Protein malnutrition alters tryptophan and angiotensin converting enzyme 2 homeostasis and adaptive immune responses in human rotavirus infected gnotobiotic pigs transplanted with human infant fecal microbiota.

Malnutrition leads to increased morbidity and is evident in almost half of all deaths in children under the age of 5 years. Mortality due to rotavirus diarrhea is common in developing countries where malnutrition is prevalent; however, the relationship between malnutrition and rotavirus infection remains unclear. In this study, gnotobiotic pigs transplanted with the fecal microbiota of a healthy 2-monthold infant were fed protein-sufficient or -deficient diets and infected with virulent human rotavirus (HRV). After human rotavirus infection, protein-deficient pigs had decreased human rotavirus antibody titers and total IgA concentrations, systemic T helper (CD3(+) CD4(+)) and cytotoxic T (CD3(+) CD8(+)) lymphocyte frequencies, and serum tryptophan and angiotensin I-converting enzyme 2. Additionally, deficientdiet pigs had impaired tryptophan catabolism postinfection compared with sufficient-diet pigs. Tryptophan supplementation was tested as an intervention in additional groups of fecal microbiota-transplanted, rotavirus-infected, sufficientand deficient-diet pigs. Tryptophan supplementation increased the frequencies of regulatory (CD4(+) or CD8(+) CD25(+) FoxP3(+)) T cells in pigs on both the sufficient and the deficient diets. These results suggest that a protein-deficient diet impairs activation of the adaptive immune response following HRV infection and alters tryptophan homeostasis.