Cell Biology of Intracellular Infection by Legionella pneumophila PDF
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Maëlle Molmeret, Dina M. Bitar, Lihui Han, Yousef Abu Kwaik
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This review article examines the cell biology of intracellular infection by Legionella pneumophila, a pathogen linked to Legionnaires' disease. It explores the bacterium's unique ability to modify host cell biology and create a favorable environment for intracellular reproduction. The article discusses growth phase-regulated virulence and the critical role of the Dot/Icm secretion system.
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Microbes and Infection 6 (2004) 129–139 www.elsevier.com/locate/micinf Review Cell biology of the intracel...
Microbes and Infection 6 (2004) 129–139 www.elsevier.com/locate/micinf Review Cell biology of the intracellular infection by Legionella pneumophila Maëlle Molmeret a, Dina M. Bitar b,c, Lihui Han b,d, Yousef Abu Kwaik a,* a Department of Microbiology and Immunology, University of Louisville College of Medicine, Louisville, KY 40292, USA b Department of Microbiology and Immunology, University of Kentucky College of Medicine, Lexington, KY 40536, USA c Department of Medical Microbiology and Immunology, Faculty of Medicine, Al-Quds University, Jerusalem, 19356, Israel d Department of Microbiology and Immunology, College of Medicine, Shandong University, Shandong, Jinan 250012, China Abstract Legionella pneumophila has become a paradigm for facultative intracellular pathogens that modulate biogenesis of their phagosomes into replicative niches. The ability to alter host cell biology and tailor it into a hospitable host for intracellular proliferation is at the crux of the mechanism of pathogenesis of Legionnaires’ disease. © 2003 Elsevier SAS. All rights reserved. Keywords: Intracellular; Dot/icm; Secretion 1. Introduction gal transfer of DNA, which has been confirmed by conjuga- tion studies [9,10]. This apparatus has also been shown to be Legionella pneumophila, a Gram-negative bacillus ubiq- involved in proper maturation of the L. pneumophila- uitous in aquatic environments, is responsible for Legion- containing phagosome in mammalian and protozoan cells, naires’ disease. It is a facultative intracellular pathogen that directing the biogenesis of the specialized vacuole in which can replicate within eukaryotic host cells such as protozoa Legionella replicates [11–13]. The dot/icm genes are also and macrophages. In humans, L. pneumophila reaches the required for macropinocytosis in A/J mouse macrophages lungs after inhalation of contaminated aerosol droplets [1,2] , upregulation of phagocytosis in human-derived mac- (Fig. 1). Once in the lungs, L. pneumophila is ingested by rophages , induction of apoptosis in macrophages alveolar macrophages, which are the major site of bacterial [16–18] and pore formation-mediated cytotoxicity in both replication. This results in an acute and severe pneumonia, protozoan and mammalian cells [13,19–21]. Legionnaires’ disease. The unique intracellular fate of L. pneumophila is one of the interesting aspects of this organism. Unlike phagosomes 2. Growth phase-regulated virulence containing inert particles or avirulent bacteria, the L. pneumophila-containing vacuoles avoid the “default” en- In contrast to exponentially growing bacteria, L. pneumo- docytic pathway, recruiting rough endoplasmic reticulum phila obtained from post-exponential cultures expresses (RER) and mitochondria, to reside in a specialized vacuole traits that are correlated with virulence, including sodium allowing intracellular replication [3–7] (Fig. 2). The forma- sensitivity, cytotoxicity, osmotic resistance, motility, and the tion of this specialized vacuole is directed by the type IV capacity to evade phagosome–lysosome fusion [22–25]. secretion system encoded by the dot/icm genes. The dot During the replication phase within host cells, L. pneumo- (defect in organelle trafficking)/icm (intracellular multiplica- phila is sodium resistant and aflagellated [22–25]. When L. tion) loci consist of 23 genes located in two distinct regions pneumophila egresses from host cells, the bacteria are flag- of the L. pneumophila chromosome [8–10]. Analysis of the ellated and sodium sensitive [22–25]. It has been hypoth- predicted amino acid sequences of the dot/icm genes has esized that amino acid limitation in vitro induces the virulent revealed several characteristics that indicate a role in conju- phenotype [22–25]. When L. pneumophila enters into post- exponential growth phase or is subjected to amino acid limi- * Corresponding author. Tel.: +1-502-852-5351; fax: +1-502-852-7531. tation, the bacteria accumulate the stringent response signal, E-mail address: [email protected] (Y.A. Kwaik). guanosine 3′,5′-bispyrophosphate (ppGpp) through the © 2003 Elsevier SAS. All rights reserved. doi:10.1016/j.micinf.2003.11.004 130 M. Molmeret et al. / Microbes and Infection 6 (2004) 129–139 Fig. 1. The environmental life of L. pneumophila within protozoa. (1) L. pneumophila from biofilms with other bacteria, or in suspension, infecting protozoa. (2) Following entry, L. pneumophila resides in a membrane-bound vacuole that recruits host cell organelles, such as the mitochondria and the RER, and does not fuse with lysosomes. (3) Mutants such as dot/icm mutants fuse to lysosomes 3b. L. pneumophila replicates within specialized vacuoles and reaches large numbers 3a. (4) The infectious particle is not known, but may include excreted legionella-filled vesicles, intact legionella-filled amoebae, or free legionellae that have lysed their host cell. (5) Transmission to humans occurs via mechanical means, such as faucets and showerheads. Infection in humans occurs by inhalation of the infectious particle and establishment of infection in the lungs. (6) Legionellae that have escaped their host cell may survive in suspension for long periods of time, reinfect other protozoa, or recolonize biofilms. Reprinted from ASM News. 66 (10) (2000) 609–616. M. Molmeret et al. / Microbes and Infection 6 (2004) 129–139 131 infection in this amoebae model. L. pneumophila in post-exponential phase becomes cytotoxic by an RpoS- independent pathway. To replicate efficiently in mac- rophages, both RpoS-independent and -dependent mecha- nisms are utilized by L. pneumophila. Thus, when nutrient levels and other conditions are favorable, L. pneu- mophila replicates within host cells, and when amino acids become rare, intracellular bacteria express several traits that permit escape from the host cell, survival in the environment and the transmission to a new host. The relA mutant, producing an undetectable level of ppGpp in the cells during stationary phase, is unable to produce pigment as it becomes flagellated. Although a previ- ous study has shown that RpoS, which accumulates when RelA is activated, is required for intracellular growth in A. castellanii , Zusman et al. have shown that the relA gene product is dispensable for intracellular growth in HL-60-derived human macrophages and in A. castellanii. Moreover, it has also been shown that RelA and RpoS have minor effects on expression of some of the dot/icm genes (icmT, R, Q, P, M, J, F, V, W). Thus, the role of RpoS in the intracellular infection seems to be host cell specific. 3. Adherence and entry into mammalian cells Invasion and intracellular replication of L. pneumophila Fig. 2. Transmission electron micrographs of the infection of A. polyphaga within pulmonary cells in the alveoli are the hallmark of (top panel) and U937 macrophages (bottom panel) by L. pneumophila. Legionnaires’ disease. The alveolar wall is composed of Coiling phagocytosis (A and B); formation of the RER-surrounded phago- macrophages and type I and type II epithelial cells. The some (C and D); and late stages of the infection (E and F). Note that in E and F, there is no intact phagosomal membrane. Reprinted from ASM News. 66 attachment of L. pneumophila in macrophages has been (10) (2000) 609–616. shown to be mediated, at least in part, through attachment of complement-coated bacteria to the complement receptor ppGpp synthetase, RelA. When relA from Escherichia , although non-complement-mediated uptake also occurs coli is expressed in L. pneumophila, ppGpp accumulates and [32,33]. The host cell receptor involved in non-complement- the bacteria express virulent traits independently of nutrient mediated uptake in macrophages and epithelial cells is not supply or cell density. The accumulation of ppGpp known. increases the amount of the stationary-phase sigma factor Uptake of L. pneumophila by monocytes and macro- RpoS, which triggers the expression of the stationary-phase phages has been shown to occur through conventional and genes. An rpoS mutant of L. pneumophila replicates coiling phagocytosis [6,32,34–36] (Fig. 2). Since heat-killed within HL60 and THP-1 monocytic cell lines, but is attenu- and formalin-killed L. pneumophila are also taken up by ated in Acanthamoeba castellanii. In bone marrow- coiling phagocytosis but are targeted to the lysosomes , derived macrophages from A/J mice, L. pneumophila rpoS this mode of uptake may not play a role in subsequent mutants replicate poorly because they traffic rapidly to a late trafficking of the bacteria. Many clinical isolates of L. pneu- endosome-like compartment. However, Bachman et al. mophila have been shown to be taken up exclusively by used a different L. pneumophila strain, Lp02, whereas Hales conventional phagocytosis [32,34]. In addition, other species et al. used JR32. It has been shown that some genotypic and of legionellae, such as L. micdadei, which is the second most phenotypic differences exist between the AA100, JR32 and common species of legionellae that causes Legionnaires’ Lp01 stains, which are the most commonly used in the disease, is taken up exclusively by conventional phagocytosis virulence studies. AA100 is clearly the most virulent,. The bacterial ligand that mediates the coiling mode of whereas Lp01 is the least. Therefore, the differences between phagocytosis is not known. Moreover, the phagocytic recep- L. pneumophila strains and/or between the host cells may tor that binds the bacteria seems to play some role in deter- explain the different intracellular growth observed for the mining the fate of the intracellular bacteria, since opsoniza- rpoS mutants. Sodium sensitivity and maximal expression of tion with antibodies reduces intracellular growth [31,37,38]. flagellin also require RpoS. Therefore, some RpoS- Studies have focused on the genetic aspects of the uptake regulated traits could be critical for efficient transmission or of L. pneumophila into its host cells. L. pneumophila mutants 132 M. Molmeret et al. / Microbes and Infection 6 (2004) 129–139 impaired in different loci, such as rtxA and enhC, display tion system is ancestrally related to type IV secretion systems significantly reduced entry into host cells, compared with that mediate conjugal DNA transfer between bacteria , L. wild-type bacteria. It has been shown recently that the pneumophila may utilize this transporter to transfer macro- enhanced phagocytosis of L. pneumophila by mammalian molecules into the host cell to evade endocytic fusion [8,10]. cells is dot/icm dependent. Interestingly, the dot/icm The dot/icm loci may be involved in the insertion of a pore in genes delay uptake and induce macropinocytosis in A/J the host cellular membrane through which the effector pro- mouse macrophages. With the exception of A/J mice, teins are exported into the host cell [52,53]. The effector most of the inbred mouse strains are not permissive to L. molecules involved in intracellular trafficking and evasion of pneumophila infection; neither are macrophages isolated the lysosomal fusion within mammalian cells are cis-acting from these mice [40,41]. Macropinosomes containing L. on the phagosome but do not alter endocytic fusion in the rest pneumophila in A/J mouse macrophages are induced tran- of the cell. With few exceptions, the function of indi- siently and shrink rapidly (5–15 min) , and this mode of vidual Dot/Icm proteins is unknown. uptake is linked to the lgn1 locus on chromosome 13 of mice The DotA protein was the first to be described. It is a [14,42,43]. In macrophages of non-permissive strains of polytopic inner membrane protein with eight hydrophobic mice, the macropinocytic uptake of L. pneumophila is re- transmembrane domains. The dotA mutants are defec- duced. The lgn1 allele makes the bacteria behave as if tive in all virulence activities that require the Dot/Icm com- they were lacking the dot/icm system. Thus, the lgn1 plex [12,45,53,55,57,58]. These data are supported by the allele is required for dot/icm-dependent macropinocytosis fact that the DotA sequence possesses significant similarities and delayed uptake by mouse macrophages. Whether to that of TraY [59,60], a component of the type IV trans- this mode of uptake plays a role in subsequent trafficking of porter required for conjugal transfer of plasmids ColIbP9 and L. pneumophila is not known. R64. However, Nagai and Roy have shown that the DotA protein is also secreted through the Dot/Icm transporter into the culture supernatant during growth of L. pneumophila 4. Intracellular fate of L. pneumophila in liquid broth via a functional type IV secretion system. Electron micrographs also show that purified DotA can form 4.1. Intracellular replication within host cells an oligomer [56,61]. Similarly to the protozoan infection, within 5 min follow- As DotH/IcmK and DotO/IcmB in growing L. pneumo- ing entry of the bacteria into macrophages and monocytes, phila cultures are mainly associated with the membranous the L. pneumophila phagosome is surrounded by host cell fraction, and as dot/icm products may be required during organelles such as mitochondria, vesicles, and the RER direct contact with host cells, the location of DotH and DotO [5,44,45] (Fig. 2). Also similarly to the trafficking of L. proteins on the surface of L. pneumophila has been examined pneumophila within protozoa , it has been shown that the. These proteins are surface exposed and associated with phagosome within mammalian macrophages does not fuse to a fibrous structure on L. pneumophila after exposure to bone lysosomes [4,6,7] (Fig. 2), at least at the early stage of the marrow-derived macrophages. In contrast, during broth cul- infection. The role of the RER in the intracellular infec- ture, this fibrous structure is absent. However, using tion is not known, but the RER is not required as a source of dotA, dotB, dotH, dotO mutants, it has been shown that the proteins for the bacteria. Interestingly, examination of exposure of DotO/DotH on the bacterial surface is not depen- the intracellular infection of macrophages, alveolar epithelial dent on other Dot/Icm proteins, including the DotH protein cells, and protozoa by another Legionella species, L. micda- for the DotO exposure, and vice versa. This result shows dei, showed that within all of these host cells, the bacteria that the surface exposure of DotH and DotO after contact were localized to RER-free phagosomes. Whether other with macrophages is not dependent on an intact Dot/Icm Legionella species replicate within RER-free phagosomes secretion system. The surface exposure of these two has still to be determined. proteins does not involve bacterial contact with the target Macrophages, peripheral blood monocytes, and alveolar cell, since bacteria incubated in medium that has been condi- epithelial cells support intracellular replication of L. pneu- tioned by bone marrow-derived macrophages for 24 h yield mophila [37,50]. Although alveolar epithelial cells, which almost identical results. In addition, DotH and DotO constitute more than 95% of the alveolar surface , have surface exposure on L. pneumophila requires intracellular been shown to allow intracellular replication of L. pneumo- growth of the bacteria in macrophages and is observed late in phila, their role in the pathogenesis has been largely over- the infection process, mostly when there are more than looked. 30 bacteria per phagosome. In fact, surface-exposed DotH and DotO disappear after uptake but reappear follow- 4.2. The dot/icm genes and their role in evasion of vesicle ing intracellular growth. The exposure of these two proteins traffıc increases L. pneumophila uptake into cells and may be necessary to promote bacterial escape from the phagosome The Dot/Icm type IV secretion system is the main L. and to facilitate the initiation of a new infection in macro- pneumophila virulence system. Because the Dot/Icm secre- phages. These data may also suggest that macrophage M. Molmeret et al. / Microbes and Infection 6 (2004) 129–139 133 components are able to induce changes in the L. pneumo- Using fluorescent markers specific for the ER, it has been phila envelope, and DotH/DotO export may occur as a re- shown that the L. pneumophila-containing vacuoles may sponse to the target macrophages just before uptake to allow resemble nascent autophagosomes. Autophagy is a cel- efficient initiation of intracellular growth. lular process for the degradation of unwanted organelles and Dot/Icm proteins such as IcmR, IcmQ, IcmX or IcmW do cellular components during which the autophagosome is not present sequence homology to other protein components formed from the smooth ER and fuses to lysosomes. The of type IV secretion system [9,10,51]. IcmX, a periplasmic hypothesis that L. pneumophila exploits the autophagy ma- protein, is required for biogenesis of the replicative phago- chinery in host cells and establishes an intracellular niche somes containing L. pneumophila. A truncated IcmX favorable for replication has been challenged recently product is secreted into culture supernatants by wild-type L. (see below) [44,64]. pneumophila growing in liquid media, but the transport of the Recent studies suggest that fusion or the exchange of protein into eukaryotic host cells has not been detected. lipid bilayer with ER vesicles on the L. pneumophila- IcmS and IcmW are small proteins required for the traf- containing phagosome occurs, allowing the phagosomal ficking of the Legionella-containing phagosome, and may membrane to become as thin as the ER membrane, with function as chaperones to help the secretion of proteins similar characteristics [44,64]. It has been shown that, within through the type IV secretion system [58,61]. It has also been 5 min of uptake, host vesicles come into contact with wild- shown that IcmS and IcmW interact, suggesting that they type Legionella-containing phagosomes and flatten along the may be components of a protein complex that is required for surface of the phagosome, and this process is completed modulating phagosome biogenesis. The phagosomes of within 15 min and is dot/icm dependent. This is the icmS and icmW mutants fuse to lysosomes. Interest- consistent with earlier studies that have shown that after 4 h ingly, phagosomes harboring icmS and icmW mutants still of infection, there are only a few vesicles associated with the recruit host vesicles including the RER. It is still to be phagosomal membrane, but there are ribosomes studding the confirmed whether recruitment of host vesicles does not phagosomal membrane. In contrast, autophagy takes prevent the phagosome from lysosomal fusion. place within 1 h, and ribosomes, mitochondria, and the The IcmR protein may also be a chaperone. An icmR nuclear membrane are not attached to the autophagosomal mutant can partially evade the endocytic pathway, but even- membrane; neither are the tiny hairs that connect ER and L. tually fuses with the lysosomes. These data suggest that pneumophila-containing phagosomes. Interestingly, the IcmR may be a co-factor for another protein effector in- thickness of the phagosomal membrane becomes similar to volved in evasion of lysosomal fusion. The icmR mutant that of the ER membrane within 15 min , which doesn’t that evades endocytic fusion does not recruit host vesicles, happen in the autophagy process. Thus, within 15 min of and the phagosome is not surrounded by the RER. Thus, infection, the phagosomal membrane resembles that of the effector molecules that recruit host cell vesicles may be ER. The ribosomes at 6 h stud the phagosomal membrane, different from the ones involved in evasion of the endocytic and L. pneumophila is thought to be located within the RER pathway.. However, these studies rely completely on the thickness Similarly to dotA and icmX mutants, an icmQ mutant is of the membranes of the ER and the phagosome membranes defective in all virulence activities. Furthermore, the to provide evidence that L. pneumophila is located within the icmQ gene, like the icmR and icmS genes, encodes soluble RER. Immunocytochemical studies should be per- protein. The IcmR and IcmQ proteins interact as protein formed to confirm these observations. It is likely that the chaperone-substrate. The presence of IcmR that has chaper- recruitment of the ER may be involved in the biogenesis of one characteristics (it is acidic, small and predicted to have a the phagosome that is dependent on the type IV secretion hydrophobic alpha-helix in its C-terminal domain) affects system, since the dot/icm mutants are unable to recruit RER, the physical state of IcmQ directly. IcmR prevents IcmQ and their phagosomes fuse to the lysosomes. from participating in the formation of high-molecular-weight complexes by dissociating IcmQ homopolymers. Interestingly, a recent study showed that recruitment of RER to forming-phagosomes may be part of regular phago- 4.3. Recruitment of RER cytosis. Electron micrographs of latex beads and patho- gens such as Salmonella within macrophages have shown In 1982 Katz and Hashemi showed that the L. that ER membranes fuse with plasmalemma, underneath the pneumophila-containing phagosome resembles the ER phagocytic cup, and successive waves of ER are recruited to membrane. By electron microscopy, replicating L. pneumo- the phagosomes of latex beads and bacteria. In neutrophils, phila within macrophages was visualized located within or- the bacteria are quickly killed, and the ER is not involved in ganelles morphologically identical with the RER the turnover of membrane for phagocytosis. However, (Fig. 2). Later, several studies demonstrated that upon inter- since the dot/icm system is essential for RER recruitment nalization of L. pneumophila by the host cell, the Legionella- , it is likely that L. pneumophila utilizes a specific containing vacuole recruits organelles such as vesicles, mito- pathogen-regulated process to recruit vesicles, and this pro- chondria and ER (Fig. 2) [5,46,66,67]. cess is distinct from regular phagocytosis. 134 M. Molmeret et al. / Microbes and Infection 6 (2004) 129–139 4.4. Interception of early vesicle traffıc from the RER The protein ADP ribosylation factor-1 (ARF1), a highly conserved small GTP-binding protein, which acts as a key regulator of vesicle traffic from ER to Golgi, is found on about 30% of the phagosomes that contain wild-type L. pneumophila but not dot/icm mutants. These data sug- gest that a protein injected through the type IV secretion system may be required for ARF1 recruitment. Searching the L. pneumophila genome for proteins that have homology to ARF-specific guanine nucleotide exchange factors (GEFs), Nagai et al. have identified a protein, RalF, that has a sec7-homology domain, known to be sufficient to stimulate the exchange of GDP for GTP. It has been shown that RalF is injected through the phagosomal membrane by a process that requires the Dot/Icm system. However, phagosomes containing ralF mutants that do not recruit ARF1 evade fusion to lysosomes, and the bacteria replicate intracellularly Fig. 3. The rib mutants’ defect in cytolysis of the host cell is due to a defect in necrosis-mediated killing. Representative transmission electron micro- within macrophages and amoebae. Thus, RalF is not graphs of infected U937 macrophages at 24 and 48 h post-infection by the essential for transport of L. pneumophila to the ER [64,70]. wild-type strain AA100 and the GN229 mutant. The original magnifications It has been shown recently that the L. pneumophila- were 7000× and 5000× for the 24- and 48-h infections, respectively. Reprin- containing phagosome is a transitional ER (tER)-derived ted from. organelle. Its biogenesis involves intercepting early secretory vesicles exiting from tER. Vesicular transport We have identified five spontaneous mutants that are un- from ER exit sites is not necessary for the recruitment of ARF able to egress from the macrophages but are able to grow as to L. pneumophila-containing phagosomes. The vesicular well as the wild-type strains within these cells. These transport from ER exit sites is an ARF-dependent process mutants, designated rib (release of intracellular bacteria), are used for remodeling the L. pneumophila-containing phago- defective in the pore-forming toxin/activity as shown by the some. The final stage of the biogenesis of the mature ER- contact-dependent hemolysis assay and by permeability to derived vacuole is marked by the loss of ARF and the accu- propidium iodide upon infection of macrophages and epithe- mulation of calnexin. Moreover, ralF mutants also mature in lial cells. The rib mutants are also defective in acute calnexin-positive RER-derived vacuole, similarly to the cytotoxic lethality to A/J mice and fail to cause alveolar wild-type strain. The RalF protein is not essential in phago- inflammation [13,20] indicating a key role for the pore- some transport, replicative organelle biogenesis or intracel- forming toxin in the pulmonary pathology of the bacterium. lular replication. Subversion of the early secretory path- We have further documented that the Rib toxin is not re- way is an effective way of gaining access to the ER lumen quired for intracellular trafficking and replication [19–21]. and exploiting translocation machinery of this environment In addition to defects in evasion of lysosomal fusion,. dot/icm mutants are also defective in induction of apoptosis , enhancement of phagocytosis by human-derived mac- 4.5. The “traffıcking” pore and the “egress” pore rophages and induction of macropinocytic delayed up- take by A/J mouse macrophages. In contrast, rib mutants Kirby et al. have described the pore-forming ability are defective in pore-forming toxin but are not defective in of L. pneumophila in host cell membranes. This was docu- evasion of lysosomal fusion, intracellular replication, or in- mented by lysis of macrophages and red blood cells, which is duction of apoptosis [18,20,21]. These observations may dependent on the Dot/Icm secretion system. Since suggest that there are at least two pores inserted into host dot/icm mutants are defective in evasion of lysosomal fusion, membranes through the type IV secretion system at different it has been proposed that the pore-forming activity is re- stages of the infection. The first pore is the “invasion and quired for export of effector molecules necessary for evasion trafficking pore”, which is inserted upon initial contact with of the lysosomal fusion. Upon initial contact with the the host cell to deliver effectors into the host cell cytoplasm host cell, L. pneumophila may insert a pore into the plasma and allow the establishment of the intracellular infection. The membrane to deliver bacterial effector molecules into the dot/icm genes necessary for the assembly of the secretion host cell [52,53]. This concept is supported by the fact that apparatus are constitutively expressed and are required for many dot/icm mutants are defective in both intracellular this step. The second pore is the “egress pore”, which is replication and pore formation-mediated cytotoxicity triggered during the late stages of intracellular replication [52,53]. Moreover, some dot/icm mutants are defective in and is essential for lysis of the host cell (Figs. 3 and 4). trafficking and intracellular replication but not in the pore- This is consistent with the fact that upon transition into the forming activity. post-exponential growth in vitro, L. pneumophila becomes M. Molmeret et al. / Microbes and Infection 6 (2004) 129–139 135 Fig. 4. A model of growth phase-dependent cytolysis of mammalian cells by L. pneumophila upon termination of intracellular bacterial replication to egress from the spent host cell. During early stages of formation of the mitochondria and RER-surrounded phagosome (A) and during exponential intracellular replication (B), expression of the pore-forming activity is turned off, but caspase-3-mediated apoptosis is triggered. Upon transition to the post-exponential phase of growth, expression of the pore-forming activity is triggered, which results in insertions of pores in the phagosomal membrane first (C), leading to its disruption (D). This is followed by insertions of pores in the plasma membrane (E), leading to osmotic lysis of the cell and release of the intracellular bacteria. Reprinted from. cytotoxic. Thus, the rib mutants retain the “invasion and Hashemi had observed on electron micrographs that trafficking pore” but are defective in the “cytolysin/egress when present in macrophages at numbers greater than 25 per pore”, since they replicate within but fail to egress from the cell, L. pneumophila was usually dispersed within the cyto- host cells (Figs. 3 and 4). plasm of the host cell. The phenotype of the rib mutants is attributable to a point deletion in the icmT gene that is predicted to result in a 5. Apoptotic or necrotic cell death truncated protein of 54 amino acids instead of the 86 amino acids of the native protein [13,21]. In contrast, an icmT null 5.1. Induction of apoptosis by L. pneumophila in mutant is defective in both intracellular replication and pore mammalian but not protozoan host cells formation [13,21,74]. It has been shown that icmT expression is induced at stationary phase compared with the exponential Apoptosis requires a cascade of activation of a family of phase. We have shown that IcmT is bifunctional and that cysteine proteases (caspases) that specifically cleave proteins the carboxy terminus is essential for the pore-forming after aspartate residues. Among them, caspase-3 plays a “cytolysin/egress pore” activity, and the amino terminus is central role, allowing caspase-activated DNase to enter the essential to export effectors involved in various pathogenic nucleus and degrade chromosomal DNA. Muller et al. traits [13,21]. have shown that L. pneumophila induces apoptosis in We hypothesized that upon transition to the post- HL-60 human-derived macrophages after 24–48 h, at a mul- exponential phase of growth, the Rib toxin activity is trig- tiplicity of infection (MOI) of 10–100. The induction of gered, resulting in insertions of pores in the phagosomal apoptosis in mammalian cells is mediated by activation of membrane, leading to its disruption and bacterial egress into caspase-3 that is dose dependent and is maximal at 3 h the cytoplasm (Figs. 3 and 4). To test this hypothesis, we post-infection at an MOI of 50 [16,17] (Fig. 4). In alveolar examined late stages of the intracellular infection of mac- epithelial cells and macrophages, the induction of apoptosis rophages and amoebae by electron microscopy. Our data is dose dependent but not largely growth-phase regulated and showed that disruption of the phagosomal membrane was can be induced by extracellular bacteria [16,17]. The dot/icm detectable 12 h post-infection of both Acanthamoeba mutants of L. pneumophila are defective in inducing polyphaga and macrophages (unpublished data). After caspase-3 activation and, thus, apoptosis [16,18]. Therefore, 12 and 18 h post-infection in both host cells, vesicles and the Dot/Icm type IV secretion system of L. pneumophila is organelles from the host cytoplasm entered into the essential for the induction of apoptosis in mammalian cells Legionella-containing phagosome. Between 18 and 24 h, [16,18]. The pore-forming toxin is not required for the induc- most of the bacteria present in this disrupted phagosomal tion of apoptosis, but upon entry into the post-exponential membrane were surrounded by cytoplasmic organelles, and growth phase, it enhances the ability of the bacteria to induce not by distinct phagosomal membrane (unpublished data). apoptosis. These data show that the phagosomal membrane is disrupted Interestingly, L. pneumophila induces apoptosis in human first, rather than undergoing lysis simultaneously with the phagocytes but not in protozoan host cells such as A. castel- plasma membrane. Whether this disruption is the result of a lanii [19,79]. Moreover, although A. polyphaga is capable of mechanical process or linked to the pore-forming activity of undergoing apoptosis, including DNA fragmentation, upon the type IV secretion system [21,53,73], is not known. Our stimulation by actinomycin D, L. pneumophila does not data are consistent with a previous study in which Katz and induce apoptosis in A. polyphaga [17,19]. 136 M. Molmeret et al. / Microbes and Infection 6 (2004) 129–139 5.2. Induction of necrosis by L. pneumophila in disruption of organelles and the plasma membrane occurs, mammalian and protozoan cells culminating in lysis of the host cells and bacterial egress. The dot/icm-regulated Rib pore-forming toxin is essential 5.4. The neuronal apoptosis inhibitory protein (Naip) for L. pneumophila induction of necrosis, killing, and exiting and susceptibility of mice to L. pneumophila the host cells [19–21]. At high MOI, mutants defective in the Rib pore-forming toxin replicate like the wild-type strains L. pneumophila is unable to replicate in macrophages within the protozoan and mammalian cells but are trapped derived from most inbred mouse strains, with the exception within these cells and cannot be released (Figs. 3 and 4) of the A/J strain. The natural resistance of these mouse [19,20]. The expression of the pore-forming activity by L. strains to infection with L. pneumophila is controlled by the pneumophila grown in vitro and within macrophages is com- expression of a single dominant locus mapped on mouse pletely repressed during exponential growth but is tempo- chromosome 13, designated lgn1 [41,43,81]. The intracellu- rarily activated upon entry into post-exponential phase lar growth of species other than L. pneumophila are not under (Fig. 4). Therefore, the Rib pore-forming activity is not lgn’s control. required for phagosomal trafficking and intracellular multi- The mouse lgn1 region includes six copies of the neuronal plication of L. pneumophila within the cells, but is essential apoptosis inhibitory protein (naip) gene. The Naip proteins for induction of cytolysis of the infected macrophages have been shown to be direct inhibitors of caspases 3 and 7 [19,20]. Thus, the C-terminus of IcmT is essential for pore. Interestingly, the Naip proteins are less expressed in formation-mediated cytolysis [20,21]. macrophages derived from permissive A/J mice than from Experiments performed with an IcmT null mutant which the non-permissive inbred strains, but their expression is is defective in intracellular trafficking, and multiplication in increased after the phagocytic events in both strains of mice both protozoan and mammalian cells, suggest that IcmT is. This increase does not require intracellular replication, bifunctional [13,21]. The C-terminus of IcmT is essential for since the avirulent dotA mutant and the inert latex particles pore formation-mediated cytolysis in mammalian cells, and also cause an increase in naip expression. This reduced the N-terminus is required for intracellular trafficking. It naip expression in A/J macrophages may result in enhanced is unlikely that IcmT is an effector or a common regulator, ability of L. pneumophila to induce apoptosis through acti- but it is possible that this protein is a co-factor involved in the vation of caspase-3 and thus, increased permissiveness to export of different substrates with roles in pore-forming infection. Recently, naip5, also known as birc1e (bacu- toxicity and intracellular trafficking. Effectors of this loviral inhibitory apoptosis protein repeat-containing 1), was type IV secretion system remain to be identified. shown to be the only gene responsible for susceptibility to Legionella [85,86]. In contrast to other Naip expression lev- 5.3. Egress of L. pneumophila els, Naip5 expression levels have shown large differences between A/J macrophages and non-permissive macrophages. The ability to lyse host cells and to egress from them is a. A bacterial artificial chromosome (BAC) transgenic line fundamental step in the pathogenic cycle of intracellular expressing a non-permissive allele of naip5 has exhibited a bacteria and determines the overall consequences of the reduction in permissiveness to Legionella [85,86]. An anti- infection of an organism. Apoptosis and necrosis are the two sense inhibitor of the translation of the mRNA of Naip5 has commonly observed types of cell death. Necrosis is charac- caused an increase in the permissiveness of permissive and terized by physical damage causing cell death. Apoptosis is a non-permissive macrophages to Legionella. These re- regulated suicide program of the cell, manifesting morpho- sults indicate a role for birc1e/naip5 in macrophage resis- logical and biochemical features distinct from those of necro- tance to L. pneumophila infection. The mechanism of action sis. Killing of mammalian cells by L. pneumophila has is not yet known. been proposed to occur in two phases [16,17] (Fig. 4). In the Although Naip differs from the classical IAPs , it was first phase, L. pneumophila induces apoptosis in macro- thought to belong to the inhibitor of apoptosis (IAP) family phages, monocytes and alveolar epithelial cells during the of anti-apoptotic proteins, which were first identified in bacu- early stages of the infection [17,79], apoptosis which is loviruses. A recent study has shown that Naip proteins mediated through the activation of caspase-3. Induction are part of the nucleotide-binding oligomerization domain of apoptosis is largely independent of the bacterial growth (NOD) proteins. NOD proteins are a large family of proteins phase. The second phase is mediated through rapid involved in apoptosis and innate immunity [89–91]. Several induction of necrosis by L. pneumophila upon entry into the NOD proteins have already been shown to be implicated in post-exponential phase of growth, when the bacteria become the activation of caspases such as APAF1, which is involved cytotoxic (Fig. 4). Our working model of bacterial egress can in activation of caspase 9. NOD1 and NOD2, also part of be presented in three steps (Fig. 4). First, upon exiting the the NOD family, have been shown to mediate the recognition exponential phase of intracellular growth, an “egress pore” is of specific Gram-negative bacterial components such as li- inserted into the phagosomal membrane, leading to its dis- popolysaccharides (LPS) and peptidoglycan, once they are ruption. Second, the bacteria egress into cytoplasm. Third, processed in the cytosol [90,93,94]. Most of the NOD family M. Molmeret et al. / Microbes and Infection 6 (2004) 129–139 137 members contain three distinct functional domains. The first protein is not essential in phagosome transport or replicative domain is the amino-terminal effector-binding domain organelle biogenesis. Interestingly, L. pneumophila avoids (EBD), which is variable among NOD family members. phagosome–lysosome fusion within the first few minutes of The EBD amino-terminal domain of the Naip proteins con- the intracellular infection, and the phagosomes are converted tains an N-terminal domain with 1–3 repeats of an approxi- into endoplasmic reticulum-derived organelles that support mately 65-amino-acid motif, termed the baculovirus IAP intracellular replication. This process involves intercept- repeat (BIR) [88,90]. The role of BIRs in Naip remains to be ing early secretory vesicles exiting from the transitional ER determined, but it is thought to bind and inhibit caspase-3. After 4 h, L. pneumophila starts to replicate within this. The second domain is a central domain, designated replicative organelle. Between 8 and 18 h, the phagosomal NOD, which mediates self-oligomerization, required for the membrane is gradually disrupted, and the bacteria become activation of downstream effector molecules. The third do- cytoplasmic and are dispersed among cytoplasmic organelles main is a carboxy-terminal ligand-recognition domain such as mitochondria and lysosomes prior to lysis of the host (LRD), generally called LRR domain (leucine-rich repeats) cell (Molmeret et al., submitted). Further investigations [89,91]. Mammalian toll-like-receptors (TLRs) have mul- should be focused on determination of whether the disruption tiple LRRs in the ectodomain. of the phagosomal membrane is due to the action of a toxin. 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