Department of Microbiology and Immunology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.
Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.
Infect Immun. 2023 Apr 18;91(4):e0049022. doi: 10.1128/iai.00490-22. Epub 2023 Mar 14.
Pneumocystis is a respiratory fungal pathogen that is among the most frequent causes of life-threatening pneumonia (PcP) in immunocompromised hosts. Alveolar macrophages play an important role in host defense against Pneumocystis, and several studies have suggested that M2 polarized macrophages have anti-Pneumocystis effector activity. Our prior work found that the immunomodulatory drug sulfasalazine (SSZ) provides a dual benefit during PcP-related immune reconstitution inflammatory syndrome (IRIS) by concurrently suppressing immunopathogenesis while also accelerating macrophage-mediated fungal clearance. The benefits of SSZ were associated with heightened Th2 cytokine production and M2 macrophage polarization. Therefore, to determine whether SSZ improves the outcome of PcP through a mechanism that requires Th2-dependent M2 polarization, RAG2 mice lacking interleukin 4 receptor alpha chain (IL-4Rα) on macrophage lineage cells were generated. As expected, SSZ treatment dramatically reduced the severity of PcP-related immunopathogenesis and accelerated fungal clearance in immune-reconstituted RAG2 mice. Similarly, SSZ treatment was also highly effective in immune-reconstituted RAG2/IL-4Rα and RAG2/gamma interferon receptor (IFN-γR) mice, demonstrating that neither IL-4Rα-dependent M2 nor IFN-γR-dependent M1 macrophage polarization programs were required for the beneficial effects of SSZ. Despite the fact that macrophages from RAG2/IL-4Rα mice could not respond to the Th2 cytokines IL-4 and IL-13, M2-biased alveolar macrophages were identified in the lungs following SSZ treatment. These data demonstrate that not only does SSZ enhance phagocytosis and fungal clearance in the absence of macrophage IL-4Rα signaling, but also that SSZ promotes M2 macrophage polarization in an IL-4Rα-independent manner. These findings could have implications for the treatment of PcP and other diseases in which M2 polarization is beneficial.
卡氏肺孢子菌是一种呼吸道真菌病原体,是免疫功能低下宿主中最常见的危及生命的肺炎(PcP)的原因之一。肺泡巨噬细胞在宿主防御卡氏肺孢子菌中发挥重要作用,几项研究表明,M2 极化的巨噬细胞具有抗卡氏肺孢子菌的效应活性。我们之前的工作发现,免疫调节药物柳氮磺胺吡啶(SSZ)在与 PcP 相关的免疫重建炎症综合征(IRIS)中提供了双重益处,同时抑制免疫发病机制,同时加速巨噬细胞介导的真菌清除。SSZ 的益处与 Th2 细胞因子产生和 M2 巨噬细胞极化增加有关。因此,为了确定 SSZ 是否通过需要 Th2 依赖性 M2 极化的机制改善 PcP 的结果,生成了缺乏巨噬细胞谱系细胞白细胞介素 4 受体α链(IL-4Rα)的 RAG2 小鼠。正如预期的那样,SSZ 治疗显著减轻了免疫重建 RAG2 小鼠中与 PcP 相关的免疫发病机制的严重程度,并加速了真菌清除。同样,SSZ 治疗在免疫重建的 RAG2/IL-4Rα和 RAG2/γ干扰素受体(IFN-γR)小鼠中也非常有效,表明 IL-4Rα 依赖性 M2 或 IFN-γR 依赖性 M1 巨噬细胞极化方案都不是 SSZ 有益作用所必需的。尽管 RAG2/IL-4Rα 小鼠的巨噬细胞不能对 Th2 细胞因子 IL-4 和 IL-13 作出反应,但在 SSZ 治疗后,在肺部中发现了 M2 偏向的肺泡巨噬细胞。这些数据表明,SSZ 不仅在缺乏巨噬细胞 IL-4Rα 信号的情况下增强吞噬作用和真菌清除,而且还以 IL-4Rα 独立的方式促进 M2 巨噬细胞极化。这些发现可能对治疗 PcP 和其他有益于 M2 极化的疾病具有重要意义。
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