Signal transducer and activator of transcription 3 (STAT3) triggered production of Th-17 cytokines mediates protective immunity against fungi. Mutations affecting the STAT3/interleukin 17 (IL-17) pathway cause selective susceptibility to fungal (Candida) infections, a hallmark of chronic mucocutaneous candidiasis (CMC). In patients with autosomal dominant CMC, we and others previously reported defective Th17 responses and underlying gain-of-function (GOF) STAT1 mutations, but how this affects STAT3 function leading to decreased IL-17 is unclear. We also assessed how GOF-STAT1 mutations affect STAT3 activation, DNA binding, gene expression, cytokine production, and epigenetic modifications. We excluded impaired STAT3 phosphorylation, nuclear translocation, and sequestration of STAT3 into STAT1/STAT3 heterodimers and confirm significantly reduced transcription of STAT3-inducible genes (RORC/IL-17/IL-22/IL-10/c-Fos/SOCS3/cMyc) as likely underlying mechanism. STAT binding to the high affinity sis-inducible element was intact but binding to an endogenous STAT3 DNA target was impaired. Reduced STAT3-dependent gene transcription was reversed by inhibiting STAT1 activation with fludarabine or enhancing histone, but not STAT1 or STAT3 acetylation with histone deacetylase (HDAC) inhibitors trichostatin A or ITF2357. Silencing HDAC1, HDAC2, and HDAC3 indicated a role for HDAC1 and 2. Reduced STAT3-dependent gene transcription underlies low Th-17 responses in GOF-STAT1 CMC, which can be reversed by inhibiting acetylation, offering novel targets for future therapies.Correspondence: Dr. Desa Lilic e-mail: desa.lilic@ncl.ac.uk * Both authors contributed equally to this work.C 2015 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim www.eji-journal.eu Eur. J. Immunol. 2015. 45: 2834-2846 Immunity to infection 2835
Keywords: Chronic mucocutaneous candidiasis (CMC) HDAC inhibitors IL-17 STAT1 gain-of-function mutation STAT3 STAT1 inhibitorsAdditional supporting information may be found in the online version of this article at the publisher's web-site
IntroductionPatients with chronic mucocutaneous candidiasis (CMC) present with recurrent or persistent infections of the skin, nails, and mucosal membranes with the fungus Candida [1]. Candida is an opportunistic yeast that does not cause disease in healthy individuals despite inhabiting bodily surfaces as it is controlled by immune mechanisms, specifically Th-17 cells and cytokines produced by them [2]. Mucosal infections with Candida species indicate an underlying T-cell deficiency, which is most often secondary to immunosuppressive and/or chemotherapy, antibiotics, biological therapies, HIV, or other permissive circumstances. However, in rare patients, these infections present as a severe syndrome coined CMC, a primary immune deficiency in which the underlying cause is a genetic mutation affecting immune pathways essential for fungal protection [3]. Research in primary immune deficiency patients with isolated CMC has documented the crucial role of the signal transducer and activator of tra...