Mycobacterium tuberculosis (Mtb), a causative agent of human tuberculosis, is responsible for 8 million new infections and 2 million deaths yearly. One third of the world population is currently estimated to be infected with
M. tuberculosis, although less than 10% of those infected show clinical signs of infection
[1]. This is mainly due to the robust granulomatous response that is initiated by the bacterium, which effectively contains the infection and allows the host to exist in equilibrium with a subclinical infection. The granulomatous response has been shown to be triggered by multiple components of the mycobacterial cell wall, such as phosphatidylinositol dimannoside, phosphatidylinositol hexamannoside, and trehalose 6,6′-dimycolate (TDM)
[2]–
[5].
The chemical structure of TDM (also known as cord factor) was solved in 1956
[6] and was identified as the predominant immunogenic mycobacterial cell wall glycolipid
[7]. TDM can elicit pro-inflammatory cytokine production
in vitro, and granulomatous responses
in vivo, when administered as a monolayer or part of an oil-water emulsion
[7]–
[10] . Although it has been known for decades that this pro-inflammatory response is mediated primarily by macrophages, binding or signaling receptors for TDM on macrophages have yet to be identified. Biochemical approaches used in our laboratory to identify TDM receptors, such as affinity isolation using TDM columns, TDM bead phagosome isolation from labeled macrophages, and mass spectrometric analysis of phagocytosed TDM-coated beads after photoactivatable cross-linking, have been unsuccessful. These observations, as well as the finding that the stimulatory activity of TDM requires presentation over a larger surface area, such as emulsions, monolayers, or large diameter particles, suggests that the TDM-receptor interaction is of low avidity and requires the aid of co-receptors or other accessory molecules
[9],
[10].
One class of receptors implicated in TDM recognition is the TLRs. TLRs have not been shown to bind to TDM directly, but bone marrow-derived macrophages (BMMΦ) from MyD88
−/− mice do not produce pro-inflammatory cytokines in response to TDM-coated polystyrene microspheres
[9]. Although TLRs have been shown to sense and signal from within the phagosome, they are not phagocytic receptors and usually require the presence of a co-receptor (e.g. CD14) to present their ligands
[11].
Class A scavenger receptors (SR), SRA and MARCO, are a class of phagocytic receptors that we have demonstrated mediate recognition and presentation of TDM. SRs bind a range of ligands of endogenous and exogenous origin with relatively low affinity. Ligands for the SRs include proteins
[12] and lipids. These lipids can be derived from either the host (e.g. oxidized lipids)
[13], or from exogenous sources (e.g. lipopolysaccharide)
[14]. Of the two class A SRs, SRA has been clearly demonstrated to be involved in host defense by suppressing excessive pro-inflammatory cytokine production in mouse models of infection and septic shock
[14],
[15]. MARCO has also been implicated in host defense against bacterial pathogens, but it is not clear whether it is a positive or negative regulator of pro-inflammatory cytokine production
[16],
[17].
It has been proposed that the class A SRs may be involved in host defense against mycobacterial infection. SRA expression is increased after interferon-gamma (IFN-γ) treatment or exposure to
M. tuberculosis, and is highly expressed on macrophages associated with
M. bovis Bacille Calmette-Guérin (BCG)-induced granulomas
[14],
[18]. There are conflicting reports as to whether expression of SRA increases uptake of
M. tuberculosis or BCG; however, its presence does not appear to affect the rate of replication of BCG, despite being protective against BCG-primed endotoxic shock
[14],
[18]. In mouse models, MARCO expression has been shown to be transiently up-regulated on macrophages in response to BCG infection and to be expressed on macrophages within, and adjacent to, BCG-containing granulomas
[19]. MARCO-expressing macrophages in the splenic marginal zone appear to phagocytose more BCG than neighboring macrophages that do not express MARCO
[19]. The mycobacterial ligands that mediate this recognition have not yet been identified.
Herein, we identify that TDM recognition and signaling is mediated, at least in part, by MARCO, TLR2, and CD14. Although SRA and MARCO have many common ligands, our results show that MARCO binds more TDM-coated beads than either isoform of SRA. MARCO is required for TDM-induced signaling via TLR2 and CD14 in a transfection system, whereas SRAI and SRAII require co-transfection of TLRs 2 and 4, and their accessory molecules, to permit even a minor response to TDM stimulation. Consistent with these data, both resident peritoneal macrophages (RPM
![[var phi]](/corehtml/pmc/pmcents/x03C6.gif)
) and BMM
![[var phi]](/corehtml/pmc/pmcents/x03C6.gif)
from TLR2/4 double-deficient mice (but not the individual mutants) have a markedly reduced response to TDM. This suggests that TDM engages TLR2 and TLR4 in a redundant fashion and that these predominantly MyD88-dependent pathways are required for the stimulatory effects of TDM
[9]. When stimulated with TDM-coated microspheres, macrophages from MARCO
−/− and MARCO
−/− SRA
−/− double-deficient (DKO) mice also show reduced activation of ERK1/2 compared to wildtype mice and are defective in subsequent pro-inflammatory cytokine production. These macrophages also produce fewer pro-inflammatory cytokines in response to infection with
M. tuberculosis, indicating that SR-mediated detection of TDM may be an important component of the response to infection. On the basis of these data we propose a model in which MARCO, and to a lesser extent SRA, cooperate with TLR2 and CD14 for TDM recognition and signaling.