INTRODUCTION
The intracellular bacterium
Coxiella burnetii is the etiological agent of Q fever, a zoonotic infectious disease. Initially, Q fever manifests as an acute self-limited flu-like illness. However, patients can develop chronic disease that can be life threatening due to serious clinical manifestations, such as endocarditis (
1). Furthermore, the current therapy recommended for chronic Q fever requires at least 18 months of doxycycline and hydroxychloroquine treatment (
2). An effective vaccine (Q-Vax) has been developed for humans but is currently licensed only in Australia due to adverse effects, especially when administered to previously infected populations (
3). In addition, Q fever outbreaks have occurred in several countries, including the Netherlands (
4), the United States (
5), Spain (
6), Australia (
7), Japan (
8), and Israel (
9), exemplifying how expansive
C. burnetii infection is worldwide and the need for novel therapeutic targets.
Human infection occurs primarily by inhaling contaminated dust or aerosols, often from close contact with livestock. In the lungs,
C. burnetii displays tropism for alveolar macrophages, where it forms a phagolysosome-like parasitophorous vacuole (PV) necessary to support bacterial growth (
10,
11).
C. burnetii's ability to survive and replicate inside the PV, an inhospitable environment for most bacteria, is a unique feature essential for
C. burnetii pathogenesis.
C. burnetii exploits the acidic PV pH for metabolic activation (
12) and actively manipulates PV fusogenicity and maintenance (
13). PV establishment requires the translocation of bacterial proteins into the host cell cytoplasm by the
C. burnetii Dot/Icm (defect in organelle trafficking/intracellular multiplication) type IVB secretion system (T4BSS), closely related to the Dot/Icm T4BSS of
Legionella pneumophila (
14). T4BSS effector proteins manipulate not only host vesicular trafficking during PV development but also other cellular processes, such as lipid metabolism, host gene expression, apoptosis, host translation, iron transport, ubiquitination, autophagy, and immunity (
15,
16). Based on
in silico prediction, there are more than 100 putative
C. burnetii T4BSS effector proteins (
17–19), but functional data are lacking for the majority of these proteins. In particular, the role of T4BSS effector proteins in manipulating the innate immune response is poorly understood. Recently, the
C. burnetii T4BSS effector protein IcaA was found to inhibit caspase 11-mediated, noncanonical activation of the nucleotide binding domain and the leucine-rich repeat-containing protein (NLRP3) inflammasome during
C. burnetii infection (
20). Since cytosolic lipopolysaccharide (LPS) is known to activate noncanonical inflammasomes (
21,
22), it is possible that
C. burnetii LPS triggers this pathway and that the bacterium utilizes T4BSS effectors, such as IcaA, to block this innate immune response. Given the low infectious dose (<10 organisms) (
23),
C. burnetii certainly inhibits several immediate host cell responses in order to establish infection.
In order to identify new immune response pathways manipulated by
C. burnetii T4BSS effector proteins, we compared the transcriptome of alveolar macrophages infected with wild-type (WT) or T4BSS mutant
C. burnetii. We identified a set of inflammatory genes downregulated by
C. burnetii T4BSS effector proteins, with the interleukin-17 (IL-17) signaling pathway being one of the top targeted host cell pathways. As IL-17 is a proinflammatory cytokine that plays a role in the protective response against a variety of bacterial infections, including those caused by the pulmonary intracellular pathogens
Mycoplasma pneumonia,
Mycobacterium tuberculosis,
Francisella tularensis, and
Legionella pneumophila (
24–27), we further investigated the role of IL-17 during
C. burnetii infection. Our data revealed that stimulation of the macrophage IL-17 signaling pathway leads to
C. burnetii killing in a dose-dependent manner, with the T4BSS mutant displaying increased sensitivity compared to WT bacteria. Finally, our findings demonstrate that
C. burnetii downregulates the IL-17 signaling pathway in macrophages through T4BSS effector proteins.
DISCUSSION
The innate immune response relies on pathogen detection by pattern recognition receptors, which activate signaling pathways and trigger an inflammatory response (
46). While the innate immune response is essential to protect the host, pathogens such as
C. burnetii have evolved strategies to overcome the host innate immune response (
47,
48). Despite being sequestered in a growth-permissive vacuole,
C. burnetii T4BSS effector proteins manipulate a variety of host cell signaling processes, including the innate immune responses of inflammasome-mediated pyroptotic and apoptotic cell death (
20,
49–51). To identify potential targets of
C. burnetii T4BSS effector proteins, we compared the transcriptomes of murine alveolar macrophages infected with either WT or T4BSS mutant
C. burnetii. We identified several inflammatory pathways downregulated by
C. burnetii T4BSS effector proteins, including IL-17 signaling. Previous studies demonstrated that IL-17 plays a protective role against several pathogens, including
L. pneumophila, the closest pathogenic relative of
C. burnetii (
25–27,
41,
42). We found that
C. burnetii downregulates the macrophage IL-17 signaling pathway in a T4BSS-dependent manner, protecting the bacteria from IL-17-mediated killing by the macrophage and blocking the secretion of proinflammatory chemokines. To our knowledge, this is the first demonstration of a pathogenic bacterium directly downregulating intracellular macrophage IL-17 signaling.
Previous studies demonstrated that
C. burnetii infection leads to secretion of the proinflammatory cytokines tumor necrosis factor alpha (TNF-α) and gamma interferon (IFN-γ), with both cytokines playing critical roles in restricting
C. burnetii replication (
52–54). In our studies, gene expression analysis during the early stages of infection revealed striking differences in the immunological response to WT and T4BSS mutant
C. burnetii, with
C. burnetii T4BSS mutant-infected macrophages having a stronger proinflammatory response. For example, the proinflammatory genes
Il1a,
Il1b, and
Tnfa are expressed at higher levels in macrophages infected with T4BSS mutant
C. burnetii than in WT-infected macrophages. Bacterium-driven downregulation of these and other proinflammatory cytokines would benefit the bacteria in establishing infection. In support of our data,
C. burnetii infection of primary macrophages does not activate caspase 1 (
20), an enzyme required for the production of the proinflammatory cytokines IL-1β and IL-1α (
55,
56). Interestingly,
C. burnetii does not directly inhibit caspase 1 activation but appears to interfere with upstream signaling events, including blocking TNF-α signaling (
20,
57). However, a recent study did not detect significant differences in TNF-α production in murine bone marrow-derived macrophages infected with WT
C. burnetii or
icmL mutant
C. burnetii, a mutant with a nonfunctional T4BSS (
31). These apparently conflicting data may be explained by the use of C57BL/6 mice in the latter study; C57BL/6 mice, in contrast to other inbred mouse strains, are not permissive for intracellular
C. burnetii replication due to the large amount of TNF-α produced upon Toll-like receptor (TLR) stimulation (
31,
58–60). Further experimentation is required to elucidate the mechanism(s) behind
C. burnetii T4BSS-mediated downregulation of the macrophage proinflammatory response.
Pathogen-associated molecular patterns (PAMPs) are sensed by different PRRs, which activate IRFs and initiate key inflammatory responses, including the transcription of type I interferons (IFN) and IFN-inducible genes (
61,
62). Type I IFN can be induced by many intracellular bacterial pathogens either via recognition of bacterial surface molecules, such as LPS, or through stimulatory ligands released by the bacteria via specialized bacterial secretion systems (
63). Our transcriptome analysis revealed
C. burnetii T4BSS-mediated downregulation of macrophage IRF activation by cytosolic and transmembrane PRRs. A recent study found that
C. burnetii does not trigger cytosolic PRRs or induce robust type I IFN production in mouse macrophages (
31). Additionally, IFN-α receptor-deficient (IFNAR
−/−) mice were protected from
C. burnetii infection, suggesting that type I IFNs are not required to restrict bacterial replication (
31,
64). However, delivery of recombinant IFN-α to the lungs of
C. burnetii-infected mice protected against bacterial replication, revealing a potential role of type I IFN in the control of
C. burnetii infection in the lung (
64). Interestingly, type I IFN is induced during
L. pneumophila infection and plays a key role in macrophage defense by restricting intracellular bacterial replication (
65,
66). However, to counteract this host immune response, the
L. pneumophila type IV secretion system (T4SS) effector protein SdhA suppresses the induction of IFN through an unknown mechanism (
67). Similarly, our data suggest that
C. burnetii T4BSS effector proteins negatively modulate the type I IFN response in alveolar macrophages, most likely as a bacterial immune evasion mechanism.
In addition to proinflammatory cytokines and PRRs, we discovered an important role for the cytokine IL-17 during
C. burnetii infection of macrophages. The protective role of IL-17 against extracellular bacteria has been extensively studied; additionally, IL-17 can be critical for the full immune response leading to the control of intracellular bacteria (
32,
42,
43,
68). IL-17 is produced by T helper 17 (Th17) cells, γδ T cells, and invariant natural killer T (iNKT) cells (
69). In the lung, γδ T cells have been implicated as a primary source of early IL-17 production in several
in vivo models of infection (
70), which may have implications for
C. burnetii lung infection. Exogenous IL-17 binds the IL-17 receptor on the surface of the macrophage, triggering chemokine secretion, neutrophil recruitment, and a Th1 response, thus enhancing bacterial clearance (
26,
27,
71,
72). By both gene expression and protein analysis, we found that
C. burnetii downregulates IL-17-stimulated chemokine secretion in macrophages in a T4BSS-dependent manner. A previous study found that following
C. burnetii aerosol infection in mice, neutrophils are not present in the airways until 7 days postinfection, though the mechanism of this delay remains unknown (
73). Further, neutrophils play a critical role in inflammation and bacterial clearance following intranasal
C. burnetii infection, but it is unknown whether neutrophils directly kill the bacteria or serve to enhance the immune response (
74). Based on our findings in alveolar macrophages, we hypothesize that
C. burnetii T4BSS effector proteins downregulate the IL-17 pathway to suppress chemokine secretion as a mechanism to avoid neutrophil recruitment at early stages of infection. This could be an important immune evasion strategy that enables the bacteria to establish long-term persistence. In addition to chemokines, the IL-17-stimulated protein LCN2 may also be downregulated by
C. burnetii. LCN2 is a siderophore-binding antimicrobial protein that can limit bacterial growth by iron restriction.
A previous study demonstrated that
C. burnetii-infected IL-17 receptor knockout mice had a bacterial burden in the spleen and lung similar to that in infected WT mice, suggesting that IL-17 does not play an essential role during
C. burnetii infection (
74). In contrast, our
in vitro studies revealed that activating the IL-17 signaling pathway in macrophages can directly kill intracellular
C. burnetii. Further, the
C. burnetii T4BSS appears to play a protective role, presumably by blocking the intracellular signaling pathway triggered by IL-17 binding to IL-17R. Our data may explain the lack of phenotypic changes in IL-17 receptor knockout mice infected by WT
C. burnetii, as the intracellular signaling pathway is not activated in the absence of the IL-17 receptor.
During acute
C. burnetii infection in humans, the number of γδ T cells rises significantly in the peripheral blood of patients (
75). Given that γδ T cells can secrete large amounts of IL-17 (
76), it is possible that the downregulation of intracellular IL-17 signaling by T4BSS effector proteins might be an essential mechanism of immune evasion that allows
C. burnetii persistence. IL-17 activates common downstream pathways in macrophages, including the nuclear factor κB (NF-κB) and mitogen-activated protein kinase (MAPK) pathways (
77,
78). Our transcriptome data suggest that the
C. burnetii T4BSS downregulates the genes involved in the IL-17 canonical NF-κB signaling pathway, including
Il17ra,
Il17rc,
Traf6,
Nfkb1, and
Nfkb2. This hypothesis is consistent with a recent study that found that
C. burnetii can modulate the NF-κB canonical pathway through the T4BSS (
79). NF-κB activation correlates with enhanced expression of inducible nitric oxide synthase (iNOS) (
80) and NADPH oxidase (NOX) (
81), which generate nitric oxide (NO) and reactive oxygen species (ROS), respectively. Both NO and ROS are signature molecules for M1 macrophages (
82), while
C. burnetii-infected macrophages exhibit an M2 polarization that is unable to control bacterial replication (
83). As IL-17 alters macrophage polarization (
84), one potential mechanism is that IL-17 polarizes toward the M1 phenotype, triggering ROS and NO, leading to
C. burnetii killing. In addition, as IFN-γ plays a clear role in
C. burnetii killing (
53,
54), the IL-17 bactericidal effect might be related to IFN-γ, as IL-17 can induce an IFN-γ response (
85). Further experimentation is needed to identify not only the
C. burnetii T4BSS effector protein modulating IL-17 signaling in macrophages but also how IL-17 leads to
C. burnetii death inside macrophages.
In summary, this study suggests that C. burnetii employs the T4BSS to downregulate IL-17 signaling in macrophages during the early stages of infection. This has important implications in both controlling the proinflammatory response elicited by the macrophages and avoiding direct killing by the macrophage. Further studies identifying the bacterial T4BSS effector proteins involved in this mechanism and elucidating how IL-17 kills C. burnetii will give new insight into immune evasion by C. burnetii.