Pneumocystis carinii major surface glycoprotein induces interleukin-8 and monocyte chemoattractant protein-1 release from a human alveolar epithelial cell line

BACKGROUND

The major surface glycoprotein (MSG) is an abundant, immunogenic glycoprotein located on the surface of Pneumocystis carinii. Little is known about the proinflammatory effects of MSG.

DESIGN

We have investigated the effect of human MSG on the secretion of the chemokines interleukin 8 (IL-8) and monocyte chemoattractant protein-1 (MCP-1) from an alveolar epithelial cell line (A549).

RESULTS

Incubation of A549 cells with MSG in concentrations from 0.4 to 10 microg mL-1 for 24 h caused dose-dependent increases in IL-8 release (3.4-fold above control, P < 0.01). Time course experiments showed increases in IL-8 release at 4 h, 8 h and 24 h compared with control cultures (all P < 0.01). There was a minor (13%) dose- and time-related increase in MCP-1 release at 24 h (P = 0.02). Co-incubation of MSG with mannan or beta-glucan decreased IL-8 release by 48% and 42% respectively, suggesting that MSG stimulates A549 cells in part through carbohydrate moieties. Dexamethasone significantly inhibited MSG-induced IL-8 release in concentrations of 10-6-10-8 mol L-1 compared with control experiments (P < 0.01). Ribonuclease protection assays for steady-state IL-8 mRNA showed that increases in response to MSG stimulation occurred by 4 h and persisted throughout 8 h of stimulation.

CONCLUSION

These findings suggest that MSG can alter alveolar epithelial cytokine release and may be capable of modulating the local inflammatory response in this manner.

Animal pneumocystosis: a model for man

Pneumocystis carinii is an important pulmonary pathogen responsible for morbidity and mortality in patients with AIDS. Apart from AIDS, cases of pneumocystosis have been reported in patients receiving immunosuppressive therapy associated with organ transplantation without chemoprophylaxis and in malignant blood diseases. In vitro models are only of limited interest because there is no continuous in vitro culture. The in vivo models have contributed a great deal to the understanding of human Pneumocystis carinii pneumonia. Indeed, animal models remain of prime interest for many purposes, principally comparative medicine, pathogenesis, epidemiology and immunology. Among animal models, the rabbit is a very susceptible host to P. carinii infection, and does not need glucocorticoid treatment. Moreover, antigenic and genomic data suggest that rabbit-derived Pneumocystis strains are more closely related to human Pneumocystis than those of mice or rats. We have therefore shown that the rabbit model permits the study of the pulmonary surfactant modification due to P. carinii infection. This model should be a very interesting model for pathogenesis or immune response studies in immunocompetent animals. The rabbit model could also be used for epidemiological studies. P. carinii transmission appears to be very rapid via contact of Pneumocystis-free rabbits with infected rabbits. These Pneumocystis-free animals could be helpful for characterizing the source and the reservoir and studying parasite transmission.

Pneumocystis carinii interactions with respiratory epithelium

Ultrastructural studies indicate that the attachment of Pneumocystis carinii to alveolar epithelial cells is a central feature during development of this pneumonia. P. carinii attaches preferentially to type I alveolar epithelial cells, and rarely binds to type II cells. Extensive in vitro investigations support roles for both fibronectin and vitronectin, which bind to the organism, and mediate P. carinii attachment to respiratory epithelial cells through corresponding integrin receptors. Additional studies indicate that P. carinii cytoskeletal rearrangement occurs after initial binding of the organism to lung cells. Further, the attachment of P. carinii to host epithelial cells is believed to induce ultrastructural changes in these cells and to result in enhanced epithelial cell permeability. Further studies will be required to determine the mechanisms and consequences of P. carinii attachment to host epithelial cells in the intact host.

Pneumocystis carinii: the art and science of survival in the hostile environment of the alveolar spaces

Pneumocystis carinii remains an important cause of pneumonia in immunocompromised patients, particularly in those who have acquired immune deficiency syndrome. Potential mechanisms by which P. carinii escapes elimination by lung defenses and proliferates are discussed. Evidence indicates that P. carinii attachment to alveolar epithelium is an important event in the establishment of infection and occurs through a variety of means. The binding of the organisms appears to be injurious to alveolar epithelial cells. Proliferation of the organism is associated with an ineffective and at times detrimental host inflammatory response. Additional studies indicate that P. carinii has the ability to invade tissues. Future investigations using new methodologies and strategies will be required to fully control this pathogen.

Sequence polymorphisms in the Pneumocystis carinii cytochrome b gene and their association with atovaquone prophylaxis failure

Atovaquone (Mepron, 566c80) is an effective agent against Pneumocystis carinii, which probably acts by binding to cytochrome b and inhibiting electron transport. To assess the possibility that atovaquone resistance might be developing, the genes for the cytochrome b from P. carinii sp. f. carinii and P. carinii sp. f. hominis were partially sequenced. Eight of 10 patient isolates had cytochrome b genes with the same amino acid sequence. The P. carinii cytochrome b genes from 2 of 4 patients who had atovaquone prophylaxis failure contained mutations resulting in amino acid changes in one of the ubiquinone (coenzyme Q) binding sites (Qo). These mutations are homologous to mutations in other microorganisms that confer resistance to similar inhibitors. Variations in the sequence of the P. carinii cytochrome b gene suggest but do not prove the development of drug resistance.

Progression of Pneumocystis carinii infection in an animal model

The development of Pneumocystis carinii infection in immunosuppressed rats is important not only in understanding the infection, but also as a source of P. carinii antigen for use in diagnostic serological tests. The aims of this study were to monitor the progression of P. carinii infection in the Sprague Dawley rat model and then determine parameters that indicate the maximum production of P. carinii antigen. Seventeen Sprague Dawley rats were killed at intervals up to 9 weeks after the start of immunosuppressive therapy. The progression of P. carinii lung infection was observed by Giemsa staining of lung imprints and by a hemi-nested polymerase chain reaction (PCR). Body weight, food and water intake and the appearance and activity of the rats were measured daily. Seven control rats were kept under the same conditions. P. carinii infection was detected in the lung 2 weeks after immunosuppression by hemi-nested PCR and after 3 weeks by Giemsa staining. No P. carinii DNA was detected in any of the blood samples. Rats with moderate or severe lung infection had been immunosuppressed for > or = 6 weeks. Body weight was significantly greater in control rats than in the immunosuppressed rats. Six weeks of immunosuppression was used as a cut-off to determine measurements to identify those rats with moderate or severe infections in their lungs. A combination of > 34% body weight loss at 6 weeks after immunosuppression and the condition of the animals with scores < or = 9 used in conjunction with duration of immunosuppression may be useful to maximise the yield of P. carinii infection from individual rats.

Relation between hospital HIV/AIDS caseload and mortality among persons with HIV/AIDS in Canada

OBJECTIVE

To assess the relation between HIV/AIDS hospital caseload and mortality in Canada.

DESIGN

Descriptive, population-based study.

SETTING

All hospitals in Canada that admitted any patients with HIV or AIDS between Mar. 31, 1987, and Apr. 1, 1994.

PATIENTS

All patients with a diagnostic code on their hospital discharge abstract for HIV infection, AIDS, or with positive serological or viral culture findings for HIV (International Classification of Diseases, 9th revision, 042, 043, 044 or 795.8).

MAIN OUTCOME MEASURE

In-hospital mortality.

RESULTS

Over the study period, 38,075 admissions attributed to HIV/AIDS (33,380 of men and 4695 of women) were recorded in 513 Canadian hospitals. Of these hospitals, 230 (45%) had fewer than 1 admission per year of patients with HIV/AIDS; 200 (39%) had between 1 and 9; 68 (13%) had between 10 and 99; and 15 (3%) had 100 or more. HIV/AIDS-related admissions ending in death were independently associated with the patient being admitted to lower-volume hospitals, being hospitalized for longer periods of time, and being older, male and at a more advanced stage of disease. During the study period, hospitals with 100 or more admissions per year reported 36% lower mortality among patients with HIV/AIDS than those that had fewer than 1 admission per year.

CONCLUSION

There is an inverse relation between hospital caseload and in-hospital mortality among patients with HIV/AIDS in Canada. We attribute this association at least in part to the propensity of high-volume hospitals to deal more effectively with seriously ill patients with HIV/AIDS.

Pneumocystis carinii glycoprotein A inhibits surfactant phospholipid secretion by rat alveolar type II cells

Pneumocystis carinii pneumonia (PCP) remains a major cause of morbidity in AIDS. The pathogenesis of PCP is poorly understood, but evidence of surfactant abnormalities is mounting. The role of the major surface glycoprotein of P. carinii, gpA, in producing surfactant abnormalities was investigated. Rat type II pneumocytes were incubated with [3H]choline, purified gpA, and modulators. Lipid was extracted, and [3H]dipalmitoyl phosphatidylcholine (DPPC) secretion was calculated. Contaminating endotoxin had no effect on DPPC secretion. gpA inhibited basal and ATP-stimulated DPPC secretion in a dose- and time-dependent manner. An anti-gpA monoclonal antibody attenuated inhibition of DPPC secretion. Unglycosylated recombinant gpA inhibited secretion, suggesting that functional activity resides in the protein moiety of gpA. These results suggest that gpA is a specific trigger for abnormalities of surfactant lipids in PCP. This is a unique role for a microbial product in disease pathogenesis and a potentially exploitable therapeutic target.

Extrapulmonary pneumocystosis

Extrapulmonary pneumocystosis is an exceedingly rare complication of Pneumocystis carinii pneumonia (PCP). Prior to the advent of the human immunodeficiency virus type 1 (HIV-1) epidemic, only 16 cases of extrapulmonary pneumocystosis in individuals who were immunocompromised by a variety of underlying diseases had been reported. Since the beginning of the HIV-1 and related PCP epidemic, at least 90 cases of extrapulmonary pneumocystosis have been reported. This review briefly presents a history of the discovery of P. carinii and its recognition as a human pathogen, the controversy regarding its taxonomy, and the epidemiology of this organism. A more detailed analysis of the incidence of extrapulmonary pneumocystosis in HIV-1-infected individuals and its occurrence despite widespread prophylaxis for PCP with either aerosolized pentamidine or systemic dapsone-trimethoprim is presented. The clinical features of published cases of extrapulmonary pneumocystosis in non-HIV-1-infected individuals are summarized and contrasted with those in HIV-1 infected individuals. The diagnosis of extrapulmonary pneumocystosis is discussed, and because clinical microbiologists and pathologists are the key individuals in establishing the diagnosis, the characteristic microscopic morphology of P. carinii as its appears when stained with a variety of stains is presented and reviewed. The review concludes with a brief discussion of treatments for extrapulmonary pneumocystosis.

Steady-state effects of vitronectin and fibronectin on the binding, uptake, and degradation of Pneumocystis carinii in rat alveolar macrophages

Pneumocystis carinii pneumonia remains a serious complication of immunodeficiency. Vitronectin (VN) and fibronectin (FN) accumulate in the lung during P. carinii infection and bind to the organism, thereby enhancing macrophage release of TNF alpha. It is not known whether VN and FN also regulate uptake and degradation of P. carinii by macrophage when present in concentrations similar to those in the lung during pneumonia. To address this, macrophages were cultured with 35S-radiolabeled P. carinii and organism binding, phagocytosis, and degradation determined in media alone (control), or in the presence of VN or FN (100 micrograms/ml each). Soluble VN and FN, in concentrations similar to those in the host, did not significantly affect binding uptake or degradation of P. carinii by alveolar macrophages. Thus, although VN and FN enhance macrophage activation during P. carinii pneumonia, phagocytosis of the organism is not increased by these host glycoproteins under steady-state conditions.

Pneumocystis carinii pneumonia in scid mice induced by viable organisms propagated in vitro

Pneumocystis carinii pneumonia remains a major cause of morbidity and mortality in human immunodeficiency virus-infected individuals, despite the widespread use of prophylaxis and the development of new chemotherapeutic agents. The study of P. carinii and of pulmonary host defenses directed against it has been limited by lack of reliable, reproducible methods to obtain pure populations of organisms in useful quantities. While recent success has been achieved with cultures of rat P. carinii organisms, cultures of mouse P. carinii organisms have not been successful. Experiments were performed to determine whether P. carinii organisms derived from mice could be propagated in vitro. Mouse P. carinii organisms, obtained from the lungs of chronically infected athymic mice, were inoculated into spinner flasks containing HEL299 feeder cells seated on microcarrier beads. The numbers of mouse P. carinii organisms increased significantly over 7 days in culture. To test the viability and pathogenicity of these cultured organisms, P. carinii organisms were harvested after 7 days of culture and were inoculated intratracheally into susceptible scid mice. Four weeks after inoculation, scid mice developed uniformly severe P. carinii pneumonia. These studies demonstrate for the first time that mouse P. carinii organisms can be propagated in vitro. Furthermore, cultured mouse P. carinii organisms maintain their pathogenicity in an in vivo model system. This culture system will have important applications in the study of P. carinii biology and in the study of host defenses directed against this important opportunistic pathogen.

Pneumocystis carinii: an atypical fungal micro-organism

The purpose of this review is to assist mycologists in having a better understanding of Pneumocystis carinii and the disease that it causes. Now considered to be a fungus, P. carinii is unusual in its life cycle and relationship with the host. P. carinii pneumonia (PCP) pathogenesis, immunology and host defence mechanisms are examined, as well as epidemiological and control strategies. Most pneumocystosis pathophysiological changes result from the parasite's attachment and proliferation in the lungs, resulting in a filling of the alveoli with masses of the micro-organism. Pathological changes include an increase in alveolar capillary membrane permeability and injury to the alveolar epithelium, which may be mediated by the release of degradative enzymes from the pathogen. A host response takes place by hypertrophy, and hyperplasia involving type II epithelial alveolar cells. P carinii interacts with pulmonary surfactants by binding to the hydrophilic proteins A and D, and by modifying their phospholipid composition. Alveolar macrophages and CD4+ T cells play a key role in the host's defence against Pneumocystis. The epidemiology of PCP remains poorly understood. Airborne transmission has been established, but the actual infective form and its source remains unknown. Studies concerning P. carinii genetic diversity have shown that the parasite polymorphism is related, at least partially, to the host species. A strong host-species specificity in P. carinii has been found. From an epidemiological perspective, there appears to be no animal reservoir for the agent of human PCP. Thus, this disease should not be considered to be zoonotic. Although a significant decrease in the incidence of pneumocystosis has been obtained when employing chemoprophylaxis, anti-P. carinii drugs are not completely successful, often inducing deleterious side-effects. For these reasons, new prophylactic and therapeutic strategies need to be developed. One approach could be based on the anti-P. carinii effect of yeast killer toxins and antibiotic anti-idiotypic antibodies.

Inhibitory effect of a Pichia anomala killer toxin on Pneumocystis carinii infectivity to the SCID mouse

A Pichia anomala killer toxin has been demonstrated to have a specific inhibitory effect on the in vitro attachment of Pneumocystis carinii. The results presented herein show that this yeast toxin is also effective against P. carinii infectivity in reducing parasite colonization in the lungs of SCID mice. The specificity of this inhibitory effect was controlled using a monoclonal antibody neutralizing the killer properties of the yeast toxin.

Pneumonia in cats caused by Pneumocystis carinii purified from mouse lungs

Fourteen mice trapped in or near houses were infected with Pneumocystis carinii and the establishment of pneumonia was helped by injecting with cortisone acetate for 6 weeks. Then 16 cats were infected with P. carinii by injection of lung homogenate from the mice which contained from 1.3 x 10(5) to 2.6 x 10(5) P. carinii cysts. The infection resulted in severe cough and tachypnea in Cats 1-8 injected with cortisone acetate, and a subclinical infection in Cats 9-16. In Cats 1-8, the main pathological finding was typical P. carinii pneumonia, but there only was slight swelling of the lungs in Cats 9-16.

[Pneumocystis pneumonia in light of personal observations]

During a period of 10 months, 87 children with Pneumocystis carinii pneumonia accompanied transient cellular immunity disorders and with normal humoral immunity were observed. It is suggested that change the invasiveness of the parasite has changed. The necessity of taking into consideration a pneumocystis etiology in diagnosis of respiratory tract diseases among children is pointed out.

Pneumocystitis carinii organisms from in vitro culture are highly infectious to the nude rat

Many in vitro systems have been used to cultivate Pneumocystis, but only limited parasite growth has been obtained by different authors. A reliable in vitro system enabling a sustained propagation of Pneumocystis appears to be an important condition for a better definition of the transmission of P. carinii pneumonia. In this work, Pneumocystis in vitro culture was performed on monolayers of L2 rat lung epithelial-like cells. Ultrastructural assessment revealed that culture parasites were structurally intact. Pneumocystis culture samples were intratracheally inoculated into corticosteroid-treated nude rats (nonlatently infected by P. carinii), which developed P. carinii pneumonia at 40 days postinoculation. The infectious power of parasites obtained in vitro was 7-10 times higher than that of parasites freshly extracted from parasitized rat lung. In summary, the present results show that it is possible to obtain in vitro highly infectious Pneumocystis forms, and this study provides a promising infectivity test for use by investigators working on Pneumocystis in vitro systems.