeostasis and the prevention of inflammation, and which is amenable to therapeutic targeting.