With the explosion of IL-17A-related research over the last 5 years, studies have discovered that CD4
+ T cells producing IL-17A can also produce the cytokine IL-22, a member of the IL-10 family of cytokines (
24). Analogous to the observations for IL-17A, additional cell types, such as lymphoid tissue inducer cells (
40), NK cells (
6), and γδ T cells (
27), can also produce IL-22. Although IL-22 can act in both an anti-inflammatory (
47) and a proinflammatory (
49) manner, IL-22 has been reported to play a major role in stimulating epithelial antimicrobial activity and host defense against multiple mucosal pathogens (
50), including the fungal organism
Candida albicans (
10). To date, only epithelial cells and keratinocytes have been identified as expressing the IL-22 receptor (
45). We have previously identified a role for Dectin-1-dependent IL-17A in host defense against
A. fumigatus (
42,
43). As IL-17A may work in tandem with IL-22 (
2,
26,
50) and IL-23 is reportedly required for IL-22 induction in several models (
10,
37,
40), we extended our studies here to investigate the role of Dectin-1 in the induction of IL-22 and the role of IL-22 in
A. fumigatus lung defense. In our initial studies, we were surprised at the magnitude of Dectin-1 dependency for IL-22 production in the lungs after
A. fumigatus challenge. In both lung homogenates and lung cell cultures from Dectin-1-deficient mice, IL-22 was produced at less than 10% of that produced by WT mice. Although we hypothesize that some of this is due to compromised IL-23 production in Dectin-1-deficient mice (
43), the dependency of IL-22 on Dectin-1 during
A. fumigatus exposure is more striking than that observed in IL-23-deficient mice systemically exposed to
C. albicans, which demonstrated IL-22 levels that were still a third of WT levels (
10). Coupling this observation with our data indicating that IL-22 production by lung cells is reduced by three-fourths in the presence of IL-23 neutralization leads us to hypothesize that at sites of infection, additional mediators are likely involved in optimal IL-22 production (i.e., the remaining quarter to a third in both
C. albicans and
A. fumigatus infections). This does not appear to be IL-6, IL-1β, or IL-18, as we show that neutralization of these cytokines had no effect on IL-22 production by lung cells from
A. fumigatus-exposed mice. As IL-23 signals through IL-12Rβ1 and IL-23Rα, it is thought to activate the STAT1, STAT4, STAT3, and STAT5 signaling pathways (
14). With respect to Th17/IL-17A responses, STAT3 activation is clearly favored by IL-23 (
23). Therefore, we can speculate that an additional mediator(s) may activate STAT3, and possibly other STATs as well, and synergize with IL-23 for optimal lung IL-22 production. Currently, studies are under way to identify additional cytokines that may be involved in IL-22 production by lung cells.
To thoroughly examine the role of IL-22 in lung host defense against
A. fumigatus, we employed two independent experimental designs: (i) neutralization and (ii) genetic deficiency. Neutralization of IL-22, as well as IL-22 deficiency, led to significantly compromised clearance of
A. fumigatus from the lungs. The level of impairment in fungal clearance was also more apparent with
A. fumigatus than in a previous report with
C. albicans, which demonstrated 2-fold changes in stomach (gastrointestinal infection) and kidney (systemic infection) burdens (3 days postchallenge) when IL-22 was genetically deficient (
10). Neutralization of IL-22 in this model had little or no effect on the
C. albicans stomach burden in C57BL/6 mice (8 days postchallenge) and increased the kidney burden by only a third in BALB/c mice (
10). In contrast, our studies revealed that IL-22 neutralization resulted in a 5-fold increase in the lung
A. fumigatus burden, whereas IL-22 genetic deficiency resulted in an 8-fold increase in the
A. fumigatus burden. There are many possibilities as to why differences were observed in our study versus the
C. albicans study. Clearly, these two pathogens are quite different in their tissue specificities and host defense requirements; thus, it is possible that host defense against one organism may require IL-22 more than the other. Moreover, our studies investigated the role of IL-22 in early/rapid host defense against
A. fumigatus, i.e., 1 to 2 days postchallenge, in contrast to the 3- to 8-day time course of the
C. albicans infections. In addition, it is also possible that the role of IL-22 may be more evident, perhaps even more important, in such tissues as the lung and gut, where the overwhelming majority of cells are epithelial cells and keratinocytes. Nevertheless, our studies point to an essential role for IL-22 at the earliest stages of
A. fumigatus lung infection.
As mentioned previously, we have documented a role for IL-17A in
A. fumigatus lung defense (
42) and now extend this to IL-22. Dual roles for IL-17A and IL-22 have also been observed in lung infection with
K. pneumoniae (
17,
2) and gut infection with
C. rodentium (
26,
50). Surprisingly, however, IL-17A and IL-22 do not always play equal roles in host defense. Cutaneous infection with
Staphylococcus aureus is worse in γδ T cell-deficient mice and is correlated with a lack of IL-17A, but not IL-22, production (
7). In models of oral infection (
8) and skin infection (
18) with
C. albicans, IL-17A, but not IL-22, was required for defense. Protective immunity to systemic infection with attenuated
Salmonella enterica serovar Enteritidis is associated with IL-22, but not IL-17 (
36), while infection with
Borrelia burgdorferi induces a potent IL-22 response, yet IL-17A is completely absent (
3). Finally, in
Listeria monocytogenes infection, IL-17A is required for clearance (
16), but not IL-22 (
15), a finding also observed in
Francisella tularensis infection (
25). However, during
A. fumigatus lung infection, our studies indicate that both IL-17A and IL-22 are simultaneously required for host defense. IL-17A levels are significantly increased in the lungs of IL-22-deficient mice challenged with
A. fumigatus, yet lung clearance is impaired. In turn, we have reported that IL-17A neutralization leads to impaired
A. fumigatus lung clearance (
42), although IL-22 levels were not affected by IL-17A neutralization (1,276 ± 105 pg/ml,
n = 10, versus 1,148 ± 98 pg/ml,
n = 10, in lung homogenates for isotype- and anti-IL-17A-treated mice, respectively). Therefore, in a scenario where either IL-17A or IL-22 is absent, our data suggest that the remaining response is not sufficient to compensate.
A well-documented role of IL-22 in the context of host defense is in the induction of the epithelial antimicrobial response. Initial studies examining the function of IL-22 showed that stimulation of epithelial cells and keratinocytes with IL-22 led to the induction of antimicrobial defense factors, such as beta-defensins, S100 proteins, and RegIII proteins (
50). IL-17A also has an acknowledged role in the induction of these factors (
2), and IL-22 can often add to or synergize with IL-17A for the induction of the epithelial antimicrobial response. Recognizing that IL-22, along with IL-17A, can evoke this response in the lungs (
2) led us to determine whether functional defects existed in the lungs of Dectin-1-deficient and IL-22-deficient mice exposed to
A. fumigatus. To this end, we demonstrated that clarified lung lavage fluid (i.e., fluid that was free of live
A. fumigatus and live host cells) from both Dectin-1-deficient and IL-22-deficient mice did not kill
A. fumigatus as robustly as lung lavage fluid from WT mice. The defect in antifungal activity was more severe in lavage fluid from Dectin-1-deficient mice, which we hypothesize is a result of these mice having significant reductions in both IL-17A (
42) and IL-22 (). Despite compromised S100A8 and S100A9 expression in IL-22-deficient mice intragastrically infected with
C. albicans (
10), we found that
S100a8 and
S100a9 mRNA expression was intact in the lungs of
A. fumigatus-exposed Dectin-1-deficient and IL-22-deficient mice (data not shown). In addition,
Reg3g levels were not found to be statistically lower in the lungs (data not shown). In contrast, we did observe a reduction in the lung levels of lipocalin 2, a siderophore binding protein induced by IL-22 (
2), in both Dectin-1-deficient and IL-22-deficient mice, suggesting a possible role for lipocalin 2 in
A. fumigatus lung defense. However, lipocalin 2-deficient mice did not demonstrate an impairment in
A. fumigatus lung clearance, indicating that lipocalin 2 does not appear to play a major role in the susceptibility of Dectin-1-deficient and IL-22-deficient mice to
A. fumigatus. Although we did not see an effect of lipocalin 2 deficiency on
A. fumigatus lung clearance, we cannot exclude the possibility that other antimicrobial factors are compensating for the loss of lipocalin 2. For example, lactoferrin can mediate reactive oxygen species (ROS)-independent killing of
A. fumigatus by neutrophils (
46). Currently, studies are under way to identify the Dectin-1- and IL-22-dependent soluble antifungal factors induced in the lungs during
A. fumigatus infection.
In summary, we have identified a role for IL-22 in early innate immune responsiveness to
A. fumigatus lung infection. Induction of IL-22 was significantly dependent on
A. fumigatus recognition by the beta-glucan receptor Dectin-1. Both neutralization of and genetic deficiency in IL-22 compromised early clearance of
A. fumigatus from the lungs. IL-22 was critical for the induction of both lung inflammatory cytokines and chemokines, as well as the lung antifungal response. However, the Dectin-1- and IL-22-dependent lung antifungal response was independent of the known IL-17A- and IL-22-associated antimicrobial factor S100 proteins, RegIIIγ and lipocalin 2, suggesting a separate, yet-to-be-characterized Dectin-1- and IL-22-dependent antifungal mechanism. As with our recent report on IL-17A (
43), our data further suggest that soluble mediators, in addition to IL-23, may also play a role in Dectin-1-dependent IL-22 production. However, as our data indicate that IL-17A and IL-22 are simultaneously needed for
A. fumigatus lung clearance and that IL-23 is essential for the induction of both cytokines during
A. fumigatus lung infection, IL-23 may be an effective immunotherapy for the treatment of IA in susceptible individuals. In conclusion, the current body of work adds depth to our understanding of the roles of Dectin-1 and the IL-23/IL-17A/IL-22 axis in innate lung defense against
A. fumigatus.