Non-typeable Haemophilus influenzae (NTHI) is an opportunistic bacterial pathogen of the human respiratory tract and is a leading cause of respiratory infections in children and adults. NTHI is considered to be an extracellular pathogen, but has consistently been observed within and between human respiratory epithelial cells and macrophages, in vitro and ex vivo. Until recently, few studies have examined the internalization, trafficking, and fate of NTHI in host cells. It is important to clarify this interaction because of a possible correlation between intracellular NTHI and symptomatic infection, and because NTHI infections frequently persist and recur despite antibiotic therapy and the development of bactericidal antibodies, suggesting a possible intracellular state or reservoir for NTHI. How does NTHI enter host cells? Can NTHI survive intracellularly and, if so, for how long? Strides have been made in the identification of host receptors, signaling, endocytosis, and trafficking pathways involved in the entry and persistence of NTHI in the respiratory tract.

Nontypeable Haemophilus influenzae (NTHI) is a leading cause of opportunistic infections of the respiratory tract in children and adults. Although considered an extracellular pathogen, NTHI has been observed repeatedly within and between cells of the human respiratory tract, and these observations have been correlated to symptomatic infection. These findings are intriguing in light of the knowledge that NTHI persists in the respiratory tract despite antibiotic therapy and the development of bactericidal antibodies. We hypothesized that intracellular NTHI avoids, escapes, or neutralizes the endolysosomal pathway and persists within human respiratory epithelial cells and that human IgA1 proteases are required for optimal internalization and persistence of NTHI. Virtually all strains encode a human IgA1 protease gene, igaA, and we previously characterized a novel human IgA1 protease gene, igaB, that is associated with disease-causing strains and is homologous to the IgA1 protease that is unique to pathogenic Neisseria spp. Here, we show that NTHI invades human bronchial epithelial cells in vitro in a lipid raft-independent manner, is subsequently trafficked via the endolysosomal pathway, and is killed in lysosomes after variable durations of persistence. IgaA is required for optimal invasion. IgaB appears to play little or no role in adherence or invasion but is required for optimal intracellular persistence of NTHI. IgaB cleaves lysosome-associated membrane protein 1 (LAMP1) at pHs characteristic of the plasma membrane, early endosome, late endosome, and lysosome. However, neither IgA1 protease inhibits acidification of intracellular vesicles containing NTHI. NTHI IgA1 proteases play important but different roles in NTHI invasion and trafficking in respiratory epithelial cells. Nontypeable Haemophilus influenzae (NTHI) is a Gram-negative, human-exclusive commensal bacterium of the nasopharynx and is a leading cause of opportunistic infections in the upper and lower respiratory tracts, including otitis media, sinusitis, conjunctivitis, community-acquired pneumonia, and exacerbations of chronic obstructive pulmonary disease (COPD) and of cystic fibrosis (1, 2).When a new strain of NTHI is acquired, the outcome depends on a variety of dynamic host and bacterial factors. Colonization and the transition from commensal to opportunistic pathogen require NTHI to resist host innate immune defenses, including nutrient sequestration, mucociliary clearance, antimicrobial peptides, secretory IgA1, and phagocytosis by immune cells or by epithelial cells. Bacterial counterresistance mechanisms under investigation include adhesins, antimicrobial peptide degradation, IgA1 protease, biofilm production, modification of surface-exposed lipooligosaccharide moieties, production of outer membrane vesicles (OMVs), and others (3-12). Understanding these factors will help identify targets for therapeutic intervention, as NTHI infections induce acquired immunity consisting largely of strain-specific bactericidal antibodies that afford littl...