Dissemination and progression of pulmonary Mycobacterium avium infection in mouse model are associated with type 2 macrophage activation

Abstract

Pulmonary infections caused by the group of nontuberculosis mycobacteria (NTM), Mycobacterium avium complex (MAC), are increasing worldwide and a growing public health concern. Pulmonary granulomas are the hallmark of MAC lung infection, yet reliable correlates of granuloma progression and susceptibility in immunocompetent hosts are poorly defined. The development of mouse models that recapitulate the diversity of granulomas seen in MAC pulmonary disease in humans is crucial to study mechanisms of susceptibility in humans and for preclinical evaluation of therapeutics. Unlike widely used inbred mouse strains, mice that carry the mutant allele at the genetic locus sst1 develop human-like pulmonary tuberculosis featuring well-organized caseating granulomas. These mice became instrumental in pre-clinical testing of novel interventions. In this study we tested whether the B6.Sst1S that carries the sst1 mutant allele on standard B6 background develop more advanced pulmonary infection with NTM M. avium spp. hominissuis (M.av). To assess pulmonary disease progression, we utilized traditional semi-quantitative histomorphological evaluation and fluorescent multiplex immunohistochemistry (fmIHC) in combination with whole slide imaging and digital image analysis. After infection with the laboratory M.av strain 101, the B6.Sst1S pulmonary lesions progressed 12 - 20 weeks post infection, although we did not observe the formation of necrotic granulomas during this interval. Using fmIHC, we determined that the disease progression was associated with a steadily increasing proportion of mycobacteria infected Arg1+ and double positive iNOS+/Arg1+ macrophages. The B6.Sst1S granulomas had a greater proportion of Arg1+ and double positive iNOS+/Arg1+ macrophages, and decreased T cell density, as compared to wild type B6 mice. Thus, the genetic composition of the B6.Sst1S mice renders them more susceptible to pulmonary M.av infection. In combination with more virulent clinical isolates of M.av these mice could provide an improved mouse model that recapitulates more severe pulmonary disease in humans. The Arg1 macrophage expression in this model combined with automated fmIHC could serve as a sensitive biomarker for the unbiased assessment of medical countermeasures against NTM infection.