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The Journal of Immunology, 1999, 162: 6734-6739.
Copyright © 1999 by The American Association of Immunologists

Improved Clearance of Mycobacterium avium Upon Disruption of the Inducible Nitric Oxide Synthase Gene1

M. Salomé Gomes, Manuela Flórido, Teresa F. Pais and Rui Appelberg2

Laboratory of Microbiology and Immunology of Infection, Institute for Molecular and Cell Biology, University of Porto, Porto, Portugal


    Abstract
 Top
 Abstract
 Introduction
 Materials and Methods
 Results
 Discussion
 References
 
Mice genetically deficient in the inducible NO synthase gene (iNOS-/-) were used to study the role played by NO during infection by Mycobacterium avium. iNOS-/- macrophages were equally able to restrict M. avium growth in vitro following stimulation by IFN-{gamma} and TNF-{alpha} as macrophages from wild-type mice. In vivo, the infection progressed at similar rates in wild-type and NO-deficient mice during the first 2 mo of infection, but the latter mice were subsequently more efficient in clearing the mycobacteria than the former. The increased resistance of iNOS-/- mice was associated with higher IFN-{gamma} levels in the serum and following in vitro restimulation of spleen cells with specific Ag, increased formation of granulomas and increased survival of CD4+ T cells. We show that NO is not involved in the antimycobacterial mechanisms of M. avium-infected macrophages and, furthermore, that it exacerbates the infection by causing the suppression of the immune response to the pathogen.


    Introduction
 Top
 Abstract
 Introduction
 Materials and Methods
 Results
 Discussion
 References
 
Mycobacteriumavium is an opportunistic pathogen of immunocompromised human patients, such as those in advanced stages of AIDS, and occasionally infects immunocompetent individuals such as chronic obstructive pulmonary disease sufferers and children, the latter developing lymphadenitis (1). This pathogen is a facultative intracellular parasite that resides inside the macrophages of the infected host in membrane-bound vacuoles interacting poorly with the lysosomal compartment (2). In vitro studies in our laboratory and others have shown that although M. avium can grow exponentially inside nonactivated macrophages, this growth is restricted if macrophages are stimulated with cytokines, namely IFN-{gamma} and TNF-{alpha} (3, 4). The antimicrobial mechanisms used by the activated macrophages to control M. avium growth are not clear. The oxygen-reactive intermediates produced by activated macrophages do not seem to play a major role in the control of bacterial proliferation, with the exception of a few strains with limited virulence (5). Recently, it has been argued that the acidification of M. avium-containing phagosomes following stimulation of these phagocytes with IFN-{gamma} and LPS was underlying the killing of the infecting mycobacterium (6).

Following the observations by Stuehr and Marletta (7, 8) that macrophages can secrete large amounts of nitrite and nitrate in response to bacterial products and cytokines, there have been countless reports implicating NO in the antimicrobial activity of macrophages against a wide variety of microorganisms (reviewed in Refs. 9 and 10). In the case of mycobacteria, NO is claimed to play a crucial role in the control of M. tuberculosis and M. bovis bacillus Calmette-Guérin (BCG). Chan et al. (11) have shown that the restriction of M. tuberculosis growth induced in macrophages by IFN-{gamma} plus LPS or TNF-{alpha} was partially reverted by the addition of an inducible NO synthase (iNOS)3 inhibitor. The same authors used two NO synthase inhibitors in vivo to treat mice after infection with M. tuberculosis. Mice rendered incapable of producing NO during infection showed increased mortality along with increased numbers of mycobacteria in their organs, as compared with control untreated mice (12). These results were more recently confirmed by MacMicking et al. (13) using iNOS gene-disrupted mice. Studying the mechanisms of microbial growth inhibition in IFN-{gamma}-activated macrophages, Flesch and Kaufmann (14) have also found a role for NO in the inhibition of growth of M. bovis BCG.

In the case of M. avium, the role of NO is not so clearly established. When studying the interaction of M. avium with bone marrow-derived macrophages (BMM{phi}) in vitro, we saw that most strains are not eliminated inside the macrophages, but rather persist and grow. The growth of a wide panel of M. avium strains was shown to be inhibited if the macrophages were treated with IFN-{gamma} and/or TNF-{alpha} (3, 4). However, this restriction of mycobacterial growth was not reversed in the presence of the NO synthase inhibitor NG-monomethyl-L-arginine (3). Similar observations were also reported by Bermudez (15). Observations by other groups on the resistance of M. avium to nitrite or NO generated in vitro (16, 17) further suggested that the production of nitrogen-reactive species was not a key factor in the control of M. avium infection in the mouse. More recently, Doherty and Sher (18), using iNOS gene-disrupted mice, showed that M. avium growth was not increased in the absence of iNOS and suggested a negative role for NO in the suppression of T cell function.

We used iNOS-deficient mice to assess the role of NO in M. avium infection and found that NO strongly exacerbated M. avium infection at late time points, probably by inhibiting the production of IFN-{gamma} by Ag-specific T cells. While this manuscript was being prepared, Karupiah et al. (19) reported that iNOS gene-disrupted mice showed increased resistance to infection by influenza A virus. These authors showed that this increased resistance was associated with and dependent on an increased production of IFN-{gamma} by lung cells and that iNOS gene-disrupted mice had less inflammation-related lung pathology.


    Materials and Methods
 Top
 Abstract
 Introduction
 Materials and Methods
 Results
 Discussion
 References
 
Bacteria

M. avium strain 25291, smooth transparent (SmT) variant, was obtained from the American Type Culture Collection (Manassas, VA). Strains 2447 SmT and 2-151 SmD were isolated from AIDS patients and given to us by F. Portaels (Institute of Tropical Medicine, Antwerp, Belgium) and J. Belisle (Colorado State University, Fort Collins, CO), respectively.

All mycobacteria were grown in Middlebrook 7H9 broth (Difco, Detroit, MI) with 0.04% Tween 80 (Sigma, St. Louis, MO). Cultures were harvested during log phase, centrifuged, washed in saline with Tween 80, briefly sonicated, and stored in aliquots at -70°C until used.

Animals

iNOS-deficient mice were bred in our facilities from a breeding pair kindly provided by Drs. J. D. MacMicking and C. Nathan (Cornell University, New York, NY) and J. Mudgett (Merck Research Laboratories, Rahway, NJ) (20). These mice were kept in HEPA-filter-bearing cages and fed sterilized chow and water. From the initial breeders, males were chosen to start the backcrossing with C57BL/6 females. Backcrossing was monitored by performing PCR of the markers for the disrupted gene on DNA samples from the progeny as described below. In one experiment, the progeny of the seventh backcross were used in an in vivo infection experiment.

C57BL/6 mice were purchased from the Gulbenkian Institute (Oeiras, Portugal), and 129Sv mice were purchased from Harlan (Bicester, U.K.). These mice were kept under standard hygiene conditions.

PCR screening for natural resistance-associated macrophage protein 1 (Nramp1) allele

Genomic DNA samples were obtained from each mouse by treating a portion of the ear with proteinase K (Sigma). The amplification of the Nramp1 gene was performed using Taq DNA polymerase (Ampligène-Oncor, Gaithersburg, MD) and primers specific for the Nramp1 gene, one oligonucleotide being common to both alleles and the other being specific for either R or S allele, as described elsewhere (21). The amplification was done in a Gene Amp PCR System 9600 (Perkin-Elmer-Roche, Branchburg, NJ). Results for the iNOS-/- mice, as well as 129Sv, C57BL/6, and (129Sv x C57BL/6)F1 mice, are shown in Fig. 1Go. According to the results of this screening, 129Sv mice were used in all experiments as iNOS+/+ controls, except for the one experiment where the mice had been backcrossed to C57BL/6.



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FIGURE 1. Genotype of the iNOS-/- mice in relation to the Nramp1 allele. Shown are the PCR products after specific amplification for the two alleles of the Nramp1 gene performed as described in Materials and Methods in genomic DNA from 129Sv, (129Sv x C57BL/6)F1, C57BL/6, and the iNOS-/- mice.

 
Infection of BMM{phi}

Macrophages were derived from the bone marrow as follows. Each femur was flushed with 5 ml of HBSS. The resulting cell suspension was centrifuged and the cells resuspended in DMEM (Life Technologies, Paisley, U.K.) containing 10% FBS (Life Technologies) and 10% L929 cell-conditioned medium (LCCM) as a source of M-CSF. The cells were distributed in 24-well plates and incubated at 37°C in a 7% CO2 atmosphere. Three days after seeding, another 0.1 ml of LCCM was added. On the 7th day, the medium was renewed.

On the 10th day of culture, when cells were completely differentiated into macrophages, they were infected with M. avium. To each well, about 106 CFU of M. avium were added, in 0.2 ml of DMEM. Cells were incubated for 4 h at 37°C in a CO2 atmosphere and then washed with warm HBSS to remove noninternalized bacteria and reincubated in DMEM, with 10% FBS and 10% LCCM. In some of the wells, the macrophages were immediately lysed and the number of viable intracellular bacteria counted as described below (time zero). The other cells were incubated during 7 days to measure the intracellular growth of the bacteria.

The measurement of mycobacterial growth was done by counting CFU. Briefly, 7 days after infection, the cells were lysed by adding 0.1% saponin to each well. The resulting bacterial suspension was serially diluted 1:10 in water containing 0.04% Tween 80. The dilutions were plated on Middlebrook 7H10 agar (Difco) and the number of colonies counted 8–10 days later. For each condition tested, three culture wells were used. The results presented correspond to the mean and SD of these three wells.

In some of the experiments, macrophages were treated from day 0 to day 4 of infection with recombinant murine IFN-{gamma} (100 U/well/day), alone, or in combination with recombinant murine TNF-{alpha} (50 U/well/day) (both cytokines from Genzyme, Cambridge, MA)

In vivo infection

Each mouse was infected i.v. with 106 CFU of M. avium, either strain 2447 SmT or strain 25291 SmT (two independent experiments). At different time points, animals were sacrificed and their livers, spleens, and lungs collected. These organs were homogenized, and serial dilutions of the resulting suspensions were plated in Middlebrook 7H10 agar medium, as described above for BMM{phi} cultures, and the bacterial colonies counted after culture for 10 days at 37°C.

In one of the experiments, endogenous IFN-{gamma} activity was blocked by treating mice with anti-IFN-{gamma} IgG1, obtained from the hybridoma XMG1.2 (DNAX, Palo Alto, CA). Control mice were treated with normal rat Ig. Abs were given i.p., 2 mg per animal every 2 wk.

Characterization of splenic populations by flow cytometry

A single cell suspension was prepared from half of each spleen and the total cell number determined by counting in a hemocytometer. To assess the proportions of CD3+, CD4+, and CD8+ cells present, cells were stained with FITC-conjugated anti-CD3 (17A2) and PE-conjugated anti-CD4 (L3T4) or FITC-anti-CD4 and PE-anti-CD8 (Ly-2) Abs (all from PharMingen, San Diego, CA) and analyzed in a FACSort Apparatus (Becton Dickinson, Mountain View, CA).

In vitro stimulation of splenic cells

Cells obtained from the spleens of each mouse were washed with HBSS, and the erythrocytes were lysed using a hemolytic solution (155 mM NH4Cl, 10 mM KHCO3 (pH 7.2)). Cells were then distributed in 96-well plates and incubated in triplicate in DMEM/10% FCS either with no further stimulus or in the presence of mycobacterial Ag (4 µg/ml) or Con A (4 µg/ml; Sigma). Supernatants from the cultures were collected after 3 days in culture, and quantification of the IFN-{gamma} produced was done by ELISA. Mycobacterial Ag was prepared as described elsewhere (22). Briefly, the culture supernatant of M. avium 25291 SmT grown in Sauton medium was concentrated by ultrafiltration, precipitated with ammonium sulfate, and extensively dialysed against PBS.

Detection of IFN-{gamma} in the serum and in culture supernatants

The measurement of IFN-{gamma} was done using an ELISA method. R4-6A2 and biotinylated AN18 anti-IFN-{gamma} mAbs were used as the capture and detection Abs, respectively. Recombinant IFN-{gamma} from Genzyme was used as standard.

Histology

Portions of the livers of the infected mice were fixed in buffered formaldehyde and embedded in paraffin. Sections were stained with hematoxylin and eosin.


    Results
 Top
 Abstract
 Introduction
 Materials and Methods
 Results
 Discussion
 References
 
Growth of different strains of M. avium inside murine BMM{phi}

Most strains of M. avium grow exponentially inside unstimulated murine BMM{phi}, the growth rate being dependent on the particular strain of the bacterium. We have previously shown that when BMM{phi} were treated with IFN-{gamma} and/or TNF-{alpha}, the intracellular growth of M. avium was restricted (3). However, we have not identified the mechanism underlying this cytokine-induced bacteriostasis. Since NO is a well-known antimicrobial mechanism of macrophages, we addressed the question of whether the IFN-{gamma}- and TNF-{alpha}-induced mycobacteriostasis seen in BMM{phi} was mediated by NO. We took BMM{phi} from mice that do not express the iNOS (iNOS-/- mice) and infected them with different strains of M. avium, as described in Materials and Methods. The infected macrophages were then treated with 100 U of IFN-{gamma} or 50 U of TNF-{alpha} per culture well and per day, both individually and in combination, during the first 4 days of infection. At different time points after infection, the cells were lysed and the number of bacteria quantified as CFU in agar medium. As control, iNOS-expressing macrophages we used BMM{phi} from the 129Sv strain. IFN-{gamma} treatment led to growth inhibition of all three strains of M. avium tested in both types of macrophages (iNOS+/+ or iNOS-/-). TNF-{alpha} led to a more modest inhibitory effect, while the combination of the two cytokines was the most efficient stimulus to induce mycobacteriostasis. The results of treatment with IFN-{gamma} plus TNF-{alpha} are shown in Fig. 2Go and compared with untreated macrophages. While wild-type macrophages treated with IFN-{gamma} plus TNF-{alpha} produced 55.3 ± 5.6, 50.1 ± 2.1, and 47.9 ± 1.6 nmol of NO2- per mg of macrophage protein during infection by strains 25291 SmT, 2447 SmT, and 2-151 SmD, respectively, no nitrite was detectable in the culture supernatants of similarly treated macrophages from iNOS-/- mice. It is clear from these data that macrophages can inhibit intracellular M. avium growth even if they are unable to produce NO.



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FIGURE 2. Effect of cytokine activation on the growth of three different strains of M.avium inside murine BMM{phi}. Macrophages derived from the bone marrow of 129Sv mice (left panels) or iNOS-/- mice (right panels) were infected with M. avium of the strains shown and were left untreated (open squares) or were treated with 100 U of IFN-{gamma} and 50 U of TNF-{alpha} per culture well and per day during the first 4 days of infection (closed squares). At different time points of infection, macrophages were lysed and intracellular bacteria quantified. The results shown are the average and SD of the number of CFU per well in three wells for each condition. Statistically significant differences in the number of CFU/well between treated and untreated cells, as evaluated by the Student’s t test, are labeled *, p < 0.05 and **, p < 0.01.

 
In vivo growth of M. avium in mice lacking iNOS; role of IFN-{gamma}

Since our in vitro results indicated that production of NO was not a key factor for the control of M. avium growth inside murine macrophages, we decided to investigate the capacity of iNOS-deficient mice to control an in vivo infection by M. avium. As a control for iNOS-/- mice, we used 129Sv mice, the strain used for the generation of the mutants. We infected them with two different strains of M. avium, namely strain 25291 SmT, which is virulent for mice, and strain 2447 SmT, which has a low virulence. At different time points after infection, we sacrificed four or five mice of each group and determined the number of CFU in their organs. The results are shown in Fig. 3Go. Mice lacking iNOS not only did not show an increased susceptibility to infection, but even controlled it more efficiently at late time points of infection. We also used a small cohort of iNOS-/- that had been backcrossed to C57BL/6 background infecting them with M. avium 25291 SmT and using C57BL/6 mice as controls. At 10 wk of infection, the mycobacterial loads in the spleens, livers, and lungs of the iNOS-/- were 8.2 ± 0.4, 9.1 ± 0.5, and 7.2 ± 0.3 log 10, respectively, as compared with 10.8 ± 0.1, 10.7 ± 0.1, and 8.5 ± 0.4 log 10 in the C57BL/6 organs.



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FIGURE 3. In vivo fate of M. avium strains 2447 SmT and 25291 SmT after i.v. inoculation into wild-type 129Sv mice (open symbols) or iNOS gene-disrupted mice (closed symbols). Each time point represents the geometric mean of CFU in the indicated organs of four mice and the SD. Statistically significant differences between the two groups of mice as evaluated by the Student’s t test are labeled *, p < 0.05 and **, p < 0.01, ***, p < 0.001.

 
Since IFN-{gamma} is required for in vivo control of M. avium growth in wild-type mice (4, 23), we tested whether this cytokine was playing a role in the control of the M. avium infection in iNOS-/- mice. Mice infected with M. avium 25291 SmT were treated with anti-IFN-{gamma} mAbs or normal rat Ig and were sacrificed 4 mo after inoculation. As shown in Fig. 4GoA, mice treated with anti-IFN-{gamma} Abs showed increased bacterial multiplication as compared with control mice, particularly in the spleen and the lung, confirming that IFN-{gamma} may mediate bacteriostasis independently of the secretion of NO.



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FIGURE 4. Role of IFN-{gamma} in restriction of growth of M. avium 25291 SmT in the presence or absence of endogenous NO production. A, Effect of IFN-{gamma} neutralization on the growth of M. avium in iNOS-/- mice infected i.v. with 106 CFU/animal and treated i.p. with anti-IFN-{gamma} Abs (black bars) or nonimmune Ig (white bars) (2 mg/animal every 2 wk). Mice were sacrificed 4 mo after infection, and the bacterial burden in their organs was evaluated. The values shown represent the average and SD of the log10 CFU/organ of three animals per group. B, IFN-{gamma} present in the sera of infected mice. The values shown are pg of IFN-{gamma} per ml of serum in iNOS+/+ (closed squares) and iNOS-/- mice (open squares). ND, not detected. C, In vitro production of IFN-{gamma} by splenic cells from iNOS+/+ (black bars) and iNOS-/- mice (white bars) infected for 2 or 4 mo with M. avium 25291 SmT. Total splenic cells were cultured in vitro in the presence of M. avium Ag or Con A for 3 days. Supernatants were collected, and IFN-{gamma} present was measured by ELISA. Values shown are the average and SD of the values found for four or five mice per group and are expressed as ng of IFN-{gamma} per ml of culture supernatant. Statistically significant difference: *, p < 0.05; **, p < 0.01, applying the Student’s t test.

 
Taken together, these results showed that iNOS-/- mice are better able than iNOS+/+ mice to control an infection by virulent strains of M. avium and that IFN-{gamma} is needed for that control. As the in vitro results had suggested, IFN-{gamma} is probably activating the macrophages for intracellular growth restriction or killing of the bacteria, in an NO-independent way.

Differences in the immune response of iNOS-/- and iNOS+/+ mice

Since IFN-{gamma} was shown to play such a critical role in the growth of M. avium in the mouse, we wanted to know if the difference in resistance between iNOS-/- and control mice could be due to a different capacity to produce IFN-{gamma} in vivo. To assess that, we measured the amount of IFN-{gamma} in the sera of infected mice throughout the course of infection. In mice infected with M. avium 25291 SmT, a clear difference in the amounts of IFN-{gamma} present in the serum was seen, with iNOS-/- mice showing at least 10 times more cytokine in the serum than their controls throughout the experiment (Fig. 4GoB). Uninfected mice of either strain had no detectable IFN-{gamma} in their sera (data not shown).

To relate the differences in IFN-{gamma} with the function and number of the producing cells, we initially studied the cell populations in the spleen during the course of infection with the 25291 SmT strain of M. avium. As shown in Table IGo, the total cell numbers in the spleen were significantly higher in iNOS-/- mice than in iNOS+/+ mice during the first 2 mo of infection. This difference was also found both among the CD4+ and CD8+ T cells, as assessed by FACS analysis, although the results were not statistically significant. By month 4 of infection, however, the numbers of cells decreased markedly in the two strains of mice. At this late time point, the iNOS-deficient mice had significantly lower numbers of CD4+ and CD8+ T cells as compared to the wild-type controls. Throughout the time course of infection, there was no difference in the relative proportions of CD3+, CD4+, and CD8+ cells in the spleens between the two strains of mice. To assess the state of differentiation of the T cells present in the spleens of infected mice, cell suspensions were prepared that were stimulated in vitro either with M. avium-secreted Ag or Con A, as described in Materials and Methods. After 3 days in culture, the supernatants were collected and assayed for IFN-{gamma}. Splenic cells from iNOS-/- mice produced two to four times more IFN-{gamma} than cells from iNOS+/+ mice (Fig. 4GoC), a difference which could not be accounted for by alterations in the percentage of CD4+ T cells in the cultures (Table IGo). Ag stimulation of splenic cells from uninfected mice of either strain led to no detectable secretion of IFN-{gamma} (data not shown).


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Table I. Cell populations x106 in the spleens of mice infected with M. avium 25291 SmT1

 
Histological analysis of granuloma formation was done in liver sections at 2 and 4 mo of infection with M. avium 25291 SmT. As shown in Fig. 5Go, both the number of granulomas and their size were considerably higher in iNOS-/- as compared with their controls. Granulomas of the iNOS-deficient mice consisted of a well-structured core of epithelioid macrophages surrounded by an extense mantle of lymphoid cells, whereas the organization of granulomas in wild-type mice was very incipient at both time points. No granulomatous inflammation or signs of any infectious disease were found in uninfected mice of either strain.



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FIGURE 5. Histological analysis of granuloma formation in wild-type (A and B) and iNOS gene-disrupted mice (C and D) infected for 2 (A and C) or 4 mo (B and D) with M. avium 25291 SmT. Typical views of liver sections are shown.

 

    Discussion
 Top
 Abstract
 Introduction
 Materials and Methods
 Results
 Discussion
 References
 
Although NO has been identified as an important effector of microbial killing inside macrophages, we were previously unable to find such a role in the bacteriostasis of M. avium induced by cytokines acting on murine macrophages (3). We extended here those observations by showing that, after cytokine activation, macrophages obtained from iNOS-deficient animals exerted a degree of bacteriostasis of three strains of M. avium similar to that of macrophages from wild-type mice. Furthermore, not only were iNOS-/- as resistant as wild-type animals to in vivo infection by M. avium during the initial 2 mo of infection, but also they became able to clear the mycobacteria at late time points of infection contrasting with the bacteriostasis found in the wild-type animals. It was already reported that iNOS-/- mice were not more susceptible to infection by a virulent strain of M. avium (18). These authors, however, ended their study at around the second month of infection, failing to observe the improved clearance of M. avium that could have taken place beyond that period of time.

One could argue that the differences in mycobacterial growth between the two groups of animals in our experiments could be related to differences in genetic background other than the iNOS gene. We find this very unlikely for the following reasons. First, the Nramp1 gene is the only gene identified so far to have a proven role in determining resistance to M. avium in murine models of infection. We screened our breeders of iNOS-/- mice and found them to have the wild-type (resistant) allele of Nramp1 gene in homozygosity. Therefore, our in vivo data were obtained by comparing infections of iNOS-/- mice with the 129Sv strain, also harboring the wild-type allele of Nramp1. Second, 129Sv mice are naturally resistant to infection, and, therefore, the iNOS-deficient mice would be expected to be equally resistant or more susceptible to infection rather than more resistant as observed here. Third, the kinetics of the infection showed that the increased resistance of the knock-out mice was a late event, and there have been no such differences in resolution of infection reported for M. avium infections when comparing different strains of mice. However, this evidence cannot exclude the possibility that unidentified genes playing a role in determining resistance to M. avium, and present in distinct allelic forms in the strains used to obtain the iNOS-deficient animals, could underlie the different susceptibilities to infection observed here. Therefore, we started to backcross the iNOS-/- strain to the C57BL/6 background, and, from a limited cohort of animals, we were able to confirm the data previously generated. It should, however, be stressed that great care should be taken when using recently generated gene-disrupted animals, as there is always a risk that data generated with those animals may depend as much on the genetically engineered deficiency as on unrelated genetic differences between the strains used in the studies.

Our data are consistent with the interpretation that NO produced during infection hampers the development or maintenance of the protective immune response. The numbers of lymphocytes present in the spleen were higher in iNOS-/- mice than in the wild-type controls during the first mo of infection, including the CD4+ T cells, which are the cells required for the development of protective immunity against M. avium (4). When the latter cells were stimulated in vitro with the specific Ag, a higher production of IFN-{gamma} was found among cells from infected iNOS-/- mice than from the controls suggesting that there was a loss or reduction of differentiation of Ag-specific Th1 cells when mice had the ability to produce NO in response to infection. Previous work done with T cell clones had suggested that NO has an inhibitory effect on IFN-{gamma} production by Th1 cells (24). The fact that IFN-{gamma} responses to a mitogen were not affected in the same way as the Ag-specific responses in our experiments means that the results with the mycobacterial Ag are not due to in vitro inhibitory effects of NO and suggests that the in vivo effects are most prominent on cells that are responding specifically to Ag rather than a general effect on the whole CD4+ T cell population. Furthermore, there was an in vivo correlate for these results, namely the amounts of serum IFN-{gamma} detected throughout the infection, which were higher in the iNOS-deficient mice as compared with the controls. These results are consistent with those obtained by MacMicking et al. (13), who found higher levels of IFN-{gamma} in the plasma of iNOS-/- vs iNOS+/+ mice infected with M. tuberculosis at early time points of infection, when there were no significant differences in bacterial burdens in the organs of infected mice. The negative effect on protective immunity mediated by NO may be particularly evident in our model of infection due to the high resistance of M. avium to NO in contrast to other microbes. Data similar to ours have been recently reported for an influenza model of infection (19). In that study, both increased resistance and increased IFN-{gamma} responses were found in iNOS-/- mice as compared with control animals, showing that this scenario may be more than an odd occurrence.

At 4 mo of infection, we found a drastic reduction in the number of T cells in both strains of mice, showing that there are other mechanisms affecting the survival of these cells during an M. avium infection. However, despite the marked decrease in total CD4+ cells, the amount of IFN-{gamma} induced by Ag stimulation remained high, suggesting that Ag-specific CD4+ T cells could survive this latter mechanism of T cell depletion or, alternatively, that these cells further differentiated into very high producers of the cytokine, allowing for a certain loss among them.

Work by other groups has already implicated NO in immunosuppression. Secondary immunosuppression following infection with attenuated Salmonella typhimurium was shown to be mediated by NO-dependent mechanisms associated with IFN-{gamma}-activated macrophages (25). Likewise, activated macrophages from Corynebacterium parvum-treated rats were shown to inhibit lymphocyte proliferation driven by a mitogen through the production of NO (26). Similar NO-mediated inhibitory mechanisms were described for mouse resident peritoneal macrophages responsible for reducing mitogen-stimulated T cell proliferation (27). On the other hand, NO may regulate macrophage function in an autocrine/paracrine way, as illustrated by the down-modulation of IL-6 secretion in IFN-{gamma}-treated, Legionella pneumophila-infected macrophages (28). Gregory et al. (29) showed, in addition, that NO could have a deleterious effect on the development of protective immune responses to Listeria monocytogenes, although there is still no consensus as to whether NO may be required for the control of experimental listeriosis (20, 31, 32, 33). A tight regulation of NO production appears to be fundamental for the host response. With M. avium, however, having no direct role in the killing of the mycobacteria, NO’s role is just a deleterious one. It is still not clear whether its effects are due to a direct toxicity on T cells or to a more subtle regulatory role, such as the determination of the balance between the type of immune response (24). We have already described the state of unresponsiveness to unrelated Ags that develops during M. avium infection and the role played by the activated macrophages in this mechanism (33). We speculate that NO may be involved in such nonspecific immunosuppression.

Two of the immunological outcomes of the lack of NO synthesis were the increased production of IFN-{gamma} and the increase in size and number of granulomas. The latter effect of NO depletion has been described in other models, such as following pulmonary embolization with latex beads coupled to purified protein derivative in sensitized animals (34). It is unclear at the moment if the increased resistance to M. avium in iNOS-/- mice is due to either of these effects or whether additional T cell-associated mechanisms may be the culprits of the late killing of M. avium seen in the iNOS-deficient mice. The organization of granulomata in mice, namely during mycobacterial infections, has been found different from that in humans. Our results suggest that NO may be related to this. In fact, NO production in human macrophages has been shown to be of a much lesser magnitude and, maybe for that reason, granulomas in man are better organized. We should also stress that we were able to detect differences in granuloma formation in iNOS-/- mice as compared with the controls because they were matched for the allele of Nramp1 they express. Otherwise, when comparing granuloma formation in the iNOS-deficient mouse strain (naturally resistant, expressing the G169 allele) to mice harboring the susceptible allele (D169), one would not have found such dramatic differences as bacterial growth would be faster in the wild-type but naturally susceptible animals as compared with the resistant ones, leading to bacterial loads able to trigger a more vigorous granuloma response.

In summary, we report here a counterprotective role for NO in an infectious model, the basis of which probably being related to its immunosuppressive effects. These data illustrate the double-edged sword nature of NO and the delicate equilibrium that should underlie its production. Also, the opposite effects of NO on the resistance of mice to two different mycobacterial species, namely M. avium and M. tuberculosis, emphasize the distinct nature of the strategies adopted by these pathogens to survive the host’s antimicrobial machinery. Of relevance to human disease is the fact that M. avium infection is especially frequent in HIV-infected individuals, in whom it could cause, through NO production, a further deterioration of the already impaired T cell function.


    Acknowledgments
 
We thank Drs. J. Mudgett, C. Nathan, and J. MacMicking for their gift of breeders of iNOS-KO mice; and A. Peixoto Ribeiro (Institute for the Biomedical Sciences, Porto, Portugal) for helpful technical assistance.


    Footnotes
 
1 This work was supported by contract P/SAU58/96 from the PRAXIS XXI programme (Lisbon). M.S.G., M.F., and T.F.P. received fellowships from the PRAXIS XXI programme. Back

2 Address correspondence and reprint requests to Dr. Rui Appelberg, Laboratory of Microbiology and Immunology of Infection, Institute for Molecular and Cell Biology, Rua do Campo Alegre 823, 4150-171 Porto, Portugal. E-mail address: Back

3 Abbreviations used in this paper: iNOS, inducible NO synthase; BMM{phi}, bone marrow-derived macrophage; LCCM, L-929 cell conditioned medium; Nramp1, natural resistance-associated macrophage protein 1; SmT, smooth transparent; SmD, smooth-domed. Back

Received for publication January 4, 1999. Accepted for publication March 17, 1999.


    References
 Top
 Abstract
 Introduction
 Materials and Methods
 Results
 Discussion
 References
 

  1. Inderlied, C. B., C. A. Kemper, L. E. M. Bermudez. 1993. The Mycobacterium avium complex. Clin. Microbiol. Rev. 6:266.[Abstract/Free Full Text]
  2. Holland, S. M.. 1996. Host defense against nontuberculous mycobacterial infections. Semin. Respir. Infect. 11:217.[Medline]
  3. Appelberg, R., I. M. Orme. 1993. Effector mechanisms involved in cytokine-mediated bacteriostasis of Mycobacterium avium infections in murine macrophages. Immunology 80:352.[Medline]
  4. Appelberg, R., A. G. Castro, J. Pedrosa, R. A. Silva, I. M. Orme, P. Minóprio. 1994. Role of {gamma} interferon and tumor necrosis factor {alpha} during T-cell-independent and -dependent phases of Mycobacterium avium infection. Infect. Immun. 62:3962.[Abstract/Free Full Text]
  5. Sarmento, A. M., R. Appelberg. 1996. Involvement of reactive oxygen intermediates in the tumor necrosis factor-dependent bacteriostasis of Mycobacterium avium. Infect. Immun. 64:3224.[Abstract]
  6. Schaible, U. E., S. Sturgill-Koszycki, P. H. Schlesinger, D. G. Russell. 1998. Cytokine activation leads to acidification and increases maturation of Mycobacterium avium-containing phagosomes in murine macrophages. J. Immunol. 160:1290.[Abstract/Free Full Text]
  7. Stuehr, D. J., M. A. Marletta. 1985. Mammalian nitrate biosynthesis: mouse macrophages produce nitrite and nitrate in response to Escherichia coli lipopolysaccharide. Proc. Natl. Acad. Sci. USA 82:7738.[Abstract/Free Full Text]
  8. Stuehr, D. J., M. A. Marletta. 1987. Induction of nitrite/nitrate synthesis in murine macrophages by BCG infection, lymphokines, or interferon-{gamma}. J. Immunol. 139:518.[Abstract]
  9. Nathan, C. F., J. B. Hibbs. 1991. Role of nitric oxide synthesis in macrophage antimicrobial activity. Curr. Opin. Immunol. 3:65.[Medline]
  10. Fang, F. C.. 1997. Mechanisms of nitric oxide-related antimicrobial activity. J. Clin. Invest. 99:2818.[Medline]
  11. Chan, J., Y. Xing, R. S. Magiozzo, B. R. Bloom. 1992. Killing of virulent Mycobacterium tuberculosis by reactive nitrogen intermediates produced by activated murine macrophages. J. Exp. Med. 175:1111.[Abstract/Free Full Text]
  12. Chan, J., K. Tanaka, D. Carroll, J. Flynn, B. R. Bloom. 1995. Effects of nitric oxide synthase inhibitors on murine infection with Mycobacterium tuberculosis. Infect. Immun. 63:736.[Abstract]
  13. MacMicking, J. D., R. J. North, R. La Course, J. S. Mudgett, S. K. Shah, C. F. Nathan. 1997. Identification of nitric oxide synthase as a protective locus against tuberculosis. Proc. Natl. Acad. Sci. USA 94:5243.[Abstract/Free Full Text]
  14. Flesch, I. E. A., S. H. E. Kaufmann. 1991. Mechanisms involved in mycobacterial growth inhibition by interferon-activated bone marrow macrophages: role of reactive nitrogen intermediates. Infect. Immun. 59:3213.[Abstract/Free Full Text]
  15. Bermudez, L. E.. 1993. Differential mechanisms of intracellular killing of Mycobacterium avium and Listeria monocytogenes by activated human and murine macrophages: the role of nitric oxide. Clin. Exp. Immunol. 91:277.[Medline]
  16. Doi, T., M. Ando, T. Akaike, M. Suga, K. Sato, H. Maeda. 1993. Resistance to nitric oxide in Mycobacterium avium complex and its implication in pathogenesis. Infect. Immun. 61:1980.[Abstract/Free Full Text]
  17. Sato, K., H. Tomioka, H. Saito. 1992. Differential susceptibilities of Mycobacterium avium and Mycobacterium intracellulare to sodium nitrite. J. Clin. Microbiol. 30:2994.[Abstract/Free Full Text]
  18. Doherty, T. M., A. Sher. 1997. Defects in cell-mediated immunity affect chronic, but not innate, resistance of mice to Mycobacterium avium infection. J. Immunol. 158:4822.[Abstract]
  19. Karupiah, G., J. Chen, S. Mahalingam, C. F. Nathan, J. D. MacMicking. 1998. Rapid interferon-{gamma}-dependent clearance of influenza A virus and protection from consolidating pneumonitis in nitric oxide synthase 2-deficient mice. J. Exp. Med. 188:1541.[Abstract/Free Full Text]
  20. MacMicking, J. D., C. Nathan, G. Hom, N. Chartrain, D. S. Fletcher, M. Trumbauer, K. Stevens, Q. Xie, K. Sokol, N. Hutchinson, H. Chen, J. S. Mudgett. 1995. Altered responses to bacterial infection and endotoxic shock in mice lacking inducible nitric oxide synthase. Cell 81:641.[Medline]
  21. Medina, E., B. J. Rogerson, R. J. North. 1996. The Nramp1 antimicrobial resistance gene segregates independently of resistance to virulent Mycobacterium tuberculosis. Immunology 88:479.[Medline]
  22. Silva, R. A., T. F. Pais, R. Appelberg. 1998. Evaluation of interleukin 12 in immunotherapy and vaccine design in experimental Mycobacterium avium infections. J. Immunol. 161:5578.[Abstract/Free Full Text]
  23. Castro, A. G., P. Minóprio, R. Appelberg. 1995. The relative impact of bacterial virulence and host genetic background on cytokine expression during Mycobacterium avium infection of mice. Immunology 85:556.[Medline]
  24. Taylor-Robinson, A. W., F. Y. Liew, A. Severn, D. Xu, S. J. McSorley, P. Garside, J. Padron, R. S. Phillips. 1994. Regulation of the immune response by nitric oxide differentially produced by T helper type 1 and T helper type 2 cells. Eur. J. Immunol. 24:980.[Medline]
  25. Al-Ramadi, B. K., J. J. Meissler, D. Huang, T. K. Eisenstein. 1992. Immunosuppression induced by nitric oxide and its inhibition by interleukin-4. Eur. J. Immunol. 22:2249.[Medline]
  26. Denham, S., I. J. Rowland. 1992. Inhibition of the reactive proliferation of lymphocytes by activated macrophages: the role of nitric oxide. Clin. Exp. Immunol. 87:157.[Medline]
  27. Albina, J. E., J. A. Abate, W. L. Henry. 1991. Nitric oxide production is required for murine resident peritoneal macrophages to suppress mitogen-stimulated T cell proliferation: role of IFN-{gamma} in the induction of the nitric oxide-synthesizing pathway. J. Immunol. 147:144.[Abstract]
  28. Yamamoto, Y., T. W. Klein, H. Friedman. 1996. Immunoregulatory role of nitric oxide in Legionella pneumophila-infected macrophages. Cell. Immunol. 171:213.
  29. Gregory, S. H., E. J. Wing, R. A. Hoffman, R. L. Simmons. 1993. Reactive nitrogen intermediates suppress the primary immunologic response to Listeria. J. Immunol. 150:2901.[Abstract]
  30. Boockvar, K. S., D. L. Granger, R. M. Ponston, M. Maybodi, M. K. Washington, J. B. Hibbs, R. L. Kurlander. 1994. Nitric oxide produced during murine listeriosis is protective. Infect. Immun. 62:1089.[Abstract/Free Full Text]
  31. Beckerman, K. P., H. W. Rogers, J. A. Corbett, R. D. Schreiber, M. L. McDaniel, E. R. Unanue. 1993. Release of nitric oxide during the T cell-independent pathway of macrophage activation. Its role in resistance to Listeria monocytogenes. J. Immunol. 150:888.[Abstract]
  32. Samson, J. N., J. A. M. Langermans, P. H. P. Groeneveld, R. van Furth. 1996. Acquired resistance against a secondary infection with Listeria monocytogenes in mice is not dependent on reactive nitrogen intermediates. Infect. Immun. 64:1197.[Abstract]
  33. Appelberg, R., R. Soares, P. Ferreira, M. T. Silva. 1989. Induction of nonspecific immunosuppression in mice by mycobacterial infections and its relation to macrophage activation. Scand. J. Immunol. 30:165.[Medline]
  34. Hogaboam, C. M., S. W. Chensue, M. L. Steinhauser, G. B. Huffnagle, N. W. Lukacs, R. M. Strieter, S. L. Kunkel. 1997. Alteration of the cytokine phenotype in an experimental lung granuloma model by inhibiting nitric oxide. J. Immunol. 159:5585.[Abstract]



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