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Infection and Immunity, January 2005, p. 201-207, Vol. 73, No. 1
0019-9567/05/$08.00+0 doi:10.1128/IAI.73.1.201-207.2005
Copyright © 2005, American Society for Microbiology. All Rights Reserved.
Instituto de Investigaciones Biotecnológicas, Universidad Nacional de General San Martín,1 Departamento de Microbiología, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina,3 Department of Molecular Cell Biology and Immunology, Faculty of Medicine, Free University, Amsterdam, The Netherlands2
Received 16 July 2004/ Returned for modification 20 August 2004/ Accepted 18 September 2004
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Chagas' disease is an endemic parasitosis that affects about 20 million people, and around 40 million people are at risk of infection in the Americas (40). Trypanosoma cruzi, the causative agent, is a flagellated parasite with a complex life cycle involving a hematophagous insect vector and a mammalian host. During the acute phase of T. cruzi infection, several hematologically abnormal parameters, including marked thrombocytopenia, are observed (9). These alterations are transient and can be prevented by trypanocidal drugs (9, 27), but there is still no suitable molecular explanation for this. T. cruzi is unable to synthesize sialic acids de novo (reviewed in reference 16) but circumvents this limitation by expressing the enzyme trans-sialidase (TS), which is able to directly transfer
(2,3)-linked sialyl residues among glycoproteins or glycolipids (16, 34). TS is anchored to the membrane by glycosylphosphatidylinositol (2, 3) and is shed into the surrounding environment, and it is detected in the blood of infected animals and human patients during the acute stage of the infection (14, 24). In the C terminus, the enzyme has tandem repetitive amino acid units that allow it to persist in blood for at least 3 days (5, 6), which allows it to induce pathological disorders even far from the infectious foci or to act on the blood cells (14, 30). One of the biological activities is induction of apoptosis in components of the immune system (25), including CD4+ CD8+ thymocyte depletion inside the nurse cell complex (29). Accordingly, virulent T. cruzi strains shed more TS activity (33). Animals that survive infection and chronic Chagas' disease patients elicit TS-neutralizing antibodies that are able to inhibit TS enzymatic activity and limit the period in which the distributed TS can systemically operate to the early steps of the infectious process. Both the systemic activity restricted to the acute phase and the ability of TS to alter the cell surface sialyl residue distribution are characteristics that are expected for a virulence factor that might be associated with the thrombocytopenia observed during this stage of the infection.
Here we report that the enzyme was able to remove sialic acids from the platelet surface, leading to faster clearance of the platelets from circulation. Furthermore, neutralization of the circulating enzyme by passive transfer of a monoclonal antibody to T. cruzi-infected animals prevented the clearance of transferred tracer platelets. Our results support the hypothesis that TS from T. cruzi is a virulence factor involved in the thrombocytopenia observed early during the infection, which provides a molecular explanation for the pathological findings.
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TS.
Enzymatically active and inactive TS recombinant proteins that differed by a single Tyr342His point mutation (12) were expressed in Escherichia coli DH5
. Proteins were induced with isopropyl ß-D-thiogalactopyranoside (Sigma Chemical Co, St. Louis Mo.) and purified to homogeneity by immobilized metal affinity chromatography through Ni2+-charged Hi-Trap chelating columns (Amersham Biosciences, Uppsala, Sweden), followed by ion-exchange chromatography with a MonoQ column (Amersham Biosciences) as described previously (7). The His tag was not removed from the recombinant enzyme. The specific activities of recombinant and natural TS were around 3 to 4 U/nmol of TS protein (1 U of TS activity was defined as the amount of enzyme that transferred 10 nmol of sialyl residue to lactose in 1 min under standard conditions). TS was injected intravenously (i.v.) at the doses indicated below for each experiment in 0.2 ml of phosphate-buffered saline (PBS).
TS assay. The enzymatic activity of purified TS was assayed by measuring the amount of sialic acid residue transferred from sialyllactose (Sigma) to [14C]lactose (Amersham Biosciences) as previously described (24).
T. cruzi infection. Q501/3, a clone of the Tulahuen T. cruzi strain (lethal, lineage II), and K-98, a clone of the CA-I T. cruzi strain (nonlethal, lineage I) (33), were maintained by serial passage in mice. Animals were inoculated with 250 (Q501/3) or 50,000 (K-98) sanguineous trypomastigote forms by the intraperitoneal route.
Platelet purification. Peripheral blood was collected from the retroocular plexus in polypropylene tubes containing 3.8% (wt/vol) sodium citrate (citrate/blood ratio, 1:9). Platelet suspensions were obtained as described previously (21), with slight modifications. Blood diluted 1:1 in PBS was overlaid onto a density gradient (HISTOPAQUE-1083; Sigma). Platelets were recovered together with the mononuclear cells, diluted 1:1 with PBS, and centrifuged at 140 x g for 10 min. The supernatant was centrifuged for 10 min at 1,500 x g, and the pellet was resuspended in citrate-treated plasma previously centrifuged at 1,500 x g (platelet-poor plasma) or PBS. All the manipulations were carried out at room temperature. The number of platelets was determined by manual counting with a Neubauer hemocytometer.
Sialic acid determination.
Platelets (5 x 107 cells) were incubated with TS (0.1 to 6 µg) for 1 h at room temperature in platelet-poor plasma. To determine the
(2,3)-linked sialic acid remaining in the surface, platelets were washed with PBS and incubated with an excess (6 mU/µl) of the specific neuraminidase from Salmonella enterica serovar Typhimurium LT2 (New England Biolabs) in 150 mM NaCl20 mM Tris-HCl (pH 6.8) for 1 h at 37°C. The platelets were centrifuged at 1,500 x g for 10 min, and the sialic acid content of the supernatant was determined by the high-performance liquid chromatography-thiobarbituric acid assay (31).
Irradiation of mice. Mice received a lethal dose (9 Gy) of gamma radiation, and 72 h later the animals were inoculated i.v. with 0.5 or 5 µg of TS. Platelet counts were determined 18 h later.
Determination of in vivo survival of TS-treated platelets. GFP-expressing platelets (5 x 107 cells) from a transgenic mouse were incubated with 0.1 to 2 µg of TS for 1 h at room temperature in platelet-poor plasma. The platelet suspension was diluted in 0.2 ml of PBS and injected i.v. Eighteen hours after transfusion, green platelets were counted by using an epifluorescence microscope (Eclipse 600; Nikon, Tokyo, Japan).
Professional phagocyte depletion. Kupffer cells and other macrophages were depleted by injection of liposome-encapsulated clodronate (dichloromethylene bisphosphonate) (4, 41, 42). Animals received 250 µl of a liposome suspension intraperitoneally 24 h before administration of 10 µg of TS. The clodronate was a gift from Roche Diagnostics GmbH, Mannheim, Germany. Phosphatidylcholine (LIPOID E PC) was obtained from Lipoid GmbH, Ludwigshafen, Germany, and cholesterol was obtained from Sigma.
Monoclonal antibody administration. A TS-neutralizing mouse monoclonal antibody (immunoglobulin G2a) was recently obtained in our lab (T. Pitcovsky R. Muiá, and O. Campetella, unpublished data), and ascitic fluid (neutralizing titer, 1:80,000, as determined by a TS inhibition assay [26]) was obtained from animals inoculated with hybridoma. In three separate experiments, mice received a single 50-µl dose of ascitic fluid intraperitoneally on day 10, 11 or 12 after infection, when the parasitemia values were 1 x 105 to 8.5 x 105 parasites/ml, and 24 h later 1 x 108 to 2 x 108 fluorescent platelets were transfused. The remaining fluorescent platelet count was determined 18 h later. Sera from passively transferred animals were able to neutralize 100% of added TS under standard conditions (26).
Splenectomy. Animals (30 to 45 days old) were splenectomized under chloral hydrate (Sigma) anesthesia and left to recover for at least 2 weeks before further analysis.
Statistical analysis. Student's t test was employed.
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FIG. 1. TS reduces the life span of platelets. (A) Administration of TS induces transient thrombocytopenia. C3H/HeJ mice were inoculated intravenously with different amounts of recombinant TS. The platelet counts and the remaining TS activity in the blood are expressed as percentages. The P values for comparisons with data obtained on day 0 or on day 6 or 7 were as follows: for platelet counts on days 1, 2, and 3 in the 10-µg dose group, P < 0.002; for platelet counts on days 1, 2, and 3 in the 5-µg dose group, P < 0.001; for platelet counts on days 1, 2, and 3 in the 2-µg dose group, P < 0.001; and for platelet counts on days 1 and 2 in the 1-µg dose group, P < 0.05. (B) TS acts on the circulating platelets. C3H/HeJ mice were lethally irradiated, and then different amounts of TS were given intravenously. Platelet counts were determined 18 h later. For a comparison of the group that received no TS and the group that received 5 µg of TS, the P value was <0.01. Each group contained at least three animals.
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Platelet surface sialic acid content is reduced by TS.
Surface sialic acid is critical for the presence of platelets, red blood cells, and glycoproteins in the circulation (23, 35). Therefore, the surface sialic acid content of platelets was quantified after TS treatment to verify the ability of this virulence factor to affect the platelet life span and to produce thrombocytopenia by direct action on the platelets. To do this, platelets were incubated with different amounts of TS (0 to 6 µg) (Fig. 2), and the remaining surface
(2,3)-linked sialic acid was quantified. A significant reduction in the sialic acid content was observed after TS treatment even when as little as 0.5 µg of the enzyme was used (Fig. 2A). To test whether treatment with these amounts of TS could alter the platelet life span, GFP-expressing platelets were assayed. When tracer platelets were treated with 0.5 µg of TS, they were rapidly removed from the circulation after administration into naïve mice (Fig. 2B). The results of these experiments clearly supported the hypothesis that TS is able to remove sialic acid from the cell surface and that this activity is associated with the reduction in the platelet life span.
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FIG. 2. Platelet desialylation by TS correlates with a reduction in the life span. (A) Platelets (5 x 107 cells) were treated in vitro with different amounts of TS, and the released sialic acid was quantified. For all groups that received 0.5 µg of TS or more, the data were statistically significant (starting at P < 0.05 for the 0.5-µg group) for comparisons with the untreated control. (B) GFP-expressing platelets were treated in vitro with different amounts of TS and then transferred to naïve animals. Green platelet counts were determined 18 h later by fluorescence microscopy. The results are expressed as percentages of the remaining green platelets; 100% was defined as the value for controls that received platelets not treated with TS. The values for groups that were treated with 0.5 and 2 µg of TS were found to be statistically significantly different from the other values (P < 0.005). Each group contained at least three animals.
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Kupffer cells are responsible for the clearance of TS-altered platelets from the blood. Beyond the small number of platelets consumed daily to maintain hemostasis, the spleen and liver are the organs where sequestration of damaged, altered, or aged platelets occurs. It has been postulated that the decrement of sialic acid from the surface of the platelets results in recognition of these cells as aged or foreign by the reticuloendothelial system (18, 23). As a first approach to assay the involvement of this compartment in the removal of the TS-altered platelets, splenectomized mice were tested. The animals received a high dose of TS (10 µg), and there was no difference in the reduction of blood platelet counts after injection between naïve and splenectomized mice (compare Fig. 1 and 3A). To further analyze this compartment, we employed GFP-expressing platelets treated with TS and then transfused them to splenectomized and normal mice. In agreement with data shown in Fig. 3A, treated fluorescent platelets were rapidly removed in splenectomized mice, as they were in normal receptor animals (Fig. 3B). These results indicated that the spleen is not the main organ for TS-altered platelet removal.
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FIG. 3. Kupffer cells are involved in the clearance of TS-altered platelets. (A) Splenectomized BALB/cJ mice were inoculated with 10 µg of TS i.v. The platelet counts and the remaining TS activity in the blood are expressed as percentages. The P values for comparisons with data obtained on days 0 and 7 were as follows: for platelet counts on days 1, 2, and 3, P < 0.001; and for platelet counts on day 4, P < 0.05. (B) GFP-expressing platelets were transferred after in vitro TS treatment (2 µg) to either normal or splenectomized (Spx) animals. Green platelet counts were determined 18 h later by fluorescence microscopy. For a comparison of the group that received TS and the group that did not receive TS, the P value was <0.005. (C) Mice were treated with liposome-encapsulated clodronate 24 h before administration of TS (10 µg). Platelet counts determined 18 h after TS administration are expressed as percentages of the value for naïve animals. Ctl, control animals that received TS; Lip, liposome-treated animals that received TS. For a comparison of the control animals and the liposome-treated animals, the P value was <0.01. Each group contained at least four animals.
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TS is associated with the thrombocytopenia observed during T. cruzi infection. Thrombocytopenia is described as one of the more relevant hematological findings during early T. cruzi infection and correlates well with the detection of TS activity in blood, which indirectly supports the hypothesis that it participates in the platelet count reduction process.
Two main possible effects have to be considered as effects that are involved in the induction of thrombocytopenia during infection, disabling of the bone marrow and alteration of the circulating platelets that leads to their destruction. To determine whether during infection platelets are altered in a way that leads to their clearance, unaltered GFP-expressing platelets were transfused to T. cruzi-infected animals. As shown in Fig. 4B, green platelets disappeared from the blood at a higher rate in infected animals than in naïve animals. This finding demonstrated that during infection, the platelet life span is shortened independent of a possible effect of the inflammatory activities derived from the infectious process on the bone marrow.
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FIG. 4. TS is associated with thrombocytopenia during T. cruzi infection. (A) Platelet counts in T. cruzi-infected mice. Mice were infected with either 50,000 K-98 parasite (lineage I clone) blood trypomastigotes ( ) or 250 Q501/3 parasite (lineage II clone) blood trypomastigotes (). An asterisk indicates that the P value is at least <0.01. There were five animals in each group. (B) In three separate experiments, GFP-expressing platelets were transferred to lethal T. cruzi strain-infected C3H/HeJ animals at day 11, 12, or 13 postinfection. Recipients were passively transfused with TS-neutralizing monoclonal antibody (nAb) 24 h before green platelet transfusion. The fluorescent platelet count was determined 18 h later. The green platelet count in transfused uninfected mice was defined as 100%. The asterisk indicates that the P value is <0.01. Each group contained at least three animals.
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To directly test whether TS is actually associated with the circulating platelet depletion in acute Chagas' disease, the enzymatic activity during T. cruzi acute infection was neutralized. For this purpose, mice were infected with Q501/3 (a T. cruzi lineage II strain) and passively transfused with a unique dose of a TS-neutralizing monoclonal antibody at days 10 to 12 postinfection. One day later the animals were transfused with untreated GFP-expressing platelets. In the infected mice in which the T. cruzi-derived TS activity was neutralized, fluorescent platelets were cleared at a rate that was lower than the rate in the mice that received unrelated antibodies (Fig. 4B). These results indicate that the TS activity is directly involved in the thrombocytopenia induced by T. cruzi in a mammalian infection by altering the circulating platelets.
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The bone marrow becomes depleted during acute infection with virulent T. cruzi strains (27). Although a possible effect of prolonged exposure to TS, as happens during infection, cannot be disregarded, from the evidence at hand it seems that the destruction of this tissue is more likely to be due to the immune response or to other parasite-derived factors. No obvious evidence of morphological alterations of the bone marrow cells was found after a single injection of the enzyme, and the thrombopoiesis capacity remained unaltered, as suggested by the recovery of normal platelet counts when the TS activity disappeared. This is consistent with the finding that in surviving animals the normal platelet count recovers when the parasitemia is controlled (9). Thrombopoietin is constitutively produced by the liver and kidneys, but its actual activity with precursor cells is regulated by the number of circulating platelets because of the expression of the corresponding receptor (c-Mpl) on the surface, which tunes the activity (20, 43). Therefore, the observed increase in the number of megakariocytes in both the bone marrow and the spleen after TS injection seems to accompany the thrombocytopenia induced by the platelet destruction instead of being related to a possible direct effect of the TS on the earlier precursor cells.
TS is in fact a modified sialidase that has acquired the ability to transfer the sialyl residue to a ß-linked terminal galactose instead to water (hydrolysis) (7, 8). Although a possible role in redistribution of the sialyl residues among the surface glycoconjugates cannot be disregarded, the loss of sialyl residues from the platelets after TS treatment strongly supports the hypothesis that their increased clearance is due to the
(2,3)-neuraminidase activity of the enzyme. As shown in Fig. 2, depletion of
(2,3)-linked sialic acid occurs at a level that is able to alter the life span of platelets in blood (18). It should be stressed that the sialyl residues linked by
(2,3) linkages, but not the residues linked by
(2,6) linkages, are the residues that are critical in determining the half-life of platelets and seric factors (15) and that the
(2,3) linkage is the linkage with specificity or a preferred configuration for almost all of the pathogen-derived sialidases, suggesting a general target for these virulence factors.
Desialylation is known to lead to sequestration of platelets from the blood by the reticuloendothelial system. Here we determined that the spleen is not critical in the destruction of TS-altered platelets, and our findings strongly support involvement of the Kupffer cells in this process instead. Similar experimental approaches recently resulted in determination of the involvement of Kupffer cells in the clearance of erythrocytes deficient in glycosyl phosphatidylinositol-linked proteins (22). In this regard it should be pointed out that strong thrombocytopenia also occurs during infection of splenectomized mice that show progressive platelet depletion, as well as in infected control animals (9). The fact that a parasite-derived virulence factor is involved is further supported by our findings obtained with parasites that were representative of the main T. cruzi lineages (Fig. 4), which showed that a nonlethal strain (T. cruzi lineage I) that expressed or shed smaller amounts of TS was unable to induce persistent thrombocytopenia, although comparable levels of parasitemia were reached. Together with the TS neutralization assay results, these results indicate that TS is the virulence factor that causes the thrombocytopenia during the acute phase of Chagas' disease.
This work was supported by grants from the Ministerio de Salud de la Nación (Becas Ramón Carrillo-Arturo Oñativia) and the Agencia Nacional de Promoción Científica y Tecnológica of Argentina, from The Mizutani Foundation for Glycoscience, Tokyo, Japan, and from the UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases. M.S.L. and O.C. are researchers of the Consejo Nacional de Investigaciones Científicas y Tecnológicas, Argentina.
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