Blackwell Science, LtdOxford, UKMMIMolecular Microbiology0950-382XBlackwell Publishing Ltd, 2004? 2004??Review ArticleThe mycobacterial lipoarabinomannan and related moleculesV. Briken, S. A. Porcelli, G. S. Besra and L. Kremer
Mycobacterial lipoarabinomannan and related lipoglycans: from biogenesis to modulation of the immune response Volker Briken,1 Steven A. Porcelli,1 Gurdyal S. Besra2 progress in the identification of genes involved in the and Laurent Kremer3* biosynthesis of LAM is discussed, in particular with
1Department of Microbiology and Immunology, Albert respect to the fact that enzymes controlling the LAM/ Einstein College of Medicine, Bronx, NY 10461, USA.LM balance might represent targets for new antituber-
2School of Biosciences, The University of Birmingham, cular drugs. In addition, inactivation of these genes may lead to attenuated strains of M. tuberculosis for
3Laboratoire des Mécanismes Moléculaires de la the development of new vaccine candidates. Pathogénie Microbienne, INSERM U629, Institut Pasteur de Lille/IBL, 1 rue Pr. Calmette, BP245-59019 Lille Cedex, Introduction
Mycobacteria are extraordinarily successful pathogenswith the remarkable ability to persist within the host’s
tissues even in the presence of an intact immune system. The cell wall component lipoarabinomannan (Man-
Pathogenic mycobacteria are predominantly intracellular
LAM) from Mycobacterium tuberculosis is involved in
parasites capable of replicating within the normally hos-
the inhibition of phagosome maturation, apoptosis
tile environment of macrophages. In this location, the
and interferon (IFN)-g signalling in macrophages and
bacillus is protected from many of the immune mecha-
interleukin (IL)-12 cytokine secretion of dendritic cells
nisms that normally eliminate bacterial invaders. One
(DC). All these processes are important for the host
major challenge that the intracellular bacteria face is
to mount an efficient immune response. Conversely,
overcoming cell-mediated mechanisms of immunity that
LAM isolated from non-pathogenic mycobacteria
detect signals originating from infected cells. An impor-
(PILAM) have the opposite effect, by inducing a potent
tant key to the success of pathogenic mycobacteria is
proinflammatory response in macrophages and DCs.
likely to be their unusual cell wall structure and its inter-
LAMs from diverse mycobacterial species differ in the
actions with the immune system. This cell envelope con-
modification of their terminal arabinose residues. The
sists of a highly complex array of distinctive lipids,
strong proinflammatory response induced by PILAM
glycolipids and proteins. It has been intensely scrutinized
correlates with the presence of phospho-myo-inositol
as a potential effector in the interaction of Mycobacteriumon the terminal arabinose. Interestingly, recent work tuberculosis with the human host (Glickman and Jacobs,
indicates that the biosynthetic precursor of LAM,
2001; Russell et al., 2002; Brennan, 2003; Flynn and
lipomannan (LM), which is also present in the cell wall, displays strong proinflammatory effects, inde-
Lipoarabinomannan (LAM) as well as its related precur-
pendently of which mycobacterial species it is iso-
sors, lipomannan (LM) and phosphatidyl-myo-inositol
lated from. Results from in vitro assays and knock-
mannosides (PIMs), are found interspersed in the myco-
out mice suggest that LM, like PILAM, mediates its
bacterial cell wall. PIMs, LM and LAM are major lipogly-
biological activity via Toll-like receptor 2. We hypoth-
cans that are non-covalently attached to the plasma
esize that the LAM/LM ratio might be a crucial factor
membrane through their phosphatidyl-myo-inositol anchor
in determining the virulence of a mycobacterial spe-
and extend to the exterior of the cell wall (Besra and
cies and the outcome of the infection. Recent
Brennan, 1997; Belanger and Inamine, 2000; Nigou et al.,2003). These complex molecules are believed to playimportant roles in the physiology of the bacterium as well
Accepted 15 April, 2004. *For correspondence. E-maillaurent.kremer@ibl.fr; Tel. (+33) 3 20 87 11 54; Fax (+33) 3 20 87 11
as in the modulation of the host response during infection.
For example, LAM is an important modulator of the
V. Briken, S. A. Porcelli, G. S. Besra and L. Kremer
immune response in the course of tuberculosis and lep-
The size and the degree of branching of the mannan core
rosy (Chatterjee and Khoo, 1998; Nigou et al., 2002) and
are species dependent. The arabinan polymer of LAM
a key ligand in the interaction between M. tuberculosis,
consists of a linear a(1Æ5)-linked arabinofuranosyl back-
macrophages and dendritic cells (DCs) (Schlesinger
bone punctuated with branched hexa-arabinofuranosides
et al., 1994; Maeda et al., 2003). In addition, recent stud-
(Ara6) and linear tetra-arabinofuranosides (Ara4) (Chatter-
ies highlight the potential role of LM in mycobacterial
jee et al., 1991; 1993) (Fig. 1).
virulence via its strong proinflammatory and apoptosis-
LAM can be classified into three major structural fami-
lies according to the capping motifs present on the non-
A thorough investigation of the roles of PIMs, LM and
reducing termini of the arabinosyl side-chains. The arabi-
LAMs in mycobacterial virulence has been hampered by
nan termini in the pathogenic strains M. tuberculosis, M.
a lack of defined mutants that fail to synthesize these
leprae, Mycobacterium avium and M. kansasii are modi-
specific cell surface components. Recently, advances in
fied with caps consisting of a single Manp, a dimannoside
the genetic manipulation of mycobacteria and related act-
or a trimannoside, with dimannosides predominating
inomycetes, together with the sequencing of the M. tuber-
(Nigou et al., 1997; Vercellone et al., 1998; Khoo et al.,
culosis genome, have allowed several lipoglycan mutants
2001; Guerardel et al., 2003), resulting in molecules des-
with defined envelope deficiencies to be generated.
ignated ManLAM. ManLAM contains about 50 Manp and
Progress in the study of mycobacterial glycolipid biosyn-
60 Araf units. A general picture of the M. tuberculosis
thesis bears the promise of identifying enzymes that might
ManLAM structure is proposed in Fig. 1. In the fast-grow-
be essential for the viability and/or virulence of M. tuber-
ing non-pathogenic species M. smegmatis, Mycobacte-culosis and targets for future drug development. rium fortuitum and in an unidentified species, branches of
This review article reports the advances made in the
the terminal arabinan are terminated by inositol phos-
current understanding of PIMs, LM and LAM biosynthesis
phate caps (Khoo et al., 1995), characterizing the PILAM
and will describe only briefly the structural organization of
family. A third LAM family, designated AraLAM, recently
the different domains comprising these complex mole-
identified in M. chelonae, comprises a LAM molecule
cules as this has been the subject of many excellent
devoid of both the manno-oligosaccharide and inositol
reviews (Chatterjee and Khoo, 1998; Brennan, 2003;
phosphate caps (Guerardel et al., 2002).
Nigou et al., 2003). We also discuss recent observationsrelating to the immunomodulatory functions of LAM and
Biogenesis of PIMs, LM and LAM
its precursors, in addition to their receptors and intracel-lular signalling pathways. The role of these lipoglycans as
Understanding the biosynthesis of PIMs, LM and LAM has
antigens presented by the CD1 system, the host’s lipid
been the focus of recent genetic and biochemical studies
antigen-presenting molecule, has been reviewed recently
(Nigou et al., 2003). Enzymes that clearly participate in
the elaboration of these complex lipoglycans are repre-sented in Fig. 1. Structure of mycobacterial LAM and related lipoglycans
PIMs and their multiglycosylated counterparts, LM and
Several mannosyltransferases involved in the mannosyla-
LAM, are complex lipoglycans that are found ubiquitously
tion steps can be distinguished with respect to the man-
in the envelopes of all mycobacterial species. PIMs, LM
nose donor they use (either GDP-Manp during early steps
and LAM all share a conserved mannosyl-phosphatidyl-
in PIM biosynthesis, or C35/C50-P-Manp later in LM syn-
myo-inositol (MPI) that is presumably used to insert these
thesis from PIM precursors). PIM biosynthesis is initiated
structures into the plasma membrane (Hunter and Bren-
by two distinct mannosyltransferases that use GDP-Manp
nan, 1990), suggesting that they are metabolically related
as the sugar donor. The first step involves the transfer of
(Besra and Brennan, 1997). In addition to the MPI, LAM
a mannose residue from GDP-Manp to the 2-position of
possesses a mannan core with a branched arabinan poly-
the myo-inositol ring of phosphatidyl-myo-inositol (PI) to
mer and, in some cases, cap motifs decorate the termini
form phosphatidyl-myo-inositol monomannoside (PIM1).
of the branched arabinan (Nigou et al., 2003) (Fig. 1).
This reaction is catalysed by the a-mannosyltransferase
The mannan core consists of an a1,6-linked Manp
PimA (Kordulakova et al., 2002). The pimA gene of which
backbone, which is substituted at C-2 by single Manp
is essential, demonstrating that PIM1, and presumably
units in numerous species, including M. tuberculosis,
higher mannosylated PIMs, are required for cell growth. Mycobacterium leprae, Mycobacterium kansasii and
Interestingly, pimA is the fourth gene in an operon of five
Mycobacterium smegmatis, and at C-3 by single Manp
genes that are all potentially involved in PIM biosynthesis
units in Mycobacterium chelonae (Guerardel et al., 2002).
(Kordulakova et al., 2002). The first gene in this cluster
2004 Blackwell Publishing Ltd, Molecular MicrobiologyThe mycobacterial lipoarabinomannan and related molecules(Rv3793, GT-53) Arabinan Hexa-arabinoside Tetra-arabinoside (Rv0557, GT-4) (MT1800, GT-4)
PgsA1 (Rv2612c) (Rv2051c, GT-2) (Rv2610c, GT-4) (Rv2611c) Fig. 1. General structure of ManLAM from M. tuberculosis and structural relationship between PIMs, LM and LAM. PIM2 is a precursor of the highly mannosylated LM molecule, which is further extended by the arabinan domain to form LAM. In both LM and LAM, an a1,6-linked Manp backbone substituted at C-2 by single Manp units constitutes the mannan domain. The arabinan polymer is a linear a(1Æ5)-linked arabinofuranosyl backbone punctuated with branched hexa-arabinofuranosides: [b-D-Araf-(1Æ2)-a-D-Araf-(1-]2Æ3 and Æ5)-a-D-Araf-(1Æ5)-a-D-ArafÆ and linear tetra-arabinofuranosides: b-D-Araf-(1Æ2)-a-D-Araf-(1Æ5)-a-D-Araf-(1Æ5)-a-D-ArafÆ. The mannose caps, which terminate the arabinan domain, consist of a single Manp residue, a dimannoside (a-D-Manp(1Æ2)-a-D-ManpÆ) or a trimannoside (a-D-Manp-(1Æ2)-a-D-Manp-(1Æ2)-a-D- ManpÆ). R1, R2 and R3 are fatty acyl chains. C35/C50-P-Manp represents a polyprenyl monophosphomannose. The a, b, c and d values are species specific. Arrows indicate enzymes confirmed to participate in the biosynthesis of these lipoglycans. PimC was found to be present in M. tuberculosis CDC1551 but absent from M. tuberculosis H37Rv. Classification of the glycosyltransferases by their CAZY family is indicated in brackets.
encodes a protein of unknown function, while the second
Rv2611c is dispensable in M. smegmatis, although its
encodes PgsA1, the PI synthase that catalyses the
disruption induces dramatic changes in the PIM content
condensation of inositol and the diglyceride of CDP-
and a severe growth defect (Kordulakova et al., 2003). The
diacylglycerol (Jackson et al., 2000). The third gene
last gene of the PIM cluster, Rv2609c, encodes a putative
(Rv2611c) of this operon encodes a protein with high
GDP-Manp hydrolase that awaits further characterization.
similarity to bacterial acyltransferases. This protein has
The second mannosylation step, catalysed by PimB,
been shown to be responsible for the acylation of the 6-
allows the transfer of another Manp residue to the 6-
position of the Manp residue linked to position 2 of the
position of the myo-inositol ring of PIM1, leading to PIM2
myo-inositol in PIM1 and PIM2, with the mono-mannosy-
(Schaeffer et al., 1999). A third Manp unit is finally intro-
lated lipid acceptor being the primary substrate of the
duced on to the growing molecule to form PIM3 in a reac-
enzyme (Kordulakova et al., 2003). In contrast to pimA or
tion carried out by the product of the pimC gene identified
pgsA1, which are both essential, the acyltransferase
in M. tuberculosis CDC1551 (Kremer et al., 2002). How-
2004 Blackwell Publishing Ltd, Molecular MicrobiologyV. Briken, S. A. Porcelli, G. S. Besra and L. Kremer
ever, inactivation of pimC in Mycobacterium bovis BCG
less, one exception is the LM of M. chelonae, which has
did not affect cell growth and did not alter the PIM/LM/
a(1Æ3)-linked Manp residues (Guerardel et al., 2002).
LAM composition of the mutant. This suggests the pres-
None of the specific genes encoding these branching
ence of an alternative synthesis pathway present in M.
mannosyltransferases has been identified. bovis BCG and M. tuberculosis CDC1551, a hypothesisthat is supported by the fact that pimC is not found in M.Biogenesis of the arabinan domain in LAMtuberculosis H37Rv (Kremer et al., 2002).
The mannose unit at the position 6 of PIM3 is then
The ‘mature’ LM is then subsequently glycosylated with
further elongated with mannose residues to generate
arabinan to form LAM. Until very recently, little was known
PIM4-6. However, mannosyltransferases participating in
about the genetics of arabinan biosynthesis. Two forms of
this elongation process have not been identified.
arabinans are found in the mycobacterial cell wall: one ispart of the heteropolysaccharide arabinogalactan (AG)and the other is part of LAM. The two forms of D-arabinan
differ in that mycolic acids esterify arabinan in AG, thus
Besra et al. (1997) established that PIMs are extended
constituting the basis of the lipid barrier of mycobacteria.
with additional Manp residues from the alkali-stable C35/
In contrast, in M. tuberculosis LAM, the arabinan moiety
C50 polyprenyl monophosphomannose (C35/C50-P-Manp)
is further capped with mannose residues responsible for
donor to form ‘linear’ LMs, containing only a(1Æ6) Manp
some of its biological functions. Therefore, arabinan rep-
residues. C35/C50-P-Manp is synthesized from GDP-Manp
resents a valid target for the generation of antimycobac-
and polyprenols by the polyprenol monophosphomannose
terial drugs because blocking of its biosynthesis would led
(ppm) synthase, encoded by the ppm1 gene (Gurcha
to dual disruption of both the mycolyl–AG–peptidoglycan
et al., 2002). Disruption of the ppm synthase gene in
Corynebacterium glutamicum, identified on the basis of
As mentioned above, the arabinan domain consists of
homology searches, induced a complex phenotype includ-
a linear a(1Æ5)-Araf backbone substituted by two kinds
ing altered cell growth rates and inability to synthesize
of arrangements, linear tetra-arabinofuranosides (Ara4)
C55-P-Manp (Gibson et al., 2003a). This mutant was also
and hexa-arabinofuranosides (Ara6). In both cases, the
unable to produce any ‘mature’ lipoglycans, such as LM
non-reducing end is characterized by the disaccharide
or LAM, but could still produce PIMs, highlighting the key
unit b-D-Araf-(1Æ2)-a-D-Araf-(1Æ) (Besra and Brennan,
role of ppm synthase in LM/LAM synthesis (Gibson et al.,
The only Araf sugar donor identified so far is the C35/
The ppm synthase-dependent a(1Æ6)-mannosyltrans-
C50 polyprenyl monophosphoarabinose (C35/C50-P-Araf)
ferase involved in the polymerization step leading to the
(Wolucka et al., 1994), which is synthesized from 5-
linear mannan core is currently unknown. Interestingly,
phospho-D-ribose pyrophosphate (Scherman et al.,
prenyl-linked benzophenone photoreactive probes have
1996). Initially identified as the major target of ethambutol
recently been shown to be excellent substrates for the
(an effective antimycobacterial drug) in M. avium
recombinant ppm synthase. Furthermore, photoactivation
(Belanger et al., 1996) and M. tuberculosis (Telenti et al.,
abolishes the enzymatic activity of ppm synthase in vitro
1997), the two homologue proteins EmbA and EmbB have
(Guy et al., 2004). More importantly, unique mannosy-
been reported to participate in the formation of the proper
lated derivatives of these photoreactive probes were all
Ara6 motif in AG (Escuyer et al., 2001). These two proteins
mannose donors through a ppm synthase-dependent
have been proposed to catalyse a1,3-arabinosyltrans-
a(1Æ6)-mannosyltransferase to a synthetic Manp-Manp
ferase activity in the arabinan of AG. M. smegmatis
dissacharide acceptor using M. smegmatis membranes.
mutants lacking embA or embB are viable, probably
In addition, photoactivation of these mannosylated probes
because the two gene products partially compensate for
led to specific inhibition of the ppm synthase-dependent
each other. Although arabinosylation of AG was dramati-
a(1Æ6)-mannosyltransferase activity (M. R. Guy, P. A.
cally diminished, arabinosylation of LAM remained unaf-
Illarionov, S. S. Gurcha, K. J. C. Gibson, P. W. Smith, D.
fected in these mutants (Escuyer et al., 2001). In M.
E. Minnikin, and G. S. Besra, submitted). We will use
tuberculosis, the Emb proteins are encoded by a cluster
these powerful tools by simply modifying the mannosy-
of three genes, embC, embA and embB (Cole et al.,
lated probes through inclusion of a radiolabelled tag in
1998). Zhang et al. (2003) found recently that inactivation
order to identify the a(1Æ6)-mannosyltransferase(s) via a
of the remaining embC gene in M. smegmatis abolished
arabinosylation of LAM, but not AG. The three Emb pro-
In M. tuberculosis and almost all other mycobacteria
teins are predicted to contain 13 membrane-spanning
analysed to date, the ‘mature’ LM consists of ‘linear’ LM
segments in their N-terminal region and a globular
bearing single a(1Æ2)-linked Manp residues. Neverthe-
C-terminal domain. It has been proposed that the N-
2004 Blackwell Publishing Ltd, Molecular MicrobiologyThe mycobacterial lipoarabinomannan and related molecules
terminus of EmbC participates in the recognition of the
ciated with ManLAM. In this regard, it is conceivable that
LM as a precursor of LAM and that the C-terminus is
inhibitors such as ethambutol may modulate the immune
responsible for arabinosylation (Zhang et al., 2003). The
interactions of M. tuberculosis with the host, although this
transmembrane segments of the Emb proteins are very
remains to be demonstrated further. Genes participating
likely to be involved in translocating the arabinan
in the synthesis of these caps have not been reported,
component across the plasma membrane. However,
and the identification of mannosyltransferases involved in
whether the C-terminal domain is able to synthesize full-
this reaction remains a challenge. Pathak et al. (2004)
length arabinan is not known. It remains possible that
reported the synthesis of two a(1Æ6)- and a(1Æ2)-linked
arabinan motifs might be preassembled on carrier
Manp-Manp disaccharides as photoaffinity probes for
molecules, polymerized and attached to the LM acceptor
active-site labelling studies. Photoaffinity probe technol-
molecule, a scenario that would suggest the requirement
ogy offers new avenues for the identification of putative
mannosyltransferases involved in the synthesis of the
EmbR belongs to the Streptomyces coelicolor antibiotic
a(1Æ6)-mannan core and mannose caps.
regulatory protein (SARP) family (Wietzorrek and Bibb,
All known sequences of glycosyltransferases have been
1997), known to regulate genes involved in the synthesis
of secondary metabolites. Belanger et al. (1996) proposed
afmb.cnrs-mrs.fr/CAZY/). It was reported recently that M.
that EmbR influences the expression of the M. aviumtuberculosis H37Rv contains 37 putative glycosyltrans-
embAB operon. M. smegmatis membranes carrying the
ferases, but the precise reaction catalysed by most of
M. avium embAB and embR genes retain significantly
them has not been determined experimentally. Classifica-
more arabinosyltransferase activity than membranes
tion of glycosyltransferases with functions that have been
originating from M. smegmatis carrying only the embAB
confirmed shows that they belong to the GT-2 (Ppm1), GT-
cluster, when treated with similar amounts of ethambutol
4 (PimA, PimB, PimC) and GT-53 (EmbC) CAZY family
(Belanger et al., 1996). The M. avium embR gene is
(Wimmerova et al., 2003). Although glycosyltransferases
located immediately upstream of embAB, while the embR
share little sequence similarity, they are proposed to adopt
gene of M. tuberculosis is elsewhere in the genome (Telenti
only two different folds, BGT and SpsA, according to the
et al., 1997; Cole et al., 1998). It was demonstrated
first structure solved in each case. For instance, Ppm1
recently that PknH, a newly described Ser/Thr kinase from
has been proposed to contain an SpsA fold, and PimA
M. tuberculosis, phosphorylates EmbR through recogni-
and PimB a BGT fold (Wimmerova et al., 2003).
tion of a FHA (forkhead-associated) domain (Molle et al.,2003). Arg-312, Ser-326 and Asn-348 in the EmbR FHA
Modulation of the immune response by PIM/LM/LAM
are key residues in the interaction between EmbR and
PknH. However, it remains to be established whether phos-phorylation of EmbR by PknH plays a role in the transcrip-
Historically, most studies analysing the effect of LAM on
tional regulation of the embCAB cluster and in ethambutol
the induction of an inflammatory response by macroph-
resistance in M. tuberculosis. Whether the PknH/EmbR
ages or DCs have been performed using ManLAM from
pair regulates the arabinosyltransferase activity of EmbC
M. tuberculosis or M. bovis BCG and PILAM from an
in vivo, ultimately leading to arabinan synthesis of LAM,
unidentified, fast-growing mycobacterial species (previ-
ously named AraLAM) that is structurally very similar toPILAM of M. smegmatis. Results from these studies dem-onstrated that treatment of macrophages with PILAM
induced the secretion of various cytokines [interleukin
LAM is modified further by either manno-oligosaccharides
(IL)-8, IL-12, tumour necrosis factor (TNF)-a] and apopto-
or phospho-inositol caps, according to the species, result-
sis, whereas ManLAM did not or did so only weakly (Chat-
ing in ManLAM or PILAM respectively. It is noteworthy
terjee et al., 1992; Roach et al., 1993; Zhang et al., 1995;
that, although ethambutol was shown to affect the com-
Riedel and Kaufmann, 1997; Yoshida and Koide, 1997;
plete elaboration of the arabinan in PILAM from an etham-
Ghosh et al., 1998). These observations led to the hypoth-
butol-resistant M. smegmatis mutant (Khoo et al., 1996),
esis that the presence of mannose caps on LAM (such as
it has also been suggested that ethambutol inhibits the
in ManLAM) inhibit its proinflammatory activity. Unfortu-
extent of mannose capping of ManLAM in M. tuberculosis
nately, uncapped LAM was not included in these studies
strains grown in the presence of subminimal inhibitory
for direct comparison of the biological effects of ManLAM
drug concentrations (Khoo et al., 2001). As mannose cap-
and PILAM. Therefore, some of the biological effects
ping is a major structural entity engaged in receptor bind-
associated with PILAM could also be attributed to their
ing and subsequent immunopathogenesis, inhibition of
phospho-myo-inositol caps. The recent isolation and char-
this motif may directly affect the biological functions asso-
acterization of LAM (AraLAM) from the facultative patho-
2004 Blackwell Publishing Ltd, Molecular MicrobiologyV. Briken, S. A. Porcelli, G. S. Besra and L. Kremer
genic M. chelonae revealed that it lacks both the manno-
molecules, thus revealing the proinflammatory activity of
oligosaccharide and phosphoinositol caps on its terminal
the LM core (Vignal et al., 2003).
arabinose residues (Guerardel et al., 2002). Interestingly,
Deciphering the complex molecular basis of LAM/LM
only PILAM, but not ManLAM or AraLAM, significantly
activities could greatly benefit from the increasing charac-
induces IL-12 expression and apoptosis (Dao et al.,
terization of new structural LAM variants. Lipoglycans
2004). PILAM, but neither ManLAM nor AraLAM, consis-
related to mycobacterial LAM have been described in
tently induces the secretion of the proinflammatory cytok-
several actinomycetes, including Rhodococcus (Garton
ines IL-8 and TNF-a (Guerardel et al., 2002; Vignal et al.,
et al., 2002), Corynebacteria (Sutcliffe, 1995), Gordonia
2003). These results support the hypothesis that mannose
(Flaherty and Sutcliffe, 1999) and Amycolatopsis (Gibson
caps do not inhibit the proinflammatory activities of LAM,
et al., 2003b). The LAM-like molecule from the intracellu-
but rather that the phosphoinositol caps of PILAM are
lar pathogen Rhodococcus equi consists of a linear (a1–
potent proinflammatory constituents. However, this does
6)-mannan backbone substituted by 2-linked single Manp
not diminish the potential importance of mannose caps
residues (Garton et al., 2002). In contrast to mycobacte-
with respect to their capacity to inhibit proinflammatory
rial LAM, there are no extensive arabinan domains but
signals engaged by other ligands, as discussed below,
single terminal a-D-Araf residues capping the 2-linked a-
which is most likely to be an important activity in the
D-Manp. This ‘simpler’ LAM molecule, which resembles an
context of infection of macrophages or DCs. The availabil-
LM-like molecule, was found to induce an early macroph-
ity of AraLAM makes it feasible to address this hypothesis
age proinflammatory response (Garton et al., 2002), sup-
porting the notion that an extended arabinan domain may
Characterization of LAM from the facultative pathogenic
hinder the LM-dependent inflammatory response.
mycobacteria M. kansasii and M. chelonae enabled us to
LAM from Tsukamurella paurometabola was recently
analyse the effects of their precursors on the induction of
demonstrated to induce the secretion of TNF-a in murine
proinflammatory cytokines and apoptosis in macroph-
and human macrophages (Gibson et al., 2004). Interest-
ages. Interestingly, whereas neither ManLAM from M.
ingly, this activity was dramatically increased after removal
kansasii nor AraLAM from M. chelonae had any activity,
of the arabinan chains by mild acidic treatment, which
the addition of LM from either species induced potent
exposed the LM core. These observations are consistent
secretion of IL-8 and TNF-a (Vignal et al., 2003) and sig-
with the results analysing mycobacterial LM/LAM, and
nificant expression of IL-12 and apoptosis (Dao et al.,
therefore reinforce our hypothesis that the LM-mediated
2004). LM purified from M. smegmatis, M. tuberculosis
proinflammatory activity is obstructed by the arabinan
and M. bovis BCG also induced proinflammatory
responses (Dao et al., 2004). Moreover, LM but not the
As a consequence, enzymes modifying the LM core by
corresponding LAM induced macrophage activation char-
the addition of arabinose residues should be important
acterized by cell surface expression of CD40 and CD86,
targets for the creation of attenuated strains of M. tuber-
as well as NO secretion (Quesniaux et al., 2004). culosis and for the discovery of new antitubercular drugs.
Therefore, LMs of mycobacteria in general are strong
One attractive gene candidate for inactivation in M. tuber-
proinflammatory factors and, as LAM and LM are part of
culosis is embC, which has been shown to participate in
the cell wall, one could argue that it is important for viru-
the arabinosylation of LM in M. smegmatis (Zhang et al.,
lent mycobacteria to minimize the amount of LM present
2003). Deletion of this gene should strongly increase the
in the cell wall in order to reduce the host’s proinflamma-
amount of LM in the cell wall and should affect the viru-
tory response. Consequently, one might expect a direct
correlation between mycobacterial virulence and a high
Several reports demonstrated that PIMs isolated from
LAM/LM ratio. Analysis of the LAM/LM ratio in the cell
M. tuberculosis are able to induce TNF-a and IL-8 secre-
walls of different virulent, facultative pathogenic and non-
tion by human and murine macrophages (Barnes et al.,
pathogenic mycobacteria would address this hypothesis.
1992; Zhang et al., 1995; Jones et al., 2001). Highly puri-
Alternatively, differences in the structural organization of
fied PIM2 and PIM6 were also found to induce similar but
the cell wall between bacteria may also lead to different
very low levels of TNF-a secretion (Gilleron et al., 2003).
accessibility of LM for its interaction with TLR-2 on
In contrast, a number of studies failed to detect significant
induction of IL-8, IL-12 and TNF-a secretion and found no
The arabinan domain of LAM inhibits the proinflamma-
increased induction of apoptosis upon treatment of mac-
tory activity of LM on macrophages, presumably by mask-
rophages with PIMs isolated from M. tuberculosis, M.
ing the mannan core of LAM (Fig. 1). Consistently, gradual
kansasii or M. chelonae compared with treatment of cells
chemical reduction in the amount of arabinan domain of
with equal molar amounts of PILAM or LM (Guerardel
the M. kansasii ManLAM correlated with increased proin-
et al., 2002; 2003; Vignal et al., 2003; Dao et al., 2004).
flammatory cytokine expression of the truncated LAM
Interestingly, the two studies (Barnes et al., 1992; Zhang
2004 Blackwell Publishing Ltd, Molecular MicrobiologyThe mycobacterial lipoarabinomannan and related moleculeset al., 1995) reporting the strongest activity of PIMs on
with ManLAM inhibit phagosome–lysosome fusion (Fratti
cytokine secretion used either primary human peripheral
et al., 2001; 2003), suggesting that ManLAM is an impor-
blood mononuclear cells or primary human alveolar mac-
tant mediator of the inhibition of phagosome maturation
rophages respectively. In contrast, the activity of PIMs on
in the context of infection with live bacteria.
cytokine secretion, reported by Jones et al. (2001) andGilleron et al. (2003), was modest compared with the
Receptors involved in inhibition and activation processes
activity of PILAM, LM or LPS and was conducted usingmurine macrophages. Therefore, it appears that PIMs dis-
Toll-like receptors are important initiators of the innate
play a residual proinflammatory activity, which becomes
immune response that are specific for pathogen-
more or less apparent depending on the sensitivity of the
associated molecular patterns, such as CpG-oligodeoxy-
target cells (primary human cells versus murine cells) and
nucleotides, lipoteichoic acid, peptidoglycan and flagellin
the detection assay [reverse transcription polymerase
(Kopp and Medzhitov, 2003). Interaction of agonists with
chain reaction (RT-PCR) versus enzyme-linked immun-
TLR-2 induces IL-12 secretion and apoptosis by the cell.
osorbent assay (ELISA)] used. In addition, the purity of
PILAMs purified from rapidly growing mycobacteria, but
the PIM fraction is critical as a crude preparation of PIM
not ManLAM from M. tuberculosis, have been shown to
would contain ‘higher’ PIMs with multiple mannose resi-
interact with TLR-2 (Heldwein and Fenton, 2002). Inter-
dues (such as PIM6), which may explain their biological
estingly, LM isolated from M. kansasii, M. chelonae or M.
activity as these structures start to resemble LM. tuberculosis all interact with TLR-2, but not with TLR-4, asdetermined by TLR-induced CD25 expression in trans-fected Chinese hamster ovary cells (Dao et al., 2004).
These results were also confirmed in in vitro assays
The first demonstration of the capacity of LAM to inhibit a
on bone marrow-derived macrophages isolated from
host response involved in defence against bacterial infec-
TLR-2–/– or TLR-4–/– mice, showing that LM had no activity
tion was conducted by Sibley et al. (1988), who reported
in the former but had normal cytokine-inducing activity in
the inhibition of the interferon (IFN)-g response of mac-
the latter (Quesniaux et al., 2004). Moreover, macrophage
rophages by ManLAM. Subsequently, live M. tuberculosis
activation by LM was also found to be mediated through
infection was shown to inhibit IFN-g signalling, as demon-
the adaptor protein myeloid differentiation factor 88
strated by the reduction in the IFN-g-mediated cell surface
(MyD88), but independent of either TLR-4 or TLR-6 rec-
expression of MHC class II and receptors for the Fc por-
ognition (Quesniaux et al., 2004). PIMs were shown to be
tion of IgG after infection of macrophages with M. tuber-
TLR-2 agonists, which may explain their biological activity
culosis (Hmama et al., 1998; Hussain et al., 1999; Ting
observed by some investigators (Jones et al., 2001;
et al., 1999; Pai et al., 2003). Furthermore, ManLAM from
M. tuberculosis inhibited the M. tuberculosis infection-
Two receptors have been implicated to date in the inhib-
induced apoptosis of macrophages (Rojas et al., 1997;
itory activity of ManLAM. ManLAM can inhibit the LPS-
Rojas et al., 2000) and the secretion of IL-12 induced by
induced IL-12 secretion of human DCs (Nigou et al.,
lipopolysaccharide (LPS) in DCs (Nigou et al., 2001) and
2001). This activity was abolished by enzymatic removal
macrophages (Knutson et al., 1998). The activity of Man-
of the mannose caps or by treatment with antimannose
LAM reflects the capacity of whole M. tuberculosis bacte-
receptor (MR) antibodies, and was mimicked by the addi-
ria to inhibit infection-induced apoptosis (Keane et al.,
tion of mannan from Saccharomyces cerevisiae, a known
2000) and Il-12 secretion of macrophages (Giacomini
agonist of the MR, suggesting that the MR is the receptor
et al., 2001; Hickman et al., 2002; Li et al., 2002). Contra-
that mediates the inhibition. Nevertheless, subsequent
dictory results show that, in DCs, M. tuberculosis seems
studies showed that anti-MR antibodies did not block bind-
either to induce secretion of IL-12 (Giacomini et al., 2001)
ing of ManLAM to DCs, in contrast to antibodies directed
or to inhibit IL-12 production (Johansson et al., 2001;
against DC-specific intracellular adhesion molecule-3-
Demangel et al., 2002). One of the hallmarks of the host–
grabbing non-integrin (DC-SIGN) (Geijtenbeek et al.,
pathogen interaction between macrophages and M. tuber-
2003; Tailleux et al., 2003). Furthermore, the binding of
culosis is the ability of M. tuberculosis to inhibit the fusion
ManLAM to DC-SIGN on DCs induced the secretion of IL-
of phagosomes with lysosomes (Armstrong and Hart,
10, a known inhibitor of IL-12 secretion (Geijtenbeek
1971). Lysosomes have a low pH and contain a multitude
et al., 2003). Thus, DC-SIGN appears as a major mediator
of lytic enzymes that are meant to lyse any bacterial or
of IL-12-inhibition by ManLAM on DCs.
parasitic invaders that have been phagocytosed by themacrophages. Therefore, the capacity of M. tuberculosisIntracellular mediators of inhibition
to inhibit the fusion of its phagosome with lysosomes iscrucial for its intracellular survival. Latex beads coated
Very little is known about the signalling components that
2004 Blackwell Publishing Ltd, Molecular MicrobiologyV. Briken, S. A. Porcelli, G. S. Besra and L. Kremer
connect DC-SIGN and/or the MR after binding of ManLAM
factor (protein/lipid/glycolipid) that has a fast turnover and
to the intracellular effectors that have been reported to be
therefore requires the continuous bacterial transcription
triggered by ManLAM binding. We propose that the M.
and translation machinery. Alternatively, the difference
tuberculosis-mediated inhibition of the increase in cytoso-
between live and dead bacteria may result from the
lic Ca2+ ([Ca2+]c) (Fig. 2), which is usually associated with
requirement for specific genes that are only induced dur-
phagocytosis of bacteria, is a central mediator of the inhi-
ing phagocytosis of the bacteria by the macrophage. In
bition of three important macrophage responses to infec-
either case, the molecular mechanism by which live M.
tion: phagosome maturation, macrophage apoptosis and
tuberculosis mediate the inhibition of SK1 activation
First, how does M. tuberculosis or ManLAM inhibit the
How does M. tuberculosis- or ManLAM-mediated inhi-
cellular [Ca2+]c response? Recent work demonstrated that
bition of the cellular [Ca2+]c response arrest the phago-
live, but not dead, M. tuberculosis inhibit sphingosine
some maturation? Initially, the inhibition of [Ca2+]c by live
kinase 1 (SK1) activity (Malik et al., 2003) (Fig. 2). This
M. tuberculosis, but not dead M. tuberculosis, was
enzyme converts sphingosine to sphingosine-1-phos-
reported as important only for inhibiting phagosome mat-
phate (S1P). Increased concentrations of S1P induce an
uration (Malik et al., 2000). Further characterization of the
increase in [Ca2+]c levels through the release of Ca2+ from
signalling pathway demonstrated that phagosomes con-
the endoplasmic reticulum by an unknown mechanism
taining live M. tuberculosis contained less of the [Ca2+]c-
that is independent of the inositol triphosphate pathway
dependent effector protein calmodulin (CaM) compared
(Malik et al., 2003). It remains to be established whether
with phagosomes containing dead M. tuberculosis (Malik
this activity of M. tuberculosis on SK1 can also be repro-
et al., 2001). This results in lower activation of the CaM-
duced using purified ManLAM. The comparison between
dependent protein kinase II (CaMKII) on the phagosome
live and dead (heat killed or irradiated) bacteria suggests
membrane. Interestingly, the same characteristics could
that the inhibition of SK1 activity is mediated through a
also be attributed to phagosomes containing ManLAM-coated latex beads compared with uncoated beads (Frattiet al., 2001; 2003; Vergne et al., 2003a). The lack of
activated CaMKII seems to decrease the recruitment ofphosphoinositol-3-kinase (PI3K) on the phagosome,thereby inhibiting the increase in phosphoinositol-3 phos-
phate (PI3P) in the membranes (Vergne et al., 2003b). The amount of PI3P is crucial for recruitment of earlyendosomal antigen 1 (EEA1) to phagosomes (Fratti et al.,2001; Vergne et al., 2003b). Furthermore, beads coated
with ManLAM, but not PIMs, inhibited the recruitment ofthe intracellular markers syntaxin 6 and cathepsin D to theengulfing phagosome as a result of inhibition of EEA1
recruitment (Fratti et al., 2003). The importance of the lipidcomposition of the phagosome membrane for its intracel-lular trafficking has been clearly demonstrated by Anes
et al. (2003). In an elegant in vitro assay, these authorscharacterized various lipids that either accelerated orinhibited phagosome maturation (Anes et al., 2003). Fur-
No change
thermore, the addition of these lipids to cells infected with
cytosolic Ca2+ cyto olic M. tuberculosis had the same effect on phagosome mat-uration, which subsequently resulted in either accelerated
Fig. 2. Induction of elevation of cytosolic Ca2+ in macrophages by dead but not live Mycobacterium tuberculosis (Mtb). Complement
killing or prolonged survival of the intracellular bacteria
opsonized bacteria are phagocytosed by the complement receptor-3
(Anes et al., 2003). These studies were the first to dem-
(CR3). This interaction activates phospholipase D, which in the case
onstrate the relationship between phagosomal lipid com-
of dead Mtb leads to activation of the sphingosine-kinase-1 (SK-1), converting sphingosine to sphingosine-1-phosphate (S1P). The rise
position, intracellular trafficking and the survival of
in S1P induces the release of Ca2+ from the endoplasmic reticulum
mycobacteria within this compartment.
by an unknown mechanism. This signalling pathway is clearly inter-
Regulation of programmed cell death via calcium fluxes
rupted at the level of SK-1 activation in the case of interaction of live Mtb with CR3, possibly through increased dephosphorylation medi-
has been reviewed recently (Mattson and Chan, 2003;
ated by the phosphatase SHP-1, which is to be activated after Mtb
Orrenius et al., 2003), and one report provides evidence
infection. Although phospholipase D is activated by infection of live
of a possible link between the activity of ManLAM in inhib-
and dead Mtb, it remains unclear whether its subcellular localization is the same, which might affect the activation of SK-1.
iting infection-induced apoptosis and its capacity to inhibit
2004 Blackwell Publishing Ltd, Molecular MicrobiologyThe mycobacterial lipoarabinomannan and related moleculesPhagosome maturation Apoptosis IFN-g Signaling Phagosome Phagosome Phagosome-Lyso e-Lys some Transcript Fig. 3. Effect of increased [Ca2+]c on the phagosome maturation, apoptosis and IFN-g signalling in macrophages. I. Rise in [Ca2+]c allows the association with calmodulin (CaM) on the phagosome membrane, which induces the activation of CaM kinase II (CaMKII) and phosphoinositol-3-kinase (PI3K). Subsequently, the PI3K increases the amount of phosphoinositol-3-phosphate (PI3P) in the phagosome membrane, which allows the recruitment of the early endosomal antigen 1 (EEA1) and syntaxin 6. The latter are part of the vesicular fusion complex that mediates the fusion of phagosomes with late endosomes and subsequently with lysosomes. II. Apoptosis can be induced by increases in [Ca2+]c in multiple ways. The association of [Ca2+]c with CaM allows the activation of the phosphatase calcineurin, which induces dephosphorylation of the proapoptotic protein Bad. Activated Bad induces the release of cytochrome C from mitochondria into the cytosol, which is a central signal for the cell to undergo apoptosis. In addition, Ca2+ displaces cytochrome C from its association with the phospholipid cardiolipin in the mitochondria, which induces the rise in reactive oxygen species (ROS), leading to oxidation of the mitochondrial membrane proteins and lipids and, as a result, increased membrane permeability. This allows the free cytochrome C to diffuse into the cytosol and to induce apoptosis. III. The same Ca2+-CaM/CaMKII pathway induced by the rise in [Ca2+]c described in (I) might also induce the phosphorylation of Stat1 on its Ser- 727 by CaMKII. This allows the efficient association of Stat1 with the CBP/p300 complex, and only this ternary complex is capable of initiating the transcription of IFN-g-inducible genes.
[Ca2+]c accumulation in macrophages (Rojas et al., 2000).
Bad/Akt signalling pathway and thus promotes cell sur-
Effector mechanisms by which [Ca2+]c accumulation might
vival (Maiti et al., 2001). In addition, ManLAM increases
lead to apoptosis include the induction of increased mem-
the activity of the Src homology 2-containing tyrosine
brane permeability of the mitochondria, which leads to
phosphatase 1 (SHP-1) (Knutson et al., 1998), which
cytochrome C release into the cytosol (Fig. 3). Increased
inhibits IFN-g signalling by inducing dephosphorylation of
cytosolic cytochrome C leads to the formation of the apo-
the IFN-g receptor-associated JAK kinases (Starr and Hil-
ptosome in which caspases are activated. Next, activated
ton, 1999). Moreover, the ability of ManLAM to inhibit
caspases and nucleases finalize the apoptosis process by
apoptosis of macrophages is absent from macrophages
digesting proteins and DNA respectively (Mattson and
isolated from mice deficient in SHP-1 expression (Rojas
Chan, 2003; Orrenius et al., 2003). et al., 2002). In addition, SHP-1 activity might also be
The connection between the Ca2+-CaM pathway and
involved in the inhibition of the [Ca2+]c response usually
IFN-g-mediated upregulation of MHC II on macrophages
associated with complement receptor 3 (CR3)-mediated
was first demonstrated using a calmodulin antagonist
phagocytosis by inducing dephosphorylation of tyrosine
(W7) that inhibited MHC II expression, whereas an inhib-
kinases that are important for the signal transduction upon
itor of the protein kinase C had no effect (Ina et al., 1987;
binding of mycobacteria to CR3 (Fig. 3).
Koide et al., 1988). Furthermore, CaMKII is known tomediate phosphorylation of residue S727 of Stat1, a crit-
Conclusion
ical event in IFN-g-induced gene activation (Nair et al.,2002), presumably because phosphorylation of Stat1 at
Considerable strides have been made in identifying and
this position allows its interaction with the transcription
characterizing genes that are required for PIMs, LM and
factors CBP and p300 (Fig. 3). Thus, an important part of
LAM biosynthesis, but there is still much to be learned.
the inhibition of IFN-g signalling by M. tuberculosis is
Genetic strategies have shown that genes involved in the
mediated through the inhibition of [Ca2+]c.
early steps of PIM biosynthesis appear to be essential for
Finally, ManLAM can probably mediate inhibition of cel-
mycobacterial growth. Recent work demonstrated that it
lular responses in addition to inhibition of the cellular
is now feasible to generate LAM-deficient strains of C.
[Ca2+]c response. Indeed, ManLAM directly activates the
glutamicum or M. smegmatis, and that LAM, in contrast
2004 Blackwell Publishing Ltd, Molecular MicrobiologyV. Briken, S. A. Porcelli, G. S. Besra and L. Kremer
to PIM, is not a requisite for in vitro growth. This also
the cell wall of Mycobacterium tuberculosis. Tuberculosis
suggests that it will be possible to generate similar
83: 91–97.
mutants in M. tuberculosis in the near future, which will
Chatterjee, D., and Khoo, K.H. (1998) Mycobacterial lipoara-
binomannan: an extraordinary lipoheteroglycan with pro-
be essential in order to establish the biological importance
found physiological effects. Glycobiology8: 113–120.
of LM/LAM in mycobacterial virulence, persistence and
Chatterjee, D., Bozic, C.M., McNeil, M., and Brennan, P.J.
replication in the infected host. Such a genetic approach
(1991) Structural features of the arabinan component of
will demonstrate a causal relationship between the multi-
the lipoarabinomannan of Mycobacterium tuberculosis. J
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Biol Chem266: 9652–9660.
LM and the effect of bacterial infection on macrophages
Chatterjee, D., Roberts, A.D., Lowell, K., Brennan, P.J., and
and DCs. In view of the vast array of effects mediated by
Orme, I.M. (1992) Structural basis of capacity of lipoarabi-nomannan to induce secretion of tumor necrosis factor.
LAM, some of these mutant strains should be strongly
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attenuated in animal models of tuberculosis and might
Chatterjee, D., Khoo, K.H., McNeil, M.R., Dell, A., Morris,
therefore be interesting vaccine candidates. These
H.R., and Brennan, P.J. (1993) Structural definition of the
mutants will also help to define targets for new tuberculo-
non-reducing termini of mannose-capped LAM from Myco-bacterium tuberculosis through selective enzymatic degra- dation and fast atom bombardment-mass spectrometry. Glycobiology3: 497–506. Acknowledgements
Cole, S.T., Brosch, R., Parkhill, J., Garnier, T., Churcher, C.,
Harris, D., et al. (1998) Deciphering the biology of
G.S.B. acknowledges support as a Lister Institute–Jenner
Mycobacterium tuberculosis from the complete genome
Research Fellow, from the Medical Research Council and the
sequence. Nature393: 537–544.
Wellcome Trust. L.K. is supported by INSERM. V.B. is sup-
Dao, D.N., Kremer, L., Guerardel, Y., Molano, A., Jacobs,
ported by NIH grant AI51696-01, and S.A.P. by NIH grants
W.R., Jr, Porcelli, S.A., and Briken, V. (2004) Mycobacte-
AI48933 and AI45889. We would like to thank Dr David J. rium tuberculosis lipomannan induces apoptosis and IL-12
Kusner for critical reading of the manuscript and helpful
production in macrophages. Infect Immun72: 2067–2074.
Demangel, C., Bertolino, P., and Britton, W.J. (2002) Auto-
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This is a description of the results of treatments for a bone fracture of my left foot. The treatments were performed by Hakan Lagergren using the ReeCept X7 laser in Stockholm, Sweden in May 2004. Because I experienced a fracture of the same area in my right foot about ten years ago in New Jersey, U.S.A., it has been interesting to compare the rates of recovery under different treatment. I a