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Infection and Immunity, May 2007, p. 2638-2641, Vol. 75, No. 5
0019-9567/07/$08.00+0 doi:10.1128/IAI.01320-06
Copyright © 2007, American Society for Microbiology. All Rights Reserved.
Enhancement of Macrophage Stimulation by Lipoteichoic Acid and the Costimulant Hemoglobin Is Dependent on Toll-Like Receptors 2 and 4
Kathleen H. Cox,1
Itzhak Ofek,2 and
David L. Hasty1,3*
Department of Anatomy and Neurobiology, University of Tennessee Health Science Center, 800 Madison Avenue, Memphis, Tennessee 38163,1
Department of Human Microbiology, Tel Aviv University, Tel Aviv 69978, Israel,2
Research Service (151), Department of Veterans Affairs Medical Center, 1030 Jefferson Avenue, Memphis, Tennessee 381043
Received 16 August 2006/
Returned for modification 14 November 2006/
Accepted 2 February 2007

ABSTRACT
Macrophage stimulation by lipoteichoic acid (LTA) and hemoglobin
(Hb) requires Toll-like receptors 2 and 4 (TLR2 and -4). There
are two distinct temporal phases of interleukin-6 (IL-6) production.
The first results in a slight enhancement of IL-6 secretion
in response to LTA plus Hb compared to that with LTA alone and
is TLR4 independent. The second requires TLR4 and accounts for
most of the additional stimulation seen with LTA plus Hb.

TEXT
It has been argued that lipoteichoic acid (LTA) is the gram-positive
counterpart of lipopolysaccharide (LPS) in inducing host responses
to infection, including septic shock (
6). This concept is based
in part on the fact that both molecules stimulate macrophages
to secrete proinflammatory cytokines, albeit via different macrophage
receptors and signaling pathways (
1). It is generally accepted
that most kinds of LPS act exclusively through Toll-like receptor
4 (TLR4) (
3,
13) and that LTAs activate macrophages through
TLR2 (
11,
14,
15,
21). Recently, we showed that stimulation
of human monocytes and murine macrophages by LTA is markedly
enhanced by a costimulatory molecule, namely, hemoglobin (Hb)
(
7). Hb appeared to form complexes with LTA, which may be responsible
for the enhanced activity. In the present study, we found that
the enhanced cytokine secretion obtained when macrophages are
incubated with LTA-Hb mixtures can be divided into two temporal
phases which are dependent upon not only TLR2 but also TLR4.
Wild-type TLR4 (HeNC2) and TLR4 mutant (GG2EE) macrophage cell lines, derived from C3H/HeN and C3H/HeJ mice, respectively (4, 8), were used in most of the studies presented here. For incubation with test substances, 2.5 x 105 cells were seeded into 24-well plates in macrophage SFM medium (Invitrogen Life Technologies), and after 2 h, the medium was replaced with fresh medium containing test substances at the concentrations indicated. After incubation at 37°C in a humidified 5% CO2 incubator for the times indicated in the figures, medium samples were removed from triplicate wells and centrifuged to remove detached cells or cellular debris, and supernatants were stored at 80°C until assay by enzyme-linked immunosorbent assay (ELISA) (for interleukin-6 [IL-6] and tumor necrosis factor alpha [TNF-
]; eBioscience). In some experiments, resident peritoneal macrophages from TLR4 mutant (C3H/HeJ) and TLR2/ (B6.129-Tlr2tm1Kir/J; Jackson Laboratory) mice, along with their appropriate wild-type controls (cells from C3H/HeOuJ and C57BL/6J mice, respectively), were used as described previously (7). LTA was purified as described previously (7), and Hb was purchased from Sigma Chemical Co. (St. Louis, MO). The level of endotoxin was determined using the QCL-1000 quantitative chromogenic Limulus amoebocyte lysate assay according to the manufacturer's directions (Bio-Whittaker). In our experiments with LTA, we ruled out the possibility that trace contamination with endotoxin accounted for the responses observed in several different ways. First, the concentrations of LPS detected in our LTA preparations were <4 pg/ml in the test solutions. LPS at such concentrations did not cause secretion of IL-6, with or without the addition of Hb (data not shown). Secondly, polymyxin B (5 µg/ml), a known inhibitor of LPS activity, was added to all stimulation assays, except for the wells testing LPS. All experiments contained unstimulated and Hb-only controls, but since IL-6 was never produced at detectable levels (>10 pg/ml) under these conditions in any of our experiments, these data are not included in the figures.
LTA induced secretion of IL-6 from the wild-type, i.e., HeNC2, macrophage cell line, and this response was potentiated >4-fold by Hb (Fig. 1). As expected, the TLR4 mutant macrophage cell line GG2EE, in which all other TLRs are functional, secreted similar levels of IL-6 when induced by LTA. Surprisingly, this macrophage cell line lacking functional TLR4 could not respond to stimulation by LTA-Hb to the same level as that in wild-type cells (i.e., enhancement was <1.5-fold). The level of alanylation of LTA does not play a role here, since macrophages responded similarly to D-Ala-rich (LTA) and D-Ala-poor (dLTA) LTAs from wild-type and dltA mutant Streptococcus pyogenes, respectively (7). Furthermore, Hb increased the response to LPS in wild-type macrophages (<2-fold), as shown previously. However, neither LPS nor LPS-Hb mixtures could induce macrophages with mutant TLR4.
To confirm the results obtained with the macrophage cell lines,
we tested resident peritoneal macrophages from C3H/HeOuJ (i.e.,
wild-type TLR4) and C3H/HeJ (i.e., TLR4 mutant) mice. The results
show that there was little enhancement of stimulation by LTA-Hb
mixtures in TLR4 mutant macrophages. This is consistent with
the data in Fig.
1 and demonstrates that the dependence upon
TLR4 for potentiation of cytokine induction by LTA and Hb is
not restricted to the macrophage cell line (Fig.
2A). While
the response trends were the same between cell lines and resident
peritoneal macrophages, there was a notable difference in the
level of responses to the various stimuli. At this time, the
reason for this quantitative variation is unknown.
To determine the role of TLR2 in responding to stimulation by
LTA and Hb, resident peritoneal macrophages from TLR2-deficient
mice and control mice were stimulated by LTA, with or without
Hb. Stimulation by LTA alone was TLR2 dependent (Fig.
2B), consistent
with data from other laboratories (
3,
15). Stimulation with
LTA-Hb mixtures demonstrated that while this response is largely
dependent on TLR2, a low level (<15%) is TLR2 independent.
The requirement for TLR2 in this signaling pathway was further
confirmed in experiments employing an inhibitory antibody against
TLR2 (TLR2.5; Bioscience). Figure
3 shows that this antibody
inhibited stimulation by LTA completely and stimulation by LTA-Hb
mixtures by 85% compared to an isotype-matched control antibody.
In addition, macrophages without functional TLR2 or TLR4 (i.e.,
TLR4-negative cells to which anti-TLR2 antibody was added) did
not secrete IL-6 at a detectable level after stimulation by
LTA or LTA-Hb mixtures, thus showing that whatever signaling
pathways may be involved in this stimulation, all require TLR2
and TLR4.
TLR2 and TLR4 have never been linked in a response to LTA induction.
To begin to define how these receptors are stimulated, we examined
the temporal responses to LTA and LTA-Hb in macrophage cell
lines expressing either wild-type or mutant TLR4. The data in
Fig.
4 show that the response to LTA-Hb can be divided into
two phases. Detectable IL-6 secretion was first observed 2 hours
after exposure of macrophages to LTA or LTA-Hb (data not shown).
Until 6 h poststimulation, the response to LTA and Hb is TLR4
independent (Fig.
4A) and is potentiated twofold compared to
stimulation with LTA alone (i.e., the ratio of responses was
about twofold, regardless of whether wild-type or TLR4 mutant
cells were assayed). Between 6 and 8 h, a second phase begins
that is TLR4 dependent and that results in a sevenfold enhancement
of IL-6 secretion when Hb is added as a costimulant with LTA
at the 20-h time point (Fig.
4A). Secretion of TNF-

follows
a similar temporal pattern (Fig.
4B), although the difference
between wild-type cells and TLR4 mutant cells was not as great
at the 20-h time point.
The results in this paper show for the first time that there
is a requirement for both TLR2 and TLR4 in the innate immune
response to LTA when it is presented to macrophages along with
the endogenous host protein Hb. The late requirement for TLR4,
several hours after a TLR2-mediated response is initiated, suggests
that this signaling pathway requires a second ligand. The nature
of this second ligand is unknown, but the experiments in this
study suggest that generation by, modification by, or some type
of interaction with a product(s) from the initial TLR4-independent
reaction may be required, as seen by Paul-Clark et al. (
12).
They showed that after TLR2 activation by gram-positive bacteria,
expression of TNF-

was required for subsequent release of nitric
oxide. An alternative explanation is that LTA-Hb mixtures contain
or generate a ligand for a TLR2/TLR4 heterodimer. The potential
for dimerization between these TLR family members was demonstrated
by Lee et al. (
10), but to date, no ligand for a TLR2/TLR4 dimer
has been identified.
The experiments described here have examined LTA-macrophage interactions in vitro. For the response to occur in vivo, LTA would have to come into contact with free Hb (or methemoglobin) within the host. Free Hb and heme are normally found at low levels except during pathological conditions that result in hemolysis (5). Streptococcus pyogenes secretes two potent hemolysins, streptolysin O and streptolysin S (2). Although streptolysin O can function independently, streptolysin S requires a carrier to stabilize it in a functional form (19). One of the carriers identified by previous investigators is LTA (18). Such an LTA-streptolysin S complex may place LTA in a position to be exposed to microenvironments rich in Hb before other host components, such as haptoglobin, can sequester it.
It is not clear how LTA may be involved in gram-positive shock, but a number of studies accumulated over the last decade suggest that LTA is capable of inducing a strong cytokine response in combination with one or more host-derived or bacterial components. Indeed, peptidoglycan and LTA were shown to induce multiple organ failure and shock in experimental animals (9). Moreover, Hb was shown to markedly enhance the ability of LPS to cause mortality in rabbits (20) and mice (16, 17). The potentiation of the inflammatory activity of LTA by Hb or other macromolecules of either host or bacterial origin that are present as a result of host cell lysis, polymicrobial infections, or other pathogenic states could be the difference between the triggering of a protective innate immune response and the induction of tissue injury and shock. A thorough understanding of the interaction of LTA and costimulatory molecules may eventually help to explain how LTA contributes to shock or other serious sequelae of gram-positive infections.

ACKNOWLEDGMENTS
We acknowledge the technical excellence and dedication of Susan
Price. We thank Fabio Re for providing the macrophage-like cell
lines and Elaine Tuomanen for providing TLR2
/ cells. We thank H. S. Courtney, J. B. Dale, F. Re, and B. K.
English for carefully reading the manuscript and providing helpful
suggestions.
This work was supported by research funds from the U.S. Department of Veterans Affairs.

FOOTNOTES
* Corresponding author. Mailing address: Research Service (151), Department of Veterans Affairs Medical Center, 1030 Jefferson Avenue, Memphis, TN 38104. Phone: (901) 523-8990. Fax: (901) 577-7273. E-mail:
dhasty{at}utmem.edu 
Published ahead of print on 12 February 2007. 
Editor: V. J. DiRita

REFERENCES
1 - Akira, S., S. Uematsu, and O. Takeuchi. 2006. Pathogen recognition and innate immunity. Cell 124:783-801.[CrossRef][Medline]
2 - Bernheimer, A. W. 1972. Hemolysins of streptococci: characterization and effects on biological membranes, p. 19-31. In L. W. Wannamaker and J. M. Matson (ed.), Streptococci and streptococcal diseases. Academic Press, New York, NY.
3 - Beutler, B., X. Du, and A. Poltorak. 2001. Identification of Toll-like receptor 4 (Tlr4) as the sole conduit for LPS signal transduction: genetic and evolutionary studies. J. Endotoxin Res. 7:277-280.[CrossRef]
4 - Blasi, E., D. Radzioch, S. K. Durum, and L. Varesio. 1987. A murine macrophage cell line, immortalized by v-raf and v-myc oncogenes, exhibits normal macrophage functions. Eur. J. Immunol. 17:1491-1498.[Medline]
5 - Bunn, H. F., and B. G. Forget. 1986. Hemoglobin: molecular, genetic and clinical aspects. Saunders, Philadelphia, PA.
6 - Ginsburg, I. 2002. Role of lipoteichoic acid in infection and inflammation. Lancet Infect. Dis. 2:171-179.[CrossRef][Medline]
7 - Hasty, D. L., S. Meron-Sudai, K. H. Cox, T. Nagorna, E. Ruiz-Bustos, E. Losi, H. S. Courtney, E. A. Mahrous, R. Lee, and I. Ofek. 2006. Monocyte and macrophage activation by lipoteichoic acid is independent of alanine and is potentiated by hemoglobin. J. Immunol. 176:5567-5576.[Abstract/Free Full Text]
8 - Jin, F.-Y., C. Nathan, D. Radzioch, and A. Ding. 1997. Secretory leukocyte protease inhibitor: a macrophage product induced by and antagonistic to bacterial lipopolysaccharide. Cell 88:417-426.[CrossRef][Medline]
9 - Kengatharan, K. M., S. De Kimpe, C. Robson, S. J. Foster, and C. Thiemermann. 1998. Mechanism of gram-positive shock: identification of peptidoglycan and lipoteichoic acid moieties essential in the induction of nitric oxide synthase, shock, and multiple organ failure. J. Exp. Med. 188:305-315.[Abstract/Free Full Text]
10 - Lee, H.-K., S. Dunzendorfer, and P. S. Tobias. 2004. Cytoplasmic domain-mediated dimerization of Toll-like receptor 4 observed by beta-lactamase enzyme fragment complementation. J. Biol. Chem. 279:10564-10574.[Abstract/Free Full Text]
11 - Opitz, B., N. W. Schröder, I. Spreitzer, K. S. Michelsen, C. J. Kirschning, W. Hallatschek, U. Zahringer, T. Hartung, U. B. Gobel, and R. R. Schumann. 2001. Toll-like receptor-2 mediates Treponema glycolipid and lipoteichoic acid-induced NF-kappaB translocation. J. Biol. Chem. 276:22041-22047.[Abstract/Free Full Text]
12 - Paul-Clark, M. J., S. K. McMaster, E. Belcher, R. Sorrentino, J. Anandarajah, M. Fleet, S. Sriskandan, and J. Mitchell. 2006. Differential effects of gram-positive versus gram-negative bacteria on NOSII and TNF alpha in macrophages: role of TLRs in synergy between the two. Br. J. Pharmacol. 148:1067-1075.[CrossRef][Medline]
13 - Poltorak, A., X. He, I. Smirnova, M. Y. Liu, C. V. Huffel, X. Du, D. Birdwell, E. Alejos, M. Silva, C. Galanos, M. Freudenberg, P. Ricciardi-Castagnoli, B. Layton, and B. Beutler. 1998. Defective LPS signaling in C3H/HeJ and C57BL/10ScCr mice: mutations in the Tlr4 gene. Science 282:2085-2088.[Abstract/Free Full Text]
14 - Schröder, N. W., S. Morath, C. Alexander, L. Hamann, T. Hartung, U. Zahringer, U. B. Gobel, J. R. Weber, and R. R. Schumann. 2003. Lipoteichoic acid (LTA) of Streptococcus pneumoniae and Staphylococcus aureus activates immune cells via Toll-like receptor (TLR)-2, lipopolysaccharide-binding protein (LBP), and CD14, whereas TLR-4 and MD-2 are not involved. J. Biol. Chem. 278:15587-15594.[Abstract/Free Full Text]
15 - Schwandner, R., R. Dziarski, H. Wesche, M. Rothe, and C. J. Kirschning. 1999. Peptidoglycan- and lipoteichoic acid-induced cell activation is mediated by Toll-like receptor 2. J. Biol. Chem. 274:17406-17409.[Abstract/Free Full Text]
16 - Su, D., R. I. Roth, M. Yoshida, and J. Levin. 1997. Hemoglobin increases mortality from bacterial endotoxin. Infect. Immun. 65:1258-1266.[Abstract]
17 - Su, D., R. I. Roth, and J. Levin. 1999. Hemoglobin infusion augments the tumor necrosis factor response to bacterial endotoxin (lipopolysaccharide) in mice. Crit. Care Med. 27:771-778.[CrossRef][Medline]
18 - Theodore, T. S., and G. B. Calandra. 1981. Streptolysin S activation by lipoteichoic acid. Infect. Immun. 33:326-328.[Abstract/Free Full Text]
19 - Wessels, M. R. 2005. Streptolysin S. J. Infect. Dis. 192:13-15.[CrossRef][Medline]
20 - White, C. T., A. J. Murray, D. J. Smith, J. R. Greene, and R. B. Bolin. 1986. Synergistic toxicity of endotoxin and hemoglobin. J. Lab. Clin. Med. 108:132-137.[Medline]
21 - Yoshimura, A., E. Lien, R. R. Ingalls, E. Tuomanen, R. Dziarski, and D. Golenbock. 1999. Cutting edge: recognition of gram-positive bacterial cell wall components by the innate immune system occurs via Toll-like receptor 2. J. Immunol. 163:1-5.[Abstract/Free Full Text]
Infection and Immunity, May 2007, p. 2638-2641, Vol. 75, No. 5
0019-9567/07/$08.00+0 doi:10.1128/IAI.01320-06
Copyright © 2007, American Society for Microbiology. All Rights Reserved.
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