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Infection and Immunity, March 2006, p. 1462-1470, Vol. 74, No. 3
0019-9567/06/$08.00+0 doi:10.1128/IAI.74.3.1462-1470.2006
Copyright © 2006, American Society for Microbiology. All Rights Reserved.
Division of Geographic Medicine and Infectious Diseases, Department of Medicine,1 Department of Pathology, Harvard Medical School, Boston, Massachusetts 02115,2 Department of Surgery, Tufts-New England Medical Center, Tupper Research Institute, Boston, Massachusetts 02111,3 Department of Host Defense, Research Institute for Microbial Diseases, Osaka University 3-1, Yamada-oka, Suita, Osaka 565-0871, Japan4
Received 14 September 2005/ Returned for modification 1 November 2005/ Accepted 2 December 2005
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Toll-like receptors (TLRs) play an integral role in mammalian innate immune defenses. TLR-2 has been shown to recognize multiple components of bacterial cell walls including peptidoglycans and lipoproteins (2). Outer surface lipoproteins of B. burgdorferi containing the Pam3Cys modification are recognized by TLR-2; the activation of TLR-2 by B. burgdorferi lipoproteins has been shown in vitro to result in the activation of peripheral blood mononuclear cells and the release of proinflammatory cytokines and chemokines (18).
Mouse studies of TLR-2 have shown a different role for TLRs in B. burgdorferi infection. As would be predicted, the lack of TLR-2 greatly diminishes the ability of the mouse to control infection, resulting in higher numbers of spirochetes in tissue and blood despite preserved development of an appropriate adaptive immune response. However, the mechanism by which TLR-2 is responsible for controlling infection does not appear to be mediated by the ability to recruit inflammatory cells, since TLR-2-deficient mice develop more severe, rather than less severe, arthritis compared with their wild-type counterparts (42).
Myeloid differentiation factor 88 (MyD88) is a common adaptor molecule for TLR, interleukin-1 (IL-1), and IL-18 signaling (3, 38). MyD88 is utilized by all of the TLRs except TLR-3 in the signaling pathway that results in the activation of NF
B, leading to the production of inflammatory mediators. MyD88 knockout mice have been shown to have increased susceptibility to infection with several pathogens including Staphylococcus aureus (37, 40), Listeria monocytogenes (33), and Mycobacterium avium (12); fungal pathogens such as Candida albicans (7); and parasites such as Toxoplasma gondii (32), Leishmania major (10), and the intestinal nematode Trichuris muris (17). Similar to TLR-2-deficient mice, MyD88-deficient mice infected with B. burgdorferi show higher tissue burdens of spirochetes (8, 24). Joint inflammation in B. burgdorferi-infected MyD88 knockout mice has been variously reported by two different groups as either unchanged from the wild type or increased, similar to what is seen with TLR-2 knockout mice (8, 24). Carditis, which is the other major manifestation of B. burgdorferi infection in mice, was unchanged from wild-type levels in MyD88-deficient mice (24). In distinction to the effects of TLR/MyD88 deficiency in B. burgdorferi-infected mice, exposure to streptococcal cell wall products in MyD88/ mice resulted in decreased joint inflammation in mice compared with that in wild-type mice (19).
Given the conceptually surprising results of increased inflammation in B. burgdorferi infection of TLR/MyD88-deficient mice, the discrepancies in results from MyD88 mice in previous studies, and the dissimilarity between the effects of MyD88 deficiency on B. burgdorferi-induced arthritis and the effects on inflammation in other diseases (13, 14, 27, 35), we sought to more fully characterize inflammation that occurs in MyD88 mice in response to B. burgdorferi infection. Cytokine and chemokine expression patterns in B. burgdorferi-infected MyD88 mice have not previously been reported. Here, we present our data showing inflammatory patterns in B. burgdorferi-infected MyD88-deficient mice.
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Histological analysis. Tissues were first fixed either in Bowen's fixative (hind legs) for 24 h and then placed in 70% ethanol or in 10% neutral buffered formalin (all other soft tissue). The hind legs were then skinned, split in half longitudinally in the center, processed for decalcification, and finally embedded in paraffin. Other tissues were processed whole. The slides were processed and stained with hematoxylin and eosin (HE) by the Histology Core Facility at New England Medical Center as previously described (6). The slides were scored for histopathology in a blinded manner on a scale of 1 to 5, with 1 being the least inflammation and 5 being the most inflammation.
Quantitative real-time RT-PCR. Total RNA was purified by using Trizol (Invitrogen) according to the manufacturer's instructions. First-strand synthesis of cDNA from total RNA was performed by using Improm II reverse transcriptase (RT) (Promega, Madison, WI) according to the manufacturer's instructions. Control reactions performed in the absence of reverse transcriptase were used to control for contamination by genomic DNA. cDNA samples contaminated by genomic DNA were discarded, and the original RNA was treated with DNase before the reverse transcriptase reaction was repeated. Quantitation of cDNA from specific mRNA transcripts was accomplished by real-time quantitative RT-PCR (iCycler; Bio-Rad, Hercules, CA) by using SYBR green technology (Quantitect SYBR green PCR kit; QIAGEN, Valencia, CA) as previously described (6). The primers used are listed in Table 1.
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TABLE 1. Primer sequences for real-time RT-PCR
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Statistical analysis. Experiments were repeated three to five times as indicated below. The statistical significance between groups was analyzed by using the nonparametric Mann-Whitney U test. Differences were considered statistically significant when the P value was equal to or less than 0.05.
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FIG. 1. MyD88 deficiency does not cause increased arthritis or carditis in B. burgdorferi-infected mice. MyD88/ and MyD88+/+ mice were infected with B. burgdorferi as described in Materials and Methods and were sacrificed 2 weeks after infection. Representative HE-stained sections of joints (A to D) and heart (E and F) of both wild-type (A, B, and E) and MyD88/ (knockout) (C, D, and F) mice are shown. B and D are the magnified pictures of the boxed areas of A and B, respectively. The insets are the magnified views of the areas in the boxes.
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TABLE 2. Pathology of MyD88-deficient mice infected with B. burgdorferia
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In the muscle, inflammation was greatest in interfasicular areas and localized around vascular and neuronal sheaths (Fig. 2). Vasculitis and neuritis is seen in human Lyme disease but has been uncommonly reported in infection of mice. Again, similar to joint tissues, infiltrates were mixed, with a slight predominance of neutrophils compared with mononuclear cells. Inflammation in the kidneys was seen as glomerulonephritis. Cellular thickening of interstitial spaces and perivascular inflammatory infiltrates were also seen (Fig. 2). Inflammation of the pancreas was primarily periductal (Fig. 2). Inflammation in the lungs showed significantly high perivascular cellular infiltration with thickening of the interstitial space (Fig. 2). The inflammation in all tissue started to appear at 2 weeks but peaked at 3 weeks postinfection (data not shown).
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FIG. 2. MyD88 deficiency results in the B. burgdorferi infection-induced development of myositis, glomerulonephritis, alveolitis, and pancreatitis. MyD88/ and MyD88+/+ mice were infected with B. burgdorferi as described in Materials and Methods and were sacrificed 3 weeks after infection. Representative HE-stained sections of muscle (A and B), kidney (C and D), lungs (E and F), and pancreas (G and H) of both MyD88/ mice (A, C, E, and G) and wild-type littermate MyD88 control mice (B, D, F, and H) are shown. The insets are the magnified views of the areas in the boxes.
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FIG. 3. B. burgdorferi-infected MyD88/ mice have higher bacterial loads in all inflamed organs. MyD88/ and MyD88+/+ mice were infected with B. burgdorferi as described in Materials and Methods and sacrificed 3 weeks after infection. DNA was isolated from joint, muscle, and kidney tissues and processed to quantitate B. burgdorferi DNA levels using real-time RT-PCR for a single-copy B. burgdorferi gene, recA. Numbers represent copies of B. burgdorferi recA normalized to the weight of tissue used to isolate DNA. Ten mice each were used for studies of wild-type (WT) and MyD88/ (knockout [KO]) joints and muscle tissue; five mice each were used for studies of kidney tissue. ***P < 0.001; **P < 0.01.
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), tumor necrosis factor alpha (TNF-
), and IL-12p40; we also examined expression of the anti-inflammatory cytokine IL-10. IFN-
was significantly elevated in both muscle (P = 0.006) and kidney (P = 0.025) but not in joint (P = 0.273) in B. burgdorferi-infected MyD88/ mice compared to MyD88+/+ controls (Fig. 4). The expression of IL-10 and TNF-
in B. burgdorferi-infected MyD88/ muscle showed a trend towards elevation compared to MyD88+/+ littermates but did not reach significance. This appeared to be due to a single outlier wild-type mouse, which showed elevations in all of these cytokines. When this mouse is removed from the analysis, both IL-10 and TNF-
were significantly higher in the B. burgdorferi-infected MyD88/ muscle than in MyD88+/+ muscle. TNF-
(P = 0.024) and IL-12p40 (P = 0.025) but not IL-12p35 (P = 0.456) levels were significantly elevated in B. burgdorferi-infected MyD88/ mouse kidneys compared to those of wild-type controls (Fig. 4B). Again, expression of IL-10 showed a trend towards an increase in MyD88/ mouse kidneys but did not reach significance (P = 0.051). No differences in IL-10 (P = 0.917), TNF-
(P = 0.251), IL-12p40 (P = 0.14), and IL-12p35 (P = 0.647) were seen in joint tissues (Fig. 4C). Granulocyte macrophage colony-stimulating factor (GM-CSF) expression was also induced significantly in B. burgdorferi-infected muscle (P = 0.022) but not in kidneys (p = 0.053) or joint tissue (P = 0.2) of MyD88/ mice.
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FIG. 4. MyD88 deficiency alters B. burgdorferi-induced proinflammatory cytokine expression patterns. MyD88/ (knockout [KO]) and MyD88+/+ (wild-type [WT]) mice were injected with B. burgdorferi (Bb) or sham as described in Materials and Methods and sacrificed 2 weeks after infection. Total RNA was extracted from the muscle (A), kidney (B), and joint (cartilage) (C), and expression of IFN- , IL-10, TNF- , IL-12p40, IL-12p35, and GM-CSF was examined by real-time RT-PCR. P values at the top of individual graphs are comparisons between infected wild-type and knockout mice. The scales on the y axis are different for each individual graph. ICAM-1, intercellular adhesion molecule 1.
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(MIP-1
), MIP-1ß, monocyte chemoattractant protein 1 (MCP-1), and RANTES (Fig. 5). All of the neutrophil and monocyte/lymphocyte chemoattractants tested in muscle tissue were elevated in B. burgdorferi-infected MyD88/ mice compared with wild-type littermates (CXCL-1, P = 0.028; CXCL-2, P = 0.007; MIP-1
, P = 0.006, MIP-1ß, P = 0.006; MCP-1, P = 0.006; RANTES, P = 0.01) (Fig. 5). In kidney, CXCL-2 (P = 0.025), MCP-1 (P = 0.025), and RANTES (P = 0.025) were significantly elevated in B. burgdorferi-infected MyD88/ mice compared to kidneys from MyD88+/+ mice (Fig. 6). There was no significant change in expression of CXCL-1 (P = 0.655) and MIP-1
(P = 456) in kidney tissue of MyD88/ and wild-type mice. Expression of MIP-1ß was undetectable in kidneys from both MyD88/ and wild-type mice. In joint tissue, where inflammation was seen in response to B. burgdorferi infection but only small differences were seen between MyD88/ and wild-type mice, only RANTES (P = 0.006) was significantly elevated in B. burgdorferi-infected MyD88/ mice compared to wild-type mice, whereas CXCL-1 (P = 0.01) was significantly elevated in B. burgdorferi-infected wild-type mice compared to MyD88/ mice (Fig. 5). CXCL-2, MIP-1
, MIP-1ß, and MCP-1 were all similarly induced in MyD88/ and wild-type animals (Fig. 5). These data confirm that differences in inflammation in muscle and kidney tissues of MyD88/ mice compared with the lack of difference in inflammation in joint tissues are the result of changes in the induction of chemotactic chemokines and inflammatory cytokines.
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FIG. 5. MyD88 deficiency alters B. burgdorferi-induced proinflammatory chemokine expression patterns. MyD88/ (knockout [KO]) and MyD88+/+ (wild-type [WT]) mice were injected with B. burgdorferi (Bb) or sham as described in Materials and Methods and sacrificed 3 weeks after infection. Total RNA was extracted from the muscle (A), kidney (B), and joint (cartilage) (C), and expression of CXCL-1, CXCL-2, MIP-1 , MIP-1ß, MCP-1, and RANTES was examined by real-time RT-PCR. P values at the top of individual graphs represent comparisons between infected wild-type and knockout mice. The scales on the y axis are different for each individual graph.
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FIG. 6. B. burgdorferi-infected mice develop arthritis and carditis in the absence of IL-18. IL-18/ mice and their wild-type littermates (IL-18+/+) were infected with B. burgdorferi as described in Materials and Methods and sacrificed 3 weeks after infection, and their joints and hearts were processed for either histology or DNA isolation. Representative HE-stained sections of joints (A to D) and heart (E and F) of both wild-type (A, B, and E) and IL-18/ (knockout) (C, D, and F) mice are shown. B and D are the magnified pictures of the boxed areas of A and B, respectively. The insets are the magnified views of the areas in the boxes. (G) DNA was isolated from joints of IL-18/ (n = 6) and wild-type (n = 5) mice and processed to quantitate B. burgdorferi DNA levels using real-time RT-PCR for a single-copy B. burgdorferi gene, recA. Numbers represent copies of B. burgdorferi recA normalized to the weight of tissue used to isolate DNA.
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TABLE 3. Pathology of IL-18-deficient mice infected with B. burgdorferia
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Although prior publications have differed on changes in joint inflammation with the MyD88 deficiency, taken together, the three studies suggest only a mild difference, if any, in joint inflammation between wild-type and knockout mice. In the study by Bolz et al., there was an increase in joint inflammation reported, but this was a small effect of less than 1.5 histologic grades (on a scale of 0 to 5) (8); in the study by Liu et al. (24), there was no difference in histologic inflammation in the joint, and we did not see any difference in joint inflammation between MyD88/ and wild-type mice. These small differences between the studies may be due to the timing of the examination, ages of the mice, or differences in the origin of the mice used (the mice used in our study were of a background identical to that used by Bolz et al. [8]), but overall, our assessment is that there is not a large difference in histologic joint inflammation.
The similarities in joint inflammation in MyD88/ and wild-type mice are supported by our examination of inflammatory cytokines and chemokines in the different tissues. Of the 13 cytokines, chemokines, and adhesion molecules we examined, only CXCL-1 and RANTES were increased in the joints of MyD88/ mice compared with wild-type mice, whereas in tissues showing greatly increased inflammation, such as muscle, the majority of inflammatory chemokines and cytokines were significantly elevated.
It is curious that increases in cytokine/chemokine expression and inflammation in MyD88/ mice compared with littermate controls are not seen in tissues that are most commonly affected in B. burgdorferi infection of mice (the heart and the joints) but instead are seen in typically uninvolved tissues such as muscle. One possible explanation for this is that spirochete numbers were greatly increased in the MyD88/ mice and that the presence of such unusually high numbers of organisms resulted in the activation of inflammatory pathways that are typically not turned on when fewer organisms are present. However, this alone cannot explain the differences between the tissues since the spirochete numbers in joints (where there was no increase in inflammation) and muscle (where there is a significant increase in inflammation) were similar. It is possible that inflammation in cardiac and joint tissue is already maximized in wild-type mice and that the addition of more spirochetes does not result in increases in inflammation compared with muscle and other tissues, where inflammation is typically low. Another possibility is that despite their in vitro role in activating NF
B and inducing inflammatory cytokines, in vivo TLR signaling may, on balance, activate pathways that suppress inflammation. Certain pathogens use TLR-based strategies to evade host defenses. Yersinia enterocolitica and Candida albicans induce immune suppression through TLR-2-mediated IL-10 release, and TLR-2-deficient mice are more resistant to lethal Yersinia and Candida infections (7, 28, 34). In Lyme arthritis, IL-10 has been shown to mediate reductions in joint inflammation, but this reduction is accompanied by an increase in spirochete burden (9). IL-10 levels in response to B. burgdorferi infection do not appear to be decreased in MyD88 knockout mice, so it is less likely that increases in inflammation are due to a loss of IL-10-mediated suppression. Oral administration of CpG oligodeoxynucleotide, the ligand for TLR-9, ameliorates inflammation in several animal models of colitis (31). B. burgdorferi DNA does contain CpG, and MyD88/ mice would be expected to lose signaling through TLR-9. Whether the increase in inflammation in MyD88/ mice is due to the loss of signaling through TLR-9 has not been tested.
IL-18 is an important mediator of both innate and adaptive immune responses and has been shown to play a role in Lyme neuroborreliosis and rheumatoid arthritis (11, 15, 16, 23, 26, 29). MyD88 is an adaptor molecule for the IL-18 receptor signaling pathway (21). IL-18 is expressed in the rheumatoid arthritis synovial membrane in macrophages, which correlates with TNF-
and IL-1ß expression and disease severity (20). IL-18-deficient mice exhibit reduced incidence and severity of collagen-induced arthritis (5, 30), and IL-18 neutralization ameliorates streptococcus-induced arthritis (41). Thus, IL-18 is an important molecule for the development of arthritis. However, our results showed that the spirochetal load and inflammation pattern observed in the various tissues of IL-18/ and IL-18+/+ mice were indistinguishable, indicating that IL-18-dependent signaling does not account for the inflammation observed in different tissues in MyD88-deficient mice.
In summary, we have shown that a deficiency of MyD88/ results in increased inflammation in tissues not typically severely affected by B. burgdorferi such as muscle and kidney, but deficiency does not appear to affect inflammation in more typically affected tissues such as the joints and heart. The mechanism for the increased inflammation appears to be through increases in the expression of inflammatory cytokines and chemokines in the muscle and kidney tissues that are not seen in joint tissue. The MyD88-independent signaling pathways that are responsible for the induction of these inflammatory mediators remain unknown and are the focus of intense investigation.
This work was supported by grants from the National Institutes of Health, R01AI44240 (L.T.H.), R01 AI50043 (L.T.H), and U01AI058266 (L.T.H.); the American Lung Association (A.K.B.); the Earle P. Charlton Research fund (A.K.B.); and the Natalie V. Zucker Research Grant (A.K.B.).
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