Glucuronoxylomannan intranasal challenge prior toCryptococcus neoformanspulmonary infection enhances cerebral cryptococcosis in rodents
Authors: Lee Hiu Ham , Carmichael Dylan J. , Ríbeiro Victoria , Parisi Dana N. , Munzen Melissa E. , Hamed Mohamed F. , Kaur Ettiman , Mishra Ayush , Patel Jiya , Rooklin Rikki B. , Sher Amina , Carrillo-Sepulveda Maria A. , Eugenin Eliseo A. , Dores Michael R. , Martinez Luis R. 
Published: October 2022

The encapsulated fungusCryptococcus neoformansis the most common cause of fungal meningitis, with the highest rate of disease in patients with AIDS or immunosuppression. This microbe enters the human body via inhalation of infectious particles.C. neoformanscapsular polysaccharide, in which the major component is glucuronoxylomannan (GXM), extensively accumulates in tissues and compromises host immune responses.C. neoformanstravels from the lungs to the bloodstream and crosses to the brain via transcytosis, paracytosis, or inside of phagocytes using a “Trojan horse” mechanism. The fungus causes life-threatening meningoencephalitis with high mortality rates. Hence, we investigated the impact of intranasal exogenous GXM administration onC. neoformansinfection in C57BL/6 mice. GXM enhances cryptococcal pulmonary infection and facilitates fungal systemic dissemination and brain invasion. Pre-challenge of GXM results in detection of the polysaccharide in lungs, serum, and surprisingly brain, the latter likely reached through the nasal cavity. GXM significantly alters endothelial cell tight junction protein expressionin vivo, suggesting significant implications for theC. neoformansmechanisms of brain invasion. Using a microtiter transwell system, we showed that GXM disrupts the trans-endothelial electrical resistance, weakening the human brain endothelial cell monolayers co-cultured with pericytes, supportive cells of blood vessels/capillaries found in the blood-brain barrier (BBB), and promotesC. neoformansBBB penetration. Our findings should be considered in the development of therapeutics to combat the devastating complications of cryptococcosis that results in an estimated ∼200,000 deaths worldwide each year.

AUTHOR SUMMARY

Cryptococcus neoformansinfection of the central nervous system (CNS) typically begins by inhalation of fungal spores and results in devastating mortality rates worldwide. Over 200,000 deaths have been reported annually, with cryptococcal meningoencephalitis being the most severe form of the disease. This study investigates the ability of the fungus to invade, colonize, and cause damage to the host through properties of the fungal polysaccharide capsule, which allows the microbe a variety of both protective and offensive abilities. This capsule, made primarily of the polysaccharide glucuronoxylomannan (GXM), has been implicated in the progression and severity of cryptococcal infection in the CNS. We determined that GXM increases the fungal burden in the lungs of mice and enhances fungal migration to the brain. Interaction of GXM with the blood-brain barrier, which is a protective structure that regulates movement of particles into the CNS, demonstrated that GXM can disrupt the integrity of this barrier, compromising the delicate balances of fluids, immune cells, and other factors vital to the maintenance of the CNS. The findings of this study reveal the substantial role of GXM in establishingC. neoformansinfection in the brain and necessitate future studies to further understand these interactions.