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Nargan K, Glasgow JN, Nadeem S, Naidoo T, Wells G, Hunter RL, Hutton A, Lumamba K, Msimang M, Benson PV, Steyn AJC. Spatial distribution of Mycobacterium tuberculosis mRNA and secreted antigens in acid-fast negative human antemortem and resected tissue. EBioMedicine 2024; 105:105196. [PMID: 38880068 DOI: 10.1016/j.ebiom.2024.105196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 05/28/2024] [Accepted: 05/28/2024] [Indexed: 06/18/2024] Open
Abstract
BACKGROUND The ability to detect evidence of Mycobacterium tuberculosis (Mtb) infection within human tissues is critical to the study of Mtb physiology, tropism, and spatial distribution within TB lesions. The capacity of the widely-used Ziehl-Neelsen (ZN) staining method for identifying Mtb acid-fast bacilli (AFB) in tissue is highly variable, which can limit detection of Mtb bacilli for research and diagnostic purposes. Here, we sought to circumvent these limitations via detection of Mtb mRNA and secreted antigens in human tuberculous tissue. METHODS We adapted RNAscope, an RNA in situ hybridisation (RISH) technique, to detect Mtb mRNA in ante- and postmortem human TB tissues and developed a dual ZN/immunohistochemistry staining approach to identify AFB and bacilli producing antigen 85B (Ag85B). FINDINGS We identified Mtb mRNA within intact and disintegrating bacilli as well as extrabacillary mRNA. Mtb mRNA was distributed zonally within necrotic and non-necrotic granulomas. We also found Mtb mRNA within, and adjacent to, necrotic granulomas in ZN-negative lung tissue and in Ag85B-positive bronchiolar epithelium. Intriguingly, we observed accumulation of Mtb mRNA and Ag85B in the cytoplasm of host cells. Notably, many AFB were negative for Ag85B staining. Mtb mRNA was observed in ZN-negative antemortem lymph node biopsies. INTERPRETATION RNAscope and dual ZN/immunohistochemistry staining are well-suited for identifying subsets of intact Mtb and/or bacillary remnants in human tissue. RNAscope can identify Mtb mRNA in ZN-negative tissues from patients with TB and may have diagnostic potential in complex TB cases. FUNDING Wellcome Leap Delta Tissue Program, Wellcome Strategic Core Award, the National Institutes of Health (NIH, USA), the Mary Heersink Institute for Global Health at UAB, the UAB Heersink School of Medicine.
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Affiliation(s)
- Kievershen Nargan
- Africa Health Research Institute, University of KwaZulu-Natal, Durban, South Africa
| | - Joel N Glasgow
- Department of Microbiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sajid Nadeem
- Department of Microbiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Threnesan Naidoo
- Africa Health Research Institute, University of KwaZulu-Natal, Durban, South Africa; Department of Forensic and Legal Medicine, Walter Sisulu University, Mthatha, South Africa
| | - Gordon Wells
- Africa Health Research Institute, University of KwaZulu-Natal, Durban, South Africa
| | - Robert L Hunter
- Department of Pathology and Laboratory Medicine, University of Texas Health Sciences Center at Houston, Houston, TX, USA
| | - Anneka Hutton
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kapongo Lumamba
- Africa Health Research Institute, University of KwaZulu-Natal, Durban, South Africa
| | - Mpumelelo Msimang
- Department of Anatomical Pathology, National Health Laboratory Service, IALCH, Durban, South Africa
| | - Paul V Benson
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Adrie J C Steyn
- Africa Health Research Institute, University of KwaZulu-Natal, Durban, South Africa; Department of Microbiology, University of Alabama at Birmingham, Birmingham, AL, USA; Centers for AIDS Research and Free Radical Biology, University of Alabama at Birmingham, Birmingham, AL, USA.
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Helle OMB, Kanthali M, Ishtiaq S, Ambreen A, Purohit MR, Mustafa T. Diagnosing adult and pediatric extrapulmonary tuberculosis by MPT64 antigen detection with immunohistochemistry and immunocytochemistry using reproduced polyclonal antibodies. J Pathol Clin Res 2024; 10:e12373. [PMID: 38572528 PMCID: PMC10993049 DOI: 10.1002/2056-4538.12373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 03/06/2024] [Accepted: 03/14/2024] [Indexed: 04/05/2024]
Abstract
Diagnosing extrapulmonary tuberculosis (EPTB) is challenging. Immunohistochemistry or immunocytochemistry has been used to diagnose tuberculosis (TB) by detection of MPT64 antigen from various extrapulmonary specimens and has shown good diagnostic performance in our previous studies. The test can distinguish between disease caused by Mycobacterium tuberculosis (Mtb) complex and nontuberculous mycobacteria and can be applied on formalin-fixed paraffin-embedded tissue. As the antibodies previously used were in limited supply, a new batch of polyclonal antibodies was developed for scale-up and evaluated for the first time in this study. Our aim was to assess the diagnostic accuracy of the MPT64 test with reproduced antibodies in the high burden settings of Pakistan and India. Patients were enrolled prospectively. Samples from suspected sites of infection were collected and subjected to histopathologic and/or cytologic evaluation, routine TB diagnostics, GeneXpert MTB/RIF (Xpert), and the MPT64 antigen detection test. Patients were followed until the end of treatment. Based on a composite reference standard (CRS), 556 patients were categorized as TB cases and 175 as non-TB cases. The MPT64 test performed well on biopsies with a sensitivity and specificity of 94% and 75%, respectively, against a CRS. For cytology samples, the sensitivity was low (36%), whereas the specificity was 81%. Overall, the MPT64 test showed higher sensitivity (73%) than Xpert (38%) and Mtb culture (33%). The test performed equally well in adults and children. We found an additive diagnostic value of the MPT64 test in conjunction with histology and molecular tests, increasing the yield for EPTB. In conclusion, immunochemical staining with MPT64 antibodies improves the diagnosis of EPTB in high burden settings and could be a valuable addition to routine diagnostics.
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Affiliation(s)
- Ole Magnus Bjørgaas Helle
- Department of Thoracic MedicineHaukeland University HospitalBergenNorway
- Centre for International Health, Department of Global Public Health and Primary CareUniversity of BergenBergenNorway
| | - Mala Kanthali
- Department of PathologyR.D. Gardi Medical CollegeUjjainIndia
| | - Sheeba Ishtiaq
- Department of HistopathologyGulab Devi HospitalLahorePakistan
| | - Atiqa Ambreen
- Department of MicrobiologyGulab Devi HospitalLahorePakistan
| | - Manju Raj Purohit
- Department of PathologyR.D. Gardi Medical CollegeUjjainIndia
- Department of Public Health SciencesKarolinska InstitutetStockholmSweden
| | - Tehmina Mustafa
- Department of Thoracic MedicineHaukeland University HospitalBergenNorway
- Centre for International Health, Department of Global Public Health and Primary CareUniversity of BergenBergenNorway
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Riaz SM, Hanevik K, Helgeland L, Sviland L, Hunter RL, Mustafa T. Novel Insights into the Pathogenesis of Human Post-Primary Tuberculosis from Archival Material of the Pre-Antibiotic Era, 1931-1947. Pathogens 2023; 12:1426. [PMID: 38133309 PMCID: PMC10745901 DOI: 10.3390/pathogens12121426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 12/01/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023] Open
Abstract
OBJECTIVES Primary and post-primary tuberculosis (TB) are distinct entities. The aim of this study was to study the histopathology of primary and post-primary TB by using the unique human autopsy material from the pre-antibiotic era, 1931-1947. MATERIAL AND METHODS Autopsy data were collected from the autopsy journals, and the human tissue was collected from the pathology archives at the Department of Pathology, the Gades Institute. RESULTS Histological presentations of TB lesions showed great diversity within a single lung. Post-primary TB starts as a pneumonia forming early lesions, characterized by the infiltration of foamy macrophages containing mycobacterial antigens within alveoli, and progressing to necrotic pneumonias with an increasing density of mycobacterial antigens in the lesions. These necrotic pneumonic lesions appeared to either resolve as fibrocaseous lesions or lead to cavitation. The typical granulomatous inflammation, the hallmark of TB lesions, appeared later in the post-primary TB and surrounded the pneumonic lesions. These post-primary granulomas contained lesser mycobacterial antigens as compared to necrotic pneumonia. CONCLUSIONS Immunopathogenesis of post-primary TB is different from primary TB and starts as pneumonia. The early lesions of post-primary TB may progress or regress, holding the key to understanding how a host can develop the disease despite an effective TB immunity.
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Affiliation(s)
- Syeda Mariam Riaz
- Centre for International Health, Department of Global Public Health and Primary Care, Faculty of Medicine and Dentistry, University of Bergen, 5007 Bergen, Norway;
| | - Kurt Hanevik
- Department of Clinical Science, Faculty of Medicine and Dentistry, University of Bergen, 5007 Bergen, Norway;
- National Centre for Tropical Infectious Diseases, Medical Department, Haukeland University Hospital, 5021 Bergen, Norway
| | - Lars Helgeland
- Department of Pathology, Haukeland University Hospital, 5021 Bergen, Norway; (L.H.); (L.S.)
- Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, 5007 Bergen, Norway
| | - Lisbet Sviland
- Department of Pathology, Haukeland University Hospital, 5021 Bergen, Norway; (L.H.); (L.S.)
- Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, 5007 Bergen, Norway
| | - Robert L. Hunter
- Department of Pathology and Laboratory Medicine, University of Texas Health Sciences Centre at Houston, Houston, TX 77030, USA;
| | - Tehmina Mustafa
- Centre for International Health, Department of Global Public Health and Primary Care, Faculty of Medicine and Dentistry, University of Bergen, 5007 Bergen, Norway;
- Department of Thoracic Medicine, Haukeland University Hospital, 5021 Bergen, Norway
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Nargan K, Naidoo T, Msimang M, Nadeem S, Wells G, Hunter RL, Hutton A, Lumamba K, Glasgow JN, Benson PV, Steyn AJ. Detection of Mycobacterium tuberculosis in human tissue via RNA in situ hybridization. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.10.04.560963. [PMID: 37873458 PMCID: PMC10592959 DOI: 10.1101/2023.10.04.560963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Rationale Accurate TB diagnosis is hampered by the variable efficacy of the widely-used Ziehl-Neelsen (ZN) staining method to identify Mycobacterium tuberculosis ( Mtb ) acid-fast bacilli (AFB). Here, we sought to circumvent this current limitation through direct detection of Mtb mRNA. Objectives To employ RNAscope to determine the spatial distribution of Mtb mRNA within tuberculous human tissue, to appraise ZN-negative tissue from confirmed TB patients, and to provide proof-of-concept of RNAscope as a platform to inform TB diagnosis and Mtb biology. Methods We examined ante- and postmortem human TB tissue using RNAscope to detect Mtb mRNA and a dual ZN/immunohistochemistry staining approach to identify AFB and bacilli producing antigen 85B (Ag85B). Measurements and main results We adapted RNAscope for Mtb and identified intact and disintegrated Mtb bacilli and intra- and extracellular Mtb mRNA. Mtb mRNA was distributed zonally within necrotic and non-necrotic granulomas. We also found Mtb mRNA within, and adjacent to, necrotic granulomas in ZN-negative lung tissue and in Ag85B-positive bronchial epithelium. Intriguingly, we observed accumulation of Mtb mRNA and Ag85B in the cytoplasm of host cells. Notably, many AFB were negative for Ag85B staining. Mtb mRNA was observed in ZN-negative antemortem lymph node biopsies. Conclusions RNAscope has diagnostic potential and can guide therapeutic intervention as it detects Mtb mRNA and morphology in ZN-negative tissues from TB patients, and Mtb mRNA in ZN-negative antemortem biopsies, respectively. Lastly, our data provide evidence that at least two phenotypically distinct populations of Mtb bacilli exist in vivo .
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Brown RE, Hunter RL. Early Lesion of Post-Primary Tuberculosis: Subclinical Driver of Disease and Target for Vaccines and Host-Directed Therapies. Pathogens 2021; 10:pathogens10121572. [PMID: 34959527 PMCID: PMC8708170 DOI: 10.3390/pathogens10121572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/16/2021] [Accepted: 11/29/2021] [Indexed: 11/16/2022] Open
Abstract
The characteristic lesion of primary tuberculosis is the granuloma as is widely studied in human tissues and animal models. Post-primary tuberculosis is different. It develops only in human lungs and begins as a prolonged subclinical obstructive lobular pneumonia that slowly accumulates mycobacterial antigens and host lipids in alveolar macrophages with nearby highly sensitized T cells. After several months, the lesions undergo necrosis to produce a mass of caseous pneumonia large enough to fragment and be coughed out to produce a cavity or be retained as the focus of a post-primary granuloma. Bacteria grow massively on the cavity wall where they can be coughed out to infect new people. Here we extend these findings with the demonstration of secreted mycobacterial antigens, but not acid fast bacilli (AFB) of M. tuberculosis in the cytoplasm of ciliated bronchiolar epithelium and alveolar pneumocytes in association with elements of the programmed death ligand 1 (PD-L1), cyclo-oxygenase (COX)-2, and fatty acid synthase (FAS) pathways in the early lesion. This suggests that M. tuberculosis uses its secreted antigens to coordinate prolonged subclinical development of the early lesions in preparation for a necrotizing reaction sufficient to produce a cavity, post-primary granulomas, and fibrocaseous disease.
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Chung WY, Lee KS, Park JH, Jung YJ, Sheen SS, Park JE, Sun JS, Ko YH, Park KJ. TB Antigen-Stimulated CXCR3 Ligand Assay for Diagnosis of Tuberculous Lymphadenitis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18158020. [PMID: 34360313 PMCID: PMC8345678 DOI: 10.3390/ijerph18158020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/23/2021] [Accepted: 07/25/2021] [Indexed: 12/21/2022]
Abstract
The diagnosis of tuberculous lymphadenitis (TB-LAP) is challenging. We evaluated the role of blood CXC chemokine receptor 3 (CXCR3) ligands in its diagnosis. A total of 65 lymphadenopathy patients were enrolled and lymph node sampling was performed. We also recruited 113 control subjects, consisting of 27 with positive results and 86 with negative results, in the interferon (IFN)-γ release assay (IGRA). In all study subjects, whole-blood samples were collected using the IGRA methodology. After incubation, plasma levels of IFN-γ and two CXCR3 ligands, IFN-inducible T-cell a chemoattractant (I-TAC) and monokine induced by IFN-γ (MIG), were measured using immunoassay. Fifty-three TB-LAP patients were enrolled. TB antigen-stimulated IFN-γ, I-TAC, and MIG levels were all significantly higher in the TB-LAP patients than in the controls and non-TB-LAP patients. The levels of I-TAC and MIG, but not IFN-γ, showed significant differences between the TB-LAP patients and IGRA-positive controls. Area under the receiver operating characteristic curves (AUROCs) of IFN-γ, I-TAC, and MIG were 0.955, 0.958, and 0.959, respectively, for differentiating TB-LAP from control group, and were 0.912, 0.956, and 0.936, respectively, for differentiating TB-LAP from non-TB-LAP. In conclusion, the TB antigen-stimulated MIG and I-TAC could be useful biomarkers in the diagnosis of TB-LAP.
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Affiliation(s)
- Wou-Young Chung
- Department of Pulmonology and Critical Care Medicine, Ajou University Hospital, Suwon 16499, Korea; (W.-Y.C.); (K.-S.L.); (J.-H.P.); (Y.-J.J.); (S.-S.S.); (J.-E.P.)
| | - Keu-Sung Lee
- Department of Pulmonology and Critical Care Medicine, Ajou University Hospital, Suwon 16499, Korea; (W.-Y.C.); (K.-S.L.); (J.-H.P.); (Y.-J.J.); (S.-S.S.); (J.-E.P.)
| | - Joo-Hun Park
- Department of Pulmonology and Critical Care Medicine, Ajou University Hospital, Suwon 16499, Korea; (W.-Y.C.); (K.-S.L.); (J.-H.P.); (Y.-J.J.); (S.-S.S.); (J.-E.P.)
| | - Yun-Jung Jung
- Department of Pulmonology and Critical Care Medicine, Ajou University Hospital, Suwon 16499, Korea; (W.-Y.C.); (K.-S.L.); (J.-H.P.); (Y.-J.J.); (S.-S.S.); (J.-E.P.)
| | - Seung-Soo Sheen
- Department of Pulmonology and Critical Care Medicine, Ajou University Hospital, Suwon 16499, Korea; (W.-Y.C.); (K.-S.L.); (J.-H.P.); (Y.-J.J.); (S.-S.S.); (J.-E.P.)
| | - Ji-Eun Park
- Department of Pulmonology and Critical Care Medicine, Ajou University Hospital, Suwon 16499, Korea; (W.-Y.C.); (K.-S.L.); (J.-H.P.); (Y.-J.J.); (S.-S.S.); (J.-E.P.)
| | - Joo-Sung Sun
- Department of Radiology, Ajou University Hospital, Suwon 16499, Korea;
| | - Young-Hwa Ko
- Department of Pathology, Ajou University Hospital, Suwon 16499, Korea;
| | - Kwang-Joo Park
- Department of Pulmonology and Critical Care Medicine, Ajou University Hospital, Suwon 16499, Korea; (W.-Y.C.); (K.-S.L.); (J.-H.P.); (Y.-J.J.); (S.-S.S.); (J.-E.P.)
- Correspondence: ; Tel.: +82-31-219-5120
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Kim JS, Cho E, Mun SJ, Kim S, Kim SY, Kim DG, Son W, Jeon HI, Kim HK, Jeong YJ, Jang S, Kim HS, Yang CS. Multi-Functional MPT Protein as a Therapeutic Agent against Mycobacterium tuberculosis. Biomedicines 2021; 9:biomedicines9050545. [PMID: 34068051 PMCID: PMC8152475 DOI: 10.3390/biomedicines9050545] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/03/2021] [Accepted: 05/12/2021] [Indexed: 02/07/2023] Open
Abstract
Mycobacterium tuberculosis (MTB), the causative agent of tuberculosis (TB), avoids the host immune system through its virulence factors. MPT63 and MPT64 are the virulence factors secreted by MTB which regulate host proteins for the survival and proliferation of MTB in the host. Here, we found that MPT63 bound directly with TBK1 and p47phox, whereas MPT64 interacted with TBK1 and HK2. We constructed a MPT63/64-derived multifunctional recombinant protein (rMPT) that was able to interact with TBK1, p47phox, or HK2. rMPT was shown to regulate IFN-β levels and increase inflammation and concentration of reactive oxygen species (ROS), while targeting macrophages and killing MTB, both in vitro and in vivo. Furthermore, the identification of the role of rMPT against MTB was achieved via vaccination in a mouse model. Taken together, we here present rMPT, which, by regulating important immune signaling systems, can be considered an effective vaccine or therapeutic agent against MTB.
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Affiliation(s)
- Jae-Sung Kim
- Department of Bionano Technology, Hanyang University, Seoul 04673, Korea; (J.-S.K.); (E.C.); (S.-J.M.); (S.-Y.K.)
- Institute of Natural Science & Technology, Hanyang University, Ansan 15588, Korea
| | - Euni Cho
- Department of Bionano Technology, Hanyang University, Seoul 04673, Korea; (J.-S.K.); (E.C.); (S.-J.M.); (S.-Y.K.)
- Center for Bionano Intelligence Education and Research, Ansan 15588, Korea; (W.S.); (H.-I.J.); (H.-K.K.); (Y.-J.J.); (S.J.)
| | - Seok-Jun Mun
- Department of Bionano Technology, Hanyang University, Seoul 04673, Korea; (J.-S.K.); (E.C.); (S.-J.M.); (S.-Y.K.)
- Center for Bionano Intelligence Education and Research, Ansan 15588, Korea; (W.S.); (H.-I.J.); (H.-K.K.); (Y.-J.J.); (S.J.)
| | - Sojin Kim
- Department of Molecular and Life Science, Hanyang University, Ansan 15588, Korea; (S.K.); (D.-G.K.)
| | - Sun-Young Kim
- Department of Bionano Technology, Hanyang University, Seoul 04673, Korea; (J.-S.K.); (E.C.); (S.-J.M.); (S.-Y.K.)
| | - Dong-Gyu Kim
- Department of Molecular and Life Science, Hanyang University, Ansan 15588, Korea; (S.K.); (D.-G.K.)
| | - Wooic Son
- Center for Bionano Intelligence Education and Research, Ansan 15588, Korea; (W.S.); (H.-I.J.); (H.-K.K.); (Y.-J.J.); (S.J.)
- Department of Molecular and Life Science, Hanyang University, Ansan 15588, Korea; (S.K.); (D.-G.K.)
| | - Hye-In Jeon
- Center for Bionano Intelligence Education and Research, Ansan 15588, Korea; (W.S.); (H.-I.J.); (H.-K.K.); (Y.-J.J.); (S.J.)
- Department of Molecular and Life Science, Hanyang University, Ansan 15588, Korea; (S.K.); (D.-G.K.)
| | - Hyo-Keun Kim
- Center for Bionano Intelligence Education and Research, Ansan 15588, Korea; (W.S.); (H.-I.J.); (H.-K.K.); (Y.-J.J.); (S.J.)
- Department of Molecular and Life Science, Hanyang University, Ansan 15588, Korea; (S.K.); (D.-G.K.)
| | - Young-Jin Jeong
- Center for Bionano Intelligence Education and Research, Ansan 15588, Korea; (W.S.); (H.-I.J.); (H.-K.K.); (Y.-J.J.); (S.J.)
- Department of Molecular and Life Science, Hanyang University, Ansan 15588, Korea; (S.K.); (D.-G.K.)
| | - Sein Jang
- Center for Bionano Intelligence Education and Research, Ansan 15588, Korea; (W.S.); (H.-I.J.); (H.-K.K.); (Y.-J.J.); (S.J.)
- Department of Molecular and Life Science, Hanyang University, Ansan 15588, Korea; (S.K.); (D.-G.K.)
| | - Hyun-Sung Kim
- Department of Pathology, Hanyang University College of Medicine, Seoul 04673, Korea;
| | - Chul-Su Yang
- Center for Bionano Intelligence Education and Research, Ansan 15588, Korea; (W.S.); (H.-I.J.); (H.-K.K.); (Y.-J.J.); (S.J.)
- Department of Molecular and Life Science, Hanyang University, Ansan 15588, Korea; (S.K.); (D.-G.K.)
- Correspondence: ; Tel.: +82-31-400-5519; Fax: +82-31-436-8153
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Mycobacterium tuberculosis Load in Host Cells and the Antibacterial Activity of Alveolar Macrophages Are Linked and Differentially Regulated in Various Lung Lesions of Patients with Pulmonary Tuberculosis. Int J Mol Sci 2021; 22:ijms22073452. [PMID: 33810600 PMCID: PMC8037353 DOI: 10.3390/ijms22073452] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 03/17/2021] [Accepted: 03/22/2021] [Indexed: 02/07/2023] Open
Abstract
Tuberculosis (TB) is a disease caused by Mycobacterium tuberculosis (Mtb) infection with the formation of a broad range of abnormal lung lesions within a single patient. Although host-pathogen interactions determine disease outcome, they are poorly understood within individual lesions at different stages of maturation. We compared Mtb load in a tuberculoma wall and the lung tissue distant from tuberculomas in TB patients. These data were combined with an analysis of activation and bactericidal statuses of alveolar macrophages and other cell subtypes examined both in ex vivo culture and on the histological sections obtained from the same lung lesions. The expression of pattern recognition receptors CD14, CD11b, and TLR-2, transcription factors HIF-1α, HIF-2α, and NF-κB p50 and p65, enzymes iNOS and COX-2, reactive oxygen species (ROS) biosynthesis, and lipid production were detected for various lung lesions, with individual Mtb loads in them. The walls of tuberculomas with insufficient inflammation and excessive fibrosis were identified as being the main niche for Mtb survival (single or as colonies) in non-foamy alveolar macrophages among various lung lesions examined. The identification of factors engaged in the control of Mtb infection and tissue pathology in local lung microenvironments, where host-pathogen relationships take place, is critical for the development of new therapeutic strategies.
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Hunter RL. The Pathogenesis of Tuberculosis-The Koch Phenomenon Reinstated. Pathogens 2020; 9:E813. [PMID: 33020397 PMCID: PMC7601602 DOI: 10.3390/pathogens9100813] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 09/11/2020] [Accepted: 09/19/2020] [Indexed: 12/24/2022] Open
Abstract
Research on the pathogenesis of tuberculosis (TB) has been hamstrung for half a century by the paradigm that granulomas are the hallmark of active disease. Human TB, in fact, produces two types of granulomas, neither of which is involved in the development of adult type or post-primary TB. This disease begins as the early lesion; a prolonged subclinical stockpiling of secreted mycobacterial antigens in foamy alveolar macrophages and nearby highly sensitized T cells in preparation for a massive necrotizing hypersensitivity reaction, the Koch Phenomenon, that produces caseous pneumonia that is either coughed out to form cavities or retained to become the focus of post-primary granulomas and fibrocaseous disease. Post-primary TB progresses if the antigens are continuously released and regresses when they are depleted. This revised paradigm is supported by nearly 200 years of research and suggests new approaches and animal models to investigate long standing mysteries of human TB and vaccines that inhibit the early lesion to finally end its transmission.
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Affiliation(s)
- Robert L Hunter
- Department of Pathology and Laboratory Medicine, University of Texas Health Sciences Center at Houston, Houston, TX 77030, USA
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10
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Mustafa T, Wergeland I, Baba K, Pathak S, Hoosen AA, Dyrhol-Riise AM. Mycobacterial antigens in pleural fluid mononuclear cells to diagnose pleural tuberculosis in HIV co-infected patients. BMC Infect Dis 2020; 20:459. [PMID: 32611401 PMCID: PMC7329517 DOI: 10.1186/s12879-020-05165-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 06/17/2020] [Indexed: 12/30/2022] Open
Abstract
Background Extra pulmonary manifestation of tuberculosis (TB) accounts for approximately one-half of TB cases in HIV-infected individuals with pleural TB as the second most common location. Even though mycobacteria are cleared, mycobacterial antigens may persist in infected tissues, causing sustained inflammation and chronicity of the disease. The aim of this study was to explore various mycobacterial antigens in pleural effusions, the impact of HIV infection and CD4+ T-cell depletion on the presence of antigens, and the diagnostic potential of antigens for improved and rapid diagnosis of pleural TB. Methods Pleural fluid specimens were collected from patients presenting with clinically suspected pleural TB, and processed routinely for culture, cytology, and adenosine deaminase activity analysis. HIV status and CD4+ T-cell counts were recorded. Pleural fluid mononuclear cells (PFMC) were isolated, and cell smears were stained with acid-fast staining and immunocytochemistry for various mycobacterial antigens. Real-time and nested-PCR were performed. Patients were categorized as pleural TB or non-TB cases using a composite reference standard. Performance of the mycobacterial antigens as diagnostic test was assessed. Results A total of 41 patients were enrolled, of which 32 were classified as pleural TB and 9 as non-TB. Thirteen patients had culture confirmed pleural TB, 26 (81%) were HIV-TB co-infected, and 64% had < 100 CD4+ T-cells/microL. Both secreted and cell-wall mycobacterial antigens were detected in PFMC. Lipoarabinomannan (LAM) was the most frequently detected antigen. There was no direct correlation between positive culture and antigens. Cases with low CD4+ T-cell counts had higher bacterial and antigen burden. By combining detection of secreted antigen or LAM, the sensitivity and specificity to diagnose pleural TB was 56 and 78%, respectively, as compared to 41 and 100% for culture, 53 and 89% for nested PCR, and 6 and 100% for real-time PCR. Conclusion Mycobacterial antigens were detectable in PFMC from tuberculous pleural effusions, even in cases where viable mycobacteria or bacterial DNA were not always detected. Thus, a combination of secreted antigen and LAM detection by immunocytochemistry may be a complement to acid-fast staining and contribute to rapid and accurate diagnosis of pleural TB.
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Affiliation(s)
- Tehmina Mustafa
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, P.O. box 7804, N-5020, Bergen, Norway. .,Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway.
| | - Ida Wergeland
- Department of Internal Medicine, Haukeland University Hospital, Bergen, Norway
| | - Kamaldeen Baba
- Department of Microbiological Pathology, Medunsa Campus, University of Limpopo, Mankweng, South Africa.,Department of Pathology and Laboratory Medicine, King Abdullah bin Abdulaziz University Hospital, Princess Noura bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Sharad Pathak
- Department of Respiratory Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Anwar A Hoosen
- Department of Microbiological Pathology, Medunsa Campus, University of Limpopo, Mankweng, South Africa.,Pathcare - Vermaak & Partners Pathologists and Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa
| | - Anne Margarita Dyrhol-Riise
- Department of Infectious Diseases, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
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11
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Riaz SM, Bjune GA, Wiker HG, Sviland L, Mustafa T. Mycobacterial antigens accumulation in foamy macrophages in murine pulmonary tuberculosis lesions: Association with necrosis and making of cavities. Scand J Immunol 2020; 91:e12866. [PMID: 31960452 DOI: 10.1111/sji.12866] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 12/06/2019] [Accepted: 01/16/2020] [Indexed: 12/16/2022]
Abstract
Understanding mechanisms of cavitation in tuberculosis (TB) is the missing link that could advance the field towards better control of the infection. Descriptions of human TB suggest that postprimary TB begins as lipid pneumonia of foamy macrophages that undergoes caseating necrosis and fragmentation to produce cavities. This study aimed to investigate the various mycobacterial antigens accumulating in foamy macrophages and their relation to tissue destruction and necrosis. Pulmonary tissues from mice with slowly progressive TB were studied for histopathology, acid-fast bacilli (AFB) and presence of mycobacterial antigens. Digital quantification using Aperio ImageScope was done. Until week 12 postinfection, mice were healthy, and lesions were small with scarce AFB and mycobacterial antigens. Colony-forming units (CFUs) increased exponentially. At week 16-33, mice were sick, macrophages attained foamy appearance with an increase in antigens (P < .05), 1.5 log increase in CFUs and an approximately onefold increase in AFB. At week 37-41, mice started dying with a shift in morphology towards necrosis. A >20-fold increase in mycobacterial antigens was observed with only less than one log increase in CFUs and sevenfold increase in AFB. Secreted antigens were significantly (P < .05) higher compared to cell-wall antigens throughout infection. Focal areas of necrosis were associated with an approximately 40-fold increase in antigen MPT46, functionally active thioredoxin, and a significant increase in all secreted antigens. In conclusion, mycobacterial antigens accumulate in the foamy macrophages in TB lesions during slowly progressive murine pulmonary TB. Secreted antigens and MPT46 correlated with necrosis, thereby implying that they might trigger the formation of cavities.
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Affiliation(s)
- Syeda Mariam Riaz
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Gunnar Aksel Bjune
- Department of Community Medicine, Institute of Health and Society, The Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Harald G Wiker
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Lisbet Sviland
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Pathology, Haukeland University Hospital, Bergen, Norway
| | - Tehmina Mustafa
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
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12
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Sannigrahi A, Nandi I, Chall S, Jawed JJ, Halder A, Majumdar S, Karmakar S, Chattopadhyay K. Conformational Switch Driven Membrane Pore Formation by Mycobacterium Secretory Protein MPT63 Induces Macrophage Cell Death. ACS Chem Biol 2019; 14:1601-1610. [PMID: 31241303 DOI: 10.1021/acschembio.9b00327] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Virulent Mycobacterium tuberculosis (MTB) strains cause cell death of macrophages (Mϕ) inside TB granuloma using a mechanism which is not well understood. Many bacterial systems utilize toxins to induce host cell damage, which occurs along with immune evasion. These toxins often use chameleon sequences to generate an environment-sensitive conformational switch, facilitating the process of infection. The presence of toxins is not yet known for MTB. Here, we show that MTB-secreted immunogenic MPT63 protein undergoes a switch from β-sheet to helix in response to mutational and environmental stresses. MPT63 in its helical form creates pores in both synthetic and Mϕ membranes, while the native β-sheet protein remains inert toward membrane interactions. Using fluorescence correlation spectroscopy and atomic force microscopy, we show further that the helical form undergoes self-association to produce toxic oligomers of different morphology. Trypan blue and flow cytometry analyses reveal that the helical state can be utilized by MTB for killing Mϕ cells. Collectively, our study emphasizes for the first time a toxin-like behavior of MPT63 induced by an environment-dependent conformational switch, resulting in membrane pore formation by toxic oligomers and Mϕ cell death.
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Affiliation(s)
- Achinta Sannigrahi
- Structural Biology & Bio-Informatics Division, CSIR-Indian Institute of Chemical Biology, 4, Raja S. C. Mallick Road, Kolkata 700032, India
| | - Indrani Nandi
- Structural Biology & Bio-Informatics Division, CSIR-Indian Institute of Chemical Biology, 4, Raja S. C. Mallick Road, Kolkata 700032, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad 201002, India
| | - Sayantani Chall
- Structural Biology & Bio-Informatics Division, CSIR-Indian Institute of Chemical Biology, 4, Raja S. C. Mallick Road, Kolkata 700032, India
| | | | - Animesh Halder
- Department of Physics, Jadavpur University, 188, Raja S. C. Mallick Road, Kolkata 700032, India
| | - Subrata Majumdar
- Department of Molecular Medicine, Bose Institute, Kolkata 700054, India
| | - Sanat Karmakar
- Department of Physics, Jadavpur University, 188, Raja S. C. Mallick Road, Kolkata 700032, India
| | - Krishnananda Chattopadhyay
- Structural Biology & Bio-Informatics Division, CSIR-Indian Institute of Chemical Biology, 4, Raja S. C. Mallick Road, Kolkata 700032, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad 201002, India
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13
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Ufimtseva E, Eremeeva N, Bayborodin S, Umpeleva T, Vakhrusheva D, Skornyakov S. Mycobacterium tuberculosis with different virulence reside within intact phagosomes and inhibit phagolysosomal biogenesis in alveolar macrophages of patients with pulmonary tuberculosis. Tuberculosis (Edinb) 2018; 114:77-90. [PMID: 30711161 DOI: 10.1016/j.tube.2018.12.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 11/27/2018] [Accepted: 12/02/2018] [Indexed: 12/14/2022]
Abstract
Tuberculosis (TB) is a dangerous airborne disease caused by Mycobacterium tuberculosis (Mtb) and characterized by a tight interplay between pathogen and host cells, mainly alveolar macrophages. Studies of the mechanisms of Mtb survival within human cells during TB disease are extremely important for the development of new strategies and drugs for TB treatment. We have used the ex vivo cultures of alveolar macrophages and histological sections obtained from the resected lungs of patients with pulmonary TB to establish the unique features of Mtb lifestyle in host cells. Our data indicate that Mtb with different virulence, as single and in colonies, with or without cording morphology, are exclusively intravacuolar pathogens with intact phagosomal membranes in viable host cells of TB patients and Mtb-infected guinea pig. Mycobacteria were detected in the cytoplasm and/or damaged vacuoles only in alveolar macrophages with morphological signs of cell death after prolonged ex vivo culture, however Mtb were found inside phagosomes in viable alveolar macrophages or cells with apoptotic/necrotic morphology in the same ex vivo cell culture. The Mtb phagosomes interacted with human different endocytic pathways, but inhibited phagolysosomal biogenesis, while intracellular vesicles containing Mtb products were fused with lysosomes in the same host cells.
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Affiliation(s)
- Elena Ufimtseva
- Laboratory of Medical Biotechnology, Research Institute of Biochemistry, Federal Research Center of Fundamental and Translational Medicine, 2 Timakova Street, 630117, Novosibirsk, Russia; Scientific Department, Ural Research Institute for Phthisiopulmonology, National Medical Research Center of Tuberculosis and Infectious Diseases of Ministry of Health of the Russian Federation, 50 XXII Partsyezda Street, 620039, Yekaterinburg, Russia.
| | - Natalya Eremeeva
- Scientific Department, Ural Research Institute for Phthisiopulmonology, National Medical Research Center of Tuberculosis and Infectious Diseases of Ministry of Health of the Russian Federation, 50 XXII Partsyezda Street, 620039, Yekaterinburg, Russia.
| | - Sergey Bayborodin
- Shared Center for Microscopic Analysis of Biological Objects, Federal Research Center Institute of Cytology and Genetics, 10 Lavrentyeva Prospect, 630090, Novosibirsk, Russia.
| | - Tatiana Umpeleva
- Scientific Department, Ural Research Institute for Phthisiopulmonology, National Medical Research Center of Tuberculosis and Infectious Diseases of Ministry of Health of the Russian Federation, 50 XXII Partsyezda Street, 620039, Yekaterinburg, Russia.
| | - Diana Vakhrusheva
- Scientific Department, Ural Research Institute for Phthisiopulmonology, National Medical Research Center of Tuberculosis and Infectious Diseases of Ministry of Health of the Russian Federation, 50 XXII Partsyezda Street, 620039, Yekaterinburg, Russia.
| | - Sergey Skornyakov
- Scientific Department, Ural Research Institute for Phthisiopulmonology, National Medical Research Center of Tuberculosis and Infectious Diseases of Ministry of Health of the Russian Federation, 50 XXII Partsyezda Street, 620039, Yekaterinburg, Russia.
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14
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Palmer MV. Emerging Understanding of Tuberculosis and the Granuloma by Comparative Analysis in Humans, Cattle, Zebrafish, and Nonhuman Primates. Vet Pathol 2018; 55:8-10. [PMID: 29254474 DOI: 10.1177/0300985817712795] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Mitchell V Palmer
- 1 Infectious Bacterial Diseases of Livestock, National Animal Disease Center, United States Department of Agriculture, Ames, IA, USA
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15
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Incipient and Subclinical Tuberculosis: a Clinical Review of Early Stages and Progression of Infection. Clin Microbiol Rev 2018; 31:31/4/e00021-18. [PMID: 30021818 DOI: 10.1128/cmr.00021-18] [Citation(s) in RCA: 291] [Impact Index Per Article: 48.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Tuberculosis (TB) is the leading infectious cause of mortality worldwide, due in part to a limited understanding of its clinical pathogenic spectrum of infection and disease. Historically, scientific research, diagnostic testing, and drug treatment have focused on addressing one of two disease states: latent TB infection or active TB disease. Recent research has clearly demonstrated that human TB infection, from latent infection to active disease, exists within a continuous spectrum of metabolic bacterial activity and antagonistic immunological responses. This revised understanding leads us to propose two additional clinical states: incipient and subclinical TB. The recognition of incipient and subclinical TB, which helps divide latent and active TB along the clinical disease spectrum, provides opportunities for the development of diagnostic and therapeutic interventions to prevent progression to active TB disease and transmission of TB bacilli. In this report, we review the current understanding of the pathogenesis, immunology, clinical epidemiology, diagnosis, treatment, and prevention of both incipient and subclinical TB, two emerging clinical states of an ancient bacterium.
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16
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Pathogenesis and Animal Models of Post-Primary (Bronchogenic) Tuberculosis, A Review. Pathogens 2018; 7:pathogens7010019. [PMID: 29415434 PMCID: PMC5874745 DOI: 10.3390/pathogens7010019] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 01/31/2018] [Accepted: 02/01/2018] [Indexed: 12/30/2022] Open
Abstract
Primary and post-primary tuberculosis (TB) are different diseases caused by the same organism. Primary TB produces systemic immunity. Post-primary TB produces cavities to support massive proliferation of organisms for transmission of infection to new hosts from a person with sufficient immunity to prevent systemic infection. Post-primary, also known as bronchogenic, TB begins in humans as asymptomatic bronchial spread of obstructive lobular pneumonia, not as expanding granulomas. Most lesions regress spontaneously. However, some undergo caseation necrosis that is coughed out through the necrotic bronchi to form cavities. Caseous pneumonia that is not expelled through the bronchi is retained to become the focus of fibrocaseous disease. No animal reproduces this entire process. However, it appears that many mammals utilize similar mechanisms, but fail to coordinate them as do humans. Understanding this makes it possible to use human tuberculous lung sections to guide manipulation of animals to produce models of particular human lesions. For example, slowly progressive and reactivation TB in mice resemble developing human bronchogenic TB. Similarly, bronchogenic TB and cavities resembling those in humans can be induced by bronchial infection of sensitized rabbits. Granulomas in guinea pigs have characteristics of both primary and post primary TB. Mice can be induced to produce a spectrum of human like caseating granulomas. There is evidence that primates can develop bronchogenic TB. We are optimistic that such models developed by coordinated study of human and animal tissues can be used with modern technologies to finally address long-standing questions about host/parasite relationships in TB, and support development of targeted therapeutics and vaccines.
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17
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Pathology of Tuberculosis: How the Pathology of Human Tuberculosis Informs and Directs Animal Models. Microbiol Spectr 2017; 5. [PMID: 28597826 DOI: 10.1128/microbiolspec.tbtb2-0029-2016] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Tuberculosis (TB) is a chronic inflammatory disease caused by the pathogenic bacterium Mycobacterium tuberculosis. A wide variety of host- and pathogen-associated variables influence the clinical manifestation of TB in different individuals within the human population. As a consequence, the characteristic granulomatous lesions that develop within the lung are heterogeneous in size and cellular composition. Due to the lack of appropriate tissues from human TB patients, a variety of animal models are used as surrogates to study the basic pathogenesis and to test experimental vaccines and new drug therapies. Few animal models mimic the clinical course and pathological response of M. tuberculosis seen in the naturally occurring disease in people. In particular, post-primary TB, which accounts for the majority of cases of active TB and is responsible for transmission between individuals via aerosol exposers, cannot be reproduced in animals and therefore cannot be adequately modeled experimentally. This article describes a new paradigm that explains the pathogenesis of post-primary TB in humans. This new evidence was derived from histological examination of tissues from patients with different stages of M. tuberculosis infection and that had not been treated with antimicrobial drugs. Gaining a better understanding of this unique stage of TB disease will lead to more effective treatment, diagnostic, and prevention strategies.
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18
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Brown RE, Hunter RL, Hwang SA. Morphoproteomic-Guided Host-Directed Therapy for Tuberculosis. Front Immunol 2017; 8:78. [PMID: 28210262 PMCID: PMC5288338 DOI: 10.3389/fimmu.2017.00078] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 01/17/2017] [Indexed: 01/08/2023] Open
Abstract
In an effort to develop more effective therapy for tuberculosis (TB), research efforts are looking toward host-directed therapy, reprograming the body's natural defenses to better control the infection. While significant progress is being made, the efforts are limited by lack of understanding of the pathology and pathogenesis of adult type TB disease. We have recently published evidence that the developing lesions in human lungs are focal endogenous lipid pneumonia that constitutes a region of local susceptibility in a person with strong systemic immunity. Since most such lesions regress spontaneously, the ability to study them directly with immunohistochemistry provides means to investigate why some progress to clinical disease while others asymptomatically regress. Furthermore, this should enable us to develop more effective host-directed therapies. Morphoproteomics has proven to be an effective means of characterizing protein expression that can be used to identify metabolic pathways, which can lead to more effective therapies. The purpose of this perspective will argue that using morphoproteomics on human TB lung tissue is a particularly promising method to direct selection of host-directed therapeutics.
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Affiliation(s)
- Robert E Brown
- Department of Pathology and Laboratory Medicine, McGovern Medical School, University of Texas Health Science Center at Houston , Houston, TX , USA
| | - Robert L Hunter
- Department of Pathology and Laboratory Medicine, McGovern Medical School, University of Texas Health Science Center at Houston , Houston, TX , USA
| | - Shen-An Hwang
- Department of Pathology and Laboratory Medicine, McGovern Medical School, University of Texas Health Science Center at Houston , Houston, TX , USA
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19
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Palmer MV, Thacker TC, Waters WR. Differential Cytokine Gene Expression in Granulomas from Lungs and Lymph Nodes of Cattle Experimentally Infected with Aerosolized Mycobacterium bovis. PLoS One 2016; 11:e0167471. [PMID: 27902779 PMCID: PMC5130274 DOI: 10.1371/journal.pone.0167471] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 11/15/2016] [Indexed: 12/26/2022] Open
Abstract
The hallmark lesion of tuberculosis in humans and animals is the granuloma. The granuloma represents a distinct host cellular immune response composed of epithelioid macrophages, lymphocytes, and multinucleated giant cells, often surrounding a caseous necrotic core. Within the granuloma, host-pathogen interactions determine disease outcome. Factors within the granulomas such as cytokines and chemokines drive cell recruitment, activity, function and ultimately the success or failure of the host's ability to control infection. Hence, an understanding of the granuloma-level cytokine response is necessary to understand tuberculosis pathogenesis. In-situ cytokine expression patterns were measured using a novel in situ hybridization assay, known as RNAScope® in granulomas of the lungs, tracheobronchial lymph nodes and caudal mediastinal lymph nodes of cattle experimentally infected with Mycobacterium bovis via aerosol exposure. In spite of microscopic morphological similarities, significant differences were seen between late stage granulomas of the lung compared to those of the tracheobronchial lymph nodes for IL-17A, IFN-γ, TGF-β, IL10 and IL-22 but not for TNF-α. Additionally, significant differences were noted between granulomas from two different thoracic lymph nodes that both receive afferent lymphatics from the lungs (i.e., tracheobronchial and caudal mediastinal lymph nodes) for TNF-α, IL-17A, IFN-γ, TGF-β and IL-10 but not for IL-22. These findings show that granuloma morphology alone is not a reliable indicator of granuloma function as granulomas of similar morphologies can have disparate cytokine expression patterns. Moreover, anatomically distinct lymph nodes (tracheobronchial vs caudal mediastinal) differ in cytokine expression patterns even when both receive afferent lymphatics from a lung containing tuberculoid granulomas. These findings show that selection of tissue and anatomic location are critical factors in assessing host immune response to M. bovis and should be considered carefully.
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Affiliation(s)
- Mitchell V. Palmer
- Infectious Bacterial Diseases of Livestock Unit, National Animal Disease Center, Agricultural Research Service, United States Department of Agriculture, Ames, Iowa, United States of America
- * E-mail:
| | - Tyler C. Thacker
- Infectious Bacterial Diseases of Livestock Unit, National Animal Disease Center, Agricultural Research Service, United States Department of Agriculture, Ames, Iowa, United States of America
| | - W. Ray Waters
- Infectious Bacterial Diseases of Livestock Unit, National Animal Disease Center, Agricultural Research Service, United States Department of Agriculture, Ames, Iowa, United States of America
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20
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Association of pellicle growth morphological characteristics and clinical presentation of Mycobacterium tuberculosis isolates. Tuberculosis (Edinb) 2016; 101S:S63-S68. [PMID: 27742461 DOI: 10.1016/j.tube.2016.09.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Trehalose 6,6'dimycolate (TDM) is a glycolipid found in nearly pure form on the surface of virulent Mycobacterium tuberculosis (MTB). This manuscript investigated the production of TDM, growth rate and colony morphology of multiple strains of MTB, each of which had been isolated from both pulmonary (sputum) and extrapulmonary sites of multiple patients. Since sputum contains MTB primarily from cavities and extrapulmonary biopsies are typically granulomas, this provided an opportunity to compare the behavior of single strains of MTB that had been isolated from cavities and granulomas. The results demonstrated that MTB isolated from pulmonary sites produced more TDM (3.23 ± 1.75 μg TDM/mg MTB), grew more rapidly as thin spreading pellicles, demonstrated early cording, and climbed culture well walls. In contrast, extrapulmonary isolates produced less TDM (1.42 ± 0.58 μg TDM/mg MTB) (p < 0.001) and grew as discrete patches with little tendency to spread or climb. Both Beijing pulmonary isolates and the non-Beijing pulmonary isolates produced significantly more TDM (1.64 ± 0.46 μg TDM/mg MTB) and grew faster than the Beijing and non-Beijing extrapulmonary isolates (1.14 ± 0.63 μg TDM/mg MTB) (p < 0.001 and p < 0.005 respectively). These results indicate that MTB from pulmonary sites (cavities) grows faster and produces more TDM than strains isolated from extrapulmonary sites (granulomas). This report suggests a critical role for TDM in cavitary TB.
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21
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Hunter RL. Tuberculosis as a three-act play: A new paradigm for the pathogenesis of pulmonary tuberculosis. Tuberculosis (Edinb) 2016; 97:8-17. [PMID: 26980490 DOI: 10.1016/j.tube.2015.11.010] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Revised: 11/22/2015] [Accepted: 11/29/2015] [Indexed: 01/08/2023]
Abstract
Lack of access to human tissues with untreated tuberculosis (TB) has forced generations of researchers to use animal models and to adopt a paradigm that granulomas are the characteristic lesion of both primary and post primary TB. An extended search of studies of human lung tissues failed to find any reports that support this paradigm. We found scores of publications from gross pathology in 1804 through high resolution CT scans in 2015 that identify obstructive lobular pneumonia, not granulomas, as the characteristic lesion of developing post-primary TB. This paper reviews this literature together with other relevant observations to formulate a new paradigm of TB with three distinct stages: a three-act play. First, primary TB, a war of attrition, begins with infection that spreads via lymphatics and blood stream before inducing systemic immunity that contains and controls the organisms within granulomas. Second, post-primary TB, a sneak attack, develops during latent TB as an asymptomatic obstructive lobular pneumonia in persons with effective systemic immunity. It is a paucibacillary process with no granulomas that spreads via bronchi and accumulates mycobacterial antigens and host lipids for 1-2 years before suddenly undergoing caseous necrosis. Third, the fallout, is responsible for nearly all clinical post primary disease. It begins with caseous necrotic pneumonia that is either retained to become the focus of fibrocaseous disease or is coughed out to leave a cavity. This three-stage paradigm suggests testable hypotheses and plausible answers to long standing questions of immunity to TB.
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Affiliation(s)
- Robert L Hunter
- Department of Pathology and Laboratory Medicine, University of Texas Health Sciences Center at Houston, MSB 2.136, 6431 Fannin, Houston, TX 77030, USA.
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22
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Che N, Qu Y, Zhang C, Zhang L, Zhang H. Double staining of bacilli and antigen Ag85B improves the accuracy of the pathological diagnosis of pulmonary tuberculosis. J Clin Pathol 2015; 69:600-6. [PMID: 26614787 DOI: 10.1136/jclinpath-2015-203244] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 11/07/2015] [Indexed: 12/24/2022]
Abstract
BACKGROUND A pathological examination plays an important role in the confirmation of a diagnosis of tuberculosis, especially for smear- and culture-negative cases. However, conventional Ziehl-Neelsen staining and histological tests lack sensitivity and specificity. OBJECTIVE To evaluate the diagnostic value of immunohistochemical staining to detect Mycobacterium tuberculosis protein Ag85B and a newly developed double staining (ZC staining) method that can simultaneously detect acid-fast bacilli and M. tuberculosis antigen in the same histological section. METHODS A total of 282 formalin-fixed paraffin-embedded lung tissues were identified following histological examination, including 212 cases of pulmonary tuberculosis and 70 other pulmonary diseases. Ziehl-Neelsen staining, Ag85B-immunohistochemistry and the newly developed ZC staining were performed on serial sections of all the specimens. RESULTS Expression patterns of Ag85B were consistent with the distribution patterns of acid-fast bacilli. The signal produced by Ag85B-immunohistochemistry was much stronger than that produced by Ziehl-Neelsen staining. The sensitivity of Ag85B-immunohistochemistry was significantly higher than that of Ziehl-Neelsen staining, 53.8% (95% CI 47.0% to 60.5%) vs 34.4% (95% CI 28.0% to 40.9%). The newly developed ZC staining, integrating advantages of both Ziehl-Neelsen staining and immunohistochemistry, further improved the rate of sensitivity up to 65.6% (95% CI 59.1% to 72.0%). CONCLUSIONS This new method, detecting both acid-fast bacilli and M. tuberculosis antigen, is a simple and sensitive method for the pathological diagnosis of tuberculosis and can be easily incorporated into routine tests of pathological laboratories.
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Affiliation(s)
- Nanying Che
- Department of Pathology, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Yang Qu
- Department of Pathology, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Chen Zhang
- Department of Pathology, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Li Zhang
- Department of Pathology, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Haiqing Zhang
- Department of Pathology, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing Chest Hospital, Capital Medical University, Beijing, China
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23
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Palmer MV, Thacker TC, Waters WR. Analysis of Cytokine Gene Expression using a Novel Chromogenic In-situ Hybridization Method in Pulmonary Granulomas of Cattle Infected Experimentally by Aerosolized Mycobacterium bovis. J Comp Pathol 2015; 153:150-9. [PMID: 26189773 DOI: 10.1016/j.jcpa.2015.06.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 06/03/2015] [Accepted: 06/13/2015] [Indexed: 02/07/2023]
Abstract
Mycobacterium bovis is the cause of tuberculosis in most animal species including cattle and is a serious zoonotic pathogen. In man, M. bovis infection can result in disease clinically indistinguishable from that caused by Mycobacterium tuberculosis, the cause of most human tuberculosis. Regardless of host, the typical lesion induced by M. bovis or M. tuberculosis is the tuberculoid granuloma. Tuberculoid granulomas are dynamic structures reflecting the interface between host and pathogen and, therefore, pass through various morphological stages (I to IV). Using a novel in-situ hybridization assay, transcription of various cytokine and chemokine genes was examined qualitatively and quantitatively using image analysis. In experimentally infected cattle, pulmonary granulomas of all stages were examined 150 days after aerosol exposure to M. bovis. Expression of mRNA encoding tumour necrosis factor (TNF)-α, transforming growth factor-β, interferon (IFN)-γ, interleukin (IL)-17A, IL-16, IL-10, CXCL9 and CXCL10 did not differ significantly between granulomas of different stages. However, relative expression of the various cytokines was characteristic of a Th1 response, with high TNF-α and IFN-γ expression and low IL-10 expression. Expression of IL-16 and the chemokines CXCL9 and CXCL10 was high, suggestive of granulomas actively involved in T-cell chemotaxis.
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Affiliation(s)
- M V Palmer
- United States Department of Agriculture, Agricultural Research Service, National Animal Disease Center, 1920 Dayton Avenue, Ames, IA, USA.
| | - T C Thacker
- United States Department of Agriculture, Agricultural Research Service, National Animal Disease Center, 1920 Dayton Avenue, Ames, IA, USA
| | - W R Waters
- United States Department of Agriculture, Agricultural Research Service, National Animal Disease Center, 1920 Dayton Avenue, Ames, IA, USA
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