Progesterone amplifies allergic inflammation and airway pathology in association with higher lung ILC2 responses

Perimenstrual worsening of asthma occurs in up to 40% of asthmatic women, leading to increased acute exacerbations requiring clinical care. The role of sex hormones during these times remains unclear. In the current study, we used a translational approach to determine whether progesterone exacerbates allergic inflammation in the traditional OVA model in BALB/c mice. Simultaneously, we used PBMC from healthy human donors to assess the effects of progesterone on circulating ILC2. Briefly, lungs of ovarectomized (OVX) or sham-operated female (F-Sham) controls were implanted with a progesterone (P4, 25mg) (OVX-P4) or placebo pellet (OVX-Placebo), followed by sensitization and challenge with ovalbumin (OVA). Progesterone increased total inflammatory histologic scores, increased hyper-responsiveness to methacholine, increased select chemokines in the BAL and serum, and increased ILC2 and neutrophil numbers, along the airways in comparison to F-Sham-OVA and OVX-Placebo-OVA animals. Lung ILC2 were sorted from F-Sham-OVA, OVX-Placebo-OVA and OVX-P4-OVA treated animals and stimulated with IL-33. OVX-P4-OVA lung ILC2 were more responsive to IL-33 compared to F-Sham-OVA treated, producing more IL-13 and chemokines following IL-33 stimulation. We confirmed the expression of the progesterone receptor (PR) on human ILC2, and showed that P4 + IL-33 stimulation also increased IL-13 and chemokine production from human ILC2. We establish that murine ILC2 are capable of responding to P4 and thereby contribute to allergic inflammation in the lung. We confirmed that human ILC2 are also hyper-responsive to P4 and IL-33 and likely contribute to airway exacerbations following allergen exposures in asthmatic women with increased symptoms around the time of menstruation.