Mycobacterium tuberculosis suppresses protective Th17 responses during infection

Reviewer #1 (Public review):

Summary:

The manuscript examines the factors that restrict the induction of IL-17-producing T cells during Mycobacterium tuberculosis (Mtb) infection. The authors show that neither the infectious route nor the duration of infection is responsible. But they do show that mice that lack the Th1-defining transcription factor, a finding consistent with prior reports in the field of immunology. They also show that 2 highly attenuated Mtb mutants in ESX-1 and PDIM, two well-known Mtb virulence factors, do induce IL-17-producing T cells. In contrast, Mtb mutants in mmpl4 are also similarly attenuated, but do not induce IL-17-producing T cells, suggesting that this property is not simply a result of attenuation but due to specific properties of ESX-1 and PDIM-deficient mutants.

Strengths:

(1) It is interesting that mice infected with ESX-1 and PDIM mutants have increased induction of Th17 cells.

(2) The data are solid and convincing throughout.

Weaknesses:

There are two main criticisms:

(1) It is not clear how much the factors uncovered here are true beyond B6 mice. B6 mice, compared to humans, are known to be very Th1-skewed, and Tbet is a strong inhibitor of Th17-specific T cells. Many people make IL-17-producing T cells in response to Mtb infection.

(2) Very few novel insights are mechanistically revealed about how Th17 induction is restricted by Mtb. Tbet induction is known to restrict Th17 development, and this is a T-cell intrinsic mechanism. In contrast, the IL-23 association revealed seems to be extrinsic to T cells and to act on T cells. How, if at all, are these factors related to each other in restricting Th17 induction? Also, the conclusion that it is not a result of attenuation is not completely convincing.

Other points:

(1) The authors show that mice infected with a deficiency in ESX-1 have more IL-17-producing CD4 T cells in response to stimulation with an ESAT-6 peptide pool (Figure 3B). Because ESAT-6 is encoded by ESX-1, why do mice infected with this Mtb mutant have any ESAT-6-specific T cells? Is it an incomplete knockdown?

(2) The manuscript states, "Under the conditions where Th17s are highly induced, mice infected with either ΔESX-1 or PDIM lacking Mtb, the Il17a-/- mice had ~3-5 fold higher CFU than WT mice (Figures 3F-G). These results indicate that the induction of Th17s is not dependent on the attenuation of Mtb in general, but instead Mtb utilizes ESX-1 and PDIM to suppress the induction of a Th17 response that enhances protection against Mtb infection." I don't think the last sentence is necessarily true. I can imagine a scenario in which the induction of the Th17s is, in fact, due to the attenuation, and the Th17 induction still contributes to protection.

(3) ESX-1, PDIM, and mmpl4 mutants all have similarly reduced CFUs in the lung, but what about the LN? The bacterial burden in the LN may be more important for regulating T-bet, IL-23, and Th17 differentiation, since the LN is where T cell priming occurs, than the CFU in the lung. Perhaps ESX-1 and PDIM mutants have reduced CFU in the LN, but mmpl4 does not. This difference in LN burdens may be the primary driver of Th17 priming, as high avidity interactions are thought to be an important driver of T-bet induction.

(4) Do LN cDC1 and high levels of IL-12 p35 in mice infected with the mmpl4 mutant? Likewise, LN cDC2's express low levels of IL-12 p19 (akin to those infected with WT Mtb)? If these observations for ESX-1 and PDIM mutants are mechanistically linked to the increased numbers of Th17 cells, then you would expect mice infected with mmpl4 mutants to be more like those infected with WT Mtb than those infected with ESX-1 and PDIM mutants.

(5) ESX-1 and PDIM are very different virulence factors - a protein secretory pathway and cell wall lipid, respectively? Mechanistically, how would mutants in these pathways give very similar outcomes regarding Th17 cells unless it was simply as an aspect of their attenuation? Perhaps, mmpl4 mutants simply differ in some aspects of their attenuation, such as bacterial burdens in LNs, or their interaction with cDCs?

Reviewer #2 (Public review):

Summary:

In this manuscript, the authors tackle an important question of why IL-17 production and TH17 responses are lower than expected during Mtb infection. The authors identify an axis of cross-regulation between TH1 and TH17 cells and provide data to support roles for Mtb virulence factors ESX1 and PDIM in promoting TH1 responses and/or suppressing TH17 responses.

Strengths:

The strengths include the significance of the work, the combination of host and Mtb genetic models to dissect the mechanistic basis for regulation of IL-17 production from T cells during infection, and the rigor of the experiments. There are a number of exciting findings from the work, including the cross-talk between T cell responses and the impact of ESX1 and PDIM on these responses.

Weaknesses:

The following conclusions and interpretations should be revisited, rephrased, and re-evaluated:

(1) The manuscript neglects to analyze T cell responses in the dLN, which is the critical site where these responses are initiated (only DC cytokine production is measured in the dLN). The differences in the lungs could reflect trafficking of T cells to the lungs, local lung T cell responses, or durability of the T cell responses in the lungs. The authors state in the last results section that "These results indicate that the ESX-1 and PDIM virulence factors impact naïve T cell differentiation at the draining mediastinal lymph node..." but T cell responses are never measured in the dLN.

(2) Figure 2: The authors state that "Importantly, IFN-γ deficient mice did not exhibit elevated levels of IL-17A producing CD4 T cells demonstrating that IFN-γ production is not the mechanism by which Th1 T cells limit a Th17 response during Mtb infection", but the difference is significantly different and even more obvious in Panel B. In fact, if the Panel D y-axis was on a log scale, the Ifng-/- would likely look more like Tbet-/- than WT. Based on this data, it seems like IFNg is having an effect and should not be completely discounted. Does the deletion of Ifng affect the number of Tbet+ T cells?

In addition, the deletion of Tbet results in an increased number of IFNg+IL-17+ double positive T cells (Figure 2B), in addition to a sizable IFNg single positive T cell population maintained in the Tbet-/- mice (10x the negative control of Ifng-/-). Is this why Tbet deletion is not as severe as Ifng deletion, because T cells are still making IFNg?

Along these lines, the statement in the text that, "Tbet-/-Il17a-/- mice completely lacked both IFN-γ producing...." T cells is not supported by the data in Figure 2C. Tbet-/-Il17a-/- mice look to have more gamma-producing T cells than Tbet-/- mice (which is already 10x the negative control of Ifng-/- in panel 2B if one includes the gamma single positive and IFNg/IL-17 double positive).

(3) In the Results sections describing Figures 3, 4, and 5, the authors equate IL-17 production by T cells with TH17 responses and IFNg expression with TH1, but Tbet and RORgt expression in the T cells should be measured to make conclusions about TH1 and TH17. Or the authors can rephrase their findings to specifically state the observations as IFNg or IL-17 expressing CD4+ T cells.

(4) Conceptually, do the authors think that ESX1/PDIM promotes TH1 responses and this blocks TH17 or are ESX1/PDIM blocking TH17 responses directly, allowing for increased TH1 responses? It would be helpful to clarify the model in this regard, describe how the data supports one model or the other, and then make sure the language is consistent throughout. Can these effects on T cell responses be tested and recapitulated in vitro using infected APC and T cell co-cultures?

Reviewer #3 (Public review):

Summary:

The manuscript by Zilinskas et al seeks to understand the mechanisms underlying the ability of Mtb to suppress Th17 differentiation. As Th17 responses are needed for protective immunity against TB, this is an important topic of investigation. They use Mtb mutants that lack eccC1 (from the ESX-1 locus) and fadD28 (encoding PDIM) and implicate a Tbet-dependent pathway by which Mtb modulates Th17 differentiation. The mechanism by which ESX-1/PDIM function to impact Th17 differentiation is, however, unclear, which limits the novelty of the results.

Strengths:

Understanding how Mtb limits Th17 differentiation has implications for vaccine development. Comparative study of KO mice and Mtb mutants is a strength.

Weaknesses:

(1) The authors should acknowledge and reference key findings from the literature that have identified suppression of Th17 differentiation as an Mtb virulence mechanism, e.g., the role of the Hip1 protease and CD40 signaling (Madan-Lala JI 2014, Sia Plos Path 2017, Enriquez iScience 2022) and Khader JI 2005, showing the requirement of IL-23 for Th17 responses in vivo in a TB mouse model.

(2) Addressing several questions related to the Tbet KO mouse experiments would strengthen the study. Do the Tbet KO mice have elevated IL-4/5/13 (which has been previously reported in non-TB studies) in addition to IL-17? The lack of Th17 cells in the IFNg KO compared to the Tbet KO may be due to a difference in timing, since only 3-week data are shown; earlier and later time points would provide better interpretation. The authors do not present any data on neutrophil infiltration in WT vs Tbet KO vs IFNg KO mice. Since IL-17 is known to be important for recruiting neutrophils to the lung, data on neutrophils are important for clarifying the mechanism for the CFU outcomes.

(3) While IL-23 is important for sustaining IL-17 production, IL-6, TGF-b and/or IL-1β are necessary for Th17 polarization. What were the levels of these cytokines in DCs in the lung? (Figure 5). Additionally, Tbet-deficient DCs exhibit impaired activation of antigen-specific Th1 cells and have reduced IL-12 production. Given the data showing higher IL-17 levels in Tbet KO mice, the authors should provide information on the DC phenotype (IL-23, IL-6, etc.) in the Tbet KO experiments.

(4) The mechanism by which ESX-1/PDIM function to impact Th17 differentiation is not clear. While data showing a role for ESX-1 and PDIMs in inhibiting Th17 responses is interesting, there is no insight into the potential mechanism of action. Figure 3 showing reduction in IFNg+ CD4 T cells after infection with eccC1 and fadD28 mutants suggests that this outcome is due to a lower bacterial load relative to WT Mtb at the 3-week time point. Since IFNg is known to suppress IL-17, the higher levels of Th17 cells could be due to the reduction in IFNg due to the attenuated growth of the mutants. Additionally, what was the level of Type I IFNs elicited by these mutants?

(5) Since macrophages have been implicated in the reduced cytokines seen in the ESX-1 mutant, IL-23 and other cytokine data on lung macrophages would complement the DC data.

(6) Figure 5. There are many fewer DCs overall in the eccC1 and fadD28 mutant groups, which could account for the increased % IL-23p19 in DCs (5D). What were the levels of IL-23 in DC1s?