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Pham T, Shi R, Ambati S, Meagher R, Lin X. All hands on Dec: Treating cryptococcosis with dectin decorated liposomes loaded with antifungals. iScience 2024; 27:110349. [PMID: 39055951 PMCID: PMC11269288 DOI: 10.1016/j.isci.2024.110349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 04/20/2024] [Accepted: 06/20/2024] [Indexed: 07/28/2024] Open
Abstract
Systemic cryptococcosis is often fatal even with the current antifungal therapy and there is no vaccine available. Induction therapy with amphotericin B (AmB) is essential for its treatment, which can be either in the form of AmB deoxycholate at 1 mg/kg/day for 7 days or a single dose of liposomal AmB (AmB-LLs) at 10 mg/kg, both in combination with flucytosine. AmB is highly toxic and it is imperative to further increase its efficacy without increasing its toxicity. Previously, we developed a targeted antifungal drug delivery system (DectiSome) that uses liposomes decorated with host-pathogen receptor dectins to target AmB to fungal cells. Here, we showed that a single dose of Dectin-2 coated liposomal AmB, relative to AmB-LLs, reduced fungal burden and prolonged animal survival in the murine model of systemic cryptococcosis. Our results demonstrate that DectiSomes are a promising antifungal delivery system that could improve cryptococcosis therapy in the future.
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Affiliation(s)
- Tuyetnhu Pham
- Department of Plant Biology, University of Georgia, Athens, GA 30602, USA
| | - Ran Shi
- Department of Microbiology, University of Georgia, Athens, GA 30602, USA
| | - Suresh Ambati
- Department of Genetics, University of Georgia, Athens, GA 30602, USA
| | - Richard Meagher
- Department of Genetics, University of Georgia, Athens, GA 30602, USA
| | - Xiaorong Lin
- Department of Plant Biology, University of Georgia, Athens, GA 30602, USA
- Department of Microbiology, University of Georgia, Athens, GA 30602, USA
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2
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Del Poeta M, Wormley FL, Lin X. Host populations, challenges, and commercialization of cryptococcal vaccines. PLoS Pathog 2023; 19:e1011115. [PMID: 36757929 PMCID: PMC9910758 DOI: 10.1371/journal.ppat.1011115] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
Abstract
Vaccines are one of the most effective public health tools to prevent and manage infectious diseases. Since the first clinical use of vaccines in the late 18th century, many vaccines have been successfully developed to combat bacterial and viral infections, including the most recent Coronavirus Disease 2019 (COVID-19) pandemic. However, there remains no vaccine that is clinically available to treat or prevent invasive fungal diseases, including cryptococcal meningoencephalitis. This fungal disease is uniformly fatal without treatment and has a global mortality rate of over 70%. Despite a dire need for an effective cryptococcal vaccine, there are many scientific and economic challenges to overcome prior to making it a reality. Here, we discuss some of these challenges as well as steps that the community is taking for commercialization of effective cryptococcal vaccines.
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Affiliation(s)
- Maurizio Del Poeta
- Department of Microbiology and Immunology, Stony Brook University, Stony Brook, New York, United States of America,Division of Infectious Diseases, Stony Brook University, Stony Brook, New York, United States of America,Institute of Chemical Biology and Drug Discovery, Stony Brook University, Stony Brook, New York, United States of America,Veteran Administration Medical Center, Northport, New York, United States of America,* E-mail: (MDP); (FLW); (XL)
| | - Floyd L. Wormley
- Department of Biology, Texas Christian University, Fort Worth, Texas, United States of America,* E-mail: (MDP); (FLW); (XL)
| | - Xiaorong Lin
- Department of Microbiology, University of Georgia, Athens, Georgia, United States of America,* E-mail: (MDP); (FLW); (XL)
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3
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Malachowski AN, Yosri M, Park G, Bahn YS, He Y, Olszewski MA. Systemic Approach to Virulence Gene Network Analysis for Gaining New Insight into Cryptococcal Virulence. Front Microbiol 2016; 7:1652. [PMID: 27833589 PMCID: PMC5081415 DOI: 10.3389/fmicb.2016.01652] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Accepted: 10/04/2016] [Indexed: 11/13/2022] Open
Abstract
Cryptococcus neoformans is pathogenic yeast, responsible for highly lethal infections in compromised patients around the globe. C. neoformans typically initiates infections in mammalian lung tissue and subsequently disseminates to the central nervous system where it causes significant pathologies. Virulence genes of C. neoformans are being characterized at an increasing rate, however, we are far from a comprehensive understanding of their roles and genetic interactions. Some of these reported virulence genes are scattered throughout different databases, while others are not yet included. This study gathered and analyzed 150 reported virulence associated factors (VAFs) of C. neoformans. Using the web resource STRING database, our study identified different interactions between the total VAFs and those involved specifically in lung and brain infections and identified a new strain specific virulence gene, SHO1, involved in the mitogen-activated protein kinase signaling pathway. As predicted by our analysis, SHO1 expression enhanced C. neoformans virulence in a mouse model of pulmonary infection, contributing to enhanced non-protective immune Th2 bias and progressively enhancing fungal growth in the infected lungs. Sequence analysis indicated 77.4% (116) of total studied VAFs are soluble proteins, and 22.7% (34) are transmembrane proteins. Motifs involved in regulation and signaling such as protein kinases and transcription factors are highly enriched in Cryptococcus VAFs. Altogether, this study represents a pioneering effort in analysis of the virulence composite network of C. neoformans using a systems biology approach.
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Affiliation(s)
- Antoni N Malachowski
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann ArborMI, USA; VA Ann Arbor Healthcare System Research Service (11R), Ann ArborMI, USA
| | - Mohamed Yosri
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann ArborMI, USA; VA Ann Arbor Healthcare System Research Service (11R), Ann ArborMI, USA; The Regional Center for Mycology and Biotechnology, Al-Azhar UniversityCairo, Egypt
| | - Goun Park
- Department of Biotechnology, College of Life Science and Biotechnology, Yonsei University Seoul, South Korea
| | - Yong-Sun Bahn
- Department of Biotechnology, College of Life Science and Biotechnology, Yonsei University Seoul, South Korea
| | - Yongqun He
- Unit for Laboratory Animal Medicine, University of Michigan Medical School, Ann ArborMI, USA; Department of Microbiology and Immunology, University of Michigan Medical School, Ann ArborMI, USA; Center for Computational Medicine and Bioinformatics, University of Michigan Medical School, Ann ArborMI, USA
| | - Michal A Olszewski
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann ArborMI, USA; VA Ann Arbor Healthcare System Research Service (11R), Ann ArborMI, USA
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4
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Simsek B, Guven E, Gumral R, Mert G, Saracli MA, Besirbellioglu B, Yildiran ST. A case of Cryptococcus neoformans meningitis in a patient with abnormal levels of isolated immunological markers. J Mycol Med 2016; 26:283-5. [PMID: 27402508 DOI: 10.1016/j.mycmed.2016.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Revised: 05/20/2016] [Accepted: 05/25/2016] [Indexed: 10/21/2022]
Abstract
Cryptococcal meningitis is considered rare in immunocompetent patients and is mainly a disease of immunocompromised patients. We report a case of cryptococcal meningitis, due to Cryptococcus neoformans, in an apparently healthy individual with abnormal levels of isolated immunological markers. Regardless of the patient's immune status, the result of the disease can be serious unless the disease is diagnosed early.
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Affiliation(s)
- B Simsek
- Kasımpasa Military Hospital, Department of Medical Microbiology, Istanbul, Turkey.
| | - E Guven
- Gulhane Military Medical Academy, Department of Infectious Diseases, Ankara, Turkey
| | - R Gumral
- Van Military Hospital, Department of Medical Microbiology, Van, Turkey
| | - G Mert
- Gulhane Military Medical Academy, Department of Infectious Diseases, Ankara, Turkey
| | - M A Saracli
- Gulhane Military Medical Academy, Department of Medical Mycology, Ankara, Turkey
| | - B Besirbellioglu
- Gulhane Military Medical Academy, Department of Infectious Diseases, Ankara, Turkey
| | - S T Yildiran
- Gulhane Military Medical Academy, Department of Medical Mycology, Ankara, Turkey
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5
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Senadim S, Alpaydin Baslo S, Tekin Güveli B, Dedei Daryan M, Kantaroglu E, Ozturk O, Atakli D. A rare cause of cerebral venous thrombosis: cryptococcal meningoencephalitis. Neurol Sci 2016; 37:1145-8. [PMID: 27025504 DOI: 10.1007/s10072-016-2550-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 03/07/2016] [Indexed: 12/01/2022]
Abstract
Cryptococcal meningoencephalitis (CM) is a serious central nervous system infection caused by Cryptococcus neoformans, seen mostly in immunocompromised hosts and less in immunocompetent patients. The vast majority of cryptococcosis cases are seen as human immunodeficiency virus infections with advanced immunosuppression. Meningitis and meningoencephalitis are the most common clinical manifestations. Nevertheless, immunocompetent patients with CM are rarely reported. Cerebral venous sinus thrombosis is a rare complication of CM. Here, we report an immunocompetent patient with CM from a non-endemic area, who presented with an acute onset and atypical symptoms associated with cerebral venous thrombosis.
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Affiliation(s)
- Songul Senadim
- Department of Neurology, Bakirkoy Research and Training Hospital for Psychiatry, Neurology, Neurosurgery, Istanbul, Turkey.
| | - Sezin Alpaydin Baslo
- Department of Neurology, Bakirkoy Research and Training Hospital for Psychiatry, Neurology, Neurosurgery, Istanbul, Turkey
| | - Betül Tekin Güveli
- Department of Neurology, Bakirkoy Research and Training Hospital for Psychiatry, Neurology, Neurosurgery, Istanbul, Turkey
| | - Metin Dedei Daryan
- Department of Neurology, Bakirkoy Research and Training Hospital for Psychiatry, Neurology, Neurosurgery, Istanbul, Turkey
| | - Elif Kantaroglu
- Department of Neurology, Bakirkoy Research and Training Hospital for Psychiatry, Neurology, Neurosurgery, Istanbul, Turkey
| | - Oya Ozturk
- Department of Neurology, Bakirkoy Research and Training Hospital for Psychiatry, Neurology, Neurosurgery, Istanbul, Turkey
| | - Dilek Atakli
- Department of Neurology, Bakirkoy Research and Training Hospital for Psychiatry, Neurology, Neurosurgery, Istanbul, Turkey
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Asanuma Y, Fujimoto H, Nakabayashi H, Akeda K, Asanuma K, Tanaka M, Nagakura T, Miura Y, Iino T, Ogawa K, Kasai Y, Sudo A. Extradural cryptococcoma at the sacral spine without bone involvement in an immunocompetent patient. J Orthop Sci 2014; 19:1040-5. [PMID: 23712789 PMCID: PMC4244543 DOI: 10.1007/s00776-013-0413-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Accepted: 05/06/2013] [Indexed: 01/04/2023]
Affiliation(s)
- Yumiko Asanuma
- Department of Orthopedic Surgery, Mie Chuo Medical Center, 2158-5 Hisai Myojincho, Tsu, Mie, 514-1101, Japan,
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Redlich S, Ribes S, Schütze S, Eiffert H, Nau R. Toll-like receptor stimulation increases phagocytosis of Cryptococcus neoformans by microglial cells. J Neuroinflammation 2013; 10:71. [PMID: 23738865 PMCID: PMC3693974 DOI: 10.1186/1742-2094-10-71] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2013] [Accepted: 05/22/2013] [Indexed: 02/07/2023] Open
Abstract
Background Toll-Like receptors (TLRs) belong to the family of pattern-recognition receptors with a crucial function of recognising pathogen-associated molecular patterns (PAMPs). Cryptococcal meningitis is a potentially fatal disease with a high mortality and risk of neurological sequelae. Methods We studied the ability of microglial cells to increase the phagocytosis of cryptococci after stimulation with agonists of TLR1/2, TLR3, TLR4 and TLR9. Results Stimulation of murine microglial cells with these TLR agonists for 24 h increased the phagocytosis of encapsulated Cryptococcus neoformans. Stimulation increased the release of TNF-α, CXCL1 (KC), IL-6, IL-10 and MIP-2, which indicated the activation of microglial cells. Unstimulated and TLR agonist-stimulated MyD88-deficient cells showed a reduced ability to phagocytose cryptococci compared to their wild-type counterpart. Intracellular killing of cryptococci was also increased in TLR-stimulated cells compared to unstimulated microglial cells. Conclusion Our observation suggests that stimulation of microglial cells by TLR agonists can increase the resistance of the brain against CNS infections caused by Cryptococcus neoformans. This may be of interest when an immunocompromised patient is unable to eliminate Cryptococcus neoformans despite antifungal therapy.
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Affiliation(s)
- Sandra Redlich
- Institute of Neuropathology, University Medical Center, Göttingen, Germany.
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Osterholzer JJ, Chen GH, Olszewski MA, Zhang YM, Curtis JL, Huffnagle GB, Toews GB. Chemokine receptor 2-mediated accumulation of fungicidal exudate macrophages in mice that clear cryptococcal lung infection. THE AMERICAN JOURNAL OF PATHOLOGY 2010; 178:198-211. [PMID: 21224057 DOI: 10.1016/j.ajpath.2010.11.006] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Revised: 08/27/2010] [Accepted: 09/02/2010] [Indexed: 12/20/2022]
Abstract
Clearance of pulmonary infection with the fungal pathogen Cryptococcus neoformans is associated with the accumulation and activation of lung macrophages. However, the phenotype of these macrophages and the mechanisms contributing to their accumulation are not well-defined. In this study, we used an established murine model of cryptococcal lung infection and flow cytometric analysis to identify alveolar macrophages (AMs) and the recently described exudate macrophages (ExMs). Exudate macrophages are distinguished from AMs by their strong expression of CD11b and major histocompatibility complex class II and modest expression of costimulatory molecules. Exudate macrophages substantially outnumber AMs during the effector phase of the immune response; and accumulation of ExMs, but not AMs, was chemokine receptor 2 (CCR2) dependent and attributable to the recruitment and subsequent differentiation of Ly-6C(high) monocytes originating from the bone marrow and possibly the spleen. Peak ExM accumulation in wild-type (CCR2(+/+)) mice coincided with maximal lung expression of mRNA for inducible nitric oxide synthase and correlated with the known onset of cryptococcal clearance in this strain of mice. Exudate macrophages purified from infected lungs displayed a classically activated effector phenotype characterized by cryptococcal-enhanced production of inducible nitric oxide synthase and tumor necrosis factor α. Cryptococcal killing by bone marrow-derived ExMs was CCR2 independent and superior to that of AMs. We conclude that clearance of cryptococcal lung infection requires the CCR2-mediated massive accumulation of fungicidal ExMs derived from circulating Ly-6C(high) monocytes.
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Affiliation(s)
- John J Osterholzer
- Pulmonary Section, Medical Service, Ann Arbor Veterans Affairs Health System, Ann Arbor, Michigan, USA.
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Olszewski MA, Zhang Y, Huffnagle GB. Mechanisms of cryptococcal virulence and persistence. Future Microbiol 2010; 5:1269-88. [PMID: 20722603 DOI: 10.2217/fmb.10.93] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Cryptococcus neoformans is an environmental yeast that is a leading cause of fatal mycosis in AIDS patients and a major cause of meningoencephalitis and CNS-related mortality around the globe. Although C. neoformans infection is mostly a manifestation of immune deficiency, up to 25% of cases reported in the USA occur in patients without recognizable immune defects, indicating that C. neoformans can develop mechanisms that allow it to evade immune defenses and persist in noncompromised hosts. This article discusses mechanisms and routes of infection and the most important elements of host response as well as the mechanisms that promote cryptococcal survival within the host. Metabolic adaptation to physiological host conditions and the mechanisms limiting immune recognition, interfering with phagocytosis and extending intracellular survival of C. neoformans are highlighted. We describe the mechanisms by which C. neoformans can alter adaptive host responses, especially cell-mediated immunity, which is required for clearance of this microbe. We also review cryptococcal strategies of survival in the CNS and briefly discuss adaptations developing in response to medical treatment.
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Affiliation(s)
- Michal A Olszewski
- Ann Arbor Veterans Administration Health System (11R), 2215 Fuller Road, Ann Arbor, MI 48105, USA.
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Chen GH, Osterholzer JJ, Choe MY, McDonald RA, Olszewski MA, Huffnagle GB, Toews GB. Dual roles of CD40 on microbial containment and the development of immunopathology in response to persistent fungal infection in the lung. THE AMERICAN JOURNAL OF PATHOLOGY 2010; 177:2459-71. [PMID: 20864680 DOI: 10.2353/ajpath.2010.100141] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Persistent pulmonary infection with Cryptococcus neoformans in C57BL/6 mice results in chronic inflammation that is characterized by an injurious Th2 immune response. In this study, we performed a comparative analysis of cryptococcal infection in wild-type versus CD40-deficient mice (in a C57BL/6 genetic background) to define two important roles of CD40 in the modulation of fungal clearance as well as Th2-mediated immunopathology. First, CD40 promoted microanatomic containment of the organism within the lung tissue. This protective effect was associated with: i) a late reduction in fungal burden within the lung; ii) a late accumulation of lung leukocytes, including macrophages, CD4+ T cells, and CD8+ T cells; iii) both early and late production of tumor necrosis factor-α and interferon-γ by lung leukocytes; and iv) early IFN-γ production at the site of T cell priming in the regional lymph nodes. In the absence of CD40, systemic cryptococcal dissemination was increased, and mice died of central nervous system infection. Second, CD40 promoted pathological changes in the airways, including intraluminal mucus production and subepithelial collagen deposition, but did not alter eosinophil recruitment or the alternative activation of lung macrophages. Collectively, these results demonstrate that CD40 helps limit progressive cryptococcal growth in the lung and protects against lethal central nervous system dissemination. CD40 also promotes some, but not all, elements of Th2-mediated immunopathology in response to persistent fungal infection in the lung.
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Affiliation(s)
- Gwo-Hsiao Chen
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Medical School, 6220 MSRB III, Box 0624, 1150 W. Medical Center Dr., Ann Arbor, MI 48109, USA
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11
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Terada T. Cryptococcosis in the Central Nervous System in a 36-Year-Old Japanese Man: An Autopsy Study. TOHOKU J EXP MED 2010; 222:33-7. [DOI: 10.1620/tjem.222.33] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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12
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Osterholzer JJ, Chen GH, Olszewski MA, Curtis JL, Huffnagle GB, Toews GB. Accumulation of CD11b+ lung dendritic cells in response to fungal infection results from the CCR2-mediated recruitment and differentiation of Ly-6Chigh monocytes. JOURNAL OF IMMUNOLOGY (BALTIMORE, MD. : 1950) 2009; 183:8044-53. [PMID: 19933856 PMCID: PMC4043300 DOI: 10.4049/jimmunol.0902823] [Citation(s) in RCA: 101] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Pulmonary clearance of the encapsulated yeast Cryptococcus neoformans is associated with the CCR2-mediated accumulation of lung dendritic cells (DC) and the development of a T1 adaptive immune response. The objective of this study was to identify the circulating DC precursor(s) responsible for this large increase in lung DC numbers. An established murine model was used to evaluate putative DC precursors in the blood, bone marrow, and lungs of CCR2(+/+) mice and CCR2(-/-) mice throughout a time course following infection with C. neoformans. Results demonstrate that numbers of Ly-6C(high) monocytes increased in parallel in the peripheral blood and lungs of CCR(+/+) mice, whereas CD11c(+) MHC class II(+) pre-DC were 10-fold less prevalent in the peripheral blood and did not differ between the two strains. Accumulation of Ly-6C(high) monocytes correlated with a substantial increase in the numbers of CD11b(+) DC in the lungs of infected CCR2(+/+) mice. Comparative phenotypic analysis of lung cells recovered in vivo suggests that Ly-6C(high) monocytes differentiate into CD11b(+) DC in the lung; differentiation is associated with up-regulation of costimulatory molecules and decreased Ly-6C expression. Furthermore, in vitro experiments confirmed that Ly-6C(high) monocytes differentiate into CD11b(+) DC. Accumulation of Ly-6C(high) monocytes and CD11b(+) DC was not attributable to their proliferation in situ. We conclude that the CCR2-mediated accumulation of CD11b(+) DC in the lungs of Cryptococcus-infected mice is primarily attributable to the continuous recruitment and differentiation of Ly-6C(high) monocytes.
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MESH Headings
- Animals
- Antigens, Ly/biosynthesis
- Antigens, Ly/physiology
- CD11b Antigen/biosynthesis
- Cell Count
- Cell Differentiation/genetics
- Cell Differentiation/immunology
- Cell Movement/genetics
- Cell Movement/immunology
- Cell Proliferation
- Cryptococcosis/immunology
- Cryptococcosis/metabolism
- Cryptococcosis/pathology
- Cryptococcus neoformans/immunology
- Cytokinesis/genetics
- Cytokinesis/immunology
- Dendritic Cells/immunology
- Dendritic Cells/metabolism
- Dendritic Cells/pathology
- Female
- Lung/immunology
- Lung/metabolism
- Lung/pathology
- Lung Diseases, Fungal/immunology
- Lung Diseases, Fungal/microbiology
- Lung Diseases, Fungal/pathology
- Mice
- Mice, Inbred BALB C
- Mice, Knockout
- Monocytes/immunology
- Monocytes/metabolism
- Monocytes/pathology
- Receptors, CCR2/biosynthesis
- Receptors, CCR2/deficiency
- Receptors, CCR2/physiology
- Stem Cells/immunology
- Stem Cells/metabolism
- Stem Cells/pathology
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Affiliation(s)
- John J Osterholzer
- Pulmonary Section, Medical Service, Ann Arbor Veterans Affairs Health System, Department of Veterans Affairs Health System, Ann Arbor, MI 48105, USA.
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Zhang Y, Wang F, Tompkins KC, McNamara A, Jain AV, Moore BB, Toews GB, Huffnagle GB, Olszewski MA. Robust Th1 and Th17 immunity supports pulmonary clearance but cannot prevent systemic dissemination of highly virulent Cryptococcus neoformans H99. THE AMERICAN JOURNAL OF PATHOLOGY 2009; 175:2489-500. [PMID: 19893050 DOI: 10.2353/ajpath.2009.090530] [Citation(s) in RCA: 128] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The present study dissected the role of a Th2 bias in pathogenesis of Cryptococcus neoformans H99 infection by comparing inhalational H99 infections in wild-type BALB/c and IL-4/IL-13 double knockout mice. H99-infected wild-type mice showed all major hallmarks of Th2 but not Th1/Th17 immunity in the lungs and lung-associated lymph nodes. In contrast, the IL-4/13(-/-) mice developed robust hallmarks of Th1 and Th17 but not Th2 polarization. The IL-4/IL-13 deletion prevented pulmonary eosinophilia, goblet cell metaplasia in the airways and resulted in elevated serum IgE, and a switch from alternative to classical activation of macrophages. The development of a robust Th1/Th17 response and classical activation of macrophages resulted in significant containment of H99 in the lungs of IL-4/13(-/-) mice compared with unopposed growth of H99 in the lungs of wild-type mice. However, IL-4/13(-/-) mice showed only 1-week longer survival compared with wild-type mice. The comparison of brain and spleen cryptococcal loads at weeks 2, 3, and 4 postinfection revealed that the systemic dissemination in IL-4/13(-/-) mice occurred with an approximate 1-week delay but subsequently progressed with similar rate as in the wild-type mice. Furthermore, wild-type and IL-4/13(-/-) mice developed equivalently severe meningitis/encephalitis at the time of death. These data indicate that the Th2 immune bias is a crucial mechanism for pulmonary virulence of H99, whereas other mechanisms are largely responsible for its central nervous system tropism and systemic dissemination.
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Affiliation(s)
- Yanmei Zhang
- VA Ann Arbor Health System, Ann Arbor, Michigan 48105, USA
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14
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Reversible dementias. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2009. [PMID: 19501724 DOI: 10.1016/s0074-7742(09)00415-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register]
Abstract
The causes of potentially reversible dementia syndromes are legion, as many perturbations of body chemistry can lead to dysfunction of higher cortical function, including the chemical interventions we call medication. It is vital for the cautious clinician to take a painstaking history to develop a differential diagnosis of potential causally related reversible phenomena. This, coupled with an extensive examination and a widecast net of serological, and when appropriate, cerebrospinal, electrophysiologic, and neuroimaging studies can increase the potential for discovering these mimics of the primary neurodegenerative dementias. While some cases of reversible dementia will be obvious from history and physical and only require a few confirmatory tests or even just a trial of treatment (or often, discontinuation of a suspect treatment), it is worthwhile to perform more extensive work-up in cases of dementia, as the costs to allowing our patients to remain in an incapacitated, possibly progressive, state of disability far outweigh the costs of ruling out reversible causes. This chapter provides a lengthy, though by no means exhaustive, review of etiologies and work-up for the currently recognized reversible dementias.
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Osterholzer JJ, Surana R, Milam JE, Montano GT, Chen GH, Sonstein J, Curtis JL, Huffnagle GB, Toews GB, Olszewski MA. Cryptococcal urease promotes the accumulation of immature dendritic cells and a non-protective T2 immune response within the lung. THE AMERICAN JOURNAL OF PATHOLOGY 2009; 174:932-43. [PMID: 19218345 DOI: 10.2353/ajpath.2009.080673] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Urease, a major virulence factor for Cryptococcus neoformans, promotes lethal meningitis/encephalitis in mice. The effect of urease within the lung, the primary site of most invasive fungal infections, is unknown. An established model of murine infection that utilizes either urease-producing (wt and ure1::URE1) or urease-deficient (ure1) strains (H99) of C. neoformans was used to characterize fungal clearance and the resultant immune response evoked by these strains within the lung. Results indicate that mice infected with urease-producing strains of C. neoformans demonstrate a 100-fold increase in fungal burden beginning 2 weeks post-infection (as compared with mice infected with urease-deficient organisms). Infection with urease-producing C. neoformans was associated with a highly polarized T2 immune response as evidenced by increases in the following: 1) pulmonary eosinophils, 2) serum IgE levels, 3) T2 cytokines (interleukin-4, -13, and -4 to interferon-gamma ratio), and 4) alternatively activated macrophages. Furthermore, the percentage and total numbers of immature dendritic cells within the lung-associated lymph nodes was markedly increased in mice infected with urease-producing C. neoformans. Collectively, these data define cryptococcal urease as a pulmonary virulence factor that promotes immature dendritic cell accumulation and a potent, yet non-protective, T2 immune response. These findings provide new insights into mechanisms by which microbial factors contribute to the immunopathology associated with invasive fungal disease.
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Affiliation(s)
- John J Osterholzer
- Veterans Affairs Ann Arbor Health System, Ann Arbor, 2215 Fuller Rd., Ann Arbor, MI 48105, USA.
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Ndiaye M, Soumaré M, Mapoure YN, Seydi M, Sène-Diouf F, Ngom NF, Sène MS, Sow AD, Diop AG, Sow PS, Ndiaye MM, Ndiaye IP. [Neuromeningeal cryptococcosis in patients apparently non-immunodeficient: report of 3 cases in Dakar, Senegal]. ACTA ACUST UNITED AC 2008; 101:311-3. [PMID: 18956812 DOI: 10.3185/pathexo3131] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Cryptococcal infection is common in immunocompromised patients. Its occurrence in immuno-competent patients is rare. We report here 3 cases of neuromeningeal cryptococcosis in patients without any immunosuppressive documented factors. They were respectively 25, 36 and 50 years old presenting clinical signs of chronic meningo-encephalitis. The HIV test was negative for all of them and the CD4 counts were normal. One patient died on the seventh day of the treatment with amphotericin B; the second was discharged on parents' request, while the third patient improved with intravenous fluconazole. This study suggests that when facing a sub-acute or chronic meningitis, an investigation for cryptococcal infection is recommended as before AIDS epidemic.
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Affiliation(s)
- M Ndiaye
- Service de neurologie, CHU de Fann, BP 5035 Dakar, Sénégal.
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Cartner M, Holley A, Allworth A. False impressions from clear cerebrospinal fluid and a normal computed tomography scan: The pressure is still on for a diagnosis. Emerg Med Australas 2008; 20:276-9. [DOI: 10.1111/j.1742-6723.2008.01095.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Inheritance of immune polarization patterns is linked to resistance versus susceptibility to Cryptococcus neoformans in a mouse model. Infect Immun 2008; 76:2379-91. [PMID: 18391002 DOI: 10.1128/iai.01143-07] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Genetic background variation between inbred strains accounts for different levels of susceptibility to Cryptococcus neoformans in the mouse infection model. To elucidate the inheritance of immunophenotypic traits and their associations with clearance outcomes during cryptococcal infection, we compared C57BL/6, BALB/c, and their first-generation hybrid, CB6F1 (F1), mice. Mice from each group were infected with C. neoformans (10(4) CFU) and analyzed at weekly intervals over a 6-week period. BALB/c mice progressively cleared the cryptococcal infection in the lungs and showed a Th1-skewed immune response: a Th1-shifted cytokine profile, modest lung pathology, and no significant elevation in the systemic immunoglobulin E (IgE) level. In contrast, C57BL/6 mice developed a chronic infection with a Th2-skewed immune response: a Th2-shifted cytokine profile, pulmonary eosinophilia, severe lung pathology, elevated serum IgE, fungemia, and cryptococcal dissemination in the central nervous system. F1 mice demonstrated intermediate resistance to C. neoformans, with a stronger resemblance to the immunophenotype of the resistant (BALB/c) mice. F1 mice also demonstrated enhanced pulmonary recruitment of lymphocytes, especially CD8(+) T cells, in comparison to both parental strains, suggesting positive heterosis. We conclude that the inheritance of traits responsible for early cytokine induction in the infected lungs and dendritic-cell maturation/activation status in draining nodes is responsible for the intermediate immune response polarization and clearance outcome observed initially in the lungs of F1 mice. The enhanced pulmonary lymphocyte recruitment could be responsible for a gradual shutdown of the undesirable Th2 arm of the immune response and subsequently improved anticryptococcal resistance in F1 mice.
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Shinjoh M, Miyairi I, Sakurai M, Takahashi M, Ariyasu D, Nakayama T, Tokumura M, Yamashita R, Sunakawa K, Takahashi T. Cryptococcal meningitis in an immunocompetent child. Eur J Pediatr 2005; 164:596-7. [PMID: 15959803 DOI: 10.1007/s00431-005-1708-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2005] [Accepted: 04/29/2005] [Indexed: 10/25/2022]
Affiliation(s)
- Masayoshi Shinjoh
- Department of Pediatrics, School of Medicine, Keio University, 35 Shinanomachi, 160-8582 Shinjuku-ku, Tokyo, Japan.
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