Despite attempts to understand and control
Mycobacterium tuberculosis for more than a century, this pathogen remains a pressing public health threat, infecting more than one-third of the world’s population and causing almost two million deaths yearly (
1). Understanding the molecular mechanism of the host/pathogen interaction is believed to be vital for controlling
M. tuberculosis infections.
Previous research showed that vaccines constructed based on
ESAT6 and CFP10 could reduce the
M. tuberculosis burden in guinea pigs and non-human primates (
2,
3). However, substantial evidence indicates that
ESAT6 and CFP10 are also virulence factors. The Rv3875 gene that encodes
ESAT6 is located within the region of difference 1 (RD1), which is present in all pathogenic mycobacteria, including
M. tuberculosis and
M. bovis, but not in attenuated
M. bovis bacillus Calmette-Gue’rin (BCG) (
4).
ESAT6 and CFP10 are secreted as 1:1 dimers through a specific secretion system, ESX-1 (
5-
7). Studies of
M. bovis BCG and RD1-complemented
M. bovis BCG have demonstrated that the secretion of
ESAT6 and CFP10 are required for the virulence, pathogenicity, and growth of
M. bovis in macrophages and in mice (
8,
9). In addition,
ESAT6 and CFP10 are produced in the lungs of infected mice (
10). The mechanisms by which
ESAT6 and CFP10 contribute to virulence are not fully defined, but are believed to be involved in the cytolysis of alveolar epithelial cells and macrophages (
11), favoring the intercellular spread of
M. tuberculosis (
12).
Nitric oxide (NO) is formed when the guanidine nitrogen of L-arginine is oxidized by a family of isoenzymes known as NO synthases. The high expression of NO in response to cytokines or to pathogen-derived molecules is important for host defense against intracellular microorganisms, such as
Toxoplasma gondii,
Listeria monocytogenes,
Ectromelia virus, and
M. tuberculosis (
13-
15). Recent studies showed that exposure of
M. tuberculosis to NO at low concentrations killed more than 99% of the bacteria in culture (
16), indicating that NO may induce macrophage apoptosis. In a TB-infection murine model, NO played an essential role in the mononuclear phagocyte killing of
M. tuberculosis (
17).