INTRODUCTION
Pneumonia kills more children under 5 years of age than any other disease worldwide, causing approximately 2 million deaths annually (
1), and probably even more in elderly as well as immunocompromised individuals.
Streptococcus pneumoniae is a leading cause of community-acquired pneumonia (CAP) (
2,
3). This bacterium alone caused an estimated 826,000 deaths and 14.5 million cases of serious illness globally in 2000 (
1). A better understanding of the bacterial interaction with the host, the antibacterial immune response, and individual risk factors might help in the development of novel preventive and/or therapeutic approaches to lower the high morbidity and mortality associated with
S. pneumoniae.
The interaction of
S. pneumoniae with the host usually starts with the asymptomatic colonization of the upper respiratory tract. Pneumonia only develops when pneumococci get access to the lower respiratory tract by aspiration and resist prompt elimination by the immune system (
2,
3). The innate immune system relies on so-called pattern recognition receptors (PRRs) expressed by macrophages, dendritic cells, and other pulmonary cells to sense infections (
4,
5). These PRRs include Toll-like receptors (TLRs), NOD-like receptors (NLRs), RIG-I-like receptors (RLRs), C-type lectin receptors (CLRs), and cytosolic DNA sensors (
4,
6,
7). Among those, TLR2, TLR9, NOD2, NLRP3, AIM2, and Mincle have been identified to mediate inflammatory responses and antibacterial defense during pneumococcal pneumonia (
8–18). In addition, we recently demonstrated that a STING-dependent cytosolic DNA-sensing pathway activates type I interferon (IFN) responses to
S. pneumoniae infection in murine macrophages (
19).
STING is both an adapter molecule mediating cytosolic DNA recognition and a direct receptor for the bacterial cyclic dinucleotides (CDNs) cyclic-di-AMP (c-di-AMP) and cyclic-di-GMP (c-di-GMP) (
20–23). In the STING-dependent cytosolic DNA sensing pathway, cyclic GMP-AMP (cGAMP) synthase (cGAS) has been identified as the primary receptor of microbial and endogenous DNA (
24). cGAS directly binds to double-stranded DNA (dsDNA) and subsequently catalyzes the production of the second messenger 2′3′-cGAMP, which in turn activates STING (
25).
Recent studies found that
TMEM173, the gene encoding STING, is polymorphic (
26,
27). The most common allele besides the wild-type (WT) allele
R232 is
HAQ TMEM173, which contains a haplotype comprised of three nonsynonymous single-nucleotide polymorphisms (SNPs), R71
H-G230
A-R293
Q. Ectopically expressed HAQ STING exhibited diminished capability to activate type I IFN production in response to endogenous and bacterial CDNs or
Listeria monocytogenes infection compared to that of WT STING (
26,
27). In contrast, the frequent
R232H SNP impairs activation by bacterial CDNs but not by endogenous 2′3′-cGAMP (
27,
28). In addition, rare gain-of-function mutations in
TMEM173 have been associated with autoinflammatory syndromes (
29,
30).
Here, we demonstrate that the cGAS/STING axis detects S. pneumoniae infection, and that this sensing is attenuated in cells of individuals carrying HAQ TMEM173 but not R232H TMEM173. Experiments in a mouse model of pneumococcal pneumonia as well as analyses aimed at elucidating a potential association between HAQ TMEM173 or R232H TMEM173 and pneumococcal pneumonia indicate, however, that the cGAS/STING pathway is largely dispensable for antipneumococcal defense in mice and humans.
DISCUSSION
Type I IFNs were discovered more than half a century ago as key antiviral mediators (
35) whose activity against viruses largely depends on the transcriptional induction of IFN-stimulated genes with direct antiviral activities (
36). In addition, increasing evidence obtained in recent years indicates that type I IFNs also play important roles in bacterial infections. They have been shown to induce the expression of proteins with antibacterial activity (
36,
37) and to regulate interleukin (
38) as well as chemokine (
39,
40) production. According to this pleiotropic function of type I IFNs, they have been demonstrated to be either beneficial or harmful for the host, probably depending on the pathogen and the mode of infection. In models of lung infections, for example, type I IFNs enhance host resistance to
Legionella pneumophila (
37,
41–43),
Chlamydia pneumoniae (
44), and
Pseudomonas aeruginosa (
45) but increase susceptibility to
Mycobacterium tuberculosis (
46) and
Staphylococcus aureus (
47). Several studies also reported that mice lacking receptors for type I IFNs exhibit impaired antibacterial defense against
S. pneumoniae in models of nasal carriage, pneumonia, and sepsis (
48–51), although other studies examining invasive serotype 1 strain (
52) or postinfluenza pneumococcal infections indicated that this cytokine family can also have detrimental effects for the host (
39,
40).
In this report, we show that production of type I IFNs during
S. pneumoniae infection depends on recognition of bacterial DNA by the cGAS/STING pathway, and that this pathway is dispensable for antibacterial defense during acute pneumococcal pneumonia in mice. Moreover, we show that expression of the hypomorphic HAQ variant of STING dramatically reduces
S. pneumoniae-induced type I IFN responses, but that it appears to have no major influence on the susceptibility of nonvaccinated individuals toward pneumococcal pneumonia or on disease severity. We speculate that the divergent effect of type I IFN versus STING deficiencies on pneumococcal infections can be explained by the capacity of cGAS/STING to also regulate the production of other mediators in addition to type I IFNs (
53,
54). Indeed, STING-dependent signaling has been shown to activate various transcription factors, such as IRF3, NF-κB, and STAT6 (
21,
53). STING deficiency might lead to a reduced production of unknown factors that impair antipneumococcal immunity, and this effect might compensate for the defect in type I IFN and IL-1β production. Moreover, human macrophages expressing HAQ STING were still able to produce small amounts of type I IFNs, which might be sufficient for mediating potentially protective effects on antibacterial immunity.
We did not find an association between carriage of
TMEM173 variants with pneumococcal pneumonia or severity of the disease in nonvaccinated patients. However, this might be different in vaccinated individuals, since STING has recently been indicated to affect B cell responses in mice (
55), and expression of a mouse equivalent of the HAQ allele reduced the efficacy of pneumococcal vaccination using Pneumovax 23 in mice (
31).
In
L. monocytogenes infection, sensing of bacterial c-di-AMP by STING has recently been shown to trigger type I IFN production (
56). Similar to
Listeria spp. and most other Gram-positive bacteria,
S. pneumoniae is able to produce c-di-AMP (
57). However, our data demonstrating that DNA sensing by cGAS is required for pneumococcus-induced type I IFN production suggest that recognition of c-di-AMP is dispensable for innate immune sensing of
S. pneumoniae. In line with this conclusion, cGAS-deficient cells exhibited decreased IFN induction in response to
S. pneumoniae infection. Additionally, cells carrying the
R232H allele, which has been reported to affect bacterial CDN recognition (
28), were fully capable of responding to
S. pneumoniae infection. Furthermore, distribution of the R232H SNP was equal in the pneumococcal pneumonia patients and healthy controls analyzed. However, while STING-deficient BMDMs showed a slightly diminished production of IL-1β and IL-6 upon
S. pneumoniae infection,
cGas−/− cells exhibited no defect in proinflammatory cytokine production. Thus, we cannot exclude a minor contribution of a STING-dependent but cGAS-independent sensing mechanism in stimulating proinflammatory responses
in vitro.
Our analyses indicate that deficiency in the STING-dependent pathway had stronger effects on the production of proinflammatory cytokines in human PBMC-derived macrophages than in murine BMDMs. This difference might be explained by the differential expression of other PRRs known to detect pneumococci between murine and human macrophages, which might compensate for the lack of cGAS/STING-dependent sensing.
In summary, we show that cGAS/STING senses pneumococcal DNA during S. pneumoniae infection to primarily stimulate production of type I IFNs and to contribute to proinflammatory cytokine production in human cells. Analyses of mice lacking STING as well as individuals expressing common STING variants, however, suggest that this pathway plays no major role in antipneumococcal host defense.
MATERIALS AND METHODS
Ethics statement.
Healthy volunteers from whom PBMCs were isolated provided written informed consent, and the study procedures were in agreement with the local ethics committee guidelines (Charité–Universitätsmedizin Berlin). Samples from patients with pneumococcal pneumonia were kindly provided by the CAPNETZ study group. This prospective multicenter study (German Clinical Trials Register DRKS00005274) was approved by the ethical review board of each participating clinical center (reference number of the leading ethics committee of Medical Faculty of Otto-von-Guericke-University in Magdeburg, 104/01; reference number for Medical School Hannover, 301/2008; see
www.capnetz.de for participating centers) and was performed in accordance with the Declaration of Helsinki. All patients provided written informed consent prior to enrollment in the study. All animal experiments were approved by institutional (Charité–Universitätsmedizin Berlin) and governmental animal welfare committees (LAGeSo Berlin; approval ID G0440/12).
Bacterial strains.
The
S. pneumoniae D39 strain, belonging to serotype 2, as well as the Δ
ply and Δ
cps isogenic mutant strains (
58), were used for
in vitro infection assays.
S. pneumoniae strain serotype 3 (NCTC 7978) was used to induce pneumonia in mice. Bacteria were cultured on Columbia blood agar plus 5% sheep blood for 12 h at 37°C. Culture of the mutant strains also required the addition of 40 μl of the following antibiotics on the agar plate: D39Δ
cps strain, 50 mg/ml kanamycin; D39Δ
ply strain, 1 mg/ml erythromycin.
BMDMs.
Bone marrow-derived macrophages (BMDMs) were isolated from femurs and tibiae of WT, Tmem173−/−, and cGas−/− female mice on a C57BL/6 background. Before infection, cells were grown in RPMI 1640 containing 30% L929 cell supernatant and 20% fetal calf serum (FCS) for 10 days.
Cell transfection and infection.
Mouse BMDMs were infected with the above-mentioned strains of S. pneumoniae at a multiplicity of infection of 1, centrifuged at 200 × g for 5 min, and then incubated for 6 h at 37°C. Bacterial DNA or synthetic dsDNA (ISD, or interferon stimulatory DNA; Invivogen) was transfected at a concentration of 1 μg/ml into the cells using Lipofectamine 2000 (Invitrogen). For siRNA-mediated cGas downregulation, BMDMs were transfected 48 h prior to infection with control nonsilencing siRNA or with a specific siRNA targeting cGas using HiPerfect (Qiagen).
Murine model of pneumococcal pneumonia.
Female WT and
Tmem173−/− mice (
23,
59), 8 to 14 weeks old on a C57BL/6 background, were housed in individually ventilated cages, with food and water provided
ad libitum. Mice were anesthetized by intraperitoneal injection of ketamine (1.6 mg) and xylazine (0.5 mg) and intranasally infected with 5 × 10
5 or 5 × 10
6 CFU
S. pneumoniae serotype 3 (NCTC 7978) in 20 μl of phosphate-buffered saline (PBS). Body weight and temperature were monitored every 12 h. Two days after infection, mice were anesthetized, heparinized, and euthanized through final blood withdrawal. Lungs were then flushed via the pulmonary artery and removed for subsequent analyses. Bacterial counts were assessed by plating serial dilutions of lung or spleen homogenates or blood on Columbia blood agar plates.
Quantitative reverse transcription-PCR (qRT-PCR).
Total RNA was isolated from cultured cells or mouse lung homogenates using the PerfectPure RNA purification system (5 Prime) or TRIzol (Life Technologies), respectively. cDNA was synthesized from total RNA using a high-capacity reverse transcription kit (Applied Biosystems), and quantitative PCR was performed using TaqMan assays (Life Technologies) or self-designed primer sets on an ABI 7300 instrument (Applied Biosystems). The input was normalized to the average expression of glyceraldehyde-3-phosphate dehydrogenase (GAPDH) in untreated cells or PBS-treated mice.
ELISA.
Protein concentrations of IP-10, IL-6, TNF-α, and IL-1β were quantified by commercially available sandwich enzyme-linked immunosorbent assay (ELISA) kits (eBioscience). Protein concentrations were quantified in a FilterMax F5 multimode microplate reader (Molecular Devices) and read at 450 nm.
Subjects.
Peripheral blood was collected from 14 healthy volunteers carrying
HAQ,
R232H, or WT
TMEM173 and belonging to a cohort group (
n = 564) assembled at the Institute of Microbiology, Charité University Medical Center Berlin. The association study between the
HAQ haplotype and pneumococcal pneumonia was performed using DNA samples obtained from 87 patients with
S. pneumoniae-induced community-acquired pneumonia (CAP) without antipneumococcal vaccination. Samples were provided by the CAPNETZ study group, a German multicenter prospective cohort study for CAP. A detailed description of the CAPNETZ methodology has been provided before (
60). The control groups were composed of a subgroup of healthy individuals of similar age and sex distribution (
n = 92) from the PolSenior program, an interdisciplinary project, designed to evaluate health and socioeconomic status of Polish Caucasians aged ≥65 years (
61) and the cohort of the Institute of Microbiology, Charité University Medical Center Berlin.
TMEM173 genotyping.
Genomic DNA was collected in buccal swabs and isolated by employing the Gentra Puregene buccal cell kit from Qiagen by following the manufacturer's instructions. Genotyping of TMEM173 R71H (rs11554776), G230A (rs78233829), R293Q (rs7380824), and the TMEM173 R232H SNP (rs1131769) was performed by PCR using fluorescence-labeled hybridization fluorescence resonance energy transfer probes (TIB Molbiol) accompanied by melting curve analysis in a LightCycler 480 (Roche Diagnostics). Primers and probes used were the following (where f-primer indicates forward primer, r-primer indicates reverse primer, and uppercase letters within the sequences [e.g., “XI”] indicate a label within the oligonucleotide probe, with “I” indicating a base analogue and “X” the modification): rs11554776 f-primer, ggagtgacacacgttgg; r-primer, gcctagctgaggagctg; simple probe, LC640-ctggagtggaXItgtggcgcag-PH; rs78233829 f-primer, gggtctcactcctgaatcaggt; r-primer, ccgatccttgatgcaagca; anchor probe, LC640-cagtttatccaggaagcgaatgttggg-PH; sensor probe, ggtcagcggtctgctgg-FL; rs7380824 f-primer, accctggtaggcaatga; r-primer, gcttagtctggtcttcctcttac; anchor probe, LC640-ggcctgctcaagcctatcctcccgg-PH; sensor probe, cctcaagtgtccggcagaagagtt-FL; rs1131769 f-primer, cccactcccctgcacactt; r-primer, tggataaactgcccaagcagac; anchor probe, LC640-aggatcgggtttacagcaacagca-PH; sensor probe, ggtgaccatgctggcatc-FL.
Infection and stimulation of human PBMCs.
Fifty-milliliter aliquots of whole peripheral blood were drawn from healthy volunteers, and PBMCs were isolated by density gradient centrifugation (
62,
63). Briefly, whole blood was diluted 1:1 with PBS and layered onto 20 ml Histopaque-1077 (Sigma-Aldrich). The gradient then was centrifuged at 800 ×
g for 25 min at room temperature, and the PBMCs were collected from the interface. PBMCs were washed twice with PBS and resuspended in RPMI medium supplemented with 10% FCS and 1%
l-glutamine. Half of the cell medium was replaced every 2 days, and the cells were kept on culture for 7 days to allow differentiation into a macrophage-like state before infection or stimulation. Infection with
S. pneumoniae and stimulation with bacterial DNA were performed as described before for mouse BMDMs.
Human monocytic THP-1 cells.
cGAS−/− (
33) and control THP-1 human cells were maintained under standard culture conditions. Cell differentiation into a macrophage-like state was induced by resuspension of cells in culture medium containing 80 nM phorbol myristate acetate (PMA) for 48 h.
Statistics.
Data analysis was carried out using Prism software (GraphPad Software). Groups were contrasted using a two-tailed Mann-Whitney U test. The association study was performed employing a chi-square test for association and calculation of odds ratios. A Fisher's exact test, together with calculation of exact confidence intervals, was used if applicable. The analysis of association between allele carriage and disease severity was conducted through an ordered logistic regression using SPSS (IBM Corporation). Differences with a P value of <0.05 were regarded as significant.
ACKNOWLEDGMENTS
We are thankful to the healthy volunteer for donating blood, the CAPNETZ foundation for providing samples from pneumococcal pneumonia patients, the investigators in the local clinical centers, and all practitioners, physicians, and respiratory specialists cooperating within the network. We thank Frank P. Mockenhaupt (Charité–Universitätsmedizin Berlin) for help with the statistical analyses, as well as Sven Hammerschmidt (Interfaculty Institute for Genetics and Functional Genomics, Ernst-Moritz-Arndt Universität Greifswald, Greifswald, Germany) and Tim Mitchell (College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom) for sharing bacterial strains. Moreover, we are grateful to Veit Hornung (Gene Center Munich, Germany) for providing cGAS-deficient THP-1 cells, Herbert “Skip” Virgin (Washington University School of Medicine, St. Louis, MO) for his kind permission to use cGas−/− mice, and Anca Dorhoi (Max Planck Institute for Infection Biology, Berlin, Germany) for providing those animals.
This work was supported by the Deutsche Forschungsgemeinschaft (GRK1673/B5 to J.S.M.R. and B.O., GRK1673/A5 to R.R.S., SFB/TR84 project A1/A5 to B.O., projects C3 and C6 to M.W., and project B1 to N.S.), the German Ministry for Education and Research (CAPSyS; grant TP4 to M.W.), the Ministry of Science and Higher Education (MEIN), Poland (PBZ-MEiN-9/2/2006–K143/P01/2007/1 to M.P.K.), and the National Institutes of Health (grants R21AI099346 and T32AI022295 to J.C.).
The funders had no role in study design, data collection and interpretation, or the decision to submit the work for publication.