Innate and Acquired Immunity in Cryptococcus neoformans Infections of the Central Nervous System

DOI: 10.1007/0-387-25445-5_24


Cryptococcus neoformans is an encapsulated yeast that causes cryptococcosis, a life-threatening disease that develops following inhalation and dissemination
of the ubiquitous organisms. C. neoformans has a predilection for the CNS, and mortality is most frequently associated with meningoencephalitis. Individuals with deficiencies
in cell-mediated immunity, such as AIDS patients, are more susceptible to cryptococcosis; thus, the incidence of cryptococcosis
is increasing as a result of the growing number of immunocompromised individuals. Loss of CD4+ T cells predisposes individuals to progressive infection with C. neoformans, further emphasizing the importance of cell-mediated immunity in host resistance to this organism and partially explaining
the high incidence of cryptococcosis in AIDS patients. Although much has been learned about host defense mechanisms against
C. neoformans in the lungs, less is known about host resistance in the CNS. Clearly, some of the same cells and mechanisms are involved
in host defense in the lungs and the CNS; however, the CNS has unique features that suggest there might be some differences
as well. In fact, experimental evidence indicates that many anticryptococcal reactions in the CNS are delayed in comparison
to extracerebral tissues, which may be due to differences in immune mechanisms in the CNS compared to other tissues. More
defined experimental studies are required to identify the critical components needed for appropriate anticryptococcal activity
in the CNS that restricts growth of C. neoformans while at the same time does not cause harmful damage to the nervous tissue.

13 Reads
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Cryptococcal meningoencephalitis develops as a result of hematogenous dissemination of inhaled Cryptococcus neoformans from the lung to the brain. The mechanism(s) by which C. neoformans crosses the blood-brain barrier (BBB) is a key unresolved issue in cryptococcosis. We used both an in vivo mouse model and an in vitro model of the human BBB to investigate the cryptococcal association with and traversal of the BBB. Exposure of human brain microvascular endothelial cells (HBMEC) to C. neoformans triggered the formation of microvillus-like membrane protrusions within 15 to 30 min. Yeast cells of C. neoformans adhered to and were internalized by the HBMEC, and they crossed the HBMEC monolayers via a transcellular pathway without affecting the monolayer integrity. The histopathology of mouse brains obtained after intravenous injection of C. neoformans showed that the yeast cells either were associated with endothelial cells or escaped from the brain capillary vessels into the neuropil by 3 h. C. neoformans was found in the brain parenchyma away from the vessels by 22 h. Association of C. neoformans with the choroid plexus, however, was not detected during up to 10 days of observation. Our findings indicate that C. neoformans cells invade the central nervous system by transcellular crossing of the endothelium of the BBB.
    Infection and Immunity 10/2004; 72(9):4985-95. DOI:10.1128/IAI.72.9.4985-4995.2004 · 3.73 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: We have previously shown that gamma interferon (IFN-gamma) is a useful adjunct to therapy of experimental systemic cryptococcosis in normal mice. To better emulate AIDS patients, SCID mice were infected intravenously with Cryptococcus neoformans. Mice received no therapy, 3 mg of amphotericin B (AmB) per kg of body weight, or 10(5) U of IFN-gamma alone (prophylactically and therapeutically or only therapeutically) or with AmB. In the first experiment, >75% of the mice survived. Therapy with AmB alone was efficacious compared to no therapy in all organs. Both regimens of IFN-gamma alone were efficacious in the brain and lungs, and the combination of AmB and IFN-gamma showed significant synergy in the kidneys. AmB alone cured 40% of mice of infection, whereas the combination regimens cured >50% of the mice and 90% of the brain infections. In a second study, IFN-gamma again proved efficacious alone, and when given with AmB its efficacy was improved. Therapeutic IFN-gamma alone was effective only in the liver compared to no therapy, and the combination regimen, although highly effective, showed no significant synergy. In a third experiment, AmB alone or in combination with IFN-gamma prolonged survival compared to no therapy or IFN-gamma alone. The combination regimen showed significant synergy over AmB alone in the brain, liver, kidneys, and lungs. AmB alone cured no mice of infections in more than two organs, whereas AmB in combination with IFN-gamma cured 55% of infections in three or more organs. These results indicate that IFN-gamma has therapeutic efficacy in severely immunodeficient animals, especially in combination with AmB. Significant synergistic activity was noted in all organs except the spleen. Overall, IFN-gamma has utility as an adjunctive therapy against systemic cryptococcosis in the severely immunocompromised host.
    Antimicrobial Agents and Chemotherapy 04/2001; 45(3):686-9. DOI:10.1128/AAC.45.3.686-689.2001 · 4.48 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The effect of Cryptococcus neoformans on the accumulation of nitrite, an indicator of nitric oxide (NO) synthesis, was investigated in cytokine (interferon-gamma [IFN-gamma] and interleukin [IL]-1)-stimulated cultures of rat peritoneal macrophages and C6 astrocytoma cells. Cytokine-induced nitrite generation in cultures of both cell types was inhibited in a dose-dependent manner by live C. neoformans, but not by heat-killed cryptococcal cells or conditioned medium from yeast cultures. C. neoformans-mediated reduction of nitrite formation coincided with impairment of NO-dependent macrophage tumoricidal activity. Cytokine-triggered induction of inducible NO synthase (iNOS) was unaffected in C6 cells, and only marginally reduced in macrophages. When cells were pretreated with cytokines for 24 h to induce iNOS, and any further induction was prevented by inhibition of protein synthesis, C. neoformans was still able to reduce nitrite accumulation in cultures of both cell types. Finally, live C. neoformans, but not heat-killed yeast cells or yeast culture supernatant, significantly reduced nitrite production in a culture solution of NO-releasing compound S-nitrosoglutathione (GSNO). Thus, it appears that cryptococcal reduction of nitrite formation in macrophage and C6 cultures was caused by the consumption of NO by some yeast molecule, rather than by the inhibition of cellular NO synthesis.
    Scandinavian Journal of Immunology 05/2000; 51(4):384-91. DOI:10.1046/j.1365-3083.2000.00683.x · 1.74 Impact Factor
Show more