Advanced age is an established risk factor for CAP (
Lexau et al. 2005), with more than 800 million people worldwide greater than 65 years of age (
Kinsella & Velkoff 2001). Overlapping with this, 210 million adults have COPD worldwide (
WHO 2009), a condition associated with and exacerbated by cellular senescence that is also a risk factor for CAP (
Lexau et al. 2005;
Aoshiba & Nagai 2009). Thus, close to 1 billion adults worldwide are at risk for pneumonia. Our finding that senescent lung cells have increased levels of K10 and LR, and can induce the expression of PAFr on normal cells, potentially helps to explain why the elderly and individuals with COPD are predisposed for CAP. Specifically we have demonstrated that senescent cells, normal cells exposed to senescent-conditioned media, aged mice, and young mice exposed to genotoxic stress, were more permissive for bacterial adhesion and susceptible to pneumococcal pneumonia, respectively.
The age-associated increase in inflammation that we observed in the lungs of healthy aged mice was consistent with prior publications that have shown elevated levels of IL-6, IL-8, and neutrophils within the lungs of healthy elderly human volunteers (
Meyer et al. 1996;
Meyer et al. 1998). Likewise, they were consistent with the reported SASP profile for senescent HeLa cells (
Coppe et al. 2008), and that observed herein for senescent lung epithelial cells. Our observation that elderly humans and aged mice had enhanced levels of p16 and pRb were also in agreement with those by others demonstrating elevated levels of senescent cells in the lungs of aged mice and elevated senescence markers in multiple tissues from aged animals (
Campisi 2005;
Kreiling et al. 2011). Thus considerable evidence now exists that cellular senescence occurs in the aged lungs and that it contributes to the observed age-associated inflammation. Notably, although increased for humans, levels of mH2A were not increased in the lungs of 19–22 month (i.e. aged) Balb/cBy mice when examined by Western blot. This was in contrast to that observed by Kreiling et al. in C57Bl/6 mice but may be due to the fact that they examined 36-month old animals (
Kreiling et al. 2011).
Bacterial attachment to lung cells is a requisite event in the pathogenesis of pneumonia (
Kline et al. 2009;
Paterson & Orihuela 2010). This is particularly true for the encapsulated extracellular respiratory tract pathogens such as
S. pneumoniae (
Orihuela et al. 2005). Yende
et al. and our own studies have shown elevated levels of IL-6 and TNFα are risk factors for CAP as a result of enhanced bacterial ligand expression (
Yende et al. 2005;
Hinojosa et al. 2009). PAFr serves as a ligand for
S. pneumoniae,
Haemophilus influenzae, and
Pseudomonas aeruginosa as well as many other bacteria that have surface exposed phosphorylcholine on their surface (
Cundell et al. 1995;
Swords et al. 2000;
Barbier et al. 2008). LR serves as a ligand for
H. influenzae and
Neisseria meningitidis (
Orihuela et al. 2009). K10 is also a ligand for PsrP from
S. pneumoniae and ClfB of
Staphylococcus aureus (
O’Brien et al. 2002;
Shivshankar et al. 2009). Respiratory tract pathogens also bind to other inflammation-regulated proteins such as Inter-cellular adhesion molecule 1 (ICAM-1) and Carcinoembryonic antigen-related cell adhesion molecule 1 (CEACAM1) that were not tested but are also most likely up-regulated as a result of age-associated inflammation (
Avadhanula et al. 2006;
Conners et al. 2008). Thus the enhanced expression of bacterial ligands on either senescent cells or normal cells exposed to SASP is one mechanism by which the lungs of the elderly and COPD patients may be primed for infection by numerous pathogens.
Between young and aged mice and in humans, the most dramatic difference in ligand levels that we observed was in regards to K10. Increased survival of aged mice infected with a PsrP-deficient mutant demonstrated the importance of this host-ligand interaction for severe pneumococcal disease. Unlike LR or PAFr, which are ubiquitously expressed, K10 is found predominantly in differentiated keratinocytes and on mucosal epithelial cells of the lungs and nares (
Paramio et al. 2001;
O’Brien et al. 2002;
Shivshankar et al. 2009). Thus the contribution of elevated K10 to infection is most likely limited to the lungs and not during sepsis or meningitis. Of note, passive and active immunization with PsrP has been shown to be protective against challenge in young mice (
Rose et al. 2008;
Shivshankar et al. 2009). This indicates that vaccines designed for use in the elderly might be optimized to neutralize the activity of bacterial adhesins that target age-dependent inflammation-regulated ligands on host cells, such as K10.
We observed that induction of senescence with bleomycin enhanced K10 expression in alveolar epithelial cells
in vitro. Because K10 expression has been shown to result in pRb activation and cell cycle arrest (
Paramio et al. 1999;
Paramio et al. 2001), this observation suggests that K10 may be involved in a positive-feed back loop with pRb that together leads to epithelial cell senescence. Further studies are warranted to examine this possibility. Induction of genotoxic stress with H
2O
2 and bleomycin corroborated the role of cellular senescence in susceptibility of live animals to infection, but was obfuscated by the pleiotropic effects of these genotoxic agents. Although administration of H
2O
2 results in generalized oxidative stress and bleomycin causes lung fibrosis, exposure to non-specific genotoxic stress occurs during smoking and possibly explains the high incidence of cellular senescence in the lungs of individuals with COPD (
Aoshiba et al. 2003;
Aoshiba & Nagai 2009).
At this time, it not possible to block the development of cellular senescence in aged mice. Thus a direct cause and effect relationship between senescent cells and the susceptibility of aged animals to pneumonia could not be demonstrated. While multiple factors were potentially involved in the increased susceptibility of aged mice to pneumonia, our observation of increased expression of p16, pRb and mH2A, enhanced lung inflammation, increased bacterial attachment to senescent cells and normal cells exposed to senescent media, and the enhanced susceptibility of aged mice to infection in a PsrP-dependent manner are strong correlative findings that support the hypothesis that senescent cells prime the lungs for pneumonia through increased bacterial adhesion. These findings clearly suggest that cellular senescence impacts inflammation and infectious disease in the lungs and provide an additional molecular explanation for the increased incidence of CAP in the elderly and those with COPD.