Low natural killer cell function in disseminated aspergillosis

Microbial killing by NK cells

It is now evident that NK cells kill bacteria, fungi, and parasites in addition to tumor and virus-infected cells. In addition to a number of recent publications that have identified the receptors and ligands, and mechanisms of cytotoxicity, new insights are reflected in the reports from researchers all over the world at the 17th Meeting of the Society for Natural Immunity held in San Antonio, TX, USA from May 28 through June 1, 2018. We will provide an overview of the field and discuss how the presentations at the meeting might shape our knowledge and future directions in the field.

Natural killer cells and antifungal host response

As a result of improved experimental methodologies and a better understanding of the immune system, there is increasing insight into the antifungal activity of natural killer (NK) cells. Murine and human NK cells are able to damage fungi of different genera and species in vitro, and they exert both direct and indirect antifungal activity through cytotoxic molecules such as perforin and through cytokines and interferons, respectively. On the other hand, recent data suggest that fungi exhibit immunosuppressive effects on NK cells. Whereas clear in vivo data are lacking in humans, the importance of NK cells in the host response against fungi has been demonstrated in animal models. Further knowledge of the interaction of NK cells with fungi might help to better understand the pathogenesis of invasive fungal infections and to improve treatment strategies.

Successful treatment of antifungal- and cryotherapy-resistant subcutaneous hyalohyphomycosis in an immunocompetent case with topical 5% imiquimod cream

Hyalohyphomycosis is an unusual opportunistic mycotic infection where the tissue morphology of the causative organism is mycelial. Etiological agents, which are not responsible for the otherwise-named infections like aspergillosis, are the species of non-dematiaceous hyaline hyphomycetes including Penicillium, Paecilomyces, Acremonium (formerly known Cephalosporium), Beauveria, Fusarium, and Scopulariopsis. Several cases of Acremonium infection have been described in immunocompromised patients; however it can cause invasive disease in an immunocompetent person very rarely. Optimum therapy of Acremonium infection is unclear because of the limited number of reported cases and conflicting results of therapies. Imiquimod, an imidazoquinoline with potent antiviral, antitumor and immunoregulatory properties, is currently approved for the topical treatment of external anogenital warts and actinic keratosis. Imiquimod has also been found to be effective for other virus-associated dermatologic lesions, including common and flat warts, molluscum contagiosum, and herpes simplex virus type-2 as well as for some cases of cutaneous leishmaniasis. We report herein, for the first time, a case of unusually recalcitrant hyalohyphomycosis of the face due to Acremonium strictum successfully treated with topical 5% imiquimod in an immunocompetent patient, who had failed to respond to various antifungals, including itraconazole, and cryotherapy.

Chemokine-mediated recruitment of NK cells is a critical host defense mechanism in invasive aspergillosis

Invasive aspergillosis is a severe pneumonia that is usually fatal despite currently available therapy. The disease disproportionately afflicts immunocompromised patients, indicating the critical importance of the immune status of the host in this infection, but the defense mechanisms against this pathogen remain incompletely understood. In the current study, we hypothesized that the chemokine ligand monocyte chemotactic protein-1, also designated CC chemokine ligand-2 (MCP-1/CCL2) is necessary for effective host defense against invasive aspergillosis in immunocompromised hosts. We found a rapid and marked induction of MCP-1/CCL2 in the lungs of neutropenic mice with invasive aspergillosis. Neutralizing MCP-1/CCL2 resulted in twofold greater mortality and greater than threefold increase in pathogen burden in the lungs. Neutralization of MCP-1/CCL2 also resulted in reduced recruitment of NK cells to the lungs at early time points, but did not affect the number of other leukocyte effector cells in the lungs. Ab-mediated depletion of NK cells similarly resulted in impaired defenses against the infection, resulting in a greater than twofold increase in mortality and impaired clearance of the pathogen from the lungs. These data establish MCP-1/CCL2-mediated recruitment of NK cells to the lungs as a critical early host defense mechanism in invasive aspergillosis and demonstrate NK cells to be an important and previously unrecognized effector cell in this infection.

Intracranial perineural extension of invasive mycosis: a novel mechanism of disease propagation by Aspergillus fumigatus

We describe an immunocompetent woman who had refractory, invasive sphenoid sinus Aspergillus fumigatus infection for which there was radiologic evidence of intracranial perineural spread. The patient responded to a combination of antifungal and adjuvant recombinant cytokine therapy.

Senescence and cytokines modulate the NK cell expression

We have been investigating senescence-related changes in human peripheral blood natural killer (NK2) cells. Data accumulated so far consistently and clearly show that both basal and cytokine (IL-2 and interferon alpha and gamma) induced antitumor MHC-unrestricted cytotoxic activity of NK cells are well-preserved in the healthy elderly. To investigate if the non-cytotoxic functions of NK cells are also spared from the influence of senescence, recombinant IL-2-inducible secretion of IFN-gamma, which serves as a first line of defense, was examined. The amount of IFN-gamma secreted by purified, 18 h activated NK cells from the elderly was only 25 percent of that released by the cells from the young. Thus, the type 1 cytokine-inducible cytotoxic and cytokine secretory functions appear to be dissociable properties of NK cells, at least in the elderly. However, this aging-related early phase secretory deficit could be overcome by chronic stimulation with IL-2 (7 day culture). Since different subsets could perform different functions, we analyzed the NK subsets by flow cytometry. A minor CD56bright subset and a major CD56dim subset could be distinguished based on the density of expression of the cell surface CD56 molecule (N-CAM). We inquired if immunosenescence is likely to impact the steady-state level of circulating NK subsets. A significant decrease (P < 0.01) in percent CD56bright among CD56+ cells was observed in the elderly with a relative sparing of the CD56dim subset. The CD56bright/CD56dim ratio, perhaps representing NK cell maturity status, declined with age. This maturation-related subset redistribution and partial loss during aging of high affinity IL-2 alpha beta gamma receptor bearing 'immature' CD56bright NK cells has not been reported before. It could be a consequence of the decline in the level of IL-2 during aging. It is concluded that post-adolescent age-associated modulations in human NK cells are not expressed uniformly; they are pronounced in some, subtle in others but negligible in yet other biological parameters.

Cytokine sensitivity of human NK cells during immunosenescence. 2. IL2-induced interferon gamma secretion

A majority of natural killer (NK) cells constitutively express intermediate affinity IL2 receptors made of beta gamma chains and respond by way of enhanced cytokine secretion. However, alterations in cytokine sensitivity of purified NK cells with respect to cytokine secretion during immunosenescence have not been examined before. In view of the major immunomodulatory role of IL2 and the anti-tumor effects of interferon gamma (IFN-gamma), we have investigated the recombinant human IL2-induced NK cell secretion of IFN-gamma in vitro. After an 18-h activation period, the secretion of IFN-gamma by the peripheral blood NK cells from the elderly was severely impaired at 80 U/ml of IL2 and above. At an optimal dose of IL2 (960 U/ml). NK cells from young and elderly showed a mean 11- and 3-fold increase in secretion, respectively. Under similar conditions, purified T cells did not respond to IL2. However, the sensitivity of NK cells to the same inductive ligand, IL2, towards a different function i.e., cytotoxic activity, was not significantly impaired in the aged. It is possible that the cytokine secretory deficiency of senescent NK cells might be an additional mechanism which could favor the establishment of tumors and viral infections in the elderly. However, as discussed here, our findings do offer alternate explanations and a potential target for experimental immunotherapy.