This project is a K08 mentored career clinical scientist award that focuses on signals that promote Aspergillus fumigatus invasion, a ubiquitous mould that causes invasive pulmonary aspergillosis (IPA) resulting in >200,000 cases of serious infection yearly. In lung transplants, invasive A. fumigatus infections cause airway anastomotic complications and IPA with a morality rate as high as 80%. Aspergillus establishes and adapts to a severely hypoxic microenvironment by vascular invasion, thrombosis, and the production of antiangiogenic factors, which likely contribute to its virulence. Transplanted lungs are particularly vulnerable to ischemia, as the only solid organ allografts that do not routinely undergo primary systemic arterial restoration during trans- plantation. Thus, ischemia, working in concert with Aspergillus infection is a unique and critical host- pathogen factor. Using a novel murine tracheal transplant model, we found that Aspergillus becomes more deeply invasive as the allograft undergoes progressive rejection-mediated ischemia. Upregulating endothelial hypoxia inducible factor (HIF)-1a (a stimulator of angiogenesis and vascular repair) limited the invasion of the mould. In preliminary studies, we have elucidated a hypothesized role for HIF-1? in repairing microvascular injury, which improves microvascular perfusion and decreases tissue iron overload (from diffuse microvascular hemorrhage, i.e., iron released from heme breakdown), and thus blocks iron overload, a putative stimulus for Aspergillus invasion and a critical substrate for fungal growth. In this proposal, we define HIF-1a as a pivotal mediator for the observed attenuation of Aspergillus invasion.
In Specific Aim 1 we focus on the host, as we investigate the effect of modulating host HIF-1a and graft iron overload on Aspergillus invasion. Two subaims evaluate these host factors:
Aim 1 a: determines how endothelial HIF-1a mitigates Aspergillus invasion, examining the contribution of tissue devitalization and allograft iron overload;
and Aim 1 b: determines the role of graft iron overload in promoting Aspergillus invasion.
For Specific Aim 2, we focus on the pathogen, studying the impact that A. fumigatus has on host microvascular repair, using highly specific angiogenic cell, transgenic murine markers. With successful outcomes of the proposed studies, we anticipate the strong conclusion that A. fumigatus invasion can be modulated by endothelial cell HIF-1a upregulation, which would have significant therapeutic implications in decreasing the risk for Aspergillus-related invasive infections and elucidate fundamental biologic principles underlying A. fumigatus pathogenesis. This result would create the opportunity for greater multidisciplinary collaborative interchange to evaluate underlying signaling mechanisms and the development of novel therapeutic strategies to improve survival after lung transplantation.

Public Health Relevance

Aspergillus fumigatus is a ubiquitous mould, and an increasing cause of life threatening lung infections. Emerging evidence suggests that protecting the integrity of airway blood vessels will prevent invasive fungal infections. This proposal tests novel therapeutic strategies to lessen the burden of these infections by improving the flow of blood to the transplanted organ.

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Clinical Investigator Award (CIA) (K08)
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Special Emphasis Panel (ZHL1)
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Colombini-Hatch, Sandra
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Stanford University
Internal Medicine/Medicine
Schools of Medicine
United States
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Hsu, Joe L; Manouvakhova, Olga V; Clemons, Karl V et al. (2018) Microhemorrhage-associated tissue iron enhances the risk for Aspergillus fumigatus invasion in a mouse model of airway transplantation. Sci Transl Med 10:
Vazquez Guillamet, Cristina; Hsu, Joe Le; Dhillon, Gundeep et al. (2018) Pulmonary Infections in Immunocompromised Hosts: Clinical. J Thorac Imaging 33:295-305
Pasupneti, S; Manouvakhova, O; Nicolls, M R et al. (2017) Aspergillus-related pulmonary diseases in lung transplantation. Med Mycol 55:96-102
Khan, M A; Hsu, J L; Assiri, A M et al. (2016) Targeted complement inhibition and microvasculature in transplants: a therapeutic perspective. Clin Exp Immunol 183:175-86
Nicolls, Mark R; Hsu, Joe L; Jiang, Xinguo (2016) Microvascular injury after lung transplantation. Curr Opin Organ Transplant 21:279-84
Jothimuthu, Preetha; Hsu, Joe L; Chen, Robert et al. (2016) Enhanced Electrochemical Sensing with Carbon Nanotubes Modified with Bismuth and Magnetic Nanoparticles in a Lab-on-a-Chip. ChemNanoMat 2:904-910
Nazik, Hasan; Penner, John C; Ferreira, Jose A et al. (2015) Effects of Iron Chelators on the Formation and Development of Aspergillus fumigatus Biofilm. Antimicrob Agents Chemother 59:6514-20