INTRODUCTION
Tuberculosis (TB) caused an estimated 1.5 million deaths in 2021. New drugs that can tune the immune response to either better sterilize infection or reduce tissue pathology are needed to help end the ongoing global pandemic. Inflammation and individual inflammatory mediators can contribute to sterilization, pathology, or both, depending on the timing and magnitude of induction. A detailed understanding of the individual interactions central to the induced inflammatory response is a necessary step toward developing strategies to tune that response to achieve desired clinical outcomes.
Macrophages are the first cells infected and remain an important niche for the causative bacterium,
Mycobacterium tuberculosis (Mtb), throughout the course of disease. Macrophage responses to bacteria are largely driven through interactions of host pattern recognition receptors (PRRs), which recognize pathogen-associated molecular patterns (PAMPs) or host cell damage associated with microbial or inflammatory responses. Mtb lacks a single-dominant PAMP, but multiple Mtb products have been described to function as PAMPs, inducing robust macrophage responses in their purified forms (
1 - 8). Unbiased approaches to identify the most inflammatory components of the mycobacterial lipid repertoire have pointed to phosphatidylinositol dimannosides (PIMs) (
9) and trehalose dimycolates (TDMs) (
10,
11). However, it remains largely unknown which of these potential interactions are most critical for the composite response to infection with live Mtb, and whether, given redundancies in possible PAMP/PRR interactions driving inflammation, individual interactions make unique contributions to macrophage responses
ex vivo and the cellular composition of responses
in vivo. A strategy commonly employed by pathogenic bacteria is active interference with innate immune signaling pathway components to limit inflammation that may contribute to bacterial clearance. Whether the response induced by infection with live Mtb qualitatively and quantitatively approximates the response induced by individual purified Mtb products is also largely unknown.
Here, we sought to identify the molecular interactions that drive the earliest responses to Mtb on population and single-cell levels. Taking an unbiased approach, we found two dominant components of the macrophage response to infection with Mtb and identified the Mtb PAMP that induced the response most similar to infection with live Mtb. We then investigated the contribution of this dominant Mtb PAMP and its cognate PRR to the response to infection on population and subpopulation levels ex vivo and in vivo.
DISCUSSION
“Tuning” the inflammatory response in TB infection has been proposed as a strategy for improving treatment outcomes; to date, approaches taken have largely focused on relatively non-specific, broadly active immune modulators (
39). A detailed understanding of the contribution of individual pathways to host inflammation upon infection with Mtb would enable more precise interventions and tailored to clinical presentation or host phenotype. Distinct from Gram-negative pathogens, for which a dominant, highly inflammatory surface PAMP drives the inflammatory response, Mtb contains a spectrum of subdominant PAMPs (
1 - 8), not all of which are readily surface-accessible. This complexity and potential redundancy make it challenging to identify the pathways most important during infection, thus offering the most promising targets. Here, we took an unbiased approach to identify the molecular interactions that contribute most to the inflammatory response to Mtb; the PIM6/TLR2 interaction emerged as driving a response most qualitatively similar to a predicted NF-kB-dependent component of the response to live Mtb.
Our findings of the centrality of TLR2 in the macrophage response to Mtb are consistent with recent work studying the interactions of live Mtb with host macrophages. In models using reporter cell lines or purified Mtb products as stimuli, many Mtb components have been shown to elicit inflammatory responses; distinguishing which of many potential interactions contribute to the aggregate response to the live bacterium and to what extent redundancy renders individual interactions moot is not possible using minimalist models. In recent work using an Mtb transposon mutant library to identify mycobacterial factors that interfere with NF-kB activation, Mtb mutants impaired in production of the glycolipid SL-1 induced more robust NF-kB signaling in a TLR2-dependent fashion (
24). This work identified TLR2 as having the potential to recognize and respond to the intact bacterium but raised the possibility that TLR2 makes a limited contribution to the overall response to live Mtb because of lipid interference with effective pathway activation. In previous work, we identified a late, endosome-specific component of the TLR2 response as blunted by the phagosomal membrane damage carried out by key Mtb virulence factors (
12). Similar to the findings in Blanc et al., our work pointed to TLR2 but raised the possibility that the contribution of TLR2 to the overall response is limited by multi-pronged mycobacterial interference. Our findings here suggest that, in spite of mycobacterial efforts to limit TLR2 activation, interactions between TLR2 and Mtb TLR2 ligands are a dominant contributor to NF-kB-dependent responses to Mtb. While Man-LAM was identified as the first Mtb-derived TLR2 ligand (
40), consistent with other work (
41), we find that PIM6 is a more robust TLR2 agonist. This work is additionally consistent with unbiased work identifying PIMs as the most inflammatory component in Mtb lipid microspheres (
10,
11). It remains uncertain which TLR2 agonist or agonists are most dominant
in vivo, and it is likely that multiple agonists contribute to the TLR2-dependent signal.
While we identify PIM6 as eliciting an inflammatory response qualitatively similar to the macrophage response to live Mtb, our results identify quantitative differences in the responses elicited by the two stimuli. We found that purified PIM6 could elicit as rapid and robust an inflammatory response as the highly inflammatory, dominant PAMP LPS. However, infection with live bacterium resulted in a slower, weaker response. The slower kinetics and lower magnitude could not be overcome by either increasing bacterial concentration or inactivation, excluding the possibilities that limited total PAMP concentration or active bacterial processes constrain the response. Together with our previous work suggesting a threshold for sustained TLR2 activation following stimulation with synthetic ligand (
26), these results raise the possibility that the local concentrations and/or context of Mtb PAMPs within the live bacterium may limit overall activation of TLR2. Previous work explored in detail how context and presentation of one biologically important Mtb lipid, TDM, changes the recognition and inflammatory properties of the lipid (
42 - 45). Our work is consistent with these findings and suggests that context and presentation likely influence recognition of and subsequent host response to a range of Mtb PAMPs. While our focus in this work was exclusively on the dominant innate immune signaling pathways activated by Mtb upon infection, the broader literature suggests that Mtb products may limit additional TLR2-dependent defenses, including activation of autophagy (
46).
Our results additionally demonstrate significant heterogeneity in induction of the dominant inflammatory response in macrophages. On a single-cell level, we found that the dominant response components were incompletely induced in Mtb-exposed or Mtb-infected cells, with only a small population of cells expressing a robust NF-kB-dependent response similar to purified PAMP when profiled by scRNAseq and incomplete induction of
Tnf in infected cells when studied using FlowFISH. Any exposure to Mtb resulted in inflammatory responses distinct from unexposed cells; the identity of cells as infected or bystanders was one main driver of differential response within exposed populations. The extent to which released cytokines vs cell-to-cell release of mycobacterial products (
47) influence bystander phenotypes is unknown. Further, our studies, which require cell fixation or harvest, necessarily offer only a snapshot of the total response. TNF has been described to have dual roles in infection—some TNF is critically important for Mtb control in experimental models and in clinical studies (
13,
14), but too much TNF drives macrophage necrosis and release of bacteria to infect new cells (
48). Our findings of heterogeneous induction of
Tnf and co-regulated genes raise the question of whether foci of progressive infection can ultimately be traced back to subsets of macrophages with a relatively anemic NF-kB-dependent response to infection. We anticipate that emerging technologies enabling tracking over time of individual infected host cells with defined phenotypes will ultimately allow questions of how subpopulations of cells differentially contribute to disease outcomes to be asked and answered.
Heterogeneity is, in fact, a hallmark of clinical TB (
49 - 51). The capacity to phenotype individual cells within complex populations has opened the door to understanding how cellular phenotypes contribute to TB disease complexity within the host environment. Two recent efforts have used scRNAseq to profile cells within established granulomas. In a study using both zebrafish and macaque models of mycobacterial infection, Type 2 activation and Stat6 were found to drive formation of necrotic granulomas (
52). In a parallel study in macaques comparing the cellular composition of granulomas that are PET-apparent by 4 week post infection (“early granulomas”) with those that are not apparent until 10 week post infection, early granulomas had a stronger Type 2 signature and higher bacterial burdens (
53). These snapshots of granuloma composition suggest cellular correlates of bacterial control and failure to control after the disease is established. A complementary study using scRNAseq and cyTOF to define subpopulations of cells in the lung that uniquely distinguish latent and active TB in a macaque model suggested cellular subsets that may contribute to control and failure to control infection (
54). Our results suggest that heterogeneity in the host response to TB infection is not only introduced at the level of established granuloma or whole-organism infection but also, in fact, encoded from the very first encounter between individual macrophages and infecting mycobacteria. The full sequence of events linking the subpopulation responses we observe in macrophages with the recruitment of distinct cellular populations and the formation of granulomas with differing capacities to control infection remains to be revealed. Our
in vivo murine analyses highlight the importance of PRR engagement in orchestrating the complex multi-cellular response to infection. Previous studies in mice lacking TLR2 have sought to determine how loss of this PRR contributes to overall bacterial burden; however, these diverse studies (Mtb strain of infection, infection dose) arrive at distinct conclusions that make it difficult to illuminate common features of immunity in mice lacking TLR2 (
55 - 58). Our studies reveal that loss of TLR2, which is largely restricted to myeloid cells, contributes to alterations in the abundance of non-classical monocytes, T cells, and B cells, suggesting that the overall quality of the adaptive immune response in these animals may be different. How these altered adaptive immune cell dynamics in the absence of TLR2 signaling contribute to immunopathology and the generation and maintenance of antigen-specific T cell responses are important areas for future inquiry. Together with recent work suggesting that the bacterium actively subverts TLR2 activation, our results suggest that modulating the TLR2 pathway, including strategies to collapse heterogeneity within populations of infected cells, may offer precision targets for future host-directed TB therapeutics.
MATERIALS AND METHODS
Isolation of bone marrow-derived macrophages
All animal use protocols were approved by the MGH IACUC and carried out in accordance with national guidelines for the ethical use of animals in research. C57BL/6J (Jackson Laboratories strain [Bar Harbor, ME, USA] Number 000664), Tlr2 −/− (B6.129-tlr2tm1Kir /J, Jackson Laboratories strain number 004650), Sting −/− (C57BL/6J-Stinggt /J, Jackson Laboratories strain number 017537), and cGAS −/− (B6(C)-Cgastm1d(EUCOMM)Hmgu/J, Jackson Laboratories strain number 026554) mice were ordered from Jackson Laboratories. Mice were euthanized by carbon-dioxide inhalation, and femurs and tibias were harvested for bone marrow isolation. Bone marrow cells were incubated at 37°C with 5% carbon dioxide in BMDM media (DMEM [Gibco, Billings, Montana, USA] with 20% fetal bovine serum [Hyclone, Logan, Utah, USA] and 25 ng/mL recombinant mouse M-CSF [R and D Systems, Minneapolis, MN, USA]) on petri dishes. After 6 days, adherent cells were washed and harvested for use as bone marrow-derived macrophages.
Cell culture
The indicated Mtb strains (H37Rv and H37Rv-GFP) were grown in Middlebrook 7H9 broth (Difco) with Middlebrook OADC (BD), 0.2% glycerol, and 0.05% Tween-80. THP-1 monocytes were grown in R10 media (RPMI-1640 supplemented with 0.5 mM 2-mercaptoethanol and 10% FBS [Hyclone, Logan, Utah USA]). THP1 cells were differentiated in R10 media containing 25 ng/mL PMA for 24 h. Cells were then washed with PBS twice and incubated for 24 h in fresh R10 media for recovery prior to use in experiments. BMDMs were grown overnight in BMDM media prior to treatments or infections.
PAMP treatment and Mtb infections
The purified Mtb surface molecules were obtained from BEI Resources (PDIM: NR-20328, PGL: NR-36510, TDM NR-14844, LAM: NR-14848, PIM2: NR-14846, PIM6: NR-14847, SL-1: NR-14845) and resuspended in DMSO at 1 mg/mL. DMSO carrier was used as the comparator control. Mtb infections were carried out as previously described (
59,
60). Briefly,
Mtb strain H37Rv was grown to mid-log phase, washed once in PBS, resuspended in PBS, and subjected to a low-speed spin to pellet clumps. Macrophages were infected at the indicated MOI, allowing 3–4 h for phagocytosis. Cells were then washed once with PBS, and media were added back to washed, infected cells. For paraformaldehyde fixation, Mtb was pelleted by centrifugation and then resuspended in 4% paraformaldehyde for 1 h at room temperature. Cells were then pelleted by centrifugation, washed twice in PBS, and resuspended in PBS.
RNA extraction and qPCR
Infected or treated BMDM/THP-1 were lysed at designated time points with β-ME-supplemented Buffer RLT (Qiagen). RNA was isolated from lysate using an RNEasy kit (Qiagen) supplemented with RNase-free DNase I digest (Qiagen), both according to manufacturer’s protocol. cDNA was prepared using SuperScript III (Thermo Fisher Scientific, Waltham, MA, USA) according to manufacturer’s protocol. qPCR was performed using PowerUP SYBR Green (Thermo Fisher Scientific, Waltham, MA USA) and primers specific to investigated genes relative to Gapdh control. Primers sequences used for qPCR: mouse Irak2: F-GAAATCAGGTGTCCCATTCCAG and R-TGGGGAGGTCGCTTCTCAA; mouse Traf1: F-TCCTGTGGAAGATCACCAATGT and R-GCAGGCACAACTTGTAGCC; mouse Nfkbia: F-CTCCGAGACTTTCGAGGAAATAC and R-GCCATTGTAGTTGGTAGCCTTCA; mouse Ifit1: F-CTGAGATGTCACTTCACATGGAA and R-GTGCATCCCCAATGGGTTCT; mouse Mx1: F-GACCATAGGGGTCTTGACCAA and R-AGACTTGCTCTTTCTGAAAAGCC; mouse Ifit2: F-CGAGCAGACAGTTACACAGCAGTCA and R-CGTTGGCATTTTAGCTGTCGCAGAT; mouse Gapdh: F-CGACCCCAACACTGAGCATCTCC and R-CGTCCCTAGGCCCCTCCTGTTATTAT; mouse Ier3: F-CGACCAGCTACCAACCGAGGAA and R-TCGGAAAGAGGACCCTCTTGGCAA; mouse Tnf: F-CGAGCCTCTTCTCATTCCTGCTTGTG and R-CGTTCATCCCTTTGGGGACCGATC.
Bulk RNA-Seq
Poly(A)-containing mRNA was isolated from 1 µg total RNA using NEBNext Poly(A) mRNA Magnetic Isolation Module (New England Biolabs, Ipswich, MA, USA). cDNA libraries were constructed using NEBNext Ultra II Directional RNA Library Prep Kit for Illumina and NEBNext Multiplex Oligos for Illumina, Index Primers Sets 3 and 4 (New England Biolabs, Ipswich, MA USA). Libraries were sequenced on an Illumina NextSeq500. Bioinformatic analysis was performed using the open source software GenePattern (
55,
61). Raw reads were aligned to mouse genome using TopHat, Cufflinks was used to estimate the transcript abundance, and Cuffdiff was used to calculate fold difference in expressions and the log2 fold change values (with
P-value ≤ 0.05 and
q-values ≤ 0.05) were used to plot the heatmap. Correlation analysis, principal component analysis, cluster analysis, and visualization were performed in RStudio and Morpheus (
https://software.broadinstitute.org/morpheus). Functional analysis was performed using IPA (Qiagen Inc.,
https://www.qiagenbio-informatics.com/products/ingenuity-pathway-analysis).
FlowFISH/PrimeFlow assays
PrimeFlow RNA Assay Kit (Thermo Fisher; Catalog number: 88-18005) was used to stain for Tnf, (probe ID number VB1-10175-PF) and control Rpl13a (probe ID number VB6-15315-PF), according to the manufacturer’s instructions with several modifications. Specifically, the permeabilization of infected macrophages was performed in ice-cold methanol for at least 15 min instead of permeabilization buffer supplied. The permeabilized cells were treated with 2% PFA in PBS and washed twice with the wash buffer. Cells were then incubated with the hybridization probes as indicated, and rest of the staining was performed as per the manufacturer’s instructions.
Mouse infections
All mouse experiments were carried out under protocols approved by the Massachusetts General Hospital Institutional Animal Care and Use Committee. Seven- to eight-week-old female C57BL/6J (Jackson Laboratories strain number 000664) or Tlr2 −/− (Jackson Laboratories strain number 021302) mice were infected via low-dose aerosol exposure with an AeroMP (Biaera Technologies, Hagerstown, MD, USA). Three to five mice per condition were harvested at day 0 to quantify inoculum. Six weeks post infection, mice were euthanized in accordance with AALAC guidelines, and lungs were harvested for histopathology, CFU, and tissue dissociation for scRNA-seq and flow cytometry quantification of cell subsets.
Murine lung cell flow cytometry
After harvest, murine lungs were dissociated using a GentleMACS Dissociator (Miltenyi Biotec, Bergisch Gladbach, Germany) in digestion buffer (RPMI with 10 mM HEPES, DNAse I 50 μg/mL, Liberase TM 100 μg/mL, and 2% FBS). After running the m_lung_01 program, samples were incubated at 37°C for 30 min before running the m_lung_02 program. Samples were filtered with a 70-μM filter, washed once, and then RBCs were lysed for 5 min using RBC Lysis Buffer (Sigma-Aldrich, Burlington, MA, USA). Samples were then quenched with FACS buffer (PBS with 2% FBS and 2 mM EDTA) and washed once. Cells were stained with fixable viability dye eFluor 455UV (Invitrogen, Carlsbad, CA, USA), incubated with Fc receptors block (TruStain FcX, clone 93, BioLegend, San Diego, CA, USA), and stained with a panel of immunophenotyping antibodies at room temperature for 30 min. The panel was made of the following antibodies (clone, dilution, manufacturer): CD45 BUV395 (30-F11, 1:400, BD Biosciences, San Jose, CA, USA), CD24 BV510 (M1/69, 1:500, BioLegend), I-A/I-E Pacific Blue (M5/114.15.2, 1:1200, BioLegend), CD64 Pe/Cyanine7 (X54-5/7.1, 1:50, BioLegend), CD11c PerCP (N418, 1:200, BioLegend), CD11b (M1/70, 1:1500, BioLegend), Ly-6G BV605 (1A8, 1:1500, BioLegend), Ly-6C AF700 (HK1.4, 1:300, BioLegend) and SiglecF PE-CF594 (E50-2440, 1:1000, BD Biosciences). Cells were then washed in PBS, fixed with 4% paraformaldehyde (Santa Cruz Biotechnology, Dallas, TX, USA), and strained through a 70 μm filter (BD biosciences). Data was acquired on a BD Symphony flow cytometer (BD Biosciences) using BD FACSDiva software (BD Biosciences) and analyzed using FlowJo software (v10.7.1, BD).
scRNA-seq libraries preparation and sequencing
For scRNAseq of BMDM, Mtb-exposed cells were infected at an MOI 2.5:1 with Mtb-GFP as described above for 4 h before washing away extracellular bacteria with PBS and incubating with fresh BMM media for 8 h. PIM6-stimulated BMMs were stimulated with 1 μg/mL PIM6 for 8 h. After 8 h, cells were detached with 1% BSA in PBS at 4°C and incubated with Total-Seq B murine hashtagging (HTO) antibodies (BioLegend, number 155831, number 155833, number 155835, number 155837, number 155839, number 155841) for 30 min on ice. Cells were washed three times with 1% BSA in PBS, counted in Trypan Blue using a Countess (Thermo Fisher), and pooled. The pooled sample was centrifuged and resuspended in PBS, filtered using a Flowmi 40-µm cell strainer (Bel-Art, H13680-0040), and counted for final concentration determination and viability for 10× loading. Cells were loaded following the 10× Chromium NextGEM Single Cell 3′ v3.1 protocol with Feature Barcoding (Revision D) with the addition of 0.5 U/μL RNase inhibitor (Roche, Rotkreuz, Switzerland) to the single-cell suspension. Post GEM-RT was performed following the 10× protocol (CG000206 Rev D) through cDNA amplification at which point the cDNA was inactivated at 95°C for 15 min and removed from the BSL3 facility. Library construction for both the gene expression and HTO was then performed according to the 10× protocol. Libraries were sequenced on a NextSeq500 (Illumina, San Diego, CA, USA).
For scRNAseq of murine lung cells, a single-cell suspension of lung cells was generated as described above. Cells were then counted prior to proceeding with MULTI-seq barcoding. Samples were multiplexed as previously described. In brief, samples were barcoded with 2.5 μM of the LMO anchor and barcode for 5 min on ice in PBS before adding 2.5 μM of the LMO co-anchor and incubating for an additional 5 min. Samples were quenched with 1% BSA in PBS and washed once. Samples were processed using the 10× Genomics NextGEM Single Cell 3′ kit v3.1 per the manufacturer’s protocol in two microfluidic lanes. Again, 0.5 U/μL RNase inhibitor (Roche, Rotkreuz, Switzerland) was added to the single-cell suspension, and cDNA was inactivated at 95°C for 15 min prior to BSL3 removal. Libraries were sequenced on a NextSeq500 (Illumina, San Diego, CA USA). The data were aligned to the mm10 reference using Cell Ranger Count v6.0.1.
scRNA-seq data processing and analysis
For BMDM scRNAseq, raw sequencing reads were converted to FASTQ files, aligned to the murine genome, and filtered, and barcodes and UMIs were counted using CellRanger (v4.0.0) from 10× Genomics. Downstream analysis then proceeded using Seurat (v3.9.9) (
62) and scTransform (v 0.3.2) (
63) for linear dimensional reduction. Sample identities were assigned using the HTO reads, and filtering was performed to remove doublets, cells with >25% mitochondrial reads, and cells with <250 unique genes/cell. Cells were clustered by a Shared Nearest Neighbor graph. Gene sets for principal components 1 and 2 of the single-cell dataset are composed of genes with the top 50 positive loadings for each component. The cluster 7 gene set is composed of the top 50 genes ranked by average log2 fold change identified as markers of this cluster over all others. Cells scoring >1 for each gene set are considered expressing the gene set. For overlap of gene set expression, cells scoring >1 for both gene sets are considered co-expressing cells. Functional analysis was performed using IPA (QIAGEN Inc., Germantown, MD, USA;
https://www.qiagenbio-informatics.com/products/ingenuity-pathway-analysis).
For murine lung scRNAseq, LMO barcode and gene expression count matrices were merged and analyzed using R (v4.0.3) and Seurat (v4.0.0). Samples were demultiplexed using HTODemux (Seurat). Genes with high ambient RNA contribution were identified using estimateAmbience (DropletUtils) and removed from downstream analysis. Cells with less than 300 genes were detected, and more than 10% mitochondrial UMIs were excluded. Three thousand variable features were used for PCA. Counts were normalized using the default parameters from NormalizeData (Seurat), i.e., scaling by 10,000 and log normalization. Walktrap (igraph) clustering was performed on the shared nearest neighbor graph generated from FindNeighbors (Seurat) using 30 principal components and k = 20. Cell type annotation was based on expert annotation and predicted cell type labels from the Tabula Muris dataset. Cell-type labels were predicted using FindTransferAnchors, MappingScore, and TransferData (Seurat) with 30 dimensions and 20 trees. Lymphocyte and myeloid cell types were subclustered separately by repeating the steps above on the cell subsets. Enrichment analyses were performed using EnrichR with the GO Biological Process 2021, ChEA 2016, and MSigDB Hallmark databases. Marker gene statistics were calculated using wilcoxauc (presto). All signature scores were calculated using AddModuleScore_UCell (UCell). Differential cell type abundance analysis was performed using a generalized binomial linear model (stats, emmeans). Cell counts per cell type were modeled as a function of an interaction term describing cell type and condition.
Statistics
Statistical tests used for each experiment are indicated in the figure legends. Two-tailed unpaired t-tests were used to analyze qPCR and flow cytometry data. Statistical methods for the analysis of RNAseq and scRNAseq data are included in the methods specific to those approaches; significance scores were corrected for multiple comparisons.
ACKNOWLEDGMENTS
The authors would like to thank Drs. Roi Avraham, Michael Chao, and Sarah Fortune for critical feedback on the manuscript and Dr. Patty Grace for experimental advice. The authors would additionally like to thank Cal Gunnarsson and Dr. Mark Godek for assistance accessing archived data.
Funding sources included a CNIHR award to A.K.B., a pilot grant on U19AI082630 (pilot grant to A.K.B.), a Ragon Institute Strategic Initiative (A.K.B. and B.D.B.), and an MGH Swartz Award (A.K.B.).
C.J., S.L.S., B.D.B., and A.K.B. conceived of and designed the experiments; C.J., S.L.S., J.M.P., S.C.P., A.E.H., J.B., and A.K.B. performed experiments and analyzed the data; C.J., S.L.S., J.M.P., B.D.B., and A.K.B. drafted the manuscript; all authors read and edited the manuscript.
The authors report no competing interests.