1
|
Behr MA, Edelstein PH, Ramakrishnan L. Rethinking the burden of latent tuberculosis to reprioritize research. Nat Microbiol 2024:10.1038/s41564-024-01683-0. [PMID: 38671272 DOI: 10.1038/s41564-024-01683-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Affiliation(s)
- Marcel A Behr
- Department of Medicine, McGill University, McGill International TB Centre, Montreal, Quebec, Canada
| | - Paul H Edelstein
- Department of Medicine, University of Cambridge, Cambridge, UK
- MRC Laboratory of Molecular Biology, Cambridge, UK
| | - Lalita Ramakrishnan
- Department of Medicine, University of Cambridge, Cambridge, UK.
- MRC Laboratory of Molecular Biology, Cambridge, UK.
| |
Collapse
|
2
|
Padmapriyadarsini C, Szumowski JD, Akbar N, Shanmugasundaram P, Jain A, Bathragiri M, Pattnaik M, Turuk J, Karunaianantham R, Balakrishnan S, Pati S, Kumar AH, Rathore MK, Raja J, Naidu KR, Horn J, Whitworth L, Sewell R, Ramakrishnan L, Swaminathan S, Edelstein PH. A Dose-Finding Study to Guide Use of Verapamil as an Adjunctive Therapy in Tuberculosis. Clin Pharmacol Ther 2024; 115:324-332. [PMID: 37983978 PMCID: PMC7615557 DOI: 10.1002/cpt.3108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 11/13/2023] [Indexed: 11/22/2023]
Abstract
Induction of mycobacterial efflux pumps is a cause of Mycobacterium tuberculosis (Mtb) drug tolerance, a barrier to shortening antitubercular treatment. Verapamil inhibits Mtb efflux pumps that mediate tolerance to rifampin, a cornerstone of tuberculosis (TB) treatment. Verapamil's mycobacterial efflux pump inhibition also limits Mtb growth in macrophages in the absence of antibiotic treatment. These findings suggest that verapamil could be used as an adjunctive therapy for TB treatment shortening. However, verapamil is rapidly and substantially metabolized when co-administered with rifampin. We determined in a dose-escalation clinical trial of persons with pulmonary TB that rifampin-induced clearance of verapamil can be countered without toxicity by the administration of larger than usual doses of verapamil. An oral dosage of 360 mg sustained-release (SR) verapamil given every 12 hours concomitantly with rifampin achieved median verapamil exposures of 903.1 ng.h/mL (area under the curve (AUC)0-12 h ) in the 18 participants receiving this highest studied verapamil dose; these AUC findings are similar to those in persons receiving daily doses of 240 mg verapamil SR but not rifampin. Moreover, norverapamil:verapamil, R:S verapamil, and R:S norverapamil AUC ratios were all significantly greater than those of historical controls receiving SR verapamil in the absence of rifampin. Thus, rifampin administration favors the less-cardioactive verapamil metabolites and enantiomers that retain similar Mtb efflux inhibitory activity to verapamil, increasing overall benefit. Finally, rifampin exposures were 50% greater after verapamil administration, which may also be advantageous. Our findings suggest that a higher dosage of verapamil can be safely used as adjunctive treatment in rifampin-containing treatment regimens.
Collapse
Affiliation(s)
| | - John D. Szumowski
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California San Francisco, USA
| | - Nabila Akbar
- National Institute for Research in Tuberculosis, Chennai, India
| | | | - Anilkumar Jain
- National Institute of Tuberculosis and Respiratory Diseases, New Delhi, India
| | | | | | | | | | | | | | | | | | | | | | - John Horn
- Department of Pharmacy, University of Washington, Seattle, USA
| | - Laura Whitworth
- Molecular Immunity Unit, Cambridge Institute of Therapeutic Immunology and Infectious Diseases, Department of Medicine, University of Cambridge, Cambridge UK
- MRC Laboratory of Molecular Biology, Cambridge, UK
| | | | - Lalita Ramakrishnan
- Molecular Immunity Unit, Cambridge Institute of Therapeutic Immunology and Infectious Diseases, Department of Medicine, University of Cambridge, Cambridge UK
- MRC Laboratory of Molecular Biology, Cambridge, UK
| | | | - Paul H. Edelstein
- MRC Laboratory of Molecular Biology, Cambridge, UK
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| |
Collapse
|
3
|
Padmapriyadarsini C, Szumowski JD, Akbar N, Shanmugasundaram P, Jain A, Bathragiri M, Pattnaik M, Turuk J, Karunaianantham R, Balakrishnan S, Pati S, Agibothu Kupparam HK, Rathore MK, Raja J, Naidu KR, Horn J, Whitworth L, Sewell R, Ramakrishnan L, Swaminathan S, Edelstein PH. A dose-finding study to guide use of verapamil as an adjunctive therapy in tuberculosis. medRxiv 2023:2023.07.28.23293316. [PMID: 37577511 PMCID: PMC10418293 DOI: 10.1101/2023.07.28.23293316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
Induction of mycobacterial efflux pumps is a cause of Mycobacterium tuberculosis (Mtb) drug tolerance, a barrier to shortening antitubercular treatment. Verapamil inhibits Mtb efflux pumps that mediate tolerance to rifampin, a cornerstone of tuberculosis treatment. Verapamil's mycobacterial efflux pump inhibition also limits Mtb growth in macrophages in the absence of antibiotic treatment. These findings suggest that verapamil could be used as an adjunctive therapy for TB treatment shortening. However, verapamil is rapidly and substantially metabolized when co-administered with rifampin. We determined in a dose-escalation clinical trial that rifampin-induced clearance of verapamil can be countered without toxicity by the administration of larger than usual doses of verapamil. An oral dosage of 360 mg sustained-release (SR) verapamil given every 12 hours concomitantly with rifampin achieved median verapamil exposures of 903.1 ng.h/ml (AUC 0-12h), similar to those in persons receiving daily doses of 240 mg verapamil SR but not rifampin. Norverapamil:verapamil, R:S verapamil and R:S norverapamil AUC ratios were all significantly greater than those of historical controls receiving SR verapamil in the absence of rifampin, suggesting that rifampin administration favors the less-cardioactive verapamil metabolites and enantiomers. Finally, rifampin exposures were significantly greater after verapamil administration. Our findings suggest that a higher dosage of verapamil can be safely used as adjunctive treatment in rifampin-containing treatment regimens.
Collapse
Affiliation(s)
| | - John D Szumowski
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California San Francisco, USA
| | - Nabila Akbar
- National Institute for Research in Tuberculosis, Chennai, India
| | | | - Anilkumar Jain
- National Institute of Tuberculosis and Respiratory Diseases, New Delhi, India
| | | | | | | | | | | | | | | | | | | | | | - John Horn
- Department of Pharmacy, University of Washington, Seattle, USA
| | - Laura Whitworth
- Molecular Immunity Unit, Cambridge Institute of Therapeutic Immunology and Infectious Diseases, Department of Medicine, University of Cambridge, Cambridge UK
- MRC Laboratory of Molecular Biology, Cambridge, UK
| | | | - Lalita Ramakrishnan
- Molecular Immunity Unit, Cambridge Institute of Therapeutic Immunology and Infectious Diseases, Department of Medicine, University of Cambridge, Cambridge UK
- MRC Laboratory of Molecular Biology, Cambridge, UK
| | | | - Paul H Edelstein
- MRC Laboratory of Molecular Biology, Cambridge, UK
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| |
Collapse
|
4
|
Ramakrishnan L. Redefining tuberculosis: an interview with Lalita Ramakrishnan. Dis Model Mech 2023; 16:dmm050189. [PMID: 36951140 PMCID: PMC10073006 DOI: 10.1242/dmm.050189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023] Open
Abstract
Professor Lalita Ramakrishnan is at the forefront of modern tuberculosis (TB) research. She has developed vital tools, most notably a robust zebrafish model, to study this disease, leading to seminal discoveries uncovering bacterial and host interactions throughout infection. Her group has harnessed this knowledge to develop new treatments for TB and shape clinical research. By unveiling these complex interactions, they have also improved our understanding of fundamental biology of macrophages and other infectious diseases, such as leprosy.
Collapse
Affiliation(s)
- Lalita Ramakrishnan
- Molecular Immunity Unit, Cambridge Institute of Therapeutic Immunology and Infectious Diseases, University of Cambridge, Cambridge CB2 OQH, UK, and MRC Laboratory of Molecular Biology, Francis Crick Avenue, Cambridge CB2 OQH, UK
| |
Collapse
|
5
|
Lake MA, Adams KN, Nie F, Fowler E, Verma AK, Dei S, Teodori E, Sherman DR, Edelstein PH, Spring DR, Troll M, Ramakrishnan L. The human proton pump inhibitors inhibit Mycobacterium tuberculosis rifampicin efflux and macrophage-induced rifampicin tolerance. Proc Natl Acad Sci U S A 2023; 120:e2215512120. [PMID: 36763530 PMCID: PMC7614234 DOI: 10.1073/pnas.2215512120] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 01/11/2023] [Indexed: 02/11/2023] Open
Abstract
Tuberculosis treatment requires months-long combination chemotherapy with multiple drugs, with shorter treatments leading to relapses. A major impediment to shortening treatment is that Mycobacterium tuberculosis becomes tolerant to the administered drugs, starting early after infection and within days of infecting macrophages. Multiple lines of evidence suggest that macrophage-induced drug tolerance is mediated by mycobacterial drug efflux pumps. Here, using assays to directly measure drug efflux, we find that M. tuberculosis transports the first-line antitubercular drug rifampicin through a proton gradient-dependent mechanism. We show that verapamil, a known efflux pump inhibitor, which inhibits macrophage-induced rifampicin tolerance, also inhibits M.tuberculosis rifampicin efflux. As with macrophage-induced tolerance, the calcium channel-inhibiting property of verapamil is not required for its inhibition of rifampicin efflux. By testing verapamil analogs, we show that verapamil directly inhibits M. tuberculosis drug efflux pumps through its human P-glycoprotein (PGP)-like inhibitory activity. Screening commonly used drugs with incidental PGP inhibitory activity, we find many inhibit rifampicin efflux, including the proton pump inhibitors (PPIs) such as omeprazole. Like verapamil, the PPIs inhibit macrophage-induced rifampicin tolerance as well as intramacrophage growth, which has also been linked to mycobacterial efflux pump activity. Our assays provide a facile screening platform for M. tuberculosis efflux pump inhibitors that inhibit in vivo drug tolerance and growth.
Collapse
Affiliation(s)
- M. Alexandra Lake
- Molecular Immunity Unit, Cambridge Institute of Therapeutic Immunology and Infectious Diseases, Department of Medicine, University of Cambridge, CB2 0AWCambridge, UK
- Medical Research Council Laboratory of Molecular Biology, CB2 0QHCambridge, UK
| | - Kristin N. Adams
- Department of Microbiology, University of Washington, Seattle98195
| | - Feilin Nie
- Yusuf Hamied Department of Chemistry, University of Cambridge, CambridgeCB2 1EW, UK
| | - Elaine Fowler
- Yusuf Hamied Department of Chemistry, University of Cambridge, CambridgeCB2 1EW, UK
| | - Amit K. Verma
- Molecular Immunity Unit, Cambridge Institute of Therapeutic Immunology and Infectious Diseases, Department of Medicine, University of Cambridge, CB2 0AWCambridge, UK
| | - Silvia Dei
- Department of Neuroscience, Psychology, Drug Research and Child Health - Section of Pharmaceutical and Nutraceutical Sciences, University of Florence, 50019Sesto Fiorentino (FI), Italy
| | - Elisabetta Teodori
- Department of Neuroscience, Psychology, Drug Research and Child Health - Section of Pharmaceutical and Nutraceutical Sciences, University of Florence, 50019Sesto Fiorentino (FI), Italy
| | - David R. Sherman
- Department of Microbiology, University of Washington, Seattle98195
| | - Paul H. Edelstein
- Molecular Immunity Unit, Cambridge Institute of Therapeutic Immunology and Infectious Diseases, Department of Medicine, University of Cambridge, CB2 0AWCambridge, UK
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA19104
| | - David R. Spring
- Yusuf Hamied Department of Chemistry, University of Cambridge, CambridgeCB2 1EW, UK
| | - Mark Troll
- Molecular Immunity Unit, Cambridge Institute of Therapeutic Immunology and Infectious Diseases, Department of Medicine, University of Cambridge, CB2 0AWCambridge, UK
- Medical Research Council Laboratory of Molecular Biology, CB2 0QHCambridge, UK
| | - Lalita Ramakrishnan
- Molecular Immunity Unit, Cambridge Institute of Therapeutic Immunology and Infectious Diseases, Department of Medicine, University of Cambridge, CB2 0AWCambridge, UK
- Medical Research Council Laboratory of Molecular Biology, CB2 0QHCambridge, UK
| |
Collapse
|
6
|
Fan J, Hale VL, Lelieveld LT, Whitworth LJ, Busch-Nentwich EM, Troll M, Edelstein PH, Cox TM, Roca FJ, Aerts JMFG, Ramakrishnan L. Gaucher disease protects against tuberculosis. Proc Natl Acad Sci U S A 2023; 120:e2217673120. [PMID: 36745788 PMCID: PMC7614233 DOI: 10.1073/pnas.2217673120] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 12/31/2022] [Indexed: 02/08/2023] Open
Abstract
Biallelic mutations in the glucocerebrosidase (GBA1) gene cause Gaucher disease, characterized by lysosomal accumulation of glucosylceramide and glucosylsphingosine in macrophages. Gaucher and other lysosomal diseases occur with high frequency in Ashkenazi Jews. It has been proposed that the underlying mutations confer a selective advantage, in particular conferring protection against tuberculosis. Here, using a zebrafish Gaucher disease model, we find that the mutation GBA1 N370S, predominant among Ashkenazi Jews, increases resistance to tuberculosis through the microbicidal activity of glucosylsphingosine in macrophage lysosomes. Consistent with lysosomal accumulation occurring only in homozygotes, heterozygotes remain susceptible to tuberculosis. Thus, our findings reveal a mechanistic basis for protection against tuberculosis by GBA1 N370S and provide biological plausibility for its selection if the relatively mild deleterious effects in homozygotes were offset by significant protection against tuberculosis, a rampant killer of the young in Europe through the Middle Ages into the 19th century.
Collapse
Affiliation(s)
- Jingwen Fan
- Molecular Immunity Unit, Cambridge Institute of Therapeutic Immunology and Infectious Diseases, Department of Medicine, University of Cambridge, CambridgeCB2 0QH, UK
- MRC Laboratory of Molecular Biology, CambridgeCB2 0QH, UK
| | | | - Lindsey T. Lelieveld
- Department of Medical Biochemistry, Leiden Institute of Chemistry, Leiden University2333 CC, Leiden, The Netherlands
| | - Laura J. Whitworth
- Molecular Immunity Unit, Cambridge Institute of Therapeutic Immunology and Infectious Diseases, Department of Medicine, University of Cambridge, CambridgeCB2 0QH, UK
- MRC Laboratory of Molecular Biology, CambridgeCB2 0QH, UK
| | - Elisabeth M. Busch-Nentwich
- Molecular Immunity Unit, Cambridge Institute of Therapeutic Immunology and Infectious Diseases, Department of Medicine, University of Cambridge, CambridgeCB2 0QH, UK
- School of Biological and Behavioral Sciences, Queen Mary University of London, LondonE1 4NS, UK
| | - Mark Troll
- Molecular Immunity Unit, Cambridge Institute of Therapeutic Immunology and Infectious Diseases, Department of Medicine, University of Cambridge, CambridgeCB2 0QH, UK
- MRC Laboratory of Molecular Biology, CambridgeCB2 0QH, UK
| | - Paul H. Edelstein
- Molecular Immunity Unit, Cambridge Institute of Therapeutic Immunology and Infectious Diseases, Department of Medicine, University of Cambridge, CambridgeCB2 0QH, UK
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, PhiladelphiaPA19104
| | - Timothy M. Cox
- Department of Medicine, University of Cambridge, CambridgeCB2 0QQ, UK
| | - Francisco J. Roca
- Molecular Immunity Unit, Cambridge Institute of Therapeutic Immunology and Infectious Diseases, Department of Medicine, University of Cambridge, CambridgeCB2 0QH, UK
- Department of Biochemistry and Molecular Biology B and Immunology, University of Murcia, Murcia30120, Spain
- Biomedical Research Institute of Murcia Pascual Parrilla (IMIB-Arrixaca), Murcia30120, Spain
| | - Johannes M. F. G. Aerts
- Department of Medical Biochemistry, Leiden Institute of Chemistry, Leiden University2333 CC, Leiden, The Netherlands
| | - Lalita Ramakrishnan
- Molecular Immunity Unit, Cambridge Institute of Therapeutic Immunology and Infectious Diseases, Department of Medicine, University of Cambridge, CambridgeCB2 0QH, UK
- MRC Laboratory of Molecular Biology, CambridgeCB2 0QH, UK
| |
Collapse
|
7
|
Pagán AJ, Lee LJ, Edwards-Hicks J, Moens CB, Tobin DM, Busch-Nentwich EM, Pearce EL, Ramakrishnan L. mTOR-regulated mitochondrial metabolism limits mycobacterium-induced cytotoxicity. Cell 2022; 185:3720-3738.e13. [PMID: 36103894 PMCID: PMC9596383 DOI: 10.1016/j.cell.2022.08.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 06/17/2022] [Accepted: 08/16/2022] [Indexed: 02/01/2023]
Abstract
Necrosis of macrophages in the granuloma, the hallmark immunological structure of tuberculosis, is a major pathogenic event that increases host susceptibility. Through a zebrafish forward genetic screen, we identified the mTOR kinase, a master regulator of metabolism, as an early host resistance factor in tuberculosis. We found that mTOR complex 1 protects macrophages from mycobacterium-induced death by enabling infection-induced increases in mitochondrial energy metabolism fueled by glycolysis. These metabolic adaptations are required to prevent mitochondrial damage and death caused by the secreted mycobacterial virulence determinant ESAT-6. Thus, the host can effectively counter this early critical mycobacterial virulence mechanism simply by regulating energy metabolism, thereby allowing pathogen-specific immune mechanisms time to develop. Our findings may explain why Mycobacterium tuberculosis, albeit humanity's most lethal pathogen, is successful in only a minority of infected individuals.
Collapse
Affiliation(s)
- Antonio J. Pagán
- Molecular Immunity Unit, Cambridge Institute of Therapeutic Immunology and Infectious Diseases, Department of Medicine, University of Cambridge, Cambridge CB2 0AW, UK,MRC Laboratory of Molecular Biology, Cambridge CB2 0QH, UK,Department of Microbiology, University of Washington, Seattle, WA 98195, USA,Corresponding author
| | - Lauren J. Lee
- Molecular Immunity Unit, Cambridge Institute of Therapeutic Immunology and Infectious Diseases, Department of Medicine, University of Cambridge, Cambridge CB2 0AW, UK,MRC Laboratory of Molecular Biology, Cambridge CB2 0QH, UK
| | - Joy Edwards-Hicks
- Max Planck Institute of Immunobiology and Epigenetics, Freiburg im Breisgau, Germany
| | - Cecilia B. Moens
- Division of Basic Sciences, Fred Hutchinson Cancer Center, Seattle, WA 98109, USA
| | - David M. Tobin
- Department of Microbiology, University of Washington, Seattle, WA 98195, USA
| | - Elisabeth M. Busch-Nentwich
- Molecular Immunity Unit, Cambridge Institute of Therapeutic Immunology and Infectious Diseases, Department of Medicine, University of Cambridge, Cambridge CB2 0AW, UK
| | - Erika L. Pearce
- Max Planck Institute of Immunobiology and Epigenetics, Freiburg im Breisgau, Germany
| | - Lalita Ramakrishnan
- Molecular Immunity Unit, Cambridge Institute of Therapeutic Immunology and Infectious Diseases, Department of Medicine, University of Cambridge, Cambridge CB2 0AW, UK,MRC Laboratory of Molecular Biology, Cambridge CB2 0QH, UK,Department of Microbiology, University of Washington, Seattle, WA 98195, USA,Corresponding author
| |
Collapse
|
8
|
Roca FJ, Whitworth LJ, Prag HA, Murphy MP, Ramakrishnan L. Tumor necrosis factor induces pathogenic mitochondrial ROS in tuberculosis through reverse electron transport. Science 2022; 376:eabh2841. [PMID: 35737799 PMCID: PMC7612974 DOI: 10.1126/science.abh2841] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Tumor necrosis factor (TNF) is a critical host resistance factor against tuberculosis. However, excess TNF produces susceptibility by increasing mitochondrial reactive oxygen species (mROS), which initiate a signaling cascade to cause pathogenic necrosis of mycobacterium-infected macrophages. In zebrafish, we identified the mechanism of TNF-induced mROS in tuberculosis. Excess TNF in mycobacterium-infected macrophages elevates mROS production by reverse electron transport (RET) through complex I. TNF-activated cellular glutamine uptake leads to an increased concentration of succinate, a Krebs cycle intermediate. Oxidation of this elevated succinate by complex II drives RET, thereby generating the mROS superoxide at complex I. The complex I inhibitor metformin, a widely used antidiabetic drug, prevents TNF-induced mROS and necrosis of Mycobacterium tuberculosis-infected zebrafish and human macrophages; metformin may therefore be useful in tuberculosis therapy.
Collapse
Affiliation(s)
- Francisco J. Roca
- Molecular Immunity Unit, Cambridge Institute of Therapeutic Immunology and Infectious Diseases, Department of Medicine, University of Cambridge, Cambridge CB2 0AW, UK
- Current affiliation: Department of Biochemistry and Molecular Biology B and Immunology, Biomedical Research Institute of Murcia (IMIB-Arrixaca), University of Murcia, Murcia 30120, Spain
| | - Laura J. Whitworth
- Molecular Immunity Unit, Cambridge Institute of Therapeutic Immunology and Infectious Diseases, Department of Medicine, University of Cambridge, Cambridge CB2 0AW, UK
- MRC Laboratory of Molecular Biology, Cambridge CB2 0QH, UK
| | - Hiran A. Prag
- MRC Mitochondrial Biology Unit, University of Cambridge, Cambridge CB2 0XY, UK
| | - Michael P. Murphy
- Molecular Immunity Unit, Cambridge Institute of Therapeutic Immunology and Infectious Diseases, Department of Medicine, University of Cambridge, Cambridge CB2 0AW, UK
- MRC Mitochondrial Biology Unit, University of Cambridge, Cambridge CB2 0XY, UK
| | - Lalita Ramakrishnan
- Molecular Immunity Unit, Cambridge Institute of Therapeutic Immunology and Infectious Diseases, Department of Medicine, University of Cambridge, Cambridge CB2 0AW, UK
- MRC Laboratory of Molecular Biology, Cambridge CB2 0QH, UK
| |
Collapse
|
9
|
Pagán AJ, Lee LJ, Edwards-Hicks J, Moens CB, Tobin DM, Pearce EL, Busch-Nentwich E, Ramakrishnan L. mTOR-associated Mitochondrial Energy Metabolism Limits Mycobacterium ESX-1-induced Cytotoxicity. The Journal of Immunology 2022. [DOI: 10.4049/jimmunol.208.supp.163.32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Abstract
Necrosis of macrophages in the tuberculous granuloma represents a major pathogenic event in tuberculosis. Through a zebrafish forward genetic screen, we identified the mTOR kinase, a master regulator of metabolism, as an early host resistance factor in tuberculosis. We found that mTOR protects macrophages from mycobacterium-induced death by enabling infection-induced increases in mitochondrial energy metabolism fueled by glycolysis. These metabolic adaptations were required to prevent mitochondrial damage and death caused specifically by the mycobacterial ESX-1 secretion system. Our finding that the host can effectively counter this early critical mycobacterial virulence mechanism simply by regulating energy metabolism may help explain why Mycobacterium tuberculosis, albeit humanity’s most lethal pathogen, only causes disease in a minority of infected individuals.
This work was supported by a Wellcome Trust Principal Research Fellowship (103950/Z/14) and an NIH MERIT award (R37 AI054503) (L.R.).
Collapse
Affiliation(s)
- Antonio J Pagán
- 1Dept. of Medicine, MRC LMB Molecular Immunity Unit, University of Cambridge, United Kingdom
- 2Cambridge Institute for Therapeutic Immunology and Infectious Disease, University of Cambridge, United Kingdom
| | - Lauren J Lee
- 1Dept. of Medicine, MRC LMB Molecular Immunity Unit, University of Cambridge, United Kingdom
- 2Cambridge Institute for Therapeutic Immunology and Infectious Disease, University of Cambridge, United Kingdom
| | - Joy Edwards-Hicks
- 2Cambridge Institute for Therapeutic Immunology and Infectious Disease, University of Cambridge, United Kingdom
| | | | | | | | | | - Lalita Ramakrishnan
- 1Dept. of Medicine, MRC LMB Molecular Immunity Unit, University of Cambridge, United Kingdom
- 2Cambridge Institute for Therapeutic Immunology and Infectious Disease, University of Cambridge, United Kingdom
| |
Collapse
|
10
|
Osman MM, Shanahan JK, Chu F, Takaki KK, Pinckert ML, Pagán AJ, Brosch R, Conrad WH, Ramakrishnan L. The C terminus of the mycobacterium ESX-1 secretion system substrate ESAT-6 is required for phagosomal membrane damage and virulence. Proc Natl Acad Sci U S A 2022; 119:e2122161119. [PMID: 35271388 PMCID: PMC8931374 DOI: 10.1073/pnas.2122161119] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 01/15/2022] [Indexed: 12/21/2022] Open
Abstract
SignificanceTuberculosis (TB), an ancient disease of humanity, continues to be a major cause of worldwide death. The causative agent of TB, Mycobacterium tuberculosis, and its close pathogenic relative Mycobacterium marinum, initially infect, evade, and exploit macrophages, a major host defense against invading pathogens. Within macrophages, mycobacteria reside within host membrane-bound compartments called phagosomes. Mycobacterium-induced damage of the phagosomal membranes is integral to pathogenesis, and this activity has been attributed to the specialized mycobacterial secretion system ESX-1, and particularly to ESAT-6, its major secreted protein. Here, we show that the integrity of the unstructured ESAT-6 C terminus is required for macrophage phagosomal damage, granuloma formation, and virulence.
Collapse
Affiliation(s)
- Morwan M. Osman
- Molecular Immunity Unit, Cambridge Institute of Therapeutic Immunology and Infectious Diseases, Department of Medicine, University of Cambridge, CB2 OQH Cambridge, United Kingdom
- Cell Biology Division, Medical Research Council Laboratory of Molecular Biology, CB2 0QH Cambridge, United Kingdom
| | - Jonathan K. Shanahan
- Molecular Immunity Unit, Cambridge Institute of Therapeutic Immunology and Infectious Diseases, Department of Medicine, University of Cambridge, CB2 OQH Cambridge, United Kingdom
- Cell Biology Division, Medical Research Council Laboratory of Molecular Biology, CB2 0QH Cambridge, United Kingdom
| | - Frances Chu
- Department of Microbiology, University of Washington, Seattle, WA 98105
| | - Kevin K. Takaki
- Molecular Immunity Unit, Cambridge Institute of Therapeutic Immunology and Infectious Diseases, Department of Medicine, University of Cambridge, CB2 OQH Cambridge, United Kingdom
- Cell Biology Division, Medical Research Council Laboratory of Molecular Biology, CB2 0QH Cambridge, United Kingdom
| | - Malte L. Pinckert
- Molecular Immunity Unit, Cambridge Institute of Therapeutic Immunology and Infectious Diseases, Department of Medicine, University of Cambridge, CB2 OQH Cambridge, United Kingdom
- Cell Biology Division, Medical Research Council Laboratory of Molecular Biology, CB2 0QH Cambridge, United Kingdom
| | - Antonio J. Pagán
- Molecular Immunity Unit, Cambridge Institute of Therapeutic Immunology and Infectious Diseases, Department of Medicine, University of Cambridge, CB2 OQH Cambridge, United Kingdom
- Cell Biology Division, Medical Research Council Laboratory of Molecular Biology, CB2 0QH Cambridge, United Kingdom
| | - Roland Brosch
- Institut Pasteur, Université de Paris, CNRS UMR 3525, Unit for Integrated Mycobacterial Pathogenomics, 75724 Paris Cedex 15, France
| | - William H. Conrad
- Molecular Immunity Unit, Cambridge Institute of Therapeutic Immunology and Infectious Diseases, Department of Medicine, University of Cambridge, CB2 OQH Cambridge, United Kingdom
- Cell Biology Division, Medical Research Council Laboratory of Molecular Biology, CB2 0QH Cambridge, United Kingdom
| | - Lalita Ramakrishnan
- Molecular Immunity Unit, Cambridge Institute of Therapeutic Immunology and Infectious Diseases, Department of Medicine, University of Cambridge, CB2 OQH Cambridge, United Kingdom
- Cell Biology Division, Medical Research Council Laboratory of Molecular Biology, CB2 0QH Cambridge, United Kingdom
- Department of Microbiology, University of Washington, Seattle, WA 98105
| |
Collapse
|
11
|
Agarwal S, Kardam S, Chatterjee P, Kumar C, Boruah M, Sharma MC, Tabin M, Ramakrishnan L. CaSR expression in normal parathyroid and PHPT: new insights into pathogenesis from an autopsy-based study. J Endocrinol Invest 2022; 45:337-346. [PMID: 34302683 DOI: 10.1007/s40618-021-01646-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 07/18/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Calcium sensing receptor (CaSR), on the surface of normal parathyroid cells, is essential for maintaining serum calcium levels. The normal pattern of CaSR immunostaining remains undefined and is presumptively circumferential. Given the physiological variation in serum calcium, we postulated that CaSR expression could not be uniformly circumferential. Also, cytoplasmic expression has not been evaluated either in normal or pathological tissues. We studied normal parathyroid tissues derived from forensic autopsies and those rimming parathyroid adenomas for membranous and cytoplasmic CaSR immunoexpression. Results were compared with primary hyperparathyroidism (PHPT) to look for any pathogenetic implications. MATERIALS AND METHODS We evaluated 34 normal parathyroid tissues from 11 autopsies, 30 normal rims, 45 parathyroid adenoma, 10 hyperplasia, and 7 carcinoma cases. Membranous expression was categorized complete/incomplete and weak/moderate/strong; scored using Her2/Neu and Histo-scores; predominant pattern noted. Cytoplasmic expression was categorized negative/weak/moderate/strong; predominant intensity noted. RESULTS Normal autopsy-derived parathyroid tissues were Her2/Neu 3 + , but incomplete membranous staining predominated in 85%. Their immune-scores were significantly more than the cases (p < < 0.05). The mean histo-score of normal rims was intermediate between the two (p < < 0.05). Cytoplasmic expression was strong in all autopsy-derived tissues, weak/negative in hyperplasia (100%), moderate in 16% adenomas, and 43% carcinomas. CONCLUSIONS Normal autopsy-derived parathyroid tissues showed strong but predominantly incomplete membranous expression. Surface CaSR expression decreased in PHPT and is probably an early event in parathyroid adenoma, seen even in normal rims. Whether there is a defect in CaSR trafficking from the cytoplasm to the cell surface in adenoma and carcinoma needs further evaluation.
Collapse
Affiliation(s)
- S Agarwal
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, 110029, India.
| | - S Kardam
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - P Chatterjee
- Department of Pathology, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
| | - C Kumar
- Department of Surgical Oncology, All India Institute of Medical Sciences, Bilaspur, Himachal Pradesh, India
| | - M Boruah
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - M C Sharma
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - M Tabin
- Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences, New Delhi, India
| | - L Ramakrishnan
- Department of Cardiac Biochemistry, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
12
|
Affiliation(s)
- Marcel A Behr
- Department of Medicine.,McGill International Tuberculosis Centre, and
| | - Eva Kaufmann
- Department of Medicine.,Meakins-Christie Laboratories, McGill University, Montreal, Quebec, Canada
| | - Jacalyn Duffin
- Hannah Professor Emerita of the History of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Paul H Edelstein
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and.,Molecular Immunity Unit MRC, Laboratory of Molecular Biology and Cambridge Institute of Therapeutic Immunology and Infectious Diseases, Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Lalita Ramakrishnan
- Molecular Immunity Unit MRC, Laboratory of Molecular Biology and Cambridge Institute of Therapeutic Immunology and Infectious Diseases, Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| |
Collapse
|
13
|
Whitworth LJ, Troll R, Pagán AJ, Roca FJ, Edelstein PH, Troll M, Tobin DM, Phu NH, Bang ND, Thwaites GE, Thuong NTT, Sewell RF, Ramakrishnan L. Elevated cerebrospinal fluid cytokine levels in tuberculous meningitis predict survival in response to dexamethasone. Proc Natl Acad Sci U S A 2021; 118:e2024852118. [PMID: 33658385 PMCID: PMC7958233 DOI: 10.1073/pnas.2024852118] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Adjunctive treatment with antiinflammatory corticosteroids like dexamethasone increases survival in tuberculosis meningitis. Dexamethasone responsiveness associates with a C/T variant in Leukotriene A4 Hydrolase (LTA4H), which regulates expression of the proinflammatory mediator leukotriene B4 (LTB4). TT homozygotes, with increased expression of LTA4H, have the highest survival when treated with dexamethasone and the lowest survival without. While the T allele is present in only a minority of the world's population, corticosteroids confer modest survival benefit worldwide. Using Bayesian methods, we examined how pretreatment levels of cerebrospinal fluid proinflammatory cytokines affect survival in dexamethasone-treated tuberculous meningitis. LTA4H TT homozygosity was associated with global cytokine increases, including tumor necrosis factor. Association between higher cytokine levels and survival extended to non-TT patients, suggesting that other genetic variants may also induce dexamethasone-responsive pathological inflammation. These findings warrant studies that tailor dexamethasone therapy to pretreatment cerebrospinal fluid cytokine concentrations, while searching for additional genetic loci shaping the inflammatory milieu.
Collapse
Affiliation(s)
- Laura J Whitworth
- Molecular Immunity Unit, Department of Medicine, University of Cambridge, CB2 0QH Cambridge, United Kingdom
- Medical Research Council Laboratory of Molecular Biology, CB2 0QH Cambridge, United Kingdom
| | - Rajan Troll
- Trinity College, CB2 1TQ Cambridge, United Kingdom
| | - Antonio J Pagán
- Molecular Immunity Unit, Department of Medicine, University of Cambridge, CB2 0QH Cambridge, United Kingdom
- Medical Research Council Laboratory of Molecular Biology, CB2 0QH Cambridge, United Kingdom
| | - Francisco J Roca
- Molecular Immunity Unit, Department of Medicine, University of Cambridge, CB2 0QH Cambridge, United Kingdom
- Medical Research Council Laboratory of Molecular Biology, CB2 0QH Cambridge, United Kingdom
| | - Paul H Edelstein
- Molecular Immunity Unit, Department of Medicine, University of Cambridge, CB2 0QH Cambridge, United Kingdom
- Medical Research Council Laboratory of Molecular Biology, CB2 0QH Cambridge, United Kingdom
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104
| | - Mark Troll
- Molecular Immunity Unit, Department of Medicine, University of Cambridge, CB2 0QH Cambridge, United Kingdom
- Medical Research Council Laboratory of Molecular Biology, CB2 0QH Cambridge, United Kingdom
| | - David M Tobin
- Department of Molecular Genetics and Microbiology, Duke University School of Medicine, Durham, NC 27710
- Department of Immunology, Duke University School of Medicine, Durham, NC 27710
| | - Nguyen Hoan Phu
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Nguyen Duc Bang
- Pham Ngoc Thach Hospital for Tuberculosis and Lung Disease, Ho Chi Minh City, Vietnam
| | - Guy E Thwaites
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, OX3 7BN Oxford, United Kingdom
| | - Nguyen Thuy Thuong Thuong
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, OX3 7BN Oxford, United Kingdom
| | | | - Lalita Ramakrishnan
- Molecular Immunity Unit, Department of Medicine, University of Cambridge, CB2 0QH Cambridge, United Kingdom;
- Medical Research Council Laboratory of Molecular Biology, CB2 0QH Cambridge, United Kingdom
| |
Collapse
|
14
|
Whitworth L, Coxon J, van Laarhoven A, Thuong NTT, Dian S, Alisjahbana B, Ganiem AR, van Crevel R, Thwaites GE, Troll M, Edelstein PH, Sewell R, Ramakrishnan L. A Bayesian analysis of the association between Leukotriene A4 Hydrolase genotype and survival in tuberculous meningitis. eLife 2021; 10:61722. [PMID: 33416499 PMCID: PMC7793626 DOI: 10.7554/elife.61722] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 11/22/2020] [Indexed: 12/15/2022] Open
Abstract
Tuberculous meningitis has high mortality, linked to excessive inflammation. However, adjunctive anti-inflammatory corticosteroids reduce mortality by only 30%, suggesting that inflammatory pathophysiology causes only a subset of deaths. In Vietnam, the survival benefit of anti-inflammatory corticosteroids was most pronounced in patients with a C/T promoter variant in the leukotriene A4 hydrolase (LTA4H) gene encoding an enzyme that regulates inflammatory eicosanoids. LTA4H TT patients with increased expression had increased survival, consistent with corticosteroids benefiting individuals with hyper-inflammatory responses. However, an Indonesia study did not find an LTA4H TT genotype survival benefit. Here using Bayesian methods to analyse both studies, we find that LTA4H TT genotype confers survival benefit that begins early and continues long-term in both populations. This benefit is nullified in the most severe cases with high early mortality. LTA4H genotyping together with disease severity assessment may target glucocorticoid therapy to patients most likely to benefit from it. Tuberculous meningitis is a serious infection of the lining of the brain, which affects over 100,000 people a year. Without treatment, it is always fatal: even with proper antibiotics, about a quarter of patients do not survive and many will have permanent brain damage. Overactive inflammation is thought to contribute to this process. Corticosteroid drugs, which dampen the inflammatory process, are therefore often used during treatment. However, they merely reduce mortality by 30%, suggesting that only some people benefit from them. Two recent studies have linked the genetic makeup of individuals who have tuberculous meningitis to how they respond to corticosteroids. There were, in particular, differences in the LTA4H gene that codes for an inflammation-causing protein. According to these results, only individuals carrying high-inflammation versions of the LTA4H gene would benefit from the treatment. Yet a third study did not find any effect of the genetic background of patients. All three papers used frequentist statistics to draw their conclusions, only examining the percentage of people who survived in each group. Yet, this type of analysis can miss important details. It also does not work well when the number of patients is small, or when the effectiveness of a drug varies during the course of an illness. Another method, called Bayesian statistics, can perform better under these limitations. In particular, it takes into account the probability of an event based on prior knowledge – for instance, that the risk of dying varies smoothly with time. Here, Whitworth et al. used Bayesian statistics to reanalyse the data from these studies, demonstrating that death rates were correlated with the type of LTA4H gene carried by patients. In particular, corticosteroid treatment worked best for people with the high inflammation versions of the gene. However, regardless of genetic background, corticosteroids were not effective if patients were extremely sick before being treated. The work by Whitworth et al. demonstrates the importance of using Bayesian statistics to examine the effectiveness of medical treatments. It could help to design better protocols for tuberculous meningitis treatment, tailored to the genetic makeup of patients.
Collapse
Affiliation(s)
- Laura Whitworth
- Molecular Immunity Unit, Department of Medicine, University of Cambridge, MRC Laboratory of Molecular Biology, Cambridge, United Kingdom
| | | | - Arjan van Laarhoven
- Department of Internal Medicine and Radboud Center for Infectious Diseases (RCI), Radboud Institute for Molecular Life Sciences (RIMLS), Radboud University Medical Center, Nijmegen, Netherlands
| | | | - Sofiati Dian
- Universitas Padjadjaran, TB-HIV Research Center, Faculty of Medicine, Bandung, Indonesia.,Department of Neurology, Faculty of Medicine/Hasan Sadikin Hospital, Universitas Padjadjaran, Sumedang, Indonesia
| | - Bachti Alisjahbana
- Universitas Padjadjaran, TB-HIV Research Center, Faculty of Medicine, Bandung, Indonesia
| | - Ahmad Rizal Ganiem
- Universitas Padjadjaran, TB-HIV Research Center, Faculty of Medicine, Bandung, Indonesia.,Department of Neurology, Faculty of Medicine/Hasan Sadikin Hospital, Universitas Padjadjaran, Sumedang, Indonesia
| | - Reinout van Crevel
- Department of Internal Medicine and Radboud Center for Infectious Diseases (RCI), Radboud Institute for Molecular Life Sciences (RIMLS), Radboud University Medical Center, Nijmegen, Netherlands
| | - Guy E Thwaites
- Oxford University Clinical Research Unit, Ho Chi Minh City, Viet Nam.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Mark Troll
- Molecular Immunity Unit, Department of Medicine, University of Cambridge, MRC Laboratory of Molecular Biology, Cambridge, United Kingdom
| | - Paul H Edelstein
- Molecular Immunity Unit, Department of Medicine, University of Cambridge, MRC Laboratory of Molecular Biology, Cambridge, United Kingdom.,Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, United States
| | | | - Lalita Ramakrishnan
- Molecular Immunity Unit, Department of Medicine, University of Cambridge, MRC Laboratory of Molecular Biology, Cambridge, United Kingdom
| |
Collapse
|
15
|
Takaki KK, Rinaldi G, Berriman M, Pagán AJ, Ramakrishnan L. Schistosoma mansoni Eggs Modulate the Timing of Granuloma Formation to Promote Transmission. Cell Host Microbe 2020; 29:58-67.e5. [PMID: 33120115 PMCID: PMC7815046 DOI: 10.1016/j.chom.2020.10.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 07/28/2020] [Accepted: 09/30/2020] [Indexed: 01/07/2023]
Abstract
Schistosome eggs provoke the formation of granulomas, organized immune aggregates, around them. For the host, the granulomatous response can be both protective and pathological. Granulomas are also postulated to facilitate egg extrusion through the gut lumen, a necessary step for parasite transmission. We used zebrafish larvae to visualize the granulomatous response to Schistosomamansoni eggs and inert egg-sized beads. Mature eggs rapidly recruit macrophages, which form granulomas within days. Beads also induce granulomas rapidly, through a foreign body response. Strikingly, immature eggs do not recruit macrophages, revealing that the eggshell is immunologically inert. Our findings suggest that the eggshell inhibits foreign body granuloma formation long enough for the miracidium to mature. Then parasite antigens secreted through the eggshell trigger granulomas that facilitate egg extrusion into the environment. In support of this model, we find that only mature S. mansoni eggs are shed into the feces of mice and humans. Foreign bodies are walled off by immune structures called granulomas Schistosoma mansoni eggshells prevent the formation of granulomas around immature parasites Secreted antigens from mature parasites induce granulomas that promote egg shedding S. mansoni modulates granuloma formation to selectively shed mature eggs into feces
Collapse
Affiliation(s)
- Kevin K Takaki
- Molecular Immunity Unit, Department of Medicine, University of Cambridge, MRC Laboratory of Molecular Biology, Cambridge CB2 0QH, UK
| | - Gabriel Rinaldi
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton CB10 1SA, UK
| | - Matthew Berriman
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton CB10 1SA, UK
| | - Antonio J Pagán
- Molecular Immunity Unit, Department of Medicine, University of Cambridge, MRC Laboratory of Molecular Biology, Cambridge CB2 0QH, UK.
| | - Lalita Ramakrishnan
- Molecular Immunity Unit, Department of Medicine, University of Cambridge, MRC Laboratory of Molecular Biology, Cambridge CB2 0QH, UK.
| |
Collapse
|
16
|
Osman MM, Pagán AJ, Shanahan JK, Ramakrishnan L. Mycobacterium marinum phthiocerol dimycocerosates enhance macrophage phagosomal permeabilization and membrane damage. PLoS One 2020; 15:e0233252. [PMID: 32701962 PMCID: PMC7377490 DOI: 10.1371/journal.pone.0233252] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 07/02/2020] [Indexed: 12/15/2022] Open
Abstract
Phthiocerol dimycocerosates (PDIMs) are a class of mycobacterial lipids that promote virulence in Mycobacterium tuberculosis and Mycobacterium marinum. It has recently been shown that PDIMs work in concert with the M. tuberculosis Type VII secretion system ESX-1 to permeabilize the phagosomal membranes of infected macrophages. As the zebrafish-M. marinum model of infection has revealed the critical role of PDIM at the host-pathogen interface, we set to determine if PDIMs contributed to phagosomal permeabilization in M. marinum. Using an ΔmmpL7 mutant defective in PDIM transport, we find the PDIM-ESX-1 interaction to be conserved in an M. marinum macrophage infection model. However, we find PDIM and ESX-1 mutants differ in their degree of defect, with the PDIM mutant retaining more membrane damaging activity. Using an in vitro hemolysis assay-a common surrogate for cytolytic activity, we find that PDIM and ESX-1 differ in their contributions: the ESX-1 mutant loses hemolytic activity while PDIM retains it. Our observations confirm the involvement of PDIMs in phagosomal permeabilization in M. marinum infection and suggest that PDIM enhances the membrane disrupting activity of pathogenic mycobacteria and indicates that the role they play in damaging phagosomal and red blood cell membranes may differ.
Collapse
Affiliation(s)
- Morwan M. Osman
- Molecular Immunity Unit, Department of Medicine, University of Cambridge, MRC Laboratory of Molecular Biology, Cambridge, United Kingdom
| | - Antonio J. Pagán
- Molecular Immunity Unit, Department of Medicine, University of Cambridge, MRC Laboratory of Molecular Biology, Cambridge, United Kingdom
| | - Jonathan K. Shanahan
- Molecular Immunity Unit, Department of Medicine, University of Cambridge, MRC Laboratory of Molecular Biology, Cambridge, United Kingdom
| | - Lalita Ramakrishnan
- Molecular Immunity Unit, Department of Medicine, University of Cambridge, MRC Laboratory of Molecular Biology, Cambridge, United Kingdom
- * E-mail:
| |
Collapse
|
17
|
Adams KN, Verma AK, Gopalaswamy R, Adikesavalu H, Singhal DK, Tripathy S, Ranganathan UD, Sherman DR, Urdahl KB, Ramakrishnan L, Hernandez RE. Diverse Clinical Isolates of Mycobacterium tuberculosis Develop Macrophage-Induced Rifampin Tolerance. J Infect Dis 2020; 219:1554-1558. [PMID: 30753612 PMCID: PMC6473171 DOI: 10.1093/infdis/jiy710] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 01/29/2019] [Indexed: 12/28/2022] Open
Abstract
The Mycobacterium tuberculosis lineage 4 strains CDC1551 and H37Rv develop tolerance to multiple antibiotics upon macrophage residence. To determine whether macrophage-induced tolerance is a general feature of clinical M. tuberculosis isolates, we assessed macrophage-induced drug tolerance in strains from lineages 1–3, representing the other predominant M. tuberculosis strains responsible for tuberculosis globally. All 3 lineages developed isoniazid tolerance. While lineage 1, 3, and 4 strains developed rifampin tolerance, lineage 2 Beijing strains did not. Their failure to develop tolerance may be explained by their harboring of a loss-of-function mutation in the Rv1258c efflux pump that is linked to macrophage-induced rifampicin tolerance.
Collapse
Affiliation(s)
- Kristin N Adams
- Center for Global Infectious Diseases Research, Seattle Children's Research Institute, Center for Infectious Diseases Research, Seattle, Washington
| | - Amit Kumar Verma
- Molecular Immunity Unit, Department of Medicine, University of Cambridge, United Kingdom
| | | | | | | | | | | | - David R Sherman
- Center for Global Infectious Diseases Research, Seattle Children's Research Institute, Center for Infectious Diseases Research, Seattle, Washington
| | - Kevin B Urdahl
- Center for Global Infectious Diseases Research, Seattle Children's Research Institute, Center for Infectious Diseases Research, Seattle, Washington
| | - Lalita Ramakrishnan
- Molecular Immunity Unit, Department of Medicine, University of Cambridge, United Kingdom
| | - Rafael E Hernandez
- Center for Global Infectious Diseases Research, Seattle Children's Research Institute, Center for Infectious Diseases Research, Seattle, Washington.,Department of Pediatrics, University of Washington, Seattle, Washington
| |
Collapse
|
18
|
Abstract
People with immunoreactivity to tuberculosis are thought to have lifelong asymptomatic infection and remain at risk for active tuberculosis. Marcel A Behr and colleagues argue that most of these people are no longer infected
Collapse
Affiliation(s)
- Marcel A Behr
- Department of Medicine, McGill University, McGill International TB Centre, Montreal, H4A 3J1, Canada
| | - Paul H Edelstein
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Molecular Immunity Unit, Department of Medicine, University of Cambridge, MRC Laboratory of Molecular Biology, Cambridge CB2 0QH, UK
| | - Lalita Ramakrishnan
- Molecular Immunity Unit, Department of Medicine, University of Cambridge, MRC Laboratory of Molecular Biology, Cambridge CB2 0QH, UK
| |
Collapse
|
19
|
Roca FJ, Whitworth LJ, Redmond S, Jones AA, Ramakrishnan L. TNF Induces Pathogenic Programmed Macrophage Necrosis in Tuberculosis through a Mitochondrial-Lysosomal-Endoplasmic Reticulum Circuit. Cell 2019; 178:1344-1361.e11. [PMID: 31474371 PMCID: PMC6736209 DOI: 10.1016/j.cell.2019.08.004] [Citation(s) in RCA: 115] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 05/15/2019] [Accepted: 08/02/2019] [Indexed: 01/07/2023]
Abstract
Necrosis of infected macrophages constitutes a critical pathogenetic event in tuberculosis by releasing mycobacteria into the growth-permissive extracellular environment. In zebrafish infected with Mycobacterium marinum or Mycobacterium tuberculosis, excess tumor necrosis factor triggers programmed necrosis of infected macrophages through the production of mitochondrial reactive oxygen species (ROS) and the participation of cyclophilin D, a component of the mitochondrial permeability transition pore. Here, we show that this necrosis pathway is not mitochondrion-intrinsic but results from an inter-organellar circuit initiating and culminating in the mitochondrion. Mitochondrial ROS induce production of lysosomal ceramide that ultimately activates the cytosolic protein BAX. BAX promotes calcium flow from the endoplasmic reticulum into the mitochondrion through ryanodine receptors, and the resultant mitochondrial calcium overload triggers cyclophilin-D-mediated necrosis. We identify ryanodine receptors and plasma membrane L-type calcium channels as druggable targets to intercept mitochondrial calcium overload and necrosis of mycobacterium-infected zebrafish and human macrophages. TNF induces mitochondrial ROS to cause necrosis of mycobacterium-infected macrophages Mitochondrial ROS activate lysosomal enzymes that lead to BAX activation BAX activates ER ryanodine receptors to cause Ca2+ flow into the mitochondrion Drugs preventing mitochondrial Ca2+ overload prevent pathogenic macrophage necrosis in TB
Collapse
Affiliation(s)
- Francisco J Roca
- Molecular Immunity Unit, Department of Medicine, University of Cambridge, MRC Laboratory of Molecular Biology, Cambridge CB2 OQH, UK.
| | - Laura J Whitworth
- Molecular Immunity Unit, Department of Medicine, University of Cambridge, MRC Laboratory of Molecular Biology, Cambridge CB2 OQH, UK
| | - Sarah Redmond
- Molecular Immunity Unit, Department of Medicine, University of Cambridge, MRC Laboratory of Molecular Biology, Cambridge CB2 OQH, UK; Department of Microbiology, University of Washington, Seattle, WA 98195, USA
| | - Ana A Jones
- Molecular Immunity Unit, Department of Medicine, University of Cambridge, MRC Laboratory of Molecular Biology, Cambridge CB2 OQH, UK
| | - Lalita Ramakrishnan
- Molecular Immunity Unit, Department of Medicine, University of Cambridge, MRC Laboratory of Molecular Biology, Cambridge CB2 OQH, UK; Department of Microbiology, University of Washington, Seattle, WA 98195, USA.
| |
Collapse
|
20
|
Abstract
Tuberculosis has a much shorter incubation period than is widely thought, say Marcel A Behr and colleagues, and this has implications for prioritising research and public health strategies
Collapse
Affiliation(s)
- Marcel A Behr
- McGill International TB Centre, Infectious Diseases and Immunity in Global Health Program, McGill University Health Centre Research Institute, Montreal H4A 3J1, Canada
| | - Paul H Edelstein
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Molecular Immunity Unit, Department of Medicine, University of Cambridge, MRC Laboratory of Molecular Biology, Cambridge CB2 0QH, UK
| | - Lalita Ramakrishnan
- Molecular Immunity Unit, Department of Medicine, University of Cambridge, MRC Laboratory of Molecular Biology, Cambridge CB2 0QH, UK
| |
Collapse
|
21
|
Hernandez RE, Galitan L, Cameron J, Goodwin N, Ramakrishnan L. Delay of Initial Feeding of Zebrafish Larvae Until 8 Days Postfertilization Has No Impact on Survival or Growth Through the Juvenile Stage. Zebrafish 2018; 15:515-518. [PMID: 30089231 PMCID: PMC6198760 DOI: 10.1089/zeb.2018.1579] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The use of early-stage zebrafish for biomedical research spans early organogenesis to free-swimming larva. A key benefit of this model organism is that repeated assessments spanning several days can be performed of individual larvae within a single experiment, often in conjunction with administered drugs. However, the initiation of feeding, typically at 5 days postfertilization (dpf), can make serial assessments challenging. Therefore, delayed feeding would increase the utility of the model. To ask whether feeding could be delayed without adversely affecting larval growth and development up to 39 dpf, we systematically raised zebrafish and introduced feeding at 5 dpf or delayed initial feeding up to 9 dpf. We assessed survival into the juvenile stage (39 dpf) and anterior-posterior length at this age as proxies for growth and development. Delaying feeding initiation up to 8 dpf did not decrease baseline survival of greater than 90%; survival decreased to 66% only when delayed to 9 dpf. Larval length was no different under any of these conditions. Our findings define 9 dpf as the critical age before which larval zebrafish must be fed when raising to 39 dpf. The option to delay feeding to 8 dpf will broaden experimental applications for the zebrafish larval model.
Collapse
Affiliation(s)
- Rafael E Hernandez
- 1 Department of Pediatrics, University of Washington , Seattle, Washington.,2 Center for Global Infectious Diseases Research, Seattle Children's Research Institute , Seattle, Washington
| | - Louie Galitan
- 2 Center for Global Infectious Diseases Research, Seattle Children's Research Institute , Seattle, Washington.,3 Department of Microbiology, University of Washington , Seattle, Washington
| | - James Cameron
- 3 Department of Microbiology, University of Washington , Seattle, Washington
| | - Nicola Goodwin
- 4 Molecular Immunity Unit, MRC Laboratory of Molecular Biology, Department of Medicine, University of Cambridge , Cambridge, United Kingdom
| | - Lalita Ramakrishnan
- 3 Department of Microbiology, University of Washington , Seattle, Washington.,4 Molecular Immunity Unit, MRC Laboratory of Molecular Biology, Department of Medicine, University of Cambridge , Cambridge, United Kingdom .,5 Department of Medicine, University of Washington , Seattle, Washington
| |
Collapse
|
22
|
Affiliation(s)
- Antonio J Pagán
- Molecular Immunity Unit, Department of Medicine, University of Cambridge, MRC Laboratory of Molecular Biology, Cambridge, UK
| | - Lalita Ramakrishnan
- Molecular Immunity Unit, Department of Medicine, University of Cambridge, MRC Laboratory of Molecular Biology, Cambridge, UK
| |
Collapse
|
23
|
Abstract
Granulomas are organized aggregates of macrophages, often with characteristic morphological changes, and other immune cells. These evolutionarily ancient structures form in response to persistent particulate stimuli-infectious or noninfectious-that individual macrophages cannot eradicate. Granulomas evolved as protective responses to destroy or sequester particles but are frequently pathological in the context of foreign bodies, infections, and inflammatory diseases. We summarize recent findings that suggest that the granulomatous response unfolds in a stepwise program characterized by a series of macrophage activations and transformations that in turn recruit additional cells and produce structural changes. We explore why different granulomas vary and the reasons that granulomas are protective and pathogenic. Understanding the mechanisms and role of granuloma formation may uncover new therapies for the multitude of granulomatous diseases that constitute serious medical problems while enhancing the protective function of granulomas in infections.
Collapse
Affiliation(s)
- Antonio J Pagán
- Molecular Immunity Unit, Department of Medicine, University of Cambridge, Cambridge CB2 0QQ, United Kingdom; , .,MRC Laboratory of Molecular Biology, Cambridge CB2 0QH, United Kingdom
| | - Lalita Ramakrishnan
- Molecular Immunity Unit, Department of Medicine, University of Cambridge, Cambridge CB2 0QQ, United Kingdom; , .,MRC Laboratory of Molecular Biology, Cambridge CB2 0QH, United Kingdom
| |
Collapse
|
24
|
Stainier DYR, Raz E, Lawson ND, Ekker SC, Burdine RD, Eisen JS, Ingham PW, Schulte-Merker S, Yelon D, Weinstein BM, Mullins MC, Wilson SW, Ramakrishnan L, Amacher SL, Neuhauss SCF, Meng A, Mochizuki N, Panula P, Moens CB. Guidelines for morpholino use in zebrafish. PLoS Genet 2017; 13:e1007000. [PMID: 29049395 PMCID: PMC5648102 DOI: 10.1371/journal.pgen.1007000] [Citation(s) in RCA: 222] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Didier Y. R. Stainier
- Department of Developmental Genetics, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany
| | - Erez Raz
- Institute of Cell Biology, ZBME, University of Münster, Münster, Germany
| | - Nathan D. Lawson
- Department of Molecular, Cell, and Cancer Biology, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
| | | | - Rebecca D. Burdine
- Department of Molecular Biology, Princeton University, Princeton, New Jersey, United States of America
| | - Judith S. Eisen
- Institute of Neuroscience, University of Oregon, Eugene, Oregon, United States of America
| | - Philip W. Ingham
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- The Living Systems Institute, University of Exeter, Exeter, United Kingdom
| | - Stefan Schulte-Merker
- Institute of Cardiovascular Organogenesis and Regeneration, WWU Münster, Faculty of Medicine, Münster, Germany
| | - Deborah Yelon
- Division of Biological Sciences, University of California, San Diego, La Jolla, California, United States of America
| | - Brant M. Weinstein
- Division of Developmental Biology, NICHD, NIH, Bethesda, Maryland, United States of America
| | - Mary C. Mullins
- Department of Cell and Developmental Biology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Stephen W. Wilson
- Department of Cell and Developmental Biology, University College London, London, United Kingdom
| | - Lalita Ramakrishnan
- Molecular Immunity Unit, Department of Medicine, University of Cambridge, MRC Laboratory of Molecular Biology, Cambridge, United Kingdom
| | - Sharon L. Amacher
- Departments of Molecular Genetics and Biological Chemistry and Pharmacology, Ohio State University, Columbus, Ohio, United States of America
| | | | - Anming Meng
- School of Life Sciences, Tsinghua University, Beijing, China
| | - Naoki Mochizuki
- National Cerebral and Cardiovascular Center Research Institute, Osaka, Japan
| | - Pertti Panula
- Department of Anatomy and Neuroscience Center, University of Helsinki, Helsinki, Finland
| | - Cecilia B. Moens
- Division of Basic Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| |
Collapse
|
25
|
Abstract
Understanding the pathogenesis of leprosy granulomas has been hindered by a paucity of tractable experimental animal models. Mycobacterium leprae, which causes leprosy, grows optimally at approximately 30°C, so we sought to model granulomatous disease in the ectothermic zebrafish. We found that noncaseating granulomas develop rapidly and eventually eradicate infection. rag1 mutant zebrafish, which lack lymphocytes, also form noncaseating granulomas with similar kinetics, but these control infection more slowly. Our findings establish the zebrafish as a facile, genetically tractable model for leprosy and reveal the interplay between innate and adaptive immune determinants mediating leprosy granuloma formation and function.
Collapse
Affiliation(s)
| | | | - Lalita Ramakrishnan
- Department of Microbiology
- Department of Immunology, and
- Department of Medicine, University of Washington, Seattle; and
- Molecular Immunity Unit, Department of Medicine, University of Cambridge, MRC Laboratory of Molecular Biology, United Kingdom
| |
Collapse
|
26
|
Madigan CA, Cambier CJ, Kelly-Scumpia KM, Scumpia PO, Cheng TY, Zailaa J, Bloom BR, Moody DB, Smale ST, Sagasti A, Modlin RL, Ramakrishnan L. A Macrophage Response to Mycobacterium leprae Phenolic Glycolipid Initiates Nerve Damage in Leprosy. Cell 2017; 170:973-985.e10. [PMID: 28841420 PMCID: PMC5848073 DOI: 10.1016/j.cell.2017.07.030] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Revised: 05/13/2017] [Accepted: 07/19/2017] [Indexed: 12/21/2022]
Abstract
Mycobacterium leprae causes leprosy and is unique among mycobacterial diseases in producing peripheral neuropathy. This debilitating morbidity is attributed to axon demyelination resulting from direct interaction of the M. leprae-specific phenolic glycolipid 1 (PGL-1) with myelinating glia and their subsequent infection. Here, we use transparent zebrafish larvae to visualize the earliest events of M. leprae-induced nerve damage. We find that demyelination and axonal damage are not directly initiated by M. leprae but by infected macrophages that patrol axons; demyelination occurs in areas of intimate contact. PGL-1 confers this neurotoxic response on macrophages: macrophages infected with M. marinum-expressing PGL-1 also damage axons. PGL-1 induces nitric oxide synthase in infected macrophages, and the resultant increase in reactive nitrogen species damages axons by injuring their mitochondria and inducing demyelination. Our findings implicate the response of innate macrophages to M. leprae PGL-1 in initiating nerve damage in leprosy.
Collapse
Affiliation(s)
- Cressida A Madigan
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA; Department of Microbiology, Immunology, and Molecular Genetics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA; Department of Microbiology, University of Washington, Seattle, WA 98195, USA.
| | - C J Cambier
- Department of Immunology, University of Washington, Seattle, WA 98195, USA
| | - Kindra M Kelly-Scumpia
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Philip O Scumpia
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Tan-Yun Cheng
- Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Joseph Zailaa
- Department of Microbiology, Immunology, and Molecular Genetics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Barry R Bloom
- Harvard School of Public Health, Boston, MA 02115, USA
| | - D Branch Moody
- Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Stephen T Smale
- Department of Microbiology, Immunology, and Molecular Genetics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA; Molecular Biology Institute, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Alvaro Sagasti
- Department of Molecular, Cell, and Developmental Biology, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Robert L Modlin
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA; Department of Microbiology, Immunology, and Molecular Genetics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Lalita Ramakrishnan
- Department of Microbiology, University of Washington, Seattle, WA 98195, USA; Department of Immunology, University of Washington, Seattle, WA 98195, USA; Department of Medicine, University of Washington, Seattle, WA 98195, USA; MRC Laboratory of Molecular Biology, Molecular Immunity Unit, Department of Medicine, University of Cambridge, Cambridge CB2 OQH, UK.
| |
Collapse
|
27
|
Cambier CJ, O'Leary SM, O'Sullivan MP, Keane J, Ramakrishnan L. Phenolic Glycolipid Facilitates Mycobacterial Escape from Microbicidal Tissue-Resident Macrophages. Immunity 2017; 47:552-565.e4. [PMID: 28844797 PMCID: PMC5610147 DOI: 10.1016/j.immuni.2017.08.003] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 06/27/2017] [Accepted: 08/11/2017] [Indexed: 12/21/2022]
Abstract
Mycobacterium tuberculosis (Mtb) enters the host in aerosol droplets deposited in lung alveoli, where the bacteria first encounter lung-resident alveolar macrophages. We studied the earliest mycobacterium-macrophage interactions in the optically transparent zebrafish. First-responding resident macrophages phagocytosed and eradicated infecting mycobacteria, suggesting that to establish a successful infection, mycobacteria must escape out of the initially infected resident macrophage into growth-permissive monocytes. We defined a critical role for mycobacterial membrane phenolic glycolipid (PGL) in engineering this transition. PGL activated the STING cytosolic sensing pathway in resident macrophages, inducing the production of the chemokine CCL2, which in turn recruited circulating CCR2+ monocytes toward infection. Transient fusion of infected macrophages with CCR2+ monocytes enabled bacterial transfer and subsequent dissemination, and interrupting this transfer so as to prolong mycobacterial sojourn in resident macrophages promoted clearing of infection. Human alveolar macrophages produced CCL2 in a PGL-dependent fashion following infection, arguing for the potential of PGL-blocking interventions or PGL-targeting vaccine strategies in the prevention of tuberculosis. Video Abstract
Microbicidal tissue-resident macrophages are first responders to mycobacteria Mycobacterial phenolic glycolipid induces macrophage CCL2 through STING activation CCL2 recruits mycobacterium-permissive monocytes to the tissue-resident macrophage Mycobacteria transfer from tissue macrophage to monocyte through a cell fusion event
Collapse
Affiliation(s)
- C J Cambier
- Department of Immunology, University of Washington, Seattle, WA 98195, USA; Molecular Immunity Unit, Department of Medicine, University of Cambridge, MRC Laboratory of Molecular Biology, Cambridge CB2 0QH, UK; Department of Chemistry, Stanford University, Stanford, CT 94305, USA
| | - Seónadh M O'Leary
- Department of Clinical Medicine, Trinity Translational Medicine Institute, Trinity College Dublin, Dublin 8, Ireland
| | - Mary P O'Sullivan
- Department of Clinical Medicine, Trinity Translational Medicine Institute, Trinity College Dublin, Dublin 8, Ireland
| | - Joseph Keane
- Department of Clinical Medicine, Trinity Translational Medicine Institute, Trinity College Dublin, Dublin 8, Ireland.
| | - Lalita Ramakrishnan
- Department of Immunology, University of Washington, Seattle, WA 98195, USA; Molecular Immunity Unit, Department of Medicine, University of Cambridge, MRC Laboratory of Molecular Biology, Cambridge CB2 0QH, UK; Department of Microbiology, University of Washington, Seattle, WA 98195, USA; Department of Medicine, University of Washington, Seattle, WA 98195, USA.
| |
Collapse
|
28
|
Boggiano C, Eichelberg K, Ramachandra L, Shea J, Ramakrishnan L, Behar S, Ernst JD, Porcelli SA, Maeurer M, Kornfeld H. "The Impact of Mycobacterium tuberculosis Immune Evasion on Protective Immunity: Implications for TB Vaccine Design" - Meeting report. Vaccine 2017; 35:3433-3440. [PMID: 28476627 DOI: 10.1016/j.vaccine.2017.04.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 03/18/2017] [Accepted: 04/04/2017] [Indexed: 12/26/2022]
Abstract
Tuberculosis (TB) is the major cause of death from infectious diseases around the world, particularly in HIV infected individuals. TB vaccine design and development have been focused on improving Bacille Calmette-Guérin (BCG) and evaluating recombinant and viral vector expressed Mycobacterium tuberculosis (Mtb) proteins, for boosting BCG-primed immunity, but these approaches have not yet yielded significant improvements over the modest effects of BCG in protecting against infection or disease. On March 7-8, 2016, the National Institute of Allergy and Infectious Diseases (NIAID) convened a workshop on "The Impact of Mtb Immune Evasion on Protective Immunity: Implications for TB Vaccine Design" with the goal of defining immune mechanisms that could be targeted through novel research approaches, to inform vaccine design and immune therapeutic interventions for prevention of TB. The workshop addressed early infection events, the impact of Mtb evolution on the development and maintenance of an adaptive immune response, and the factors that influence protection against and progression to active disease. Scientific gaps and areas of study to revitalize and accelerate TB vaccine design were discussed and prioritized. These included a comprehensive evaluation of innate and Mtb-specific adaptive immune responses in the lung at different stages of disease; determining the role of B cells and antibodies (Abs) during Mtb infection; development of better assays to measure Mtb burden following exposure, infection, during latency and after treatment, and approaches to improving current animal models to study Mtb immunogenicity, TB disease and transmission.
Collapse
Affiliation(s)
- Cesar Boggiano
- Division of AIDS/NIAID/NIH, 5601 Fishers Lane, Rm: 9D10B, MSC: 9829, Rockville, MD 20852, USA.
| | - Katrin Eichelberg
- Division of Microbiology and Infectious Diseases/NIAID/NIH, Rockville, MD, USA
| | - Lakshmi Ramachandra
- Division of Allergy, Immunology and Transplantation/NIAID/NIH, Rockville, MD, USA
| | | | | | - Samuel Behar
- University of Massachusetts Medical School, Worcester, MA, USA
| | - Joel D Ernst
- New York University School of Medicine, New York, NY, USA
| | | | | | - Hardy Kornfeld
- University of Massachusetts Medical School, Worcester, MA, USA
| |
Collapse
|
29
|
Thuong NTT, Heemskerk D, Tram TTB, Thao LTP, Ramakrishnan L, Ha VTN, Bang ND, Chau TTH, Lan NH, Caws M, Dunstan SJ, Chau NVV, Wolbers M, Mai NTH, Thwaites GE. Leukotriene A4 Hydrolase Genotype and HIV Infection Influence Intracerebral Inflammation and Survival From Tuberculous Meningitis. J Infect Dis 2017; 215:1020-1028. [PMID: 28419368 PMCID: PMC5426373 DOI: 10.1093/infdis/jix050] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 01/20/2017] [Indexed: 11/13/2022] Open
Abstract
Background Tuberculous meningitis (TBM) is the most devastating form of tuberculosis, yet very little is known about the pathophysiology. We hypothesized that the genotype of leukotriene A4 hydrolase (encoded by LTA4H), which determines inflammatory eicosanoid expression, influences intracerebral inflammation, and predicts survival from TBM. Methods We characterized the pretreatment clinical and intracerebral inflammatory phenotype and 9-month survival of 764 adults with TBM. All were genotyped for single-nucleotide polymorphism rs17525495, and inflammatory phenotype was defined by cerebrospinal fluid (CSF) leukocyte and cytokine concentrations. Results LTA4H genotype predicted survival of human immunodeficiency virus (HIV)-uninfected patients, with TT-genotype patients significantly more likely to survive TBM than CC-genotype patients, according to Cox regression analysis (univariate P = .040 and multivariable P = .037). HIV-uninfected, TT-genotype patients had high CSF proinflammatory cytokine concentrations, with intermediate and lower concentrations in those with CT and CC genotypes. Increased CSF cytokine concentrations correlated with more-severe disease, but patients with low CSF leukocytes and cytokine concentrations were more likely to die from TBM. HIV infection independently predicted death due to TBM (hazard ratio, 3.94; 95% confidence interval, 2.79-5.56) and was associated with globally increased CSF cytokine concentrations, independent of LTA4H genotype. Conclusions LTA4H genotype and HIV infection influence pretreatment inflammatory phenotype and survival from TBM. LTA4H genotype may predict adjunctive corticosteroid responsiveness in HIV-uninfected individuals.
Collapse
Affiliation(s)
- Nguyen T T Thuong
- Oxford University Clinical Research Unit
- Nuffield Department of Medicine, University of Oxford
| | - Dorothee Heemskerk
- Oxford University Clinical Research Unit
- Nuffield Department of Medicine, University of Oxford
| | - Trinh T B Tram
- Oxford University Clinical Research Unit
- Nuffield Department of Medicine, University of Oxford
| | - Le T P Thao
- Oxford University Clinical Research Unit
- Nuffield Department of Medicine, University of Oxford
| | | | - Vu T N Ha
- Oxford University Clinical Research Unit
- Nuffield Department of Medicine, University of Oxford
| | - Nguyen D Bang
- Pham Ngoc Thach Hospital for Tuberculosis and Lung Diseases, and
| | - Tran T H Chau
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Nguyen H Lan
- Pham Ngoc Thach Hospital for Tuberculosis and Lung Diseases, and
| | - Maxine Caws
- Oxford University Clinical Research Unit
- Liverpool School of Tropical Medicine, United Kingdom ; and
| | - Sarah J Dunstan
- Peter Doherty Institute for Infection and Immunity, University of Melbourne, Australia
| | | | - Marcel Wolbers
- Oxford University Clinical Research Unit
- Nuffield Department of Medicine, University of Oxford
| | - Nguyen T H Mai
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Guy E Thwaites
- Oxford University Clinical Research Unit
- Nuffield Department of Medicine, University of Oxford
| |
Collapse
|
30
|
Conrad WH, Osman MM, Shanahan JK, Chu F, Takaki KK, Cameron J, Hopkinson-Woolley D, Brosch R, Ramakrishnan L. Mycobacterial ESX-1 secretion system mediates host cell lysis through bacterium contact-dependent gross membrane disruptions. Proc Natl Acad Sci U S A 2017; 114:1371-1376. [PMID: 28119503 PMCID: PMC5307465 DOI: 10.1073/pnas.1620133114] [Citation(s) in RCA: 163] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Mycobacterium tuberculosis and Mycobacterium marinum are thought to exert virulence, in part, through their ability to lyse host cell membranes. The type VII secretion system ESX-1 [6-kDa early secretory antigenic target (ESAT-6) secretion system 1] is required for both virulence and host cell membrane lysis. Both activities are attributed to the pore-forming activity of the ESX-1-secreted substrate ESAT-6 because multiple studies have reported that recombinant ESAT-6 lyses eukaryotic membranes. We too find ESX-1 of M. tuberculosis and M. marinum lyses host cell membranes. However, we find that recombinant ESAT-6 does not lyse cell membranes. The lytic activity previously attributed to ESAT-6 is due to residual detergent in the preparations. We report here that ESX-1-dependent cell membrane lysis is contact dependent and accompanied by gross membrane disruptions rather than discrete pores. ESX-1-mediated lysis is also morphologically distinct from the contact-dependent lysis of other bacterial secretion systems. Our findings suggest redirection of research to understand the mechanism of ESX-1-mediated lysis.
Collapse
Affiliation(s)
- William H Conrad
- Department of Medicine, University of Cambridge, Cambridge CB2 0QH, United Kingdom
| | - Morwan M Osman
- Department of Medicine, University of Cambridge, Cambridge CB2 0QH, United Kingdom
- Molecular and Cellular Biology Graduate Program, University of Washington, Seattle, WA 98105
| | - Jonathan K Shanahan
- Department of Medicine, University of Cambridge, Cambridge CB2 0QH, United Kingdom
- Wellcome Trust PhD Program in Infection, Immunity, and Inflammation, University of Cambridge, Cambridge CB2 0XY, United Kingdom
| | - Frances Chu
- Department of Microbiology, University of Washington, Seattle, WA 98105
| | - Kevin K Takaki
- Department of Medicine, University of Cambridge, Cambridge CB2 0QH, United Kingdom
| | - James Cameron
- Department of Microbiology, University of Washington, Seattle, WA 98105
| | | | - Roland Brosch
- Unit for Integrated Mycobacterial Pathogenomics, Institut Pasteur, 75015 Paris, France
| | - Lalita Ramakrishnan
- Department of Medicine, University of Cambridge, Cambridge CB2 0QH, United Kingdom;
- Department of Microbiology, University of Washington, Seattle, WA 98105
| |
Collapse
|
31
|
Ramakrishnan L, Anwar A, Wort JS, Quinlan GJ. P244 Haemoglobin mediated proliferation and il-6 release in human pulmonary artery endothelial cells: a role for cd163 and implications for pulmonary vascular remodelling. Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
32
|
Thakkar H, Vincent V, Roy A, Singh S, Ramakrishnan L, Singh A. Estimation of HDL antioxidative activity in subjects with acute coronary syndrome. Atherosclerosis 2016. [DOI: 10.1016/j.atherosclerosis.2016.07.607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
33
|
Berg RD, Levitte S, O'Sullivan MP, O'Leary SM, Cambier CJ, Cameron J, Takaki KK, Moens CB, Tobin DM, Keane J, Ramakrishnan L. Lysosomal Disorders Drive Susceptibility to Tuberculosis by Compromising Macrophage Migration. Cell 2016; 165:139-152. [PMID: 27015311 PMCID: PMC4819607 DOI: 10.1016/j.cell.2016.02.034] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 11/30/2015] [Accepted: 02/02/2016] [Indexed: 12/19/2022]
Abstract
A zebrafish genetic screen for determinants of susceptibility to Mycobacterium marinum identified a hypersusceptible mutant deficient in lysosomal cysteine cathepsins that manifests hallmarks of human lysosomal storage diseases. Under homeostatic conditions, mutant macrophages accumulate undigested lysosomal material, which disrupts endocytic recycling and impairs their migration to, and thus engulfment of, dying cells. This causes a buildup of unengulfed cell debris. During mycobacterial infection, macrophages with lysosomal storage cannot migrate toward infected macrophages undergoing apoptosis in the tuberculous granuloma. The unengulfed apoptotic macrophages undergo secondary necrosis, causing granuloma breakdown and increased mycobacterial growth. Macrophage lysosomal storage similarly impairs migration to newly infecting mycobacteria. This phenotype is recapitulated in human smokers, who are at increased risk for tuberculosis. A majority of their alveolar macrophages exhibit lysosomal accumulations of tobacco smoke particulates and do not migrate to Mycobacterium tuberculosis. The incapacitation of highly microbicidal first-responding macrophages may contribute to smokers’ susceptibility to tuberculosis. Lysosomal storage diseases reduce macrophage endocytic recycling and migration Reduced macrophage migration increases tuberculosis severity via granuloma breakdown Tobacco smoke particles accumulate in lysosomes of smokers’ alveolar macrophages Lysosomal particles reduce smokers’ macrophage migration to infecting mycobacteria
Collapse
Affiliation(s)
- Russell D Berg
- Molecular & Cellular Biology Graduate Program and Medical Scientist Training Program, University of Washington, Seattle, WA 98195, USA
| | - Steven Levitte
- Molecular & Cellular Biology Graduate Program and Medical Scientist Training Program, University of Washington, Seattle, WA 98195, USA; Department of Medicine, University of Cambridge, MRC Laboratory of Molecular Biology, Cambridge CB2 0QH, UK
| | - Mary P O'Sullivan
- Department of Clinical Medicine, Institute of Molecular Medicine, Trinity College Dublin, Dublin 8, Ireland
| | - Seónadh M O'Leary
- Department of Clinical Medicine, Institute of Molecular Medicine, Trinity College Dublin, Dublin 8, Ireland
| | - C J Cambier
- Immunology Graduate Program, University of Washington, Seattle, WA 98195, USA
| | - James Cameron
- Department of Microbiology, University of Washington, Seattle, WA 98195, USA
| | - Kevin K Takaki
- Department of Medicine, University of Cambridge, MRC Laboratory of Molecular Biology, Cambridge CB2 0QH, UK
| | - Cecilia B Moens
- Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
| | - David M Tobin
- Department of Molecular Genetics and Microbiology, Duke University, Durham, NC 27710, USA; Department of Immunology, Duke University, Durham, NC 27710, USA
| | - Joseph Keane
- Department of Clinical Medicine, Institute of Molecular Medicine, Trinity College Dublin, Dublin 8, Ireland.
| | - Lalita Ramakrishnan
- Department of Medicine, University of Cambridge, MRC Laboratory of Molecular Biology, Cambridge CB2 0QH, UK; Department of Microbiology, University of Washington, Seattle, WA 98195, USA.
| |
Collapse
|
34
|
Abstract
With increasing longevity of lupus patients, peripheral vascular disease (PVD) has become an important cause of morbidity. With no systematic study of PVD in systemic lupus erythematosus (SLE), this study was undertaken to define the frequency and spectrum of PVD in SLE and factors affecting such an occurrence. All medium-sized peripheral arteries of bilateral upper and lower extremities were studied in 50 SLE patients using Doppler ultrasonography. PVD was defined clinically as one or more of intermittent claudication, absent/unequal pulses, gangrene or ischemic ulcers and sub-clinically as asymptomatic patients with Doppler abnormalities, with ≥50% reduction in diameter considered hemodynamically significant. Mean (SD) age of the patients was 31.6 (10.1) years. Forty-one percent were hypertensive. Dyslipidemia was found in 62%. Fifteen (30%) had Raynaud's phenomenon. Fourteen (28%) patients had PVD, of whom three had positive markers for antiphospholipid antibody (aPL) and six were asymptomatic. Ischemic ulcers were seen in eight (16%), gangrene in three (6%), femoral artery plaques in two (4%), stenosis in four (8%) and intermittent claudication in none. Dyslipidemia was found to independently affect occurrence of PVD (OR = 5.37, [95% CI 1.05—27.5], P = 0.05). The causes of PVD overlap significantly and further studies are needed to ascertain the relative contribution of each. Lupus (2007) 16, 720—723.
Collapse
Affiliation(s)
- S P Bhatt
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | | | | | | | | | | | | | | |
Collapse
|
35
|
Pagan AJ, Levitte S, Berg RD, Hernandez L, Zimmerman J, Tobin DM, Ramakrishnan L. mTOR deficiency reveals an immunological trade-off in innate resistance to mycobacterial infection in vivo. The Journal of Immunology 2016. [DOI: 10.4049/jimmunol.196.supp.200.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Abstract
The Mechanistic Target of Rapamycin (mTOR) has been implicated in myeloid cell development and survival. As adequate myelopoiesis has been recently shown to be a resistance factor in tuberculosis, mTOR deficiency would be expected to increase mycobacterial growth and thus host susceptibility to this disease. In contrast, mTOR inhibition decreases Mycobacterium tuberculosis infection burdens in cultured macrophages, an effect attributed to the triggering of autophagy. Which of these contradictory effects of mTOR deficiency influences infection outcome in vivo is unknown. We have examined the effects of mTOR on mycobacterial infection using the optically transparent and genetically tractable Mycobacterium marinum-zebrafish model of tuberculosis. A forward genetic screen in zebrafish initially identified an mtor mutant as being hypersusceptible to M. marinum, a phenotype that mapped to mTOR complex 1 and was reproduced with rapamycin. However, using very low inoculums typical of human tuberculosis (1–3 mycobacteria) revealed mTOR’s dichotomous role: mTOR-deficient animals were more likely to clear infection early, but those that did not clear the infection progressed rapidly to more severe disease characterized by the death of infected macrophages and subsequent release of mycobacteria into the more growth-permissive extracellular space. Thus, mTOR supports macrophage homeostasis at the expense of a transient enhancement in microbicidal capacity that could reduce the likelihood of mycobacterial colonization but would inevitably thwart long-term immunity.
Collapse
|
36
|
Soler FJR, Redmond S, Ramakrishnan L. The pro-apoptotic factor Bax regulates macrophage necrosis during Mycobacterial infection. The Journal of Immunology 2016. [DOI: 10.4049/jimmunol.196.supp.63.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Abstract
In the zebrafish-Mycobacterium marinum model for tuberculosis infection, excess TNF triggers necrosis of infected macrophages which leads to exuberant extracellular bacterial growth and host susceptibility (Tobin et al., 2012; Roca and Ramakrishnan, 2013). It has been shown that in infected macrophages, excess TNF induces production of mitochondrial reactive oxygen species (ROS) which activate two death pathways that converge in macrophage necrosis: cyclophilin D-dependent mitochondrial transition pore and acid sphingomyelinase-dependent ceramide production that leads to lysosomal permeabilization.
In exploring the events downstream of lysosomal permeabilization, we found that ceramide acts in a Cathepsin D-dependent manner to induce cell death. In the cytosol Cathepsin D initiates the activation of pro-apoptotic factors including Bid and Bax. We engineered Bax mutants that lack its different functional domains and studied the ability of each mutant protein to regulate apoptosis and necrosis. Then we infected Bax-deficient zebrafish larvae expressing the Bax mutants that were unable to induce apoptosis. We found the BH3 domain, which is required for Bax oligomerization during apoptosis, not to be required for necrosis under excess TNF conditions. Rather, an N-terminal transmembrane helix suggested to be the first portion of Bax in contact with the mitochondrial membrane was found to be required for necrosis. Current studies are focused on understanding post-translational modifications of Bax that determine whether activation of the same protein promotes apoptosis or necrosis.
Collapse
|
37
|
Pagán AJ, Yang CT, Cameron J, Swaim LE, Ellett F, Lieschke GJ, Ramakrishnan L. Myeloid Growth Factors Promote Resistance to Mycobacterial Infection by Curtailing Granuloma Necrosis through Macrophage Replenishment. Cell Host Microbe 2016; 18:15-26. [PMID: 26159717 PMCID: PMC4509513 DOI: 10.1016/j.chom.2015.06.008] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Revised: 06/01/2015] [Accepted: 06/19/2015] [Indexed: 12/14/2022]
Abstract
The mycobacterial ESX-1 virulence locus accelerates macrophage recruitment to the forming tuberculous granuloma. Newly recruited macrophages phagocytose previously infected apoptotic macrophages to become new bacterial growth niches. Granuloma macrophages can then necrose, releasing mycobacteria into the extracellular milieu, which potentiates their growth even further. Using zebrafish with genetic or pharmacologically induced macrophage deficiencies, we find that global macrophage deficits increase susceptibility to mycobacterial infection by accelerating granuloma necrosis. This is because reduction in the macrophage supply below a critical threshold decreases granuloma macrophage replenishment to the point where apoptotic infected macrophages, failing to get engulfed, necrose. Reducing macrophage demand by removing bacterial ESX-1 offsets the susceptibility of macrophage deficits. Conversely, increasing macrophage supply in wild-type fish by overexpressing myeloid growth factors induces resistance by curtailing necrosis. These findings may explain the susceptibility of humans with mononuclear cytopenias to mycobacterial infections and highlight the therapeutic potential of myeloid growth factors in tuberculosis. Myeloid deficiencies increase innate immune susceptibility to mycobacterial infection Depletion of macrophage supply below a critical threshold hastens granuloma necrosis Increasing macrophage supply to the granuloma delays granuloma necrosis
Collapse
Affiliation(s)
- Antonio J Pagán
- Department of Medicine, University of Cambridge, Cambridge CB2 0QH, UK; Department of Microbiology, University of Washington, Seattle, WA 98195, USA
| | - Chao-Tsung Yang
- Department of Microbiology, University of Washington, Seattle, WA 98195, USA
| | - James Cameron
- Department of Microbiology, University of Washington, Seattle, WA 98195, USA
| | - Laura E Swaim
- Department of Microbiology, University of Washington, Seattle, WA 98195, USA
| | - Felix Ellett
- Cancer and Haematology Division, Walter and Eliza Hall Institute of Medical Research, Parkville, VIC 3052, Australia
| | - Graham J Lieschke
- Cancer and Haematology Division, Walter and Eliza Hall Institute of Medical Research, Parkville, VIC 3052, Australia; Australian Regenerative Medicine Institute, Monash University, Clayton, VIC 3800, Australia
| | - Lalita Ramakrishnan
- Department of Medicine, University of Cambridge, Cambridge CB2 0QH, UK; Department of Microbiology, University of Washington, Seattle, WA 98195, USA; Department of Immunology, University of Washington, Seattle, WA 98195, USA; Department of Medicine, University of Washington, Seattle, WA 98195, USA.
| |
Collapse
|
38
|
Srivastava R, Batra A, Tyagi A, Dhawan D, Ramakrishnan L, Bakhshi S. Adiponectin correlates with obesity: A study of 159 childhood acute leukemia survivors from India. Indian J Cancer 2016; 52:195-7. [PMID: 26853401 DOI: 10.4103/0019-509x.175824] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Acute lymphoblastic leukemia survivors are predisposed to obesity. However, the exact underlying mechanisms are not known. AIMS The study was done to assess the role of biomarkers of obesity in acute leukemia survivors. SETTINGS AND DESIGNS This is a cross-sectional study conducted at All India Institute of Medical Sciences in survivors of acute leukemia who had completed treatment at least 1 year before enrollment in this study. MATERIALS AND METHODS Obesity was studied by determining the body mass index. Potential biomarkers were studied by assessing serum leptin, resistin, and adiponectin by enzyme-linked immunosorbant assay, and the results were compared in obese versus nonobese survivors. STATISTICAL ANALYSIS Descriptive analysis for baseline demographic factors and Student's t-test for comparing the mean levels of biomarkers among the obese and nonobese survivors. RESULTS One hundred and fifty-nine acute leukemia patients were enrolled in this study with a median follow-up of 36.8 months. The median age was 10 (range: 3-18) years, and 123 (77.3%) patients were males. The overall prevalence of overweight/obesity was 26.4%, and this was similar in acute myeloid leukemia and acute lymphoblastic leukemia sub-groups (26.2% vs. 27.3%, P = 0.9). Mean serum leptin and resistin were similar in obese and nonobese leukemia survivors (3.7 vs. 2.85 pg/mL, P = 0.064; 8.01 vs. 9.33 ng/mL, P = 0.36). However, mean serum adiponectin was significantly lower in obese leukemia survivors (7.97 vs. 11.5 μg/mL, P = 0.023). CONCLUSIONS Obese leukemic survivors had lower serum adiponectin levels than nonobese survivors. However, serum resistin and leptin levels were similar in the two groups.
Collapse
Affiliation(s)
| | | | | | | | | | - S Bakhshi
- Department of Medical Oncology, Dr. B. R. A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
39
|
Abstract
In recent years, the zebrafish has emerged as an increasingly prominent model in biomedical research. To showcase the translational impact of the model across multiple disease areas, Disease Models & Mechanisms has compiled a Special Issue that includes thought-provoking reviews, original research reporting new and important insights into disease mechanisms, and novel resources that expand the zebrafish toolkit. This Editorial provides a summary of the issue’s contents, highlighting the diversity of zebrafish disease models and their clinical applications.
Collapse
Affiliation(s)
- E Elizabeth Patton
- MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, UK.
| | - Paraminder Dhillon
- Disease Models & Mechanisms, The Company of Biologists, Bidder Building, 140 Cowley Road, Cambridgeshire, UK
| | | | | |
Collapse
|
40
|
Ramakrishnan L, Mumby S, Wort J, Quinlan G. S36 Ferroportin Is Expressed In Human Pulmonary Artery Smooth Muscle Cells: Implications For Pulmonary Arterial Hypertension. Thorax 2014. [DOI: 10.1136/thoraxjnl-2014-206260.42] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
41
|
Chowdhury J, Ramakrishnan L, Svermova T, Mumby S, Shao D, Wort S, Burke-Gaffney A. P18 Robo1/4-slit2 Expression In Pulmonary Vascular Cells: Implications For Pah? Thorax 2014. [DOI: 10.1136/thoraxjnl-2014-206260.168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
42
|
Abstract
Granulomas, organized aggregates of immune cells, are a defining feature of tuberculosis (TB). Granuloma formation is implicated in the pathogenesis of a variety of inflammatory disorders. However, the tuberculous granuloma has been assigned the role of a host protective structure which "walls-off" mycobacteria. Work conducted over the past decade has provided a more nuanced view of its role in pathogenesis. On the one hand, pathogenic mycobacteria accelerate and exploit granuloma formation for their expansion and dissemination by manipulating host immune responses to turn leukocyte recruitment and cell death pathways in their favor. On the other hand, granuloma macrophages can preserve granuloma integrity by exerting a microbicidal immune response, thus preventing an even more rampant expansion of infection in the extracellular milieu. Even this host-beneficial immune response required to maintain the bacteria intracellular must be tempered, as an overly vigorous immune response can also cause granuloma breakdown, thereby directly supporting bacterial growth extracellularly. This review will discuss how mycobacteria manipulate inflammatory responses to drive granuloma formation and will consider the roles of the granuloma in pathogenesis and protective immunity, drawing from clinical studies of TB in humans and from animal models--rodents, zebrafish, and nonhuman primates. A deeper understanding of TB pathogenesis and immunity in the granuloma could suggest therapeutic approaches to abrogate the host-detrimental aspects of granuloma formation to convert it into the host-beneficial structure that it has been thought to be for nearly a century.
Collapse
Affiliation(s)
- Antonio J Pagán
- Department of Microbiology, University of Washington, Seattle, Washington 98195
| | - Lalita Ramakrishnan
- Department of Microbiology, University of Washington, Seattle, Washington 98195 Department of Medicine, University of Washington, Seattle, Washington 98195 Department of Immunology, University of Washington, Seattle, Washington 98195
| |
Collapse
|
43
|
Patton EE, Dhillon P, Amatruda JF, Ramakrishnan L. Spotlight on Zebrafish: Translational Impact. Development 2014. [DOI: 10.1242/dev.114744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
44
|
Pagan A, Yang CT, Swaim L, Ramakrishnan L. Replenishment of granuloma macrophages promotes mycobacterial resistance by preventing extracellular bacterial growth (INC7P.410). The Journal of Immunology 2014. [DOI: 10.4049/jimmunol.192.supp.186.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Abstract
Pathogenic mycobacteria exploit the early tuberculous granuloma for their expansion by inducing infected macrophage apoptosis and accelerating uninfected macrophage recruitment and infection upon engulfing the dying macrophages. Whether sustained macrophage recruitment to established granulomas is also host-detrimental is unclear. We addressed this question in the zebrafish model of tuberculosis by manipulating the macrophage colony stimulation factor 1 (CSF-1) pathway, which promotes macrophage development. Early granuloma formation was normal in CSF-1 receptor-deficient fish in spite of having fewer macrophages. However, they became hypersusceptible upon depleting their macrophages, leading to the sudden loss of new recruits that would normally engulf the infected dead cells. The unphagocytosed infected macrophages underwent necrosis, releasing mycobacteria into the extracellular milieu that promotes exuberant growth. Partial macrophage depletion with lipo-clodranate produced the same effects in wild-type fish. Conversely, overexpression of CSF-1 in wild-type fish increased macrophage numbers and reduced susceptibility to infection. These results suggest that granuloma kinetics must be nuanced to promote resistance - while delaying granuloma formation is host-beneficial, abolishing macrophage recruitment to established granulomas is detrimental. These results might also explain why monocytopenias confer susceptibility to mycobacterial infections in humans.
Collapse
Affiliation(s)
- Antonio Pagan
- 1Microbiology, University of Washington, Seattle, WA
| | | | - Laura Swaim
- 1Microbiology, University of Washington, Seattle, WA
| | - Lalita Ramakrishnan
- 1Microbiology, University of Washington, Seattle, WA
- 2Immunology, University of Washington, Seattle, WA
- 3Medicine, University of Washington, Seattle, WA
| |
Collapse
|
45
|
Abstract
During the past 12 years, we have developed the zebrafish as a model for the study of tuberculosis pathogenesis and immunology. We have taken advantage of the optical transparency and the genetic and pharmacological tractability of the developing zebrafish to monitor infection in real time. Detailed information about the sequential interactions among the host and the pathogen, the cell types, and the molecules involved has yielded surprising insights into this ancient disease. We have identified a number of host evasion strategies deployed by pathogenic mycobacteria as well as host responses that provide broad insights into host immunity. Many of these discoveries have relevance to human tuberculosis and suggest new therapeutic avenues for tuberculosis as well as other inflammatory diseases.
Collapse
Affiliation(s)
- Lalita Ramakrishnan
- Departments of Microbiology, Medicine, and Immunology, University of Washington, Seattle, Washington 98195
| |
Collapse
|
46
|
Adams KN, Szumowski JD, Ramakrishnan L. Verapamil, and its metabolite norverapamil, inhibit macrophage-induced, bacterial efflux pump-mediated tolerance to multiple anti-tubercular drugs. J Infect Dis 2014; 210:456-66. [PMID: 24532601 DOI: 10.1093/infdis/jiu095] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Drug tolerance likely represents an important barrier to tuberculosis treatment shortening. We previously implicated the Mycobacterium tuberculosis efflux pump Rv1258c as mediating macrophage-induced tolerance to rifampicin and intracellular growth. In this study, we infected the human macrophage-like cell line THP-1 with drug-sensitive and drug-resistant M. tuberculosis strains and found that tolerance developed to most antituberculosis drugs, including the newer agents moxifloxacin, PA-824, linezolid, and bedaquiline. Multiple efflux pump inhibitors in clinical use for other indications reversed tolerance to isoniazid and rifampicin and slowed intracellular growth. Moreover, verapamil reduced tolerance to bedaquiline and moxifloxacin. Verapamil's R isomer and its metabolite norverapamil have substantially less calcium channel blocking activity yet were similarly active as verapamil at inhibiting macrophage-induced drug tolerance. Our finding that verapamil inhibits intracellular M. tuberculosis growth and tolerance suggests its potential for treatment shortening. Norverapamil, R-verapamil, and potentially other derivatives present attractive alternatives that may have improved tolerability.
Collapse
Affiliation(s)
| | | | - Lalita Ramakrishnan
- Department of Microbiology Department of Medicine, Division of Infectious Diseases Department of Immunology, University of Washington, Seattle, Washington
| |
Collapse
|
47
|
Cambier CJ, Takaki KK, Larson RP, Hernandez RE, Tobin DM, Urdahl KB, Cosma CL, Ramakrishnan L. Mycobacteria manipulate macrophage recruitment through coordinated use of membrane lipids. Nature 2013; 505:218-22. [PMID: 24336213 PMCID: PMC3961847 DOI: 10.1038/nature12799] [Citation(s) in RCA: 329] [Impact Index Per Article: 29.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Accepted: 10/18/2013] [Indexed: 12/22/2022]
Abstract
The evolutionary survival of Mycobacterium tuberculosis, the cause of human tuberculosis (TB), depends on its ability to invade the host, replicate, and transmit infection. At its initial peripheral infection site in the distal lung airways, M. tuberculosis infects macrophages which transport it to deeper tissues1. How mycobacteria survive in these broadly microbicidal cells is an important question. Here we show that M. tuberculosis, and its close pathogenic relative Mycobacterium marinum, preferentially recruit and infect permissive macrophages while evading microbicidal ones. This immune evasion is accomplished by using cell surface associated phthiocerol dimycoceroserate (PDIM) lipids2 to mask underlying pathogen-associated molecular patterns (PAMPs). In the absence of PDIM, these PAMPs signal a toll-like receptor (TLR)-dependent recruitment of macrophages that produce microbicidal reactive nitrogen species. Concordantly, the related phenolic glycolipids (PGL)2, promote recruitment of permissive macrophages via a host chemokine receptor 2 (CCR2)-mediated pathway. Thus, we have identified coordinated roles for PDIM, known to be essential for mycobacterial virulence3 and PGL, which (along with CCR2) is known to be associated with human TB4,5. Our findings also suggest an explanation for the longstanding observation that M. tuberculosis initiates infection in the relatively sterile environment of the lower respiratory tract, rather than in the upper respiratory tract, where resident microflora and inhaled environmental microbes may continually recruit microbicidal macrophages through TLR-dependent signaling.
Collapse
Affiliation(s)
- C J Cambier
- Department of Immunology, University of Washington, Seattle, Washington 98195, USA
| | - Kevin K Takaki
- Department of Microbiology, University of Washington, Seattle, Washington 98195, USA
| | - Ryan P Larson
- 1] Department of Immunology, University of Washington, Seattle, Washington 98195, USA [2] Seattle Biomedical Research Institute, Seattle, Washington 98109, USA
| | - Rafael E Hernandez
- Department of Pediatrics, University of Washington, Seattle, Washington 98195, USA
| | - David M Tobin
- Department of Microbiology, University of Washington, Seattle, Washington 98195, USA
| | - Kevin B Urdahl
- 1] Department of Immunology, University of Washington, Seattle, Washington 98195, USA [2] Seattle Biomedical Research Institute, Seattle, Washington 98109, USA [3] Department of Pediatrics, University of Washington, Seattle, Washington 98195, USA
| | - Christine L Cosma
- Department of Microbiology, University of Washington, Seattle, Washington 98195, USA
| | - Lalita Ramakrishnan
- 1] Department of Immunology, University of Washington, Seattle, Washington 98195, USA [2] Department of Microbiology, University of Washington, Seattle, Washington 98195, USA [3] Department of Medicine, University of Washington, Seattle, Washington 98195, USA
| |
Collapse
|
48
|
Shetkar S, Sharma G, Singh S, Roy A, Ramakrishnan L, Bahl VK. Wilkins score as predictor of atrial fibrillation in rheumatic mitral stenosis. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht310.p4742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
49
|
Tobin DM, Roca FJ, Ray JP, Ko DC, Ramakrishnan L. An enzyme that inactivates the inflammatory mediator leukotriene b4 restricts mycobacterial infection. PLoS One 2013; 8:e67828. [PMID: 23874453 PMCID: PMC3708926 DOI: 10.1371/journal.pone.0067828] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 05/22/2013] [Indexed: 02/05/2023] Open
Abstract
While tuberculosis susceptibility has historically been ascribed to failed inflammation, it is now known that an excess of leukotriene A4 hydrolase (LTA4H), which catalyzes the final step in leukotriene B4 (LTB4) synthesis, produces a hyperinflammatory state and tuberculosis susceptibility. Here we show that the LTB4-inactivating enzyme leukotriene B4 dehydrogenase/prostaglandin reductase 1 (LTB4DH/PTGR1) restricts inflammation and independently confers resistance to tuberculous infection. LTB4DH overexpression counters the susceptibility resulting from LTA4H excess while ltb4dh-deficient animals can be rescued pharmacologically by LTB4 receptor antagonists. These data place LTB4DH as a key modulator of TB susceptibility and suggest new tuberculosis therapeutic strategies.
Collapse
Affiliation(s)
- David M. Tobin
- Department of Molecular Genetics and Microbiology, Duke University Medical Center, Durham, North Carolina, United States of America
- Center for Microbial Pathogenesis, Duke University Medical Center, Durham, North Carolina, United States of America
- Center for AIDS Research, Duke University Medical Center, Durham, North Carolina, United States of America
- * E-mail: (DT); (LR)
| | - Francisco J. Roca
- Department of Microbiology, University of Washington, Seattle, Washington, United States of America
| | - John P. Ray
- Department of Microbiology, University of Washington, Seattle, Washington, United States of America
| | - Dennis C. Ko
- Department of Molecular Genetics and Microbiology, Duke University Medical Center, Durham, North Carolina, United States of America
- Center for Microbial Pathogenesis, Duke University Medical Center, Durham, North Carolina, United States of America
- Center for AIDS Research, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Lalita Ramakrishnan
- Department of Microbiology, University of Washington, Seattle, Washington, United States of America
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
- Department of Immunology, University of Washington, Seattle, Washington, United States of America
- * E-mail: (DT); (LR)
| |
Collapse
|
50
|
Abstract
There is a growing appreciation of the diverse roles that lipid mediators play in modulating inflammatory responses during infection. In the case of tuberculosis, virulent mycobacteria induce host production of anti-inflammatory mediators, including lipoxins, which limit the host inflammatory response and lead to necrotic cell death of infected macrophages. Recent work using the zebrafish model suggests that, while excess anti-inflammatory lipoxins are host detrimental during mycobacterial infections, excess pro-inflammatory lipids also drive host susceptibility. The balance of these inflammatory states is influenced by common human genetic variation in Asia. Fuller understanding of the mechanisms of eicosanoid-mediated inflammatory imbalance during tuberculosis infection has important implications for the development of adjunctive therapies.
Collapse
Affiliation(s)
- David M Tobin
- Department of Molecular Genetics and Microbiology, Duke University Medical Center, Durham, NC, USA.
| | | |
Collapse
|