Glucosylceramide synthase is an essential regulator of pathogenicity of Cryptococcus neoformans

The pathogenic fungus Cryptococcus neoformans infects humans upon inhalation and causes the most common fungal meningoencephalitis in immunocompromised subjects worldwide. In the host, C. neoformans is found both intracellularly and extracellularly, but how these two components contribute to the development of the disease is largely unknown. Here we show that the glycosphingolipid glucosylceramide (GlcCer), which is present in C. neoformans, was essential for fungal growth in host extracellular environments, such as in alveolar spaces and in the bloodstream, which are characterized by a neutral/alkaline pH, but not in the host intracellular environment, such as in the phagolysosome of macrophages, which is characteristically acidic. Indeed, a C. neoformans mutant strain lacking GlcCer did not grow in vitro at a neutral/alkaline pH, yet it had no growth defect at an acidic pH. The mechanism by which GlcCer regulates alkali tolerance was by allowing the transition of C. neoformans through the cell cycle. This study establishes C. neoformans GlcCer as a key virulence factor of cryptococcal pathogenicity, with important implications for future development of new antifungal strategies.

Cryptococcus neoformans is an environmental yeast distributed worldwide and is the most common cause of fungal meningoencephalitis in immunocompromised hosts (1). Infection is initiated upon inhalation of spores or desiccated yeast. In the lung, the fungus proliferates in the alveolar space, and in immunocompetent subjects the infection is normally contained in this organ. However, in immunocompromised subjects, dissemination of the yeast cells from the lung to the brain can occur intracellularly (within host cells) and extracellularly (in the bloodstream), leading to the development of a life-threatening disease (2–4). Since C. neoformans is a facultative intracellular pathogen, many studies have addressed how the fungus survives and grows within host cells (2, 5–9), but how fungal cells survive and proliferate extracellularly is not well understood.

One of the cell surface molecules of this fungus is glucosylceramide (GlcCer), an antigenic glycosphingolipid that elicits an antibody response in patients affected with cryptococcosis (10) and in mice (11). GlcCer is synthesized by uridine diphosphate–glucose:ceramide (UDP-glucose:ceramide) glucosyltransferases encoded by GlcCer synthase (GCS) genes, which catalyze the first step in glycosphingolipid biosynthesis leading to the formation of the membrane lipid GlcCer. Very little is known about the role and function of GCS in fungal cells. The synthesis of GlcCer is absent in the yeast Saccharomyces cerevisiae, but it has been demonstrated in other fungi, such as Pichia pastoris; in fungi pathogenic to plants, such as Magnaporthe grisea (12); in fungi pathogenic to humans, such as C. neoformans (10), Candida albicans (12–14), Aspergillus fumigatus (15, 16), Histoplasma capsulatum (17), Paracoccidioides brasiliensis (18), and Sporotrix schenckii (19); and in other fungi (reviewed in refs. 20–22). The gene encoding for GCS (GCS1) has been isolated from P. pastoris, M. grisea, and C. albicans (12). The GCS1 gene has been deleted in the pathogenic fungus C. albicans, but its role in the pathogenicity of this fungus has yet to be elucidated.

Other studies have suggested a role for GlcCer in the regulation of fungal growth and pathogenesis. For instance, in C. neoformans GlcCer is mainly localized in the cell wall and mostly accumulates at the budding site of dividing cells. Interestingly, antibodies against C. neoformans GlcCer produced by patients affected with cryptococcosis inhibit budding and division of C. neoformans cells grown in vitro (10) as well as differentiation and germ-tube formation of Pseudallescheria boydii and C. albicans (23). Additionally, production of antibodies against fungal glycolipids has been demonstrated in patients with paracoccidioidomycosis (24), although in this disease the antibodies are mostly interacting with galactosylceramide instead of GlcCer. In other fungi, disruption of the GlcCer biosynthetic pathway altered spore germination, hyphal development, and fungal growth (16, 25). Monoclonal antibodies against fungal GlcCer have been produced (11), and, interestingly, treatment with anti-GlcCer antibody enhanced macrophage function against the fungus Fonsecaea pedrosoi (26). Together, these studies suggest an important role for GlcCer in fungal cell growth and differentiation and — because germ-tube formation and hyphal growth are provirulent factors — also suggest that GlcCer might be implicated in the regulation of fungal virulence. Thus we wondered whether GlcCer would have a role in the development and progression of cryptococcosis.

Here we have identified that GCS is a key regulator of pathogenicity of C. neoformans by ensuring cell cycle progression and growth of fungal cells in environments characterized by neutral/alkaline pH and physiological concentrations of CO₂. Since these environments are characteristically found in the lung alveolar spaces, GCS regulates survival of C. neoformans upon inhalation through the respiratory tract, with important implications for the dissemination of fungal cells to the brain and the development of meningo-encephalitis.

The C. neoformans GCS1 gene encodes for GCS activity. By sequence homology to the human GCS cDNA, a candidate C. neoformans GCS1 cDNA was identified. To investigate the potential activity of the C. neoformansGCS1 gene product as a GCS, the effect of GCS1 expression on sphingolipid metabolism was studied in S. cerevisiae, which totally lacks endogenous GCS activity. The human GCS gene was also expressed in a pYES vector as a positive control, and S. cerevisiae carrying the pYES empty vector was used as a negative control. Yeast cells were labeled in vivo with tritiated dihydrosphingosine ([³H]-DHS; Figure 1A), a precursor of ceramide/phytoceramide (the substrate of GCS) in mammalian and yeast cells. The results showed that, when induced by galactose, C. neoformans Gcs1 produced a radiolabeled sphingolipid that migrated similarly to a soy GlcCer standard; this sphingolipid was absent when repressed by glucose. As expected, expression of human GCS1 showed the formation of the putative GlcCer under conditions of induction but not repression (Figure 1A). Cells carrying the empty vector lacked this sphingolipid under conditions of induction and repression. These results suggest that C. neoformans Gcs1 is functional when expressed in S. cerevisiae and that it may use endogenous ceramides as substrates.

Figure 1

Expression of GCS1 genes in S. cerevisiae. (A) In vivo labeling in S. cerevisiae with [³H]-DHS. Expression of cryptococcal and human GCS1 produced GlcCer (boxed region) in galactose (+), but not in glucose (–). DHS, dihydrosphingosine; S1P, sphingosine-1-phosphate. Inositol phosphoryl ceramide (IPC), mannose-IPC (MIPC), and mannose-(inositol phosphoryl)2 ceramide (MIP2C) are complex sphingolipids. (B) In vitro assay in S. cerevisiae using NBD-C6-ceramides. Proteins extracted from yeast cells expressing pYES2-HuGCS1 and incubated with NBD-ceramides produced NBD-GlcCer under induction by galactose. NBD-GlcCer production was not observed in yeast cells expressing pYES2-CnGCS1 or pYES2 empty vector.

Mammalian GCS efficiently recognizes fluorescently labeled short-chain ceramide analogs as substrates in vitro and in vivo. To study the substrate specificity of the C. neoformans Gcs1, 7-nitro-2-1,3-benzoxadiazol-4-yl–C6–ceramide (NBD-C6-ceramide) and NBD-C6-phytoceramide were tested as substrates in vitro, using cell protein extracts of S. cerevisiae expressing C. neoformansGCS1 or human GCS genes, under conditions of induction or repression. In contrast to what we observed for human GCS, C. neoformans Gcs1 did not recognize NBD-C6-ceramides as substrates (Figure 1B). The inability of C. neoformans Gcs1 to use short-chain fluorescent ceramide analogs was also confirmed by in vivo labeling using NBD-ceramides (data not shown). Together, these results show that C. neoformans Gcs1 does not share the same substrate specificity as human GCS.

C. neoformans Gcs1 produces GlcCer. To examine whether the C. neoformansGCS1 gene encodes for GCS, the C. neoformansGCS1 gene was deleted in the C. neoformans var. grubii strain (WT), creating the Δgcs1 mutant, and was subsequently reconstituted, generating the Δgcs1 + GCS1 strain (Supplemental Figure 1; supplemental material available online with this article; doi:10.1172/JCI27890DS1). To verify that the C. neoformans Δgcs1 mutant lacks the putative GlcCer, in vivo labeling using [³H]-DHS in WT, Δgcs1, and Δgcs1 + GCS1 strains was performed. As illustrated in Figure 2A, a radiolabeled compound that migrated onto a TLC similarly to the soy GlcCer standard was clearly lost in the Δgcs1 strain, whereas it was completely restored in the reconstituted strain. Use of NBD-ceramides in C. neoformans for in vitro or in vivo labeling did not result in the formation of the corresponding identifiable sphingolipid in the tested strains (data not shown), in agreement with the finding that C. neoformans Gcs1 expressed in S. cerevisiae was unable to recognize NBD-ceramide analogs as substrates.

Figure 2

C. neoformans GCS1 gene encodes for GCS. (A) In vivo labeling of C. neoformans WT, Δgcs1, and Δgcs1 + GCS1 using [³H]-DHS. The formation of GlcCer (boxed area) was examined by analysis of the extracted lipids onto a TLC. The soy GlcCer standard was visualized by iodine stain. (B) Analysis of purified GlcCer from the cultured strains using HPTLC. The lipids containing the sugar residues were visualized by staining with orcinol in 70% sulfuric acid, and the putative GlcCer is indicated. Plates were also stained with iodine to ensure equal lipid loading among the lanes (arrowhead). (C) Electrospray tandem mass spectrometric analysis of the glycosphingolipid analyzed on the HPTLC. The regions of the chromatogram indicated in B were extracted and analyzed by mass spectrometry as described in Methods. The indicated peaks are consistent with the [M+H]⁺ ions for monoexosylceramide with a methyl-sphingadienine backbone and a hydroxy-C18:1 fatty acid (the major species, m/z 756.7), a non–hydroxy-C18:0 fatty acid (m/z 740.7), and a hydroxy-C16:0 fatty acid (m/z 728.7). (D and E) ¹H-¹H–double quantum filtered correlation spectroscopy (D) and ¹H-¹³C heteronuclear single quantum correlation (E) NMR spectra of the monohexosylceramide WT extracted from the HPTLC. The solid connectivities in D among the 7 nonexchangeable hexose protons and their ¹H and ¹³C chemical shift characteristics (E) show that glucose was attached to the ceramide backbone, defining this glycosphingolipid as GlcCer. Dashed connectivities in D identify the exchangeable 6-OH in 100% dimethyl-sulfoxide-d6.

To confirm that the missing sphingolipid in the Δgcs1 is GlcCer, we purified and concentrated the putative sphingolipid from C. neoformans strains, and the extracted lipids were analyzed by high-performance TLC (HPTLC), electrospray tandem mass spectrometry, and NMR. The analysis of the purified lipid extracts onto the HPTLC plate stained with orcinol clearly showed a band of a sugar-containing lipid migrating in tandem with the GlcCer standard from soy. This band was absent in the Δgcs1 strain and reconstituted in the Δgcs1 + GCS1 strain (Figure 2B).

The structure of the GlcCer was confirmed by syringe infusion of the glycosphingolipid into an API 3000 triple quadrupole mass spectrometer. Neutral loss scans of m/z 180 (loss of hexose headgroup), as well as precursor ion scans for the types of sphingoid bases commonly found in fungi, were performed. A major peak in C. neoformans WT was observed at m/z 756.7, which corresponded to a [M+H]⁺ charge for a monohexosylceramide with a lipid backbone composed of 37 carbons, 2 double bonds, and an additional hydroxyl (Figure 2C). Fragmentation of this ion yielded a product ion of m/z 276.4, which identified the lipid backbone as having an 18-carbon sphingadienine base with one additional methyl group (for a total of 19 carbons) plus an amide-linked hydroxy-C18:1 fatty acid. This is consistent with the backbone structure of a GlcCer that has been previously isolated from this organism (9-methyl-4,8-sphingadienine in amide linkage to 2-hydroxyoctadecanoic acid) (10). Precursor ion scans for m/z 276.4 also revealed lower-abundance species that probably reflect GlcCer with a non–hydroxy-C18:0 fatty acid (at m/z 740.7) and a hydroxy-C16:0 fatty acid (at m/z 728.7). Precursor scans in the Δgcs1 mutant revealed minor peaks also present in the WT spectrum, whereas none of these GlcCers were detected (Figure 2C). Importantly, the reconstituted strain displayed a strong m/z 756.7 ion for the major GlcCer of the WT cells; interestingly, the minor C18:0 and hydroxy-C16:0 species were not detected.

Since no standards are available for these compounds, liquid chromatography mobility could not definitely identify the sugar head group. Thus we performed 2-dimensional NMR spectroscopy to uniquely define the structure of the hexose moiety of the purified sphingolipid (WT), as shown in Figure 2, D and E. The NMR characterization of the hexose commenced with the assignment of the glycoside protons in the ¹H-NMR spectrum of the monohexosylceramide (Supplemental Table 1). The unambiguous identification of the H1′ anomeric proton was straightforward due to its unique chemical shift (¹H, δ 4.17 ppm; ¹³C, δ 103.11 ppm) and doublet multiplicity (³J_H1′,H2′, 7.7 Hz). A combination of 2-dimensional ¹H-¹H–double quantum filtered correlation spectroscopy and total correlated spectroscopy spectra clearly revealed the complete hexose proton spin system, which was supported by the ¹³C heteronuclear single quantum correlation data (Figure 2, D and E). The stereochemistry of the hexose could be unambiguously determined from the first 4 vicinal ³J-coupling constants. The large ³J_HH-coupling constants observed (>7 Hz) indicated antiperiplanar orientations of the vicinal hexapyranose H1′/H2′, H2′/H3′ (³J_H2′,H3′, 8.9 Hz), H3′/H4′ (³J_H3′,H4′, 8.2 Hz), and H4′/H5′ (³J_H4′,H5′, 9.1 Hz) ring protons (Supplemental Table 1). The analysis of 1D–nuclear Overhauser effect (1D-NOE) difference experiments corroborated the previous β-glycopyranosyl assignment. NOEs were observed from H1′ to H3′ and H5′; saturation at H2′ produced a strong NOE at H4′. Thus, based on our results and on previous NMR analysis of GlcCer species from other pathogenic fungi (27, 28), we conclude that glucose is attached to the ceramide backbone of the sphingolipid produced by the C. neoformans Gcs1 enzyme.

Role of Gcs1 in the pathogenicity of C.neoformans. To determine the role of GCS1 in the pathogenicity of C. neoformans, we performed virulence studies using a murine animal model (CBA/J) of cryptococcosis. The average survival of mice infected intranasally with WT and Δgcs1 + GCS1 strains was 24.6 ± 3.9 and 27.3 ± 4.8 days, respectively (P < 0.0001; Figure 3A), whereas mice infected with C. neoformans Δgcs1 were all alive after 90 days of observation. At the ninetieth day, even though the 11 mice infected with C. neoformans Δgcs1 mutant showed no clinical signs of meningoencephalitis, they were sacrificed, and lungs and brains were removed and analyzed for CFUs and histology. Yeast cells were absent in 8 of 11 brains. The 3 yeast cell–positive brains showed approximately 6 × 10⁵, 500, and 28,000 cells per organ. Among the 11 lungs, 6 lungs were used to determine fungal tissue burden, and an average of 5–10 × 10³ yeast cells/lung were found, which corresponds to an approximately 100-fold reduction of the initial inoculum. These results were confirmed by a study aiming to determine the lung fungal burden up to 70 days after infection with WT or Δgcs1 strains (Supplemental Figure 2). These findings suggest that Gcs1 plays a key role in the pathogenicity of C. neoformans and growth of yeast cells in the lung.

Figure 3

Survival studies of C. neoformans strains in a murine animal model. (A) CBA/J mice infected intranasally with C. neoformans cells. The average survival of mice infected with the C. neoformans WT and Δgcs1 + GCS1 strains was 24.6 ± 3.9 days and 27.3 ± 4.8 days, respectively. All mice infected with Δgcs1 mutant strain survived after 90 days of infection (P < 0.0001). (B) CBA/J mice infected intravenously with C. neoformans cells. The average survival of mice infected with the C. neoformans WT and Δgcs1 + GCS1 strains was 6.3 ± 0.51 days and 6.2 ± 0.46 days, respectively, whereas the average survival of mice infected with C. neoformans Δgcs1 strain was 15 days (P < 0.01).

To examine whether the lung environment plays a role in protecting the host against the dissemination of the Δgcs1 strain, we challenged CBA/J mice intravenously with WT, Δgcs1, and Δgcs1 + GCS1 strains and monitored their survival. Mice infected with the WT and Δgcs1 + GCS1 strains showed a similar average survival rate of 6.3 ± 0.5 days and 6.2 ± 0.4 days, respectively (Figure 3B). Mice infected with the Δgcs1 mutant were apparently healthy until 13–15 days of infection, when they rapidly showed severe clinical signs of meningoencephalitis such as intense tremor, rigidity, lack of balance, and inability to coordinate movements. On the fifteenth day, mice were sacrificed because they were unable to reach food or water. Brains, lungs, kidneys, spleens, and livers were removed and assayed for tissue burden culture and histology. Analysis of CFUs of brains showed an average number of 8.4 ± 0.06 (log₁₀ CFU ± SD) yeast cells, which was significantly higher (P < 0.01) than CFU in other organs (5.5 ± 0.5 in lung, 5.6 ± 0.1 in kidney, 5.3 ± 0.2 in spleen, and 5.6 ± 0.1 in liver). These results clearly suggest that when CBA/J mice are challenged intravenously, they cannot efficiently prohibit Δgcs1 cells from disseminating throughout the body.

Inflammatory response against the C. neoformans Δgcs1 strain. To examine the host inflammatory response against C. neoformans Δgcs1, 5 lungs and 5 brains from CBA/J mice challenged intranasally and 4 lungs and 4 brains of CBA/J mice challenged intravenously with C. neoformans Δgcs1 were analyzed for histology. Figure 4, A–D, and Supplemental Figure 3, A and C, show representative fields from 4 different lungs recovered from mice infected intranasally. Supplemental Figure 3, E and G, show a representative field of 2 lungs and Supplemental Figure 3, F and H, show a representative field of 2 brains recovered from mice infected intravenously.

Figure 4

Histopathology of 2 different lungs obtained from CBA/J mice infected intranasally with the C. neoformans Δgsc1 strain. (A and B) Movat stain. (C and D) Verhoeff–van Gieson stain. Boxed areas in A and C are magnified in B and D. In A, white arrowhead indicates C. neoformans cells stained alcian blue, white arrow indicates necrotic tissue, black arrowheads indicate macrophages, black arrows indicate lymphocyte infiltration with fibroblasts and fibrotic tissue, and green arrows indicate normal lung tissue. In B, yeast cells (white arrowhead) were found within necrotic tissue. Also, many yeast cells appear as “ghosts” or degenerated cells (yellow arrowheads) within macrophages. In C, black arrowhead indicates collagen stained red in the peripheral of a nodule containing necrotic tissue, yeast cells, macrophages, and lymphocytes. In D, note the collagen deposition (red stain) between lymphocytes and fibrotic tissue. A giant cell in gray (black arrowheads) was loaded with C. neoformans in the internal side of the nodule, surrounded by granulocytes and lymphocytes. Scale bars: 500 μm (A and C); 50 μm (B and D).

The lungs of mice challenged intranasally showed a strong granulomatous response consisting of the formation of extensive spheric nodules, in which Δgcs1 cells were mainly trapped in the center with abundant necrotic tissue and numerous neutrophils (Figure 4). The necrotic tissue was surrounded by a ring of foamy macrophages and giant cells loaded with yeast cells and/or cellular debris or “ghosts” of yeast cells, which appeared to be degenerated (Figure 4C). The ring of macrophages was then surrounded by lymphocytes, fibroblasts, and fibrotic tissue (Figure 4A), in which a significant deposition of collagen was observed (Figure 4, C and D). These nodules ranged from 500 to 2,500 μm in diameter and were confined in the lung, with no invasion into the mediastinal area. In other cases, smaller nodules were observed — such as those shown in Supplemental Figure 3, A and C — in which few C. neoformans cells were engulfed in macrophages surrounded by other macrophages containing “ghosts” of C. neoformans cells (Supplemental Figure 3B). Few lymphocytic interstitial infiltrations were localized in the proximity of the nodules (Supplemental Figure 3). Other portions of the lung appeared to be normal. These structures were present only in lungs infected with C. neoformans Δgsc1, with different degrees of organization, whereas the nodules were not found in lungs of mice infected with the C. neoformans WT strain during the course of the infection (data not shown). All brains selected from mice infected intranasally with Δgsc1 and analyzed by histology showed no sign of yeast cells.

Histology analysis was also performed on lungs, brains, and other organs of mice infected intravenously. In the lungs, Δgcs1 cells were contained within small, spheric, nodule-like structures (Supplemental Figure 3, E and G) similar to those illustrated in Supplemental Figure 3, A and C. In the brain, C. neoformans cells were almost exclusively localized within brain abscesses of different size, which were not surrounded by any host inflammatory response (Supplemental Figure 3, F and H). Numerous abscesses containing Δgcs1 cells were also found in the kidney (data not shown). In the liver, the Δgcs1 cells were found in very small periportal lesions with no host cellular infiltrates, whereas in the spleen the Δgcs1 strain was surrounded by a granulomatous response invading the white pulp and characterized by the presence of yeast cells surrounded by macrophages, lymphocytes, neutrophils, and a few megakaryocytes (data not shown). These results suggest that when C. neoformans Δgsc1 cells are introduced intranasally, the host organizes a strong granulomatous response, in which yeast cells are confined by macrophages, lymphocytes, fibroblasts, fibrotic tissue, and collagen deposition, with almost total containment of the infection within the lung tissue. In contrast, when yeast cells are introduced intravenously, C. neoformans Δgsc1 cells do disseminate to the brain and other organs, eventually killing the animal.

Effect of Gcs1 on intracellular and extracellular growth of C. neoformans In the host, C. neoformans proliferates intracellularly, within the acidic environment of the phagolysosome, and extracellularly, an environment characterized by alkaline/neutral pH and high CO₂ concentration. Thus we investigated the effect of the loss of GlcCer on the growth of C. neoformans intracellularly and in in vitro acidic and alkaline environments. For intracellular growth, C. neoformans WT, Δgcs1, and Δgcs1 + GCS1 strains were incubated with J774.16 macrophage-like J774.16 cells, and the number of buds of internalized cells per phagocytic index was measured. As shown in Supplemental Figure 4, we found no differences in intracellular growth among the tested strains, suggesting that GlcCer has no effect on fungal growth once C. neoformans is internalized within macrophages.

In order to evaluate in vitro cell culture growth, we performed growth curves of C. neoformans WT, Δgcs1, and Δgcs1 + GCS1 strains incubated in 5% CO₂ at either a neutral/alkaline or an acidic pH. As shown in Figure 5A, the Δgcs1 mutant was unable to grow at a neutral/alkaline pH in the presence of 5% CO₂ (Figure 5A), whereas growth was observed at an acidic pH (Figure 5B). This difference in growth was not observed in the presence of atmospheric CO₂ concentration (~0.04%) at pH 7.4 or 4.0 (data not shown). Importantly, the growth defect at 5% CO₂ and neutral pH was reversible because when yeast cells were switched to fresh acidic medium, cell growth was completely restored (data not shown), suggesting that growth of Δgcs1 cells is arrested at alkaline pH and 5% CO2.

Figure 5

GlcCer is required for growth of C. neoformans cells in 5% CO₂ at pH 7.4. C. neoformans WT, Δgcs1, and Δgcs1 + GCS1 strains were grown in DMEM medium at 37°C in 5% CO₂ at pH 7.4 (A) and pH 4.0 (B). *P < 0.001, Δgcs1 versus WT. (C) Succession of biological events characterizing a yeast cell cycle.

To determine which phases of the C. neoformans cell cycle are affected by lack of GlcCer, we performed flow cytometry analysis of C. neoformans cells incubated for 24 hours and 36 hours at alkaline pH and 5% CO₂. We found that a significantly greater percentage of Δgcs1 cells were locked in S and G₂/M phases compared with the WT and Δgcs1 + GCS1 cells at both 24 (Table 1) and 36 hours (data not shown), suggesting that GlcCer is important for exiting from the S and G₂/M phases of the cell cycle.

Table 1

Cell cycle analysis of C. neoformans strains

In the present study the role of C. neoformans GCS in the virulence of this pathogenic fungus was investigated. Our results show that C. neoformans GCS was an essential factor in determining the success of the fungal infection by regulating survival of C. neoformans during the initial colonization of the lung. In addition, we found that GCS guaranteed survival of C. neoformans in the lung extracellular space by ensuring cell-cycle progression at neutral/alkaline pH and physiologic CO₂ concentration (Table 2).

Table 2

Pathobiological features of C. neoformans Δgcs1 mutant strain

The dramatic protection against pathogenicity imparted by loss of GCS underlines the importance of the extracellular component of fungal cells during C. neoformans infection. C. neoformans infects the host through inhalation, and upon its arrival in the alveoli it encounters 2 environments in which normally grows: the extracellular space, characterized by a neutral/alkaline pH and a physiologic CO₂ concentration of approximately 5.0% (compared to 0.04% present in the air, ref. 29); and the intracellular environment of the phagolysosome of alveolar macrophages, characterized by an acidic pH. Our results suggest that GlcCer is critical for C. neoformans to grow in the extracellular (alkaline) but not in the intracellular (acidic) environment of the lung. Since during the infection most C. neoformans cells are found in the host extracellular space (30), the overall effect of the loss of GlcCer on C. neoformans pathogenicity is significant. Indeed, when the Δgcs1 strain was introduced intranasally, the overall growth of yeast cells in the alveoli was arrested (Supplemental Figure 2); even if the mutant grew intracellularly (Supplemental Figure 4), the host responded with the formation of well-organized granulomas (Figure 4 and Supplemental Figure 3), which efficiently contained Δgcs1 cells in the lung. This allowed the host to survive the cryptococcal infection without any evident clinical sign of disease (Figure 3A).

When the Δgcs1 strain was introduced intravenously, mice survived longer than those infected with the WT or reconstituted strains (Figure 3B). In the blood, Δgcs1 also finds a hostile environment because the pH is approximately 7.4 and the CO₂ concentration is approximately 5% (partial pressure of CO₂ [pCO₂], ~40 mmHg). Thus growth of Δgcs1 cells in the bloodstream was arrested until yeast cells were either internalized by phagocytic cells or they left the bloodstream and invaded the organs, in which they formed abscesses such as those found in the brain (Supplemental Figure 3, F and H) and the kidney (data not shown). In both the intracellular environment and in abscesses, the pH was characteristically acidic, and growth of Δgcs1 could resume. Indeed, it was interesting to note that in the brain upon intravenous challenge of Δgcs1, yeast cells were almost exclusively contained within abscesses (Supplemental Figure 3, F and H), whereas in the WT strain, in addition to being present in abscesses, cells were also present in the surrounding tissue (data not shown). Thus we hypothesize that once the acidic abscess is formed, Δgcs1 cells promptly restore growth, and the consequent destruction of brain tissue will eventually manifest abruptly with clinical sign of meningoencephalitis. The animal infected intravenously with Δgcs1 would eventually die, although it would take longer than mice infected with the control strains due to the transient growth arrest that yeast cells undergo in the bloodstream upon injection.

We believe the results from these studies identify GlcCer as a novel virulence factor for C. neoformans because loss of this glycosphingolipid does not affect other fungal characteristics, such as capsule production, melanin formation, or growth at ambient CO₂ and 37°C (Supplemental Figure 5), known to be required to cause disease (1). Interestingly, a greater sensitivity of Δgcs1 mutant to SDS was observed (Supplemental Figure 5), suggesting an alteration of cell wall integrity. This hypothesis is supported by previous observations of the corrleation of GlcCer density at the cell surface with the cell wall thickness of C. neoformans (10). However, the difference in cell growth of Δgcs1 in the presence of SDS compared with control strains was not so dramatic to account for the significant loss of virulence of the mutant. Instead, the growth of Δgcs1 mutant was arrested in environments characterized by alkaline pH and 5% CO2.

In budding yeasts such as C. neoformans, the S and G₂ phases of the cell cycle are characterized by bud formation and maturation (Figure 5C). Interestingly, previous studies have shown that GlcCer is localized at the budding site of C. neoformans, and addition of human antibodies against C. neoformans GlcCer to in vitro C. neoformans culture inhibits cell budding and fungal cell growth (10). Our studies showed that loss of GlcCer significantly prolonged the S and the G₂/M phases in alkaline environments, therefore suggesting a mechanism whereby GlcCer regulates fungal cell growth by allowing yeast cells to complete the cell cycle.

The role of GCS in alkaline tolerance is not restricted to C. neoformans, as recent findings showed that a Kluyveromyces lactis mutant defective in GlcCer cannot grow at pH 8.5 (31). On the other hand, the molecular mechanism by which GlcCer regulates alkaline tolerance at high but not low CO₂ is not known. Studies have proposed that fungal cells sense different concentrations of CO₂ and, in conditions in which CO₂ is elevated (e.g., 5%), fungi respond by upregulating virulence factors. For instance, CO₂ stimulates capsule formation in C. neoformans (32) and the transformation of yeast cells to filamentous forms in C. albicans through adenylyl cyclase (33). In other pathogenic fungi, such as Coccidioides immitis, CO₂ promotes the formation of endosporulating spherules (34), which is a process required for virulence. These studies suggest the existence of a conserved signaling pathway that regulates fungal virulence through the sensing of CO₂. C. neoformans senses CO₂ through 2 β-class carbonic anhydrases (Can1 and Can2), which have been recently identified (35, 36), but whether GlcCer regulates signaling events mediated by CO₂-carbonic anhydrases at different pHs awaits further investigation.

In conclusion, these studies showed that GlcCer plays a key role in the pathogenicity of C. neoformans through a mechanism that ensures the transition through the cell cycle of yeast cells in alkaline environments with a physiological concentration of CO₂. Since in cases of cryptococcosis extracellular organisms predominate, the function of GlcCer becomes clinically relevant. Interestingly, Gcs1 and GlcCer are found in a variety of pathogenic fungi, and because a significant biochemical difference between human and C. neoformans Gcs1 exists, compounds that would specifically inhibit the fungal enzyme might represent a novel class of antifungal agents against fungal infections (16, 25). Furthermore, since antibodies against the fungal GlcCer inhibit C. neoformans growth in vitro and do not interact with the human GlcCer (11), they may represent a new therapeutic approach to control infections by fungal microorganisms producing GlcCe.

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We are grateful to Helio Takahashi, Yusuf Hannun, Lina Obeid, Deepak Bastia, Edward Balish, Lincoln Scott, and Carolina Westwater for discussion. Special thanks to Margaret Romano and to Russell Harley for invaluable help and discussion with the histology staining and to Stefka Spassieva for helping in the purification of GlcCer. We also thank all members of the M. Del Poeta and C. Luberto laboratories for guidance. We gratefully acknowledge John Oatis for helping with NMR analysis. This work was supported in part by the Burroughs Welcome Fund; NIH grant AI56168 (to M. Del Poeta); grants RR17677 Project 2 (to M. Del Poeta) and Project 6 (to C. Luberto) from the Centers of Biomedical Research Excellence Program of the National Center for Research Resources; National Science Foundation/EPSCoR grant #EPS-0132573 (to C. Luberto); NIH grant C06 RR015455 from the Extramural Research Facilities Program of the National Center for Research Resources; and, for the sphingolipid analysis by mass spectrometry, NIH grant GM069338 (LIPID MAPS, to A.H. Merrill). M. Del Poeta is a Burroughs Wellcome New Investigator in Pathogenesis of Infectious Diseases.

Address correspondence to: Maurizio Del Poeta, Department of Biochemistry and Molecular Biology, Medical University of South Carolina, 173 Ashley Avenue, BSB 503, Charleston, South Carolina 29425, USA. Phone: (843) 792-8381; Fax: (843) 792-8565; E-mail: delpoeta@musc.edu .

Nonstandard abbreviations used: GCS, GlcCer synthase; GlcCer, glucosylceramide; [³H]-DHS, tritiated dihydrosphingosine; HPTLC, high-performance TLC; NBD, 7-nitro-2-1,3-benzoxadiazol-4-yl; NOE, nuclear Overhauser effect; pYES2-CnGCS1, pYES2 vector expressing C. neoformansGCS1; pYES2-HuGCS1, pYES2 vector expressing human GCS1; SDW, sterile distilled water; YNB, yeast nitrogen base; YPD, yeast extract/peptone/2%extrose.

Conflict of interest: The authors have declared that no conflict of interest exists.

Reference information: J. Clin. Invest.116:1651–1659 (2006). doi:10.1172/JCI27890.

Philipp C. Rittershaus and Talar B. Kechichian contributed equally to this work.

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