Modelling tuberculous meningitis in zebrafish using Mycobacterium marinum

Abstract

Abstract Tuberculous meningitis (TBM) is one of the most severe extra-pulmonary manifestations of tuberculosis with a high morbidity and mortality. Characteristic pathological features of TBM are Rich foci, i.e. brain and spinal cord-specific granulomas formed after haematogenous spread of pulmonary tuberculosis. Little is known about early pathogenesis of TBM and the role of Rich foci. We have adapted the zebrafish - Mycobacterium marinum model to study TBM. First, we analyzed whether TBM occurs in adult zebrafish and showed that intraperitoneal infection resulted in granuloma formation in the meninges in 20% of the cases, with occasional brain parenchyma involvement. In zebrafish embryos, bacterial infiltration and clustering of infected phagocytes was observed after infection via three different inoculation routes, i.e. parenchyma, hindbrain ventricle and caudal vein. Infection via the bloodstream resulted in the formation of early granulomas in brain tissue in 70% of the cases. In these zebrafish embryos, infiltrates were located in the proximity of blood vessels. Interestingly, no differences were observed when embryos were infected before or after early formation of the blood-brain barrier (BBB), indicating that bacteria are able to cross this barrier with relatively high efficiency. In agreement with this observation, infected zebrafish larvae also showed infiltration of the brain tissue. Upon infection of embryos with a M. marinum ESX-1 mutant only small clusters and scattered isolated phagocytes with a high bacterial load were present in the brain tissue. In conclusion, our adapted zebrafish - M. marinum infection model for studying granuloma formation in the brain, will allow for the detailed analysis of both bacterial and host factors involved in TBM. It will help solve longstanding questions on the role of Rich foci and potentially contribute to development of better diagnostics and therapeutics.