Interaction of Aspergillus fumigatus Spores with Human Leukocytes and Serum

Effective Neutrophil Phagocytosis of Aspergillus fumigatus Is Mediated by Classical Pathway Complement Activation

Aspergillus fumigatus is an important airborne fungal pathogen and a major cause of invasive fungal infections. Susceptible individuals become infected via the inhalation of dormant conidia. If the immune system fails to clear these conidia, they will swell, germinate and grow into large hyphal structures. Neutrophils are essential effector cells for controlling A. fumigatus infection. In general, opsonization of microbial particles is crucial for efficient phagocytosis and killing by neutrophils. Although the antibodies present in human serum do bind to all fungal morphotypes, we observed no direct antibody-mediated phagocytosis of A. fumigatus. We show that opsonization, phagocytosis and killing by neutrophils of A. fumigatus is complement-dependent. Using human sera depleted of key complement components, we investigated the contribution of the different complement initiation pathways in complement activation on the fungal surface. We describe the classical complement pathway as the main initiator of complement activation on A. fumigatus swollen conidia and germ tubes. Antibodies play an important role in complement activation and efficient innate recognition, phagocytosis and killing of A. fumigatus by neutrophils.

Restoration of NET formation by gene therapy in CGD controls aspergillosis

Chronic granulomatous disease (CGD) patients have impaired nicotinamide adenine dinucleotide phosphate (NADPH) oxidase function, resulting in poor antimicrobial activity of neutrophils, including the inability to generate neutrophil extracellular traps (NETs). Invasive aspergillosis is the leading cause of death in patients with CGD; it is unclear how neutrophils control Aspergillus species in healthy persons. The aim of this study was to determine whether gene therapy restores NET formation in CGD by complementation of NADPH oxidase function, and whether NETs have antimicrobial activity against Aspergillus nidulans. Here we show that reconstitution of NET formation by gene therapy in a patient with CGD restores neutrophil elimination of A nidulans conidia and hyphae and is associated with rapid cure of preexisting therapy refractory invasive pulmonary aspergillosis, underlining the role of functional NADPH oxidase in NET formation and antifungal activity.

Human polymorphonuclear leukocytes inhibit Aspergillus fumigatus conidial growth by lactoferrin-mediated iron depletion

Aspergillus fumigatus, a common mold, rarely infects humans, except during prolonged neutropenia or in cases of chronic granulomatous disease (CGD), a primary immunodeficiency caused by mutations in the NADPH oxidase that normally produces fungicidal reactive oxygen species. Filamentous hyphae of Aspergillus are killed by normal, but not CGD polymorphonuclear leukocytes (PMN); however, the few studies on PMN-mediated host defenses against infectious conidia (spores) of this organism have yielded conflicting results, some showing that PMN do not inhibit conidial growth, with others showing that they do, most likely using reactive oxygen species. Given that CGD patients are exposed daily to hundreds of viable A. fumigatus conidia, yet considerable numbers of them survive years without infection, we reasoned that PMN use ROS-independent mechanisms to combat Aspergillus. We show that human PMN from both normal controls and CGD patients are equipotent at arresting the growth of Aspergillus conidia in vitro, indicating the presence of a reactive oxygen species-independent factor(s). Cell-free supernatants of degranulated normal and CGD neutrophils both suppressed fungal growth and were found to be rich in lactoferrin, an abundant PMN secondary granule protein. Purified iron-poor lactoferrin at concentrations occurring in PMN supernatants (and reported in human mucosal secretions in vivo) decreased fungal growth, whereas saturation of lactoferrin or PMN supernatants with iron, or testing in the presence of excess iron in the form of ferritin, completely abolished activity against conidia. These results demonstrate that PMN lactoferrin sequestration of iron is important for host defense against Aspergillus.

Recombinant human macrophage colony-stimulating factor augments pulmonary host defences against Aspergillus fumigatus

The in vivo and ex vivo effects of macrophage colony-stimulating factor (M-CSF) were studied in a profoundly neutropenic rabbit model in order to determine its potential to augment pulmonary host defence against Aspergillus. M-CSF (100-600 microg/kg/d) was administered prophylactically to neutropenic rabbits with pulmonary aspergillosis starting three days pre-inoculation and then throughout neutropenia. Rabbits receiving M-CSF had significantly increased survival (P=0.01) and decreased pulmonary injury, as measured by decreased pulmonary infarction (P=0.004), when compared with untreated controls. Microscopic studies demonstrated greater numbers of activated pulmonary alveolar macrophages (PAMs) in lung tissue of rabbits receiving M-CSF, in comparison to controls (P<0.001). PAMs harvested from rabbits treated with M-CSF had a significantly greater percent phagocytosis of Aspergillus fumigatus conidia than did PAMs from controls (P=0.04). These data indicate that prophylactic administration of M-CSF augments pulmonary host defence against A. fumigatus and suggest a potential role for this cytokine as adjunctive therapy in the treatment of pulmonary aspergillosis in the setting of profound neutropenia.

Aspergillus fumigatus and aspergillosis

Aspergillus fumigatus is one of the most ubiquitous of the airborne saprophytic fungi. Humans and animals constantly inhale numerous conidia of this fungus. The conidia are normally eliminated in the immunocompetent host by innate immune mechanisms, and aspergilloma and allergic bronchopulmonary aspergillosis, uncommon clinical syndromes, are the only infections observed in such hosts. Thus, A. fumigatus was considered for years to be a weak pathogen. With increases in the number of immunosuppressed patients, however, there has been a dramatic increase in severe and usually fatal invasive aspergillosis, now the most common mold infection worldwide. In this review, the focus is on the biology of A. fumigatus and the diseases it causes. Included are discussions of (i) genomic and molecular characterization of the organism, (ii) clinical and laboratory methods available for the diagnosis of aspergillosis in immunocompetent and immunocompromised hosts, (iii) identification of host and fungal factors that play a role in the establishment of the fungus in vivo, and (iv) problems associated with antifungal therapy.

Cloning and sequencing of a Candida albicans catalase gene and effects of disruption of this gene

Catalase plays a key role as an antioxidant, protecting aerobic organisms from the toxic effects of hydrogen peroxide, and in some cases has been postulated to be a virulence factor. To help elucidate the function of catalase in Candida albicans, a single C. albicans-derived catalase gene, designated CAT1, was isolated and cloned. Degenerate PCR primers based on highly conserved areas of other fungal catalase genes were used to amplify a 411-bp product from genomic DNA of C. albicans ATCC 10261. By using this product as a probe, catalase clones were isolated from genomic libraries of C. albicans. Nucleotide sequence analysis revealed an open reading frame encoding a protein of 487 amino acid residues. Construction of a CAT1-deficient mutant was achieved by using the Ura-blaster technique for sequential disruption of multiple alleles by integrative transformation using URA3 as a selectable marker. Resulting mutants exhibited normal morphology and comparable growth rates of both yeast and mycelial forms. Enzymatic analysis revealed an abundance of catalase in the wild-type strain but decreasing catalase activity in heterozygous mutants and no detectable catalase in a homozygous null mutant. In vitro assays showed the mutant strains to be more sensitive to damage by both neutrophils and concentrations of exogenous peroxide that were sublethal for the parental strain. Compared to the parental strain, the homozygous null mutant strain was far less virulent for mice in an intravenous infection model of disseminated candidiasis. Definitive linkage of CAT1 with virulence would require restoration of activity by reintroduction of the gene into mutants. However, initial results in mice, taken together with the enhanced susceptibility of catalase-deficient hyphae to damage by human neutrophils, suggest that catalase may enhance the pathogenicity of C. albicans.

Absence of respiratory burst in X-linked chronic granulomatous disease mice leads to abnormalities in both host defense and inflammatory response to Aspergillus fumigatus

Mice with X-linked chronic granulomatous disease (CGD) generated by targeted disruption of the gp91phox subunit of the NADPH-oxidase complex (X-CGD mice) were examined for their response to respiratory challenge with Aspergillus fumigatus. This opportunistic fungal pathogen causes infection in CGD patients due to the deficient generation of neutrophil respiratory burst oxidants important for damaging A. fumigatus hyphae. Alveolar macrophages from X-CGD mice were found to kill A. fumigatus conidia in vitro as effectively as alveolar macrophages from wild-type mice. Pulmonary disease in X-CGD mice was observed after administration of doses ranging from 10(5) to 48 spores, none of which produced disease in wild-type mice. Higher doses produced a rapidly fatal bronchopneumonia in X-CGD mice, whereas progression of disease was slower at lower doses, with development of chronic inflammatory lesions. Marked differences were also observed in the response of X-CGD mice to the administration of sterilized Aspergillus hyphae into the lung. Within 24 hours of administration, X-CGD mice had significantly higher numbers of alveolar neutrophils and increased expression of the proinflammatory cytokines IL-1 beta and TNF-alpha relative to the responses seen in wild-type mice. By one week after administration, pulmonary inflammation was resolving in wild-type mice, whereas X-CGD mice developed chronic granulomatous lesions that persisted for at least six weeks. This is the first experimental evidence that chronic inflammation in CGD does not always result from persistent infection, and suggests that the clinical manifestations of this disorder reflect both impaired microbial killing as well as other abnormalities in the inflammatory response in the absence of a respiratory burst.

Purification and characterization of factors produced by Aspergillus fumigatus which affect human ciliated respiratory epithelium

The mechanisms by which Aspergillus fumigatus colonizes the respiratory mucosa are unknown. Culture filtrates of eight of nine clinical isolates of A. fumigatus slowed ciliary beat frequency and damaged human respiratory epithelium in vitro. These changes appeared to occur concurrently. Culture filtrates of two clinical isolates of Candida albicans had no effect on ciliated epithelium. We have purified and characterized cilioinhibitory factors of a clinical isolate of A. fumigatus. The cilioinhibitory activity was heat labile, reduced by dialysis, and partially extractable into chloroform. The activity was associated with both high- and low-molecular-weight factors, as determined by gel filtration on Sephadex G-50. A low-molecular-weight cilioinhibitory factor was further purified by reverse-phase high-performance liquid chromatography and shown by mass spectrometry to be gliotoxin, a known metabolite of A. fumigatus. Gliotoxin significantly slowed ciliary beat frequency in association with epithelial damage at concentrations above 0.2 microgram/ml; other Aspergillus toxins, i.e., fumagillin and helvolic acid, were also cilioinhibitory but at much higher concentrations. High-molecular-weight (> or = 35,000 and 25,000) cilioinhibitory materials had neither elastolytic nor proteolytic activity and remain to be identified. Thus, A. fumigatus produces a number of biologically active substances which slow ciliary beating and damage epithelium and which may influence colonization of the airways.

Interactions between conidia of Aspergillus fumigatus and human complement component C3

Activation and deposition of C3 on Aspergillus fumigatus conidia have been previously demonstrated. This study investigated in further detail the interactions between complement component C3 and the conidia of A. fumigatus. Immunoblotting and 125I-C3 binding studies showed that C3 deposition was rapid (less than 15 min) and parallel to the formation of iC3b. Immunoblotting experiments identified a 54- to 58-kDa conidial protein which binds human complement component C3 and/or a C3 fragment(s). 125I labeling of the outer layer of the conidia demonstrated that this protein doublet was present on the surface of the spore. The further degradation of C3 to low-molecular-mass fragments (40, 37, and 30 kDa), in the absence of plasma, by intact living conidia and a preparation of the outer conidial wall layer indicated the ability of fungal components to cleave C3. These data suggest that interactions between conidia and C3 are not limited only to deposition via activation of the alternative complement pathway; they also include degradation of bound C3.

Invasive aspergillosis of the maxilla in an immunocompromised patient

Patients who are immunocompromised have a high susceptibility to infection, which can be fatal. Studies have shown that patients receiving chemotherapeutic and adjunctive medications have inhibited inflammatory response to microbes, particularly those increasing the potential for the development of invasive infection. Aspergillus is a fungus often found in the atmosphere. Colonization of Aspergillus in the upper respiratory tract is common. In the immunocompromised patient, Aspergillus flavus is found to be the most frequent fungus cultured in the maxillary sinus. Because of the depressed immunologic state of the patient, A. flavus can differentiate into hyphal forms producing toxins that destroy epithelial tissues. Penetration of Aspergillus into connective and vascular tissue produces thrombosis and ultimately necrosis of hard and soft tissue.

Activation of C3 and binding to Aspergillus fumigatus conidia and hyphae

Complement activation by Aspergillus fumigatus may play a crucial role in stimulating binding and killing of this organism by phagocytes. We examined the amount and type of C3 deposited on resting conidia, swollen conidia, and hyphae of A. fumigatus after incubation in pooled human serum. All three life forms of A. fumigatus were potent activators of the complement cascade, with deposition on the organisms of similar amounts of C3 per unit of surface area. The rate of deposition was slowest for resting conidia, although maximal deposition was still achieved within 40 min. The roles of the alternative and classical pathways were assessed by use of serum chelated with magnesium EGTA [magnesium ethylene glycol-bis(beta-aminoethyl ether)-N,N,N',N'-tetraacetic acid] and with an alternative pathway reconstituted from the six purified alternative-pathway proteins. Complement activation by resting conidia was mediated by the alternative pathway. In contrast, there was a progressive dependence on the classical pathway as the fungal particles matured into swollen conidia and then hyphae. Treatment with hydroxylamine, which disrupts ester linkages, removed 89 to 95% of the C3 bound to all three forms of A. fumigatus. This released C3 contained a mixture of C3b and iC3b, as determined by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and autoradiography. These data demonstrate that although all three forms of A. fumigatus are potent activators of the complement system, the transition from resting conidia to swollen conidia to hyphae results in progressive changes in the manner in which the fungal particles interact with the complement system. The lack of participation of the classical pathway in complement activation by resting conidia may have important implications regarding their ability to effectively stimulate phagocytes.

Experimental basis for the clinical epidemiology of fungal infections. A review

Based on the concept that the agents of deep fungal infections can be divided into primary pathogens and opportunists the experimental basis for the clinical epidemiology of mycoses is outlined. Kinetics of experimental infections with opportunists and primary pathogens discriminate between the two fungal categories. Natural resistance eliminates opportunists and prevents the establishment of progressive infection in the normal host. Primary pathogens call upon mechanisms of adoptive cell mediated immunity for their control. Therefore athymic mice which are not more susceptible to opportunists than control mice, cannot control infection with primary pathogens. In order to induce comparable overwhelming opportunistic mycoses with reasonable challenge doses, non-specific phagocytic resistance has to be eliminated. In agreement with in vivo studies, in vitro studies of the susceptibility of fungi to killing by phagocytes point out, that the susceptibility of the tissue phase of fungi to killing by "immunologically unarmed" phagocytes discriminates between opportunists and primary pathogens. In order to restrain primary pathogenic fungi, phagocytes have also in vitro to call upon adoptive, T cell-dependent immune mechanisms, which appear superfluous for control of opportunists. This difference explains the discrepant opportunistic proclivities of the two fungal categories. Patients with defective phagocytic defenses are prone to opportunistic mycoses, while deficient cell mediated immunity results in a greater vulnerability to primary pathogens.

Killing of Aspergillus fumigatus spores by human lung macrophages: a paradoxical effect of heat-labile serum components

Spores of Aspergillus fumigatus can interfere with certain aspects of phagocytic cell function. In this study we have looked at the ability of human pulmonary macrophages to bind and kill spores of A. fumigatus which have been opsonized in untreated and heat-treated serum. For comparison, the non-pathogenic fungus Penicillium ochrochloron has been used. More than 60% of spores of both fungal species became cell-associated with the macrophages following incubation at 37 degrees C for 1 h. Spores of A. fumigatus opsonized in 5% pooled normal serum were significantly more resistant to killing by pulmonary macrophages than similarly opsonized spores of P. ochrochloron (p less than 0.02). However, serum which had been heated to 56 degrees C for 30 min prior to opsonization significantly increased (by approximately 80%) the ability of pulmonary macrophages to kill spores of A. fumigatus when compared with untreated sera (p less than 0.001). No such difference occurred with spores of P. ochrochloron. These unexpected observations fit with the known propensity of A. fumigatus to colonize the airways of patients with asthma and cystic fibrosis, conditions in which a protein-rich bronchial exudate characteristically occurs. Moreover, the presence of such a protective mechanism in a soil organism strongly suggests that complement-like substances may also play a role in protozoal phagocytosis. This is an area of research that does not appear to have been investigated.

Oxidative killing of Aspergillus fumigatus proceeds by parallel myeloperoxidase-dependent and -independent pathways

The relative importance of several oxygen intermediates in fungicidal action against opsonized Aspergillus fumigatus conidia was investigated with monocytes from normal volunteers and patients with either chronic granulomatous disease or myeloperoxidase (MPO) deficiency. Results from experiments in which catalase, taurine, mannitol, or glucose-glucose oxidase were added to these phagocytes indicated that the MPO-hydrogen peroxide-halide system and an MPO-independent oxidative system exerted comparable conidiacidal activity. These findings offer a plausible explanation for the susceptibility of patients with chronic granulomatous disease to invasive Aspergillus infections; their phagocytes fail to generate hydrogen peroxide, a substrate necessary for both systems. Patients with MPO deficiency are not known to be predisposed to invasive aspergillosis, suggesting that an MPO-independent oxidative system may provide an alternative mechanism for the oxidative killing of Aspergillus spp.

Resistance of spores of Aspergillus fumigatus to ingestion by phagocytic cells

Phagocytic cells are believed to have an important role in the eradication of fungal spores from the lung. The ability of human and mouse cells to phagocytose the opportunistic fungus Aspergillus fumigatus has been examined, spores of the non-pathogenic fungus Penicillium ochrochloron being used for comparison. Most spores became associated with cells. Those of A fumigatus appeared to remain bound to the surface of the phagocyte rather than being ingested; in contrast, P ochrochloron spores appeared to be phagocytosed more readily, although they also were seen, in small numbers, o n the cell surface. In view of the subjective nature of these observations, the effects of spore diffusates on phagocytosis were examined. Diffusates from spores of A fumigatus were shown to inhibit phagocytosis of antibody coated radiolabelled sheep red blood cells by primed mouse phagocytic cells. Diffusates of spores of P ochrochloron had no such effect. These results suggest that when spores of A fumigatus become bound to the surface of phagocytes they are able to release a substance that inhibits their ingestion while having little or no effect on surface binding.

Inhibition of germ tube development of Aspergillus fumigatus in cell-free transudate produced in subcutaneous chambers in rabbits

The interaction of Aspergillus fumigatus conidia with host factors produced in rabbits was studied by means of subcutaneous, perforated plastic chambers. Transudate fluid from spore-free chambers, sampled 30 days after implantation, supported germ tube development and rapid hyphal growth of A. fumigatus in an assay in vitro. Inoculation of spores into chambers implanted 30 days previously produced a rapid infiltration of leukocytes, predominately neutrophils, into the chamber fluid. Cell-free supernatants, prepared from transudates collected 5-6 days after inoculation, inhibited germ tube development in vitro. This inhibition was also demonstrated using lysates derived from 3.6 X 10(6) leukocytes obtained from chambers 5 days after inoculation with 1 X 10(7) spores. However, lysates derived from greater than 10(7) leukocytes obtained from pre-inoculated chambers as well as peritoneal exudate cells did not inhibit germ tube development in vitro. The inhibitory activity of cell free supernatants was not altered by heating at 56 degrees C for 30 min but was destroyed by pronase treatment as well as boiling. These results provide evidence for a host defense mechanism against rapid hyphal extension mediated by the extracellular release of inhibitory factors by leukocytes.

Suppression of host defences by Aspergillus fumigatus

An important feature of the microbicidal action of phagocytic cells is their ability to produce reactive oxygen intermediates. In an attempt to identify the mechanisms by which the fungus Aspergillus fumigatus resists normal host defences the effect of spores and spore diffusates of A fumigatus on the production of superoxide anion and hydrogen peroxide by primed rodent phagocytic cells has been measured. For comparison we have used the non-pathogenic fungus Penicillium ochrochloron. Production of these reactive oxygen intermediates in response to A fumigatus was significantly lower than that in response to P ochrochloron. A similar reduction was achieved by diffusate prepared from freshly washed spores. The inhibitory component was of low molecular weight (less than 14,000) and its effect was dose dependent. These results suggest that spores of A fumigatus fail to trigger and also inhibit the production of reactive oxygen intermediates by phagocytic cells.

An overview of macrophage-fungal interactions

A review of the literature (148 references) on the interactions of fungi with polymorphonuclear cells, monocytes and macrophages is presented. The interactions of Aspergillus species, Coccidioides immitis, Blastomyces dermatitidis, Histoplasma capsulatum, Cryptococcus neoformans, Candida albicans, and Candida species with human and experimental animal derived immune cells are examined in this overview. An effort has been made to present the reader with a comprehensive list of references with the intent of encouraging additional reading and research in this important area.

Host-parasite relationship in opportunistic mycoses

Aspergillosis and mucormycosis are opportunistic fungal infections that share several unique features. The etiologic agents of aspergillosis and mucormycosis are ubiquitous in the environment, but are opportunistic organisms and usually infect only patients predisposed by some underlying disease or treatment. These infections are typically characterized by hyphal tissue invasion and a predilection of the organism for blood vessel invasion with hemorrhage, necrosis, and infarction. Also, these organisms are not dimorphic, like the true pathogenic dimorphic fungi, as they grow both in the environment and within the host in hyphal forms. However, the host must contend with several forms to successfully eliminate them. Each form displays different antigenic and surface features and elicits different host responses. Finally, if germination and hyphal growth occur, the host must compete with a rapidly growing organism that is too large to be ingested by a single cell and so must be handled by extracellular defense mechanisms.

Immunology of fungal infections in animals

The nature of immunity to fungal infection is discussed predominantly for mammals and birds. T-cell-mediated immunity seems essential for recovery both from cutaneous and mucosal infections (Candida, Malassezia and dermatophytes) and from infections of systemic fungal pathogens (Cryptococcus, Blastomyces, Histoplasma, and Coccidioides). Often chronic progressive disease caused by these fungi is associated with a depression or absence of T-cell-mediated immunity to antigens of the infecting fungus. In contrast recovery from disease, or absence of clinical disease after exposure to these fungi, is associated with the presence of strong T-cell-mediated immune responses to the fungus. The activation of macrophages and the stimulation of epidermal growth and keratinization are the processes induced by T-cell-mediated immunity which result in the resolution of systemic or cutaneous and mucosal disease. Other cell types, for example NK cells and PMNs (polymorphonuclear leucocytes), may be important in these diseases in reducing the effective amount of inoculum to which an animal is exposed and thereby reducing the likelihood of disseminated disease. Invasive opportunistic fungi (Candida, Aspergillus, Mucorales) are resisted by PMNs which attach to the hyphae or pseudohyphae and damage them via an extracellular mechanism. Other host cell types may be important in natural resistance, fungal spores being handled by the macrophages which, under conditions when animals are not immunosuppressed, are likely to be an effective first line of defense. Subcutaneous pathogens and miscellaneous other fungal diseases are discussed from a point of view of host immunity and immunodiagnosis. Vaccine development for ringworm and for other mycoses is discussed.

Killing of Aspergillus fumigatus spores and Candida albicans yeast phase by the iron-hydrogen peroxide-iodide cytotoxic system: comparison with the myeloperoxidase-hydrogen peroxide-halide system

A new fungicidal system composed of ferrous ion, H2O2, and iodide is described and compared with the myeloperoxidase-hydrogen peroxide-halide system. Both systems had similar activity against Aspergillus fumigatus spores and the Candida albicans yeast phase, but only the ferrous ion-hydrogen peroxide-iodide system was inhibited by hydroxyl radical scavengers.

Interaction of Aspergillus fumigatus spores and pulmonary alveolar macrophages of rabbits

The in vitro and in vivo interaction of rabbit pulmonary alveolar macrophages (PAM) and Aspergillus fumigatus spores was studied. In vitro experiments showed that PAM from normal rabbits failed to appreciably kill A. fumigatus spores in 4 hours, while A. flavus and A. niger spores were destroyed effectively. Prior opsonization of the spores with normal rabbit serum, rabbit anti-A. fumigatus serum, complement or lung lavage fluid has no profound enhancing effect on the phagocytosis or killing of the spores. Activated macrophages, however, killed slightly more spores than normal macrophages. When A. fumigatus spores were injected intratracheally into rabbits, no dissemination to organs other than the lungs was detected during the first hour, while dissemination to the liver, spleen and kidneys was observed one hour after the inoculation. Free spores in the bronchoalveolar washings and ingested spores in macrophages diminished in 4 hours, while spores in the lung homogenate increased considerably.

Killing of Aspergillus spores depends on the anatomical source of the macrophage

To resolve the controversy over the capacity of macrophages to kill or inhibit germination of Aspergillus spores, we compared this function in peritoneal and alveolar macrophages. Alveolar macrophages from rabbits killed 82 to 90% and completely digested 72 to 82% of spores of Aspergillus fumigatus in 30 h. In contrast, peritoneal macrophages could not even inhibit the germination of ingested spores; more than 85% transformed into mycelia within 24 h. Killing by alveolar macrophages was delayed for 3 to 6 h after phagocytosis and was independent of oxidative killing mechanisms and immune activation. The ability of alveolar macrophages to kill Aspergillus spores without modulation by T lymphocytes or the generation of oxygen intermediates points out that concepts built on studies of peritoneal macrophages may be misleading and underscores the importance of studying the role of macrophages in immunity with cells from the appropriate anatomical site.

Chromoblastomycosis. A morphological investigation of the host-parasite interaction

Chromoblastomycosis is a distinct cutaneous mycotic infection. Histologically it is characterized by the presence of fungus invariably in the yeast phase and by macrophages in large numbers. The morphology of fungus in both yeast and hyphal phases and its interaction with mononuclear phagocytes were examined using ultrastructural techniques. The major structural difference between the fungus in cutaneous tissue and that from a culture medium was a striking increase in cell wall thickness in the former. In the skin, the organisms were phagocytised by macrophages and enclosed in large membrane limited intracytoplasmic vacuoles. The thick, stratified, electron-dense fungal cell wall was observed in stages of alteration of varying severity. Most common was a granular modification of the outermost layers of the cell wall in contact with the vacuolar content. Fragmentation, splitting and rupture of this and deeper layers was also seen. Several ultrastructural features suggested that cell wall damage resulted from an active host cell digestion. The cell wall changes were in sharp contrast with the usual normal fungal cytoplasmic appearance. Only rare intracellular debris which we supposed to represent dead yeast cells were found. These findings suggested that the yeast responsible for chromoblastomycosis resisted fungicidal activities of cutaneous macrophages which possessed the ultrastructural features of stimulated phagocytes.

Selective protection against conidia by mononuclear and against mycelia by polymorphonuclear phagocytes in resistance to Aspergillus. Observations on these two lines of defense in vivo and in vitro with human and mouse phagocytes

By comparing natural immunity to Aspergillus fumigatus (AF) in vivo with the action of human or mouse phagocytes against AF in vitro, we delineated two sequential lines of defense against AF. The first line of defense was formed by macrophages and directed against spores. Macrophages prevented germination and killed spores in vitro and rapidly eradicated conidia in vivo, even in neutropenic and athymic mice. The second was the neutrophilic granulocyte (PMN), which protected against the hyphal form of AF. Human and mouse PMN killed mycelia in vitro. Normal, but not neutropenic mice, stopped hyphal growth, and eradicated mycelia. Either line of defense acting alone protected mice from high challenge doses. Natural immunity collapsed only when both the reticuloendothelial system and PMN were impaired. These findings are in keeping with the clinical observation that high doses of cortisone and neutropenia are the main risk factors for invasive aspergillosis. Cortisone inhibited the conidiacidal activity of mouse macrophages in vivo and of human or mouse mononuclear phagocytes in vitro. Cortisone damaged this first line of defense directly and not through the influence of T lymphocytes or other systems modifying macrophage function as shown in athymic mice and in vitro. In addition, daily high doses of cortisone in mice reduced the mobilization of PMN so that the second line of defense was also impaired. Thus, cortisone can break down natural resistance on its own. Myelosuppression rendered mice susceptible only when the first line of defense was overpowered by high challenge doses, by activated spores that cannot be killed by macrophages, or by cortisone suppression of the conidiacidal activity of macrophages. The host, thus, can call upon two independent phagocytic cell lines that form graded defense systems against aspergillus. These lines of defense function in the absence of a specific immune response, which seems superfluous in the control and elimination of this fungus.

Defective Aspergillus killing by neutrophil leucocytes in a case of systemic aspergillosis

A persistent defect of Aspergillus killing was observed in the neutrophils of a 6-year-old patient with a systemic A. fumigatus infection which was highly refractory to anti-mycotic therapy. Aspergillus phagocytosis in vitro was normal, but nearly 80% of the ingested organisms (versus 30% in the controls) survived intracellularly during the 2-hr assay period. The patient's neutrophils showed a subnormal frequency of nitroblue tetrazolium reduction and a subnormal hexose monophosphate shunt activation in response to phagocytosis. The metabolic responsiveness, however, was clearly superior to that of chronic granulomatous disease neutrophils tested for comparison. The immune status of the patient and the following properties of his neutrophils were found to be normal: random and chemotactic motility, killing of S. aureus and C. albicans, and the contents of several granula enzymes. Our findings suggest the existence of neutrophil factors or functions which are required for killing Aspergillus, but not S. aureus and C. albicans.

Phagocytosis: a review

Primitive unicellular organisms depend greatly on internalization of particulate matter for nourishment. In metazoa, this process is further developed to play a major role in mechanisms of defense. This review analyzes, mainly in mammalian systems, the various phenomena surrounding the phagocytic act. Much of the emphasis is placed on experimental work which has recently elucidated some of its features. Both the structural and functional aspects of phagocytosis are considered throughout the review, which is subdivided into an examination of chemotaxis and the various agents inducing it, the mode of recognition of particles to be phagocytized, and the mechanisms of ingestion. The last includes a discussion of the possible means whereby recognition is translated into ingestion, the modes of adhesion of particles onto the surface of phagocytes, the formation and fusion of pseudopodia during engulfment and ingestion, and process and significance of degranulation. In addition, the metabolic changes in phagocytes during the processes of chemotaxis, ingestion, and digestion are described. A discussion of the various ways phagocytes may destroy microorganisms incorporates an appreciation of the importance of the microbicidal action of the acidic environment of the phagosome, the various lysosomal contents, hydrogen peroxide, superoxide, singlet oxygen, and chemiluminescence. The interdependence and interrelationship of the induction and cooperation of these mechanisms are examined.

Damage to hyphal forms of fungi by human leukocytes in vitro. A possible host defense mechanism in aspergillosis and mucormycosis

Evidence suggests that neutrophils are important in host defenses against invasive aspergillosis and mucormycosis, although hyphae in these lesions are too large to be phagocytized. Interactions of neutrophils with hyphae of Aspergillus fumigatus and Rhizopus oryzae were studed in vitro. Light and electron microscopic observations indicated that neutrophils attached to and spread over the surfaces of hyphae, even in the absence of serum. This was followed by dramatic morphologic changes which suggested severe damage and probably death of hyphae. An assay of neutrophil-induced reduction of uptake of radioisotopes was used to quantitate damage to the fungi by neutrophils from normal subjects. Damage to hyphae was inhibited by a variety of compounds which are known to affect neutrophil surface functions, motility, and metabolism. Use of inhibitors of oxidative microbicidal mechanisms of neutrophils indicated the central importance of these mechanisms in damage to hyphae. Inhibitors of neutrophil cationic proteins altered damage only to Rhizopus. Damage to hyphae by lysozyme suggested that it may play a secondary role in the neutrophil, primarily against Aspergillus. This new nonphagocytic mechanism may play an important role in host defenses against these and other hyphal forms of fungi.

Fate of Histoplasma capsulatum in guinea pig polymorphonuclear leukocytes

Guinea pig polymorphonuclear leukocytes (PMN) were parasitized in vitro with yeast cells of Histoplasma capsulatum. Preparations stained after 3 h at 37 C with May Greenwald-Giemsa revealed that 87% of the yeasts were tinctorially altered. Such alterations corresponded to those displayed by fungus cells intentionally killed by heat or other means and thus the altered yeast were presumed to be dead. A combination of 10(-5) M H(2)O(2), 10(-5) M KI, and horseradish peroxidase killed H. capsulatum. Death was assessed by the eosin-y dye exclusion test. All of the listed components were required for death of the fungus. A granule lysate preparation derived from guinea pig PMN leukocytes could replace the horseradish peroxidase in the fungicidal system. The granule lysates behaved in keeping with the attributes of a myeloperoxidase. Thus, PMN leukocytes and certain extracellular peroxidase systems kill the yeast cell phase of the dimorphic fungus H. capsulatum.

Intracellular fate of Cryptococcus neoformans

Human peripheral leukocytes were found to engulf and kill cells of Cryptococcus neoformans. Fewer encapsulated than nonencapsulated cells met this fate, since cryptococcal capsular polysaccharide inhibited phagocytosis. During 10 to 12 hr of incubation of nonencapsulated cells in human serum, sufficient polysaccharide was produced to inhibit phagocytosis by 50%. The polysaccharide inhibitor was found in the sera of four patients with cryptococcosis, but not on the surfaces of their leukocytes. Additional experiments indicated that serum is not essential for effective phagocytosis. However, normal human serum contains anticryptococcal activity which is not inhibited by capsular material. Preliminary findings indicate that the phagocytic index of a patient with cryptococcosis may be correlated with the severity of his disease.