Background: Asthma has been considered an immunologic disease mediated by TH2 cells and adaptive immunity. However, clinical and experimental observations suggest that additional pathways might regulate asthma, particularly in its nonallergic forms, such as asthma associated with air pollution, stress, obesity, and infection.

Objectives: Our goal was to understand TH2 cell–independent conditions that might lead to airway hyperreactivity (AHR), a cardinal feature of asthma.

Methods: We examined a murine model of experimental asthma in which AHR was induced with glycolipid antigens, which activate natural killer T (NKT) cells.

Results: In this model AHR developed rapidly when mice were treated with NKT cell–activating glycolipid antigens, even in the absence of conventional CD41 T cells. The activated NKT cells directly induced alveolar macrophages to produce IL-33, which in turn activated NKT cells, as well as natural helper cells, a newly described non-T, non-B, innate lymphoid cell type, to increase production of IL-13. Surprisingly, this glycolipid-induced AHR pathway required not only IL-13 but also IL-33 and its receptor, ST2, because it was blocked by an anti-ST2 mAb and was greatly reduced in ST22/2 mice. When adoptively transferred into IL-132/2 mice, both wild-type natural helper cells and NKT cells were sufficient for the development of glycolipid-induced AHR.

Conclusion: Because plant pollens, house dust, and some bacteria contain glycolipids that can directly activate NKT cells, these studies suggest that AHR and asthma can fully develop or be greatly enhanced through innate immune mechanisms involving IL-33, natural helper cells, and NKT cells. (J Allergy Clin Immunol 2012;129:216-27.)