Mycolactone Suppresses T Cell Responsiveness by Altering Both Early Signaling and Posttranslational Events

Unité Postulante Pathogénomique Mycobactérienne Intégrée, Institut Pasteur, Paris, France.
The Journal of Immunology (Impact Factor: 4.92). 02/2010; 184(3):1436-44. DOI: 10.4049/jimmunol.0902854
Source: PubMed


Mycolactone is a diffusible lipid toxin produced by Mycobacterium ulcerans, the causative agent of a necrotizing skin disease referred to as Buruli ulcer. Intriguingly, patients with progressive lesions display a systemic suppression of Th1 responses that resolves on surgical excision of infected tissues. In this study, we examined the effects of mycolactone on the functional biology of T cells and identified two mechanisms by which mycolactone suppresses cell responsiveness to antigenic stimulation. At noncytotoxic concentrations, mycolactone blocked the activation-induced production of cytokines by a posttranscriptional, mammalian target of rapamycin, and cellular stress-independent mechanism. In addition, mycolactone triggered the lipid-raft association and activation of the Src-family kinase, Lck. Mycolactone-mediated hyperactivation of Lck resulted in the depletion of intracellular calcium stores and downregulation of the TCR, leading to impaired T cell responsiveness to stimulation. These biochemical alterations were not observed when T cells were exposed to other bacterial lipids, or to structurally related immunosuppressors. Mycolactone thus constitutes a novel type of T cell immunosuppressive agent, the potent activity of which may explain the defective cellular responses in Buruli ulcer patients.

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    • "Recently paradoxical reactions, or immune reconstitution inflammatory syndrome reactions, have been recognized to occur following antibiotic treatment, [6-9] and can be mistaken for treatment failure. Although more research needs to be done to clarify the aetiology of paradoxical reactions, it is proposed their pathogenesis may involve reversal of an immune-inhibitory state induced by mycolactone, [10-12] due to antibiotic mediated killing of the organism and the secondary reduction in mycolactone levels [13-15]. This enables the development of an intense immunological reaction presumably against persisting dead or viable mycobacteria, [6,8,15] manifest clinically by worsening of existing, or the appearance of new, lesions and histologically by the appearance in lesions of intense inflammation [6,15]. "
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    ABSTRACT: Paradoxical reactions from antibiotic treatment of Mycobacterium ulcerans have recently been recognized. Data is lacking regarding their incidence, clinical and diagnostic features, treatment, outcomes and risk factors in an Australian population. Data was collected prospectively on all confirmed cases of M. ulcerans infection managed at Barwon Health Services, Australia, from 1/1/1998-31/12/2011. Paradoxical reactions were defined on clinical and histological criteria and cases were determined by retrospectively reviewing the clinical history and histology of excised lesions. A Poisson regression model was used to examine associations with paradoxical reactions. Thirty-two of 156 (21%) patients developed paradoxical reactions a median 39 days (IQR 20-73 days) from antibiotic initiation. Forty-two paradoxical episodes occurred with 26 (81%) patients experiencing one and 6 (19%) multiple episodes. Thirty-two (76%) episodes occurred during antibiotic treatment and 10 (24%) episodes occurred a median 37 days after antibiotic treatment. The reaction site involved the original lesion (wound) in 23 (55%), was separate to but within 3 cm of the original lesion (local) in 11 (26%) and was more than 3 cm from the original lesion (distant) in 8 (19%) episodes. Mycobacterial cultures were negative in 33/33 (100%) paradoxical episodes. Post-February 2009 treatment involved more cases with no antibiotic modifications (12/15 compared with 11/27, OR 5.82, 95% CI 1.12-34.07, p=0.02) and no further surgery (9/15 compared with 25/27, OR 18.75, 95% CI 2.62-172.73, p<0.001). Six severe cases received prednisone with marked clinical improvement. On multivariable analysis, age >= 60 years (RR 2.84, 95% CI 1.12-7.17, p=0.03), an oedematous lesion (RR 3.44, 95% CI 1.11-10.70, p=0.03) and use of amikacin in the initial antibiotic regimen (RR 6.33, 95% CI 2.09-19.18, p<0.01) were associated with an increased incidence of paradoxical reactions. Paradoxical reactions occur frequently during or after antibiotic treatment of M. ulcerans infections in an Australian population and may be increased in older adults, oedematous disease forms, and in those treated with amikacin. Recognition of paradoxical reactions led to changes in management with less surgery, fewer antibiotic modifications and use of prednisolone for severe reactions.
    BMC Infectious Diseases 09/2013; 13(1):416. DOI:10.1186/1471-2334-13-416 · 2.61 Impact Factor
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    • "Down regulation of immune responses via local production of ROS has been identified as important mechanism for prevention of an autoimmune response in arthritis [34] and can be observed at the cellular level in macrophages as responsible for suppression of IL-2 production by T cells [35]. Inhibition of cytokine production by mycolactone in peripheral blood cells has been shown to occur at 100 ng/ml,a non-cytotoxic concentration for T cells, is manifested at the posttranscriptional level [36] and involves activation of the Src-family kinase Lck [37]. Interestingly, Lck activation by phosphorylation is dependent on redox regulation of cellular phosphatase activity and can be induced by treatment of T cells with H2O2 [38], [39]. "
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    ABSTRACT: Mycobacterium ulcerans is the causative agent of necrotizing skin ulcerations in distinctive geographical areas. M. ulcerans produces a macrolide toxin, mycolactone, which has been identified as an important virulence factor in ulcer formation. Mycolactone is cytotoxic to fibroblasts and adipocytes in vitro and has modulating activity on immune cell functions. The effect of mycolactone on keratinocytes has not been reported previously and the mechanism of mycolactone toxicity is presently unknown. Many other macrolide substances have cytotoxic and immunosuppressive activities and mediate some of their effects via production of reactive oxygen species (ROS). We have studied the effect of mycolactone in vitro on human keratinocytes--key cells in wound healing--and tested the hypothesis that the cytotoxic effect of mycolactone is mediated by ROS. The effect of mycolactone on primary skin keratinocyte growth and cell numbers was investigated in serum free growth medium in the presence of different antioxidants. A concentration and time dependent reduction in keratinocyte cell numbers was observed after exposure to mycolactone. Several different antioxidants inhibited this effect partly. The ROS inhibiting substance deferoxamine, which acts via chelation of Fe(2+), completely prevented mycolactone mediated cytotoxicity. This study demonstrates that mycolactone mediated cytotoxicity can be inhibited by deferoxamine, suggesting a role of iron and ROS in mycolactone induced cytotoxicity of keratinocytes. The data provide a basis for the understanding of Buruli ulcer pathology and the development of improved therapies for this disease.
    PLoS ONE 11/2010; 5(11):e13839. DOI:10.1371/journal.pone.0013839 · 3.23 Impact Factor
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    ABSTRACT: Buruli ulcer is a neglected infectious disease caused by Mycobacterium ulcerans and is characterized by necrotic cutaneous lesions induced by the exotoxin mycolactone. Despite evidence of Th1-mediated protective immunity, M. ulcerans infection has been associated with systemic immunosuppression. We show that early during mouse infection with either mycolactone-positive or negative strains, pathogen-specific gamma interferon (IFN-γ)-producing T cells developed in the draining lymph node (DLN). CD4+ cells migrated to the infection foci, but progressive infection with virulent M. ulcerans led to the local depletion of recruited cells. Moreover, dissemination of virulent M. ulcerans to the DLN was accompanied by extensive DLN apoptotic cytopathology, leading to depletion of CD4+ T cells and abrogation of IFN-γ expression. Advanced footpad infection with virulent M. ulcerans did not induce increased susceptibility to systemic coinfection by Listeria monocytogenes. These results show that infection with M. ulcerans efficiently triggers a mycobacterium-specific T-cell response in the DLN and that progression of infection with highly virulent M. ulcerans leads to a local and regional suppression of that immune response, but without induction of systemic immunosuppression. These results suggest that prophylactic and/or therapeutic interventions to prevent dissemination of M. ulcerans to DLN during the early phase of infection would contribute for the maintenance of protective immunity and disease control.
    Infection and immunity 10/2010; 79(1):421-30. DOI:10.1128/IAI.00820-10 · 3.73 Impact Factor
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