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Wieruszewski PM, Barreto EF, Barreto JN, Yadav H, Tosh PK, Mara KC, Limper AH. Preadmission Corticosteroid Therapy and the Risk of Respiratory Failure in Adults Without HIV Presenting With Pneumocystis Pneumonia. J Intensive Care Med 2019; 35:1465-1470. [PMID: 30813829 DOI: 10.1177/0885066619834242] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Corticosteroid therapy is a well-recognized risk factor for Pneumocystis pneumonia (PCP); however, it has also been proposed as an adjunct to decrease inflammation and respiratory failure. OBJECTIVE To determine the association between preadmission corticosteroid use and risk of moderate-to-severe respiratory failure at the time of PCP presentation. METHODS This retrospective cohort study evaluated HIV-negative immunosuppressed adults diagnosed with PCP at Mayo Clinic from 2006 to 2016. Multivariable regression models were used to evaluate the association between preadmission corticosteroid exposure and moderate-to-severe respiratory failure at presentation. RESULTS Of the 323 patients included, 174 (54%) used preadmission corticosteroids with a median daily dosage of 20 (interquartile range: 10-40) mg of prednisone or equivalent. After adjustment for baseline demographics, preadmission corticosteroid therapy did not decrease respiratory failure at the time of PCP presentation (odds ratio: 1.23, 95% confidence interval: 0.73-2.09, P = .38). Additionally, after adjusting for inpatient corticosteroid administration, preadmission corticosteroid use did not impact the need for intensive care unit admission (P = .98), mechanical ventilation (P = .92), or 30-day mortality (P = .11). CONCLUSIONS Corticosteroid exposure before PCP presentation in immunosuppressed HIV-negative adults was not associated with a reduced risk of moderate-to-severe respiratory failure.
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Affiliation(s)
- Patrick M Wieruszewski
- Department of Pharmacy, 4352Mayo Clinic, Rochester, MN, USA.,Multidisciplinary Epidemiology and Translational Research in Intensive Care (METRIC), 4352Mayo Clinic, Rochester, MN, USA
| | - Erin F Barreto
- Department of Pharmacy, 4352Mayo Clinic, Rochester, MN, USA.,Multidisciplinary Epidemiology and Translational Research in Intensive Care (METRIC), 4352Mayo Clinic, Rochester, MN, USA.,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, 4352Mayo Clinic, Rochester, MN, USA
| | | | - Hemang Yadav
- Multidisciplinary Epidemiology and Translational Research in Intensive Care (METRIC), 4352Mayo Clinic, Rochester, MN, USA.,Division of Pulmonary and Critical Care Medicine, 4352Mayo Clinic, Rochester, MN, USA
| | - Pritish K Tosh
- Division of Infectious Diseases, 4352Mayo Clinic, Rochester, MN, USA
| | - Kristin C Mara
- Division of Biomedical Statistics and Informatics, 4352Mayo Clinic, Rochester, MN, USA
| | - Andrew H Limper
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, 4352Mayo Clinic, Rochester, MN, USA.,Division of Pulmonary and Critical Care Medicine, 4352Mayo Clinic, Rochester, MN, USA.,Department of Biochemistry and Molecular Biology, 4352Mayo Clinic, Rochester, MN, USA.,Thoracic Diseases Research Unit, 4352Mayo Clinic, Rochester, MN, USA
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Ruan S, Cai Y, Ramsay AJ, Welsh DA, Norris K, Shellito JE. B cell and antibody responses in mice induced by a putative cell surface peptidase of Pneumocystis murina protect against experimental infection. Vaccine 2017; 35:672-679. [PMID: 28012778 PMCID: PMC5241231 DOI: 10.1016/j.vaccine.2016.11.073] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 10/21/2016] [Accepted: 11/22/2016] [Indexed: 10/20/2022]
Abstract
RATIONALE Pneumocystis pneumonia is a major cause of morbidity and mortality in HIV-infected subjects, cancer patients undergoing chemotherapy and solid organ transplant recipients. No vaccine is currently available. By chemical labeling coupled with proteomic approach, we have identified a putative surface protein (SPD1, Broad Institute gene accession number PNEG_01848) derived from single suspended P. murina cysts. SPD1 was expressed in an insect cell line and tested for vaccine development. METHODS Mice were immunized with SPD1 plus adjuvant MF-59 by subcutaneous injection. Three weeks after the last immunization, CD4+ cells were depleted with anti-CD4 antibody GK1.5. The mice were then challenged with 2×105Pneumocystis organisms. Mice were sacrificed at 4 and 6weeks after PC challenge. Spleen/lung cells and serum were harvested. B cells and memory B cells were assessed via flow cytometry. Specific Pneumocystis IgG antibody was measured by ELISA before and after challenge. Infection burden was measured as real-time PCR for P. murina rRNA. RESULTS Normal mice infected with Pneumocystis mounted a serum IgG antibody response to SPD1. Serum from rhesus macaques exposed to Pneumocystis showed a similar serum IgG response to purified SPD1. SPD1 immunization increased B cell and memory B cell absolute cell counts in CD4-depleted Balb/c mice post Pneumocystis challenge in spleen and lung. Immunization with SPD1 significantly increased specific Pneumocystis IgG antibody production before and after challenge. Mice immunized with SPD1 showed significantly decreased P. murina copy number compared with mice that did not receive SPD1 at 6weeks after challenge. CONCLUSION Immunization with SPD1 provides protective efficacy against P. murina infection. SPD1 protection against Pneumocystis challenge is associated with enhanced memory B cell production and higher anti-Pneumocystis IgG antibody production. SPD1 is a potential vaccine candidate to prevent or treat pulmonary infection with Pneumocystis.
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MESH Headings
- Animals
- Antibodies, Fungal/blood
- Antibody Formation
- Antigens, Fungal/genetics
- Antigens, Fungal/immunology
- B-Lymphocytes/immunology
- Colony Count, Microbial
- Disease Models, Animal
- Enzyme-Linked Immunosorbent Assay
- Female
- Fungal Vaccines/administration & dosage
- Fungal Vaccines/genetics
- Fungal Vaccines/immunology
- Lung/microbiology
- Macaca mulatta
- Membrane Proteins/genetics
- Membrane Proteins/immunology
- Mice, Inbred BALB C
- Peptide Hydrolases/genetics
- Peptide Hydrolases/immunology
- Pneumocystis/enzymology
- Pneumocystis/immunology
- Pneumonia, Pneumocystis/prevention & control
- Vaccines, Synthetic/administration & dosage
- Vaccines, Synthetic/genetics
- Vaccines, Synthetic/immunology
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Affiliation(s)
- Sanbao Ruan
- Section of Pulmonary, Critical Care Medicine, and Allergy/Immunology, LSU Health Sciences Center, New Orleans, United States
| | - Yang Cai
- The Research Institute for Children, Children's Hospital, New Orleans and Department of Chemistry, University of New Orleans, United States
| | - Alistair J Ramsay
- Department of Microbiology, Immunology, and Parasitology, LSU Health Sciences Center, New Orleans, United States
| | - David A Welsh
- Section of Pulmonary, Critical Care Medicine, and Allergy/Immunology, LSU Health Sciences Center, New Orleans, United States
| | - Karen Norris
- Department of Immunology, University of Pittsburgh, United States
| | - Judd E Shellito
- Section of Pulmonary, Critical Care Medicine, and Allergy/Immunology, LSU Health Sciences Center, New Orleans, United States.
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Abstract
Although the incidence of Pneumocystis pneumonia (PCP) has decreased since the introduction of combination antiretroviral therapy, it remains an important cause of disease in both HIV-infected and non-HIV-infected immunosuppressed populations. The epidemiology of PCP has shifted over the course of the HIV epidemic both from changes in HIV and PCP treatment and prevention and from changes in critical care medicine. Although less common in non-HIV-infected immunosuppressed patients, PCP is now more frequently seen due to the increasing numbers of organ transplants and development of novel immunotherapies. New diagnostic and treatment modalities are under investigation. The immune response is critical in preventing this disease but also results in lung damage, and future work may offer potential areas for vaccine development or immunomodulatory therapy. Colonization with Pneumocystis is an area of increasing clinical and research interest and may be important in development of lung diseases such as chronic obstructive pulmonary disease. In this review, we discuss current clinical and research topics in the study of Pneumocystis and highlight areas for future research.
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4
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Thomas CF, Limper AH. Current insights into the biology and pathogenesis of Pneumocystis pneumonia. Nat Rev Microbiol 2007; 5:298-308. [PMID: 17363968 DOI: 10.1038/nrmicro1621] [Citation(s) in RCA: 175] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The fungal infection Pneumocystis pneumonia is the most prevalent opportunistic infection in patients with AIDS. Although the analysis of this opportunistic fungal pathogen has been hindered by the inability to isolate it in pure culture, the use of molecular techniques and genomic analysis have brought insights into its complex cell biology. Analysis of the intricate relationship between Pneumocystis and the host lung during infection has revealed that the attachment of Pneumocystis to the alveolar epithelium promotes the transition of the organism from the trophic to the cyst form. It also revealed that Pneumocystis infection elicits the production of inflammatory mediators, culminating in lung injury and impaired gas exchange. Here we discuss these and other recent findings relating to the biology and pathogenesis of this intractable fungus.
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Affiliation(s)
- Charles F Thomas
- Thoracic Diseases Research Unit, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Rochester, Minnesota 55905, USA.
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Israël-Biet D, Esvant H, Laval AM, Cadranel J. Impairment of beta chemokine and cytokine production in patients with HIV related Pneumocystis jerovici pneumonia. Thorax 2004; 59:247-51. [PMID: 14985564 PMCID: PMC1746968 DOI: 10.1136/thx.2003.013763] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Pneumocystis jerovici pneumonia (PJP) remains a frequent opportunistic infection in HIV infected patients which markedly upregulates HIV replication by mechanisms so far poorly elucidated. PJP triggers the production of proinflammatory mediators with activating effects on HIV. However, anti-inflammatory factors with inhibiting effects on HIV are normally produced in parallel. We postulated that an imbalance of mediators normally controlling HIV replication could underlie its marked increase during PJP. METHODS The production of tumour necrosis factor alpha (TNFalpha), interleukins IL-6 and IL-10, and beta-chemokine by bronchoalveolar lavage (BAL) cells recovered from HIV infected patients with and without PJP was compared. The pulmonary viral load was determined and correlations with cytokine and chemokine production were examined. RESULTS TNFalpha and IL-6 release was similar in patients with and without PJP but IL-10 and beta-chemokine release was markedly lower in the PJP group (IL-10: p<10(-2), RANTES, MIP-1alpha and MIP-1beta: p<0.001). The pulmonary viral load was markedly higher in patients with PJP (p<0.001) and correlated negatively with levels of MIP-1alpha, RANTES and IL-10 in BAL fluid cells (p<0.05). CONCLUSION Pulmonary IL-10 and beta-chemokine production is markedly defective in HIV infected patients with PJP, while pulmonary TNFalpha and IL-6 levels are normal. The resulting excess of these latter factors, which are known to upregulate HIV replication, might contribute to the increase in pulmonary viral load and to the more rapid HIV disease progression observed in patients with PJP.
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Affiliation(s)
- D Israël-Biet
- Laboratoire d'Immunopathologie Pulmonaire, UPRES EA220, Université Paris V, Paris, France.
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Keisari Y, Wang H, Mesika A, Matatov R, Nissimov L, Crouch E, Ofek I. Surfactant protein D‐coated
Klebsiella pneumoniae
stimulates cytokine production in mononuclear phagocytes. J Leukoc Biol 2001. [DOI: 10.1189/jlb.70.1.135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Yona Keisari
- Department of Human Microbiology, Sackler Faculty of Medicine, Tel Aviv University, Israel, and
| | - Hongbin Wang
- Department of Human Microbiology, Sackler Faculty of Medicine, Tel Aviv University, Israel, and
| | - Adi Mesika
- Department of Human Microbiology, Sackler Faculty of Medicine, Tel Aviv University, Israel, and
| | - Robert Matatov
- Department of Human Microbiology, Sackler Faculty of Medicine, Tel Aviv University, Israel, and
| | - Liat Nissimov
- Department of Human Microbiology, Sackler Faculty of Medicine, Tel Aviv University, Israel, and
| | - Erika Crouch
- Department of Pathology and Immunology, Washington University Medical School, St. Louis, Missouri
| | - Itzhak Ofek
- Department of Human Microbiology, Sackler Faculty of Medicine, Tel Aviv University, Israel, and
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7
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Abstract
The production of chemokines at the site of a fungal infection is critical for effective recruitment of leukocytes to that site. Over 40 chemokines and 20 chemokine receptors have been identified. The most intriguing biological property of chemokines is that they often play non-redundant roles in vivo even though they are highly related, have multiple activities and bind multiple chemokine receptors. Almost all of the chemokine studies to date have concentrated on responses to Cryptococcus, Candida, Aspergillus or Pneumocystis. The role of chemokines in infections caused by fungi such as Histoplasma, Blastomyces, Coccidioides and Paracoccidioides remains to be explored. In this review we have summarized what is currently known about the role of chemokines during fungal infection, including the influence of these signaling proteins on effector cell recruitment and development of cell-mediated immunity.
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Affiliation(s)
- T R Traynor
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, USA
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Benfield TL, Lundgren B, Shelhamer JH, Lundgren JD. Pneumocystis carinii major surface glycoprotein induces interleukin-8 and monocyte chemoattractant protein-1 release from a human alveolar epithelial cell line. Eur J Clin Invest 1999; 29:717-22. [PMID: 10457157 DOI: 10.1046/j.1365-2362.1999.00517.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
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.
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Affiliation(s)
- T L Benfield
- University of Copenhagen, Hvidovre Hospital, Hvidovre, Denmark.
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Wright TW, Johnston CJ, Harmsen AG, Finkelstein JN. Chemokine gene expression during Pneumocystis carinii-driven pulmonary inflammation. Infect Immun 1999; 67:3452-60. [PMID: 10377126 PMCID: PMC116531 DOI: 10.1128/iai.67.7.3452-3460.1999] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Severe combined immunodeficient (SCID) mice lack functional lymphocytes and therefore develop Pneumocystis carinii pneumonia. However, when infected SCID mice are immunologically reconstituted with congenic spleen cells, a protective inflammatory cascade is initiated. Proinflammatory cytokines are produced, and lymphocytes and macrophages are recruited specifically to alveolar sites of infection. Importantly, uninfected regions of the lung remain free from inflammatory involvement, suggesting that there are specific mechanisms that limit inflammation in the infected lung. Therefore, to determine whether chemokines are involved in targeting the P. carinii-driven inflammatory response, steady-state mRNA levels of several chemokines were measured in the lungs of both reconstituted and nonreconstituted P. carinii-infected SCID mice. Despite significant organism burdens in the lungs of 8- and 10-week-old SCID mice, there was no evidence of elevated chemokine gene expression, which is consistent with the lack of an inflammatory response in these animals. However, when 8-week-old infected SCID mice were immunologically reconstituted, signs of focal pulmonary inflammation were observed, and levels of RANTES, MCP-1, lymphotactin, MIP-1alpha, MIP-1beta, and MIP-2 mRNAs were all significantly elevated. Chemokine mRNA abundance was elevated at day 10 postreconstitution (PR), was maximal at day 12 PR, and returned to baseline by day 22 PR. In situ hybridization demonstrated that during the peak of inflammation, RANTES gene expression was localized to sites of inflammatory cell infiltration and P. carinii infection. Thus, these observations indicate that chemokines play a role in the focal targeting of inflammatory cell recruitment to sites of P. carinii infection after the passive transfer of lymphocytes to the host.
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Affiliation(s)
- T W Wright
- Departments of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York 14642, USA.
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10
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Walzer PD. Immunological features of Pneumocystis carinii infection in humans. CLINICAL AND DIAGNOSTIC LABORATORY IMMUNOLOGY 1999; 6:149-55. [PMID: 10066645 PMCID: PMC95678 DOI: 10.1128/cdli.6.2.149-155.1999] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- P D Walzer
- Veterans Affairs Medical Center, Cincinnati, Ohio 45220, USA.
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11
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Downing JF, Kachel DL, Pasula R, Martin WJ. Gamma interferon stimulates rat alveolar macrophages to kill Pneumocystis carinii by L-arginine- and tumor necrosis factor-dependent mechanisms. Infect Immun 1999; 67:1347-52. [PMID: 10024581 PMCID: PMC96467 DOI: 10.1128/iai.67.3.1347-1352.1999] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Pneumocystis carinii pneumonia remains a serious complication for immunocompromised patients. In the present study, P. carinii organisms interacted with gamma interferon (IFN-gamma)-stimulated alveolar macrophages (AMs) to activate the L-arginine-dependent cytocidal pathway involving reactive nitrogen intermediates (RNI) that were assayed as nitrite (NO2-). Unstimulated cultures of AMs produced negligible quantities of RNI. Addition of P. carinii organisms to IFN-gamma-primed AMs resulted in greatly enhanced production of RNI. NO2- levels increased from 0.8 +/- 0.4 to 11.1 +/- 3.8 microM as early as 6 h after P. carinii organisms were incubated with IFN-gamma-stimulated AMs and to 35.1 +/- 8.9 microM after a 24-h incubation, a near-maximum level. High levels of NO2- were produced by AMs primed with as little as 10 U of IFN-gamma per ml in the presence of P. carinii, and a 20-fold increase in IFN-gamma concentration resulted in only a further 65% increase in NO2- production. RNI-dependent killing of P. carinii was demonstrated by both a 51Cr release assay and a [35S]methionine pulse immunoprecipitation assay. Addition of either monoclonal tumor necrosis factor alpha (TNF-alpha) neutralizing antibody or 200 microM NG-monomethyl-L-arginine (L-NGMMA), a competitive inhibitor of the L-arginine-dependent pathway, significantly decreased NO2- production and reduced P. carinii killing. TNF-alpha alone had no effect on P. carinii viability. These results suggest that (i) the specific interaction of P. carinii organisms with IFN-gamma-primed AMs triggers the production of RNI, (ii) RNI are toxic to P. carinii, and (iii) TNF-alpha likely plays a central role in mediating P. carinii killing by IFN-gamma-stimulated AMs.
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Affiliation(s)
- J F Downing
- Division of Pulmonary, Allergy, Critical Care and Occupational Medicine, Department of Medicine, Indiana University Medical Center, Indianapolis, Indiana 46202-2879, USA
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12
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Benfield TL, Lundgren JD. The Pneumocystis carinii major surface glycoprotein (MSG): its potential involvement in the pathophysiology of pneumocystosis. FEMS IMMUNOLOGY AND MEDICAL MICROBIOLOGY 1998; 22:129-34. [PMID: 9792071 DOI: 10.1111/j.1574-695x.1998.tb01197.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- T L Benfield
- Department of Infectious Diseases, University of Copenhagen, Hvidovre Hospital, Denmark.
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13
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Rajagopalan-Levasseur P, Allaert A, Dridba M, Odberg-Ferragut C, Jouault T, Creusy C, Camus D, Dei-Cas E. Response to Pneumocystis infection in an immunocompetent host. FEMS IMMUNOLOGY AND MEDICAL MICROBIOLOGY 1998; 22:107-21. [PMID: 9792069 DOI: 10.1111/j.1574-695x.1998.tb01195.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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