Effective macrophage clearance of Klebsiella pneumoniae requires the inducible nitric oxide synthase iNOS and is independent of reactive oxygen species generated by NADPH oxidase

Klebsiella pneumoniae is a leading cause of pneumonia and bacteremia and is especially dangerous in healthcare settings. Despite massive clinical significance, the mechanisms used by macrophages to kill K. pneumoniae are not well defined. Macrophages are critical for controlling K. pneumoniae as mice lacking monocyte-derived or alveolar macrophages have higher bacterial tissue burdens and mortality. Two prominent mechanisms used by macrophages to kill bacteria are the production of reactive oxygen species (ROS) via the NADPH oxidase NOX2 and reactive nitrogen species (RNS) via the inducible nitric oxide synthase iNOS. Previously, we found that K. pneumoniae uses similar genetic factors to survive during bacteremia and within macrophages. The ability of these factors to enhance intracellular fitness was significantly correlated with resistance against RNS, not ROS. Here, we aimed to define whether macrophage ROS and RNS contribute to intracellular K. pneumoniae clearance. Using wild-type, Cybb-/-, and Nos2-/- cells, we measured K. pneumoniae survival within macrophages lacking such defenses. NOX2 was dispensable for K. pneumoniae clearance, and ROS was undetectable in K. pneumoniae-infected macrophages. We confirmed that ROS was undetectable within alveolar-like macrophages, indicating a conserved ROS evasion phenotype across macrophage subsets. Instead, iNOS significantly contributed to macrophage clearance of K. pneumoniae and enhanced cytokine production. iNOS likely enhances K. pneumoniae clearance through coordination of immunity and RNS. Activation of pathways upstream of iNOS may be the most relevant to supporting effective macrophage control of K. pneumoniae. This study defines unexpected differential roles for ROS and RNS in macrophage clearance of K. pneumoniae.