Cited by 196Trace Elements in HealthIron Metabolism and DisordersImmune Response and Inflammation

The Impact of Dietary Transition Metals on Host-Bacterial Interactions

Open access
Lopez, Christopher A., Skaar, Eric P.·2018·Cell Host & Microbe

Abstract

Transition metals are required cofactors for many proteins that are critical for life, and their concentration within cells is carefully maintained to avoid both deficiency and toxicity. To defend against bacterial pathogens, vertebrate immune proteins sequester metals, in particular zinc, iron, and manganese, as a strategy to limit bacterial acquisition of these necessary nutrients in a process termed “nutritional immunity.” In response, bacteria have evolved elegant strategies to access metals and counteract this host defense. In mammals, metal abundance can drastically shift due to changes in dietary intake or absorption from the intestinal tract, disrupting the balance between host and pathogen in the fight for metals and altering susceptibility to disease. This review describes the current understanding of how dietary metals modulate host-microbe interactions and the subsequent impact on the outcome of disease.

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Crossref · 10.1016/j.chom.2018.05.008

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  • Premisenone given

    Hosts have evolved metal-sequestering mechanisms collectively called nutritional immunity to limit bacterial growth.

    “To limit bacterial growth, hosts have evolved mechanisms to sequester metals in a process termed “nutritional immunity” (Figure 2).”
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    • Rests on an assumption: Bacteria require nutrient metals for essential biological processes.
    • Rests on an assumption: Dietary metals are rapidly complexed to host-derived molecules, so bacteria must compete with hosts to obtain the metals they need to survive.
  • Interpretationreasoning

    Dietary metals can shift the distribution and function of the intestinal microbiota.

    “Dietary metals, as a critical nutrient, also have the potential to shift the distribution and function of the microbiota.”
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  • Premisecitation

    Neutrophils limit nutrient metal availability by releasing lactoferrin to sequester iron.

    “Neutrophils further limit nutrient metal availability by releasing lactoferrin to sequester iron (Legrand et al., 2004)”
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  • Interpretationreasoning

    Redistribution of metals away from bacteria is a key contributor to host-pathogen interactions.

    “Host control of metal availability underscores how the redistribution of metals away from bacteria represents a key contributor to host-pathogen interactions.”
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  • Premisecitation

    Lipocalin-2 sequesters high-affinity metal-binding siderophores released by pathogenic bacteria, preventing their uptake.

    “Lipocalin-2 sequesters the high affinity metal binding siderophore molecules released by pathogenic bacteria to prevent uptake (Xiao et al., 2017).”
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    • cites Xiao et al., 2017 source

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    Premisereasoning

    Cellular transition metal levels must be tightly regulated because these metals are toxic at high concentrations.

    “Despite their importance to numerous cellular processes, transition metals are toxic at high concentrations. Thus, transition metal levels inside the cell must be tightly controlled to maintain homeostasis.”
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    Premisecitation

    Enteroaggregative E. coli is the main causative agent of traveler's diarrhea and encodes virulence factors that allow attachment to and aggregation on the intestinal epithelium.

    “Enteroaggregative E. coli (EAEC), the main causative agent of traveler’s diarrhea, encodes virulence factors that allow the pathogen to attach to and aggregate on the intestinal epithelium (Okhuysen and Dupont, 2010).”
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    Resource availability strongly shapes population structure, and limiting resources drive competition between species and individuals.

    “As with any ecosystem, resource availability is a strong force dictating population structure, with limiting resources driving competition between species and even individuals (Hornung et al., 2018).”
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    Premisecitation

    Most known enzymes use at least one metal cofactor, and zinc is the most frequent enzyme-associated transition metal, followed by iron and manganese.

    “Nearly 60% of known enzymes contain at least one metal cofactor, with zinc being the most common enzyme-associated transition metal ion followed by iron and manganese (Andreini et al., 2008).”
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    Premisecitation

    Dietary zinc supplementation reverses EAEC disease progression, inhibits EAEC adherence and biofilm formation, and reduces epithelial pro-inflammatory cytokine production.

    “Consistently, dietary zinc supplementation reverses disease progression, inhibits EAEC adherence and biofilm formation, and reduces epithelial production of pro-inflammatory cytokines (Medeiros et al., 2013).”
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    Premisecitation

    Zinc deficiency stresses EAEC and increases expression of virulence factors, including toxins that worsen diarrheal episodes and weight loss.

    “Zinc deficiency serves as a stressor for EAEC and leads to increased expression of virulence factors, including toxins that worsen diarrheal episodes and exaggerate weight loss (Bolick et al., 2014).”
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    Zinc deficiency is correlated with lower relative abundances of Clostridiales and Verrucomicrobia and higher abundances of Enterobacteriaceae and Enterococcus.

    “Specifically, zinc deficiency is correlated with low relative abundances of Clostridiales and Verrucomicrobia populations and concomitant increases in Enterobacteriaceae and Enterococcus (Reed et al., 2015; Starke et al., 2014).”
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    High levels of Akkermansia muciniphila are associated with low inflammation and normal lipid and carbohydrate metabolism.

    “High levels of Akkermansia muciniphila, a member of the Verrucomicrobia, is associated with low inflammation and normal lipid and carbohydrate metabolism (Dao et al., 2016; Schneeberger et al., 2015)”
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    Enteropathogenic E. coli exposed to high dietary zinc experiences cell envelope stress and reduced expression of the LEE pathogenicity island.

    “Another virulent E. coli, enteropathogenic E. coli (EPEC), experiences cell envelope stress and reduced expression of the main virulence factor, the locus of enterocyte effacement (LEE) pathogenicity island, upon exposure to high dietary zinc (Xue et al., 2015).”
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    Interpretationreasoning

    Excess zinc intake could disrupt gut microbial populations and predispose individuals to infection.

    “While zinc supplementation is essential for zinc-deficient individuals, excess zinc intake could disrupt the balance of gut microbial populations and predispose individuals to infection.”
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    Premisereasoning

    In the intestinal lumen, calprotectin competes with pathogens for manganese and represses the bacterial response to superoxide radicals.

    “In the intestinal lumen, calprotectin competes with pathogens for manganese and represses the bacterial response to superoxide radicals.”
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    Premisecitation

    Zinc supplementation can improve host resistance to infection, but in some cases it fails to correct impairments in the immune response.

    “While zinc supplementation can improve host resistance to infection, in some cases it fails to correct impairments in the immune response (Yuan et al., 2016).”
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    • cites Yuan et al., 2016

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    Premisecitation

    S. Typhimurium increases expression of the manganese and iron transporter SitABCD, which is required for full virulence.

    “In response, S. Typhimurium increases expression of the manganese and iron transporter SitABCD, which is required for full virulence (Boyer et al., 2002; Janakiraman and Slauch, 2000).”
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    • cites Janakiraman and Slauch, 2000

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    S. Typhimurium increases expression of iron transport systems required for full virulence, in part by supplying iron to FeS clusters needed for respiration.

    “S. Typhimurium also increases expression of iron transport systems required for full virulence (Boyer et al., 2002; Janakiraman and Slauch, 2000) in part by providing iron to iron-sulfur (FeS) clusters necessary for respiration (Byndloss et al., 2018).”
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    • cites Janakiraman and Slauch, 2000

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    Interpretationcitation

    Zinc may have anti-inflammatory properties and limit collateral damage during inflammation.

    “and suggest that zinc may have anti-inflammatory properties and limit collateral damage during inflammation (Liu et al., 2013).”
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    Premisecitation

    During Salmonella-induced inflammation, the host releases lactoferrin to sequester iron and lipocalin-2 to bind bacterial siderophores and undermine bacterial iron acquisition.

    “During Salmonella-induced inflammation, the host releases lactoferrin to sequester iron and lipocalin-2 to bind bacterial siderophores and undermine bacterial iron acquisition (Raffatellu et al., 2009).”
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    Interpretationreasoning

    C. jejuni may benefit from siderophores produced by other bacteria, suggesting a form of bacterial commensalism.

    “This suggests a type of bacterial commensalism where C. jejuni benefits from the energy expended by other bacteria to produce siderophores.”
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    Premisecitation

    Dietary iron has less than 20% absorption efficiency, leaving most ingested iron in the intestinal lumen for the microbiota.

    “Dietary iron has less than 20% absorption efficiency leaving the bulk of iron intake within the intestinal lumen to the microbiota (Jaeggi et al., 2015).”
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    Premisecitation

    Manganese is a required coenzyme for some superoxide dismutases that detoxify bactericidal superoxide radicals generated during inflammation, making it important for pathogens after immune stimulation.

    “Manganese is a required coenzyme for some superoxide dismutases in the detoxification of bactericidal superoxide radicals (Damo et al., 2012) generated during inflammation and as such is important for pathogens after stimulating an immune response.”
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    Premisecitation

    The high-zinc dysbiotic community becomes more susceptible to antibiotics, so lower doses are needed to overcome colonization resistance and allow C. difficile colonization.

    “Yet, the new community structure becomes more susceptible to antibiotics, thus lower doses are needed to overcome colonization resistance and allow C. difficile to colonize (Zackular et al., 2016).”
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    Premisecitation

    In rats, oral iron administration increases Ruminococcaceae, Defluvitalaceae, and Coprococcus and decreases Lachnospiraceae.

    “In rats, oral iron administration leads to increased representation of Ruminococcaceae, Defluvitalaceae, and Coprococcus, as well as decreased representation of Lachnospiraceae (Fang et al., 2018).”
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    Premisecitation

    In patients with low enteric pathogen burdens, iron supplementation effects on the gut range from marginally impactful to beneficial through increased fecal short-chain fatty acids and lowered inflammation.

    “In cases where patients naturally have low enteric pathogen burdens, the effects of iron supplementation on the gut ranges from marginally impactful (Dostal et al., 2014a) to beneficial through increasing fecal concentrations of anti-inflammatory short chain fatty acids (Dostal et al., 2014b) and lowering inflammation (Kortman et al., 2015).”
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    • cites Kortman et al., 2015

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    Premisecitation

    C. jejuni can bind and take up enterobactin but does not encode the machinery to produce siderophores.

    “C. jejuni can also bind and uptake enterobactin; however, it does not encode the machinery to produce siderophores (Xu et al., 2010).”
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    Premisecitation

    EcN outcompetes and suppresses S. Typhimurium colonization in an iron-dependent manner and only when lipocalin-2 is present.

    “EcN is able to outcompete and suppress S. Typhimurium colonization in an iron-dependent manner and only in the presence of lipocalin-2 (Deriu et al., 2013)”
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    Premisecitation

    Low dietary zinc is associated with lowered antibody titers, reduced lymphocyte proliferation, and reduced circulating T lymphocytes, CD4+ memory T cells, and naïve T cells.

    “where low zinc is associated with lowered antibody titers (Girodon et al., 1999), reduced lymphocyte proliferation, and reduced levels of circulating T lymphocytes, CD4+ memory T cells, and naïve T cells (Barnett et al., 2010; Fraker and King, 2004).”
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    • cites Girodon et al., 1999

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    • cites Barnett et al., 2010

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    • cites Fraker and King, 2004

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    Premisecitation

    Butyrate production is associated with increased regulatory T-cell differentiation and lowered inflammation.

    “Butyrate production is associated with increased differentiation of regulatory T-cells and lowered inflammation (Sun et al., 2017).”
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    • cites Sun et al., 2017

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    Interpretationreasoning

    Altering manganese availability in the intestines likely drives bacterial population shifts that may compromise microbiota function and host health.

    “It is unknown how dietary manganese deficiency or excess in humans affects the gut population but as with other necessary nutrients it is likely that altering manganese availability within the intestines drives bacterial population shifts that may compromise microbiota function and host health.”
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    Premisecitation

    In children, zinc supplementation to correct zinc deficiency is reported to lower median time to recovery from severe pneumonia, though some studies found no benefit.

    “In children, zinc supplementation to correct zinc deficiency is reported to lower the median time to recovery from severe pneumonia, though it is important to note that some studies found no benefit to zinc supplementation (Basnet et al., 2015).”
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    Premisecitation

    S. Typhimurium produces the stealth siderophore salmochelin, whose additional glycosylation moiety prevents lipocalin-2 binding.

    “To subvert host nutritional immunity, S. Typhimurium produces the stealth siderophore salmochelin that includes an additional glycosylation moiety (Fischbach et al., 2006) that prevents lipocalin-2 binding.”
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    • cites Fischbach et al., 2006

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    Premisecitation

    Zinc deficiency is correlated with increased risk of lung infection and arises from low zinc intake and consumption of foods high in zinc-sequestering phytates and fiber, affecting nearly a third of the world's population.

    “Zinc deficiency is correlated with an increased risk of lung infection and arises from both low zinc intake and consumption of foods high in zinc-sequestering phytates and fiber to affect nearly a third of the world’s population (Wessells and Brown, 2012).”
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    Premisecitation

    E. coli Nissle 1917 encodes mechanisms to take up exogenous iron and heme and to use the siderophores yersiniabactin, aerobactin, and salmochelin.

    “The probiotic bacterium E. coli Nissle 1917 (EcN) encodes mechanisms to uptake exogenous iron and heme as well as the siderophores yersiniabactin, aerobactin, and salmochelin (Deriu et al., 2013).”
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    Premisecitation

    Hemoglobin holds a significant portion of the body's iron, and restoring hemoglobin via dietary or parenteral nutrition in iron-deficiency anemia patients is common.

    “Hemoglobin holds a significant portion of the body’s iron and restoring hemoglobin levels via dietary or parenteral nutrition in iron-deficiency anemia patients is a common practice (Camaschella, 2015).”
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    Dietary African iron loading is characterized by high intracellular macrophage iron due to leaching from drinking containers and is enhanced in individuals with an Fpn1 mutation.

    “Dietary African iron loading is a condition characterized by high concentrations of intracellular macrophage iron due to leaching from drinking containers that is enhanced in individuals with a genetic predisposition based on a Fpn1 mutation (Gordeuk et al., 2003).”
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    Within alveolar macrophages, M. tuberculosis experiences iron starvation and upregulates metal import genes and releases the siderophore mycobactin.

    “Within alveolar macrophages, M. tuberculosis experiences iron starvation and, in response, upregulates genes involved in metal import (Dubnau et al., 2005) and releases the siderophore mycobactin (De Voss et al., 2000).”
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    Premisecitation

    Pseudomonas biofilms are negatively charged due to extracellular DNA and chelate positively charged divalent metal ions, including zinc, to promote bacterial virulence and survival.

    “Pseudomonas biofilms are negatively charged owing to extracellular DNA and chelate positively charged divalent metal ions, including zinc, to promote bacterial virulence and survival (Mulcahy et al., 2008).”
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    Premisecitation

    Ethanol-induced zinc deficiency in macrophages leads to impaired phagocytosis, suggesting zinc deficiency may prevent adequate pathogen clearance.

    “However, zinc deficiency may prevent adequate pathogen clearance, as ethanol-induced zinc-deficiency in macrophages leads to impaired phagocytosis (Konomi et al., 2015).”
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    Premisecitation

    Iron deficiency has complex effects on macrophage function and bactericidal radical formation: low iron reduces Fenton-mediated hydroxyl formation but also increases radical generation through respiratory chain defects and reduced oxidative stress handling.

    “The effects of iron deficiency on macrophage function and bactericidal radical formation is complex, as low iron reduces Fenton-mediated hydroxyl formation but also increases radical generation through defects in the respiratory chain and a reduced capacity to handle oxidative stress (Koskenkorva-Frank et al., 2013).”
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    Premisecitation

    Plasmodium infection induces anemia and increased IL-10 expression, which synergize to suppress phagocytic cell control of NTS and contribute to co-infection.

    “Plasmodium infection induces anemia and increased expression of the anti-inflammatory cytokine IL-10, which synergize to suppress phagocytic cell control of NTS and contributes to co-infection (Lokken et al., 2014).”
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    Premisecitation

    NTS enhances iron availability by triggering ERRγ expression, leading to increased hepcidin expression and iron store accumulation within macrophages.

    “NTS also enhances iron availability through triggering expression of estrogen-related receptor gamma (ERRγ), which leads to increased hepcidin expression and accumulation of iron stores within macrophages (Kim et al., 2014).”
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    Premisecitation

    Excess iron interferes with nitric oxide production, which feeds back to limit Fpn1 expression and increases intracellular iron stores.

    “To compound the effect, excess iron interferes with nitric oxide production, which feeds back to limit Fpn1 expression and increases intracellular iron stores (Nairz et al., 2013; Nairz et al., 2007)(Figure 2).”
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    Interpretationreasoning

    Zinc deficiency may enhance innate immune cell recruitment, but cell dysfunction could inhibit effective bacterial killing.

    “While zinc deficiency may enhance innate immune cell recruitment to combat pathogen invasion, cell dysfunction could inhibit effective bacterial killing.”
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    Interpretationreasoning

    P. aeruginosa zinc acquisition affects both bacterial replication and virulence factor expression.

    “P. aeruginosa zinc acquisition has consequences not only for bacterial replication, but also in the expression of virulence factors.”
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    Interpretationreasoning

    Host calprotectin release and metal transporter activity collectively slow intracellular bacterial replication.

    “These responses collectively slow intracellular bacterial replication.”
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    Premisecitation

    A. baumannii infection triggers neutrophil calprotectin release to limit metal availability to extracellular bacteria, while host metal transporters including NRAMP1 export divalent metals from bacteria-containing endosomes.

    “A. baumannii infection triggers the release of calprotectin from infiltrating neutrophils to limit metal availability to extracellular bacteria while host metal transporters including NRAMP1 (Nevo and Nelson, 2006) export multiple divalent metals out of bacteria-containing endosomes.”
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    Premisecitation

    B lymphocytes show reduced proliferation in iron deficiency, and long-term iron deficiency reduces IgG and IgM antibody production.

    “B lymphocytes also show reduced proliferation (Kuvibidila et al., 1983) and long-term iron deficiency reduces production of IgG and IgM antibodies (Kochanowski and Sherman, 1985).”
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    • cites Kochanowski and Sherman, 1985

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    Premisecitation

    Iron deficiency in animal models inhibits T cell proliferation in the liver, spleen, and thymus and reduces activation of T cells and natural killer T cells.

    “Immunologically, iron deficiency in animal models inhibits T cell proliferation in the liver (Bonaccorsi-Riani et al., 2015), spleen (Kuvibidila et al., 1983), and thymus (Brekelmans et al., 1994) and reduces activation of T cells and natural killer T cells (Bonaccorsi-Riani et al., 2015).”
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    • cites Bonaccorsi-Riani et al., 2015

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    • cites Kuvibidila et al., 1983

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    • cites Brekelmans et al., 1994

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    Premisecitation

    One study found that children given iron supplements had increased risk of death compared with controls, prompting early termination of the study.

    “As an example, one study found that children provided iron supplements were at an increased risk of death compared to controls, prompting early termination of the study (Sazawal et al., 2006).”
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    • cites Sazawal et al., 2006 source

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    Premisecitation

    Under zinc limitation, A. baumannii Zur de-represses the energy-dependent zinc transporter ZnuABC, which is necessary for survival in murine pneumonia, partly by supporting anti-oxidative stress defenses via a zinc-copper superoxide dismutase.

    “In response to zinc limitation, the A. baumannii transcriptional zinc uptake regulator (Zur) de-represses the energy-dependent zinc transporter ZnuABC that is necessary for survival in murine models of pneumonia (Mortensen et al., 2014), in part by contributing to anti-oxidative stress defenses via a zinc-copper superoxide dismutase (Hassan et al., 2017).”
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    • cites Mortensen et al., 2014

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    • cites Hassan et al., 2017

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    Premisecitation

    Zinc acquisition by P. aeruginosa transporters is complemented by release of the siderophore pyochelin, which can bind multiple divalent cations.

    “Zinc acquisition by P. aeruginosa transporters is complemented by the release of the siderophore pyochelin, which can bind multiple divalent cations (Brandel et al., 2012).”
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    • cites Brandel et al., 2012

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    Premisecitation

    High dietary iron weakens host defense by inhibiting macrophage interferon-γ signaling, decreasing neutrophil recruitment, and reducing pro-inflammatory cytokine expression.

    “Additionally, high dietary iron weakens other arms of the host defense. Iron inhibits macrophage interferon-γ signaling, a pro-inflammatory cytokine important for producing bactericidal nitric oxide gas (Weiss et al., 1992), decreases the recruitment of neutrophils (a primary innate defense against M. tuberculosis infection), and reduces pro-inflammatory cytokine expression (Agoro et al., 2017).”
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    • cites Weiss et al., 1992

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    Premisecitation

    Moderate iron supplementation increases T-cell recruitment to granulomas and enhances reactive oxygen species production that limits M. tuberculosis replication.

    “It should be noted that moderate iron supplementation also results in increased T-cell recruitment to granulomas and enhanced reactive oxygen species production that limits M. tuberculosis replication (Agoro et al., 2017).”
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    Premisecitation

    Zinc triggers increased antibiotic resistance and promotes biofilm formation within cystic fibrosis sputum.

    “Zinc triggers increased resistance to antibiotics and promotes biofilm formation within cystic fibrosis sputum (Marguerettaz et al., 2014).”
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    • cites Marguerettaz et al., 2014

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    H. pylori infection is associated with iron deficiency, possibly by reducing gastric acid production and iron absorption or by inducing blood loss through gastric ulcers.

    “H. pylori infection itself is associated with iron deficiency, possibly through reducing gastric acid production and iron absorption (Dale et al., 1998) or by inducing blood loss through gastric ulcers (Beckett et al., 2016).”
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    There is controversy over whether H. pylori is the driver in causing iron deficiency.

    “However, there is controversy over whether H. pylori is the driver in causing iron deficiency (Banerjee and Bishop, 2005).”
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    Interpretationcitation

    High dietary manganese undermines nutritional immunity and increases pathogen virulence.

    “In this manner, high dietary manganese subverts nutritional immunity and potentiates pathogen virulence.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: S. aureus invasion of organ tissue usually causes neutrophils to migrate to bacterial abscesses and release calprotectin, which binds manganese.
  • May combine two claims.

    Premisecitation

    Hereditary hemochromatosis is caused by an HFE mutation that leads to excess iron absorption through disrupted hepcidin and Fpn1 interactions and increases susceptibility to multiple bacterial pathogens including V. vulnificus, Y. pseudotuberculosis, Y. enterocolitica, and L. monocytogenes.

    “Hereditary hemochromatosis is caused by a mutation in the HFE gene (chromosome 6p21.3) that leads to the excess absorption of iron through disruption of hepcidin and Fpn1 interactions (Adams and Barton, 2007) and increases susceptibility to multiple bacterial pathogens (Khan et al., 2007), including V. vulnificus, Y. pseudotuberculosis, Y. enterocolitica, and L. monocytogenes.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Adams and Barton, 2007

      Not checked in the free run.

    • cites Khan et al., 2007 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Local copper levels rise at sites of bacterial invasion and cause bactericidal toxicity.

    “it is widely accepted that localized copper abundance increases at sites of bacterial invasion to cause bactericidal toxicity (Besold et al., 2016)”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Besold et al., 2016 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Others discovered a positive link between H. pylori and reduced iron absorption.

    “others discovered a positive link between H. pylori and reduced iron absorption(Beckett et al., 2016).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Beckett et al., 2016

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The Isd system contains high-affinity receptors that remove heme from hemoglobin for transport across the cell wall, and cytosolic heme oxygenases degrade heme to release iron.

    “The Isd system contains high affinity receptors to remove heme from hemoglobin for transport across the cell wall (Grigg et al., 2010) and once internalized, cytosolic heme oxygenases degrade heme to release iron (Wilks and Heinzl, 2014).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Grigg et al., 2010

      Not checked in the free run.

    • cites Wilks and Heinzl, 2014

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Some researchers found that Helicobacter infection does not influence absorption from iron supplementation.

    “Whereas some researchers found that Helicobacter infection does not influence absorption from iron supplementation (Herter-Aeberli et al., 2017)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Herter-Aeberli et al., 2017

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Nickel serves as a cofactor in bacterial urease and NiFe hydrogenases, which aid pathogen virulence.

    “Nickel is a cofactor in bacterial urease and NiFe hydrogenases that contribute to pathogen virulence (de Reuse et al., 2013; Remy et al., 2013).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites de Reuse et al., 2013

      Not checked in the free run.

    • cites Remy et al., 2013

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    In humans, recognized causes of copper deficiency include gastric surgery, too much zinc intake, and malabsorption.

    “In humans, the causes of copper deficiency, if known, include prior gastric surgery, excessive zinc consumption, and malabsorption (Kumar, 2006).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Kumar, 2006

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Other Gram-positive and Gram-negative pathogens have evolved diverse mechanisms to use heme as an iron source and could complicate efforts to correct iron deficiency by hemoglobin restoration.

    “However, other Gram-positive as well as Gram-negative pathogens have evolved diverse mechanisms to use heme as an iron source (Anzaldi and Skaar, 2010) and could also complicate efforts to correct iron deficiency by hemoglobin restoration.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Anzaldi and Skaar, 2010 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Copper availability affects host-pathogen interactions directly and also influences iron homeostasis.

    “Thus, copper availability both directly affects host-pathogen interactions as well as impacts iron homeostasis.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Copper, nickel, cobalt, and molybdenum come from the diet and are needed for several cellular processes.
  • May combine two claims.

    Premisecitation

    In mice given a high-manganese diet, calprotectin does not restrict manganese availability even though S. aureus triggers calprotectin release around heart abscesses.

    “While S. aureus induces the release of calprotectin around the heart abscess, calprotectin fails to limit manganese availability when mice are provided a high manganese diet (Juttukonda et al., 2017).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Juttukonda et al., 2017

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    H. pylori infects nearly one-half of the world's population and is one of the greatest risk factors for distal gastric carcinomas.

    “H. pylori infects nearly one-half of the world’s population and is one of the greatest risk factors for the development of distal gastric carcinomas (Cover and Peek, 2013).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Cover and Peek, 2013

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Vibrio vulnificus is highly virulent and contributes to upwards of 50% of mortality from bloodstream infections in hereditary hemochromatosis patients.

    “The Gram-negative bacterium Vibrio vulnificus is highly virulent and contributes to upwards of 50% of the mortality of blood stream infections in patients suffering from hereditary hemochromatosis (Horseman and Surani, 2011).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Horseman and Surani, 2011 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    S. aureus senses heme through the HssRS two-component system, which under high heme activates the HrtAB efflux pump and limits intracellular heme availability.

    “To protect against heme toxicity, S. aureus senses heme through the two-component regulatory system HssRS, which under high heme conditions activates expression of the efflux pump HrtAB and limits intracellular heme availability (Stauff and Skaar, 2009).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Stauff and Skaar, 2009

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Increased iron in the blood of hereditary hemochromatosis patients may serve as an iron pool for pathogens such as V. vulnificus, which increase high-affinity iron transporters or siderophores during iron starvation.

    “Increased iron in the blood of hereditary hemochromatosis patients (Adams and Barton, 2007) may then serve as a pool of iron available for pathogens such as V. vulnificus, which increase expression of high affinity iron transporters or iron-binding siderophore molecules during iron starvation (Pajuelo et al., 2016).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Adams and Barton, 2007

      Not checked in the free run.

    • cites Pajuelo et al., 2016

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Cobalt is part of coenzyme B12 and is needed for several processes, including ethanolamine use that supports S. Typhimurium growth in the gut.

    “Cobalt is incorporated into coenzyme B12 and is necessary for multiple physiological processes including ethanolamine utilization that contributes to S. Typhimurium growth in the intestines (Thiennimitr et al., 2011).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Thiennimitr et al., 2011

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationreasoning

    The availability of one metal often changes the distribution of other metal cations.

    “with the availability of one metal often influencing the distribution of other metal cations”
    Quote in the paperNot a substantial claim
71 of 71
  • The paper relies on this without support.

    Bacteria require nutrient metals for essential biological processes.

    “Bacteria, like their mammalian hosts, require nutrient metals for essential biological processes.”
  • The paper relies on this without support.

    Dietary metals are rapidly complexed to host-derived molecules, so bacteria must compete with hosts to obtain the metals they need to survive.

    “Given that dietary metals are rapidly complexed to host-derived molecules (Figure 1), bacteria must compete with their hosts to obtain the metals required to survive.”
  • The paper relies on this without support.

    The link between dietary manganese and susceptibility to infectious disease is poorly understood.

    “The role of dietary manganese and susceptibility to infectious disease is not well described”
  • The paper relies on this without support.

    S. aureus invasion of organ tissue usually causes neutrophils to migrate to bacterial abscesses and release calprotectin, which binds manganese.

    “S. aureus invasion into organ tissue typically results in neutrophil migration to the bacterial abscesses where they release calprotectin to bind manganese.”
  • The paper relies on this without support.

    Other metals, despite being less abundant, are essential for life.

    “However, other metals, though not as abundant, are also critical for life.”
  • The paper relies on this without support.

    Copper, nickel, cobalt, and molybdenum come from the diet and are needed for several cellular processes.

    “Copper, nickel, cobalt, and molybdenum are diet-derived and important for the proper functioning of several cellular processes.”
  • The paper relies on this without support.

    Nickel, cobalt, and molybdenum are important in many bacterial enzymes.

    “Nickel, cobalt, and molybdenum are important in many bacterial enzymes.”
  • The paper relies on this without support.

    Associations between H. pylori, gastric cancer, and iron deficiency are well established.

    “Though there are well-established associations between H. pylori, gastric cancer, and iron deficiency”
  • The paper relies on this without support.

    It is unclear how the inflammatory environment caused by high dietary manganese affects susceptibility to bacterial colonization.

    “It remains unclear how the altered inflammatory environment mediated by elevated manganese from the diet affects susceptibility to bacterial colonization”
9 of 9

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Tissue metal levels in vertebrate hosts are mainly controlled by absorption from dietary sources in the intestinal tract, whereas bacterial pathogens acquire metal from the extracellular and intracellular environments of host tissues during infection.

    “Tissue metal levels in vertebrate hosts are mainly controlled by absorption from dietary sources in the intestinal tract, whereas bacterial pathogens acquire metal from the extracellular and intracellular environments of host tissues during infection 5 .”

    From Nutritional immunity: the battle for nutrient metals at the host–pathogen interface (2022) · cites this paper as [5]

    Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

    Experimental — accuracy not yet measured

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Authors
Lopez, C. A., & Skaar, E. P.
Affiliations
  • Vanderbilt University Medical Center (US)
  • Vanderbilt University (US)
Corresponding author
Skaar, Eric P.
Venue
Cell Host & Microbe
Publisher
Elsevier BV
Published
2018-06
Volume
23
Issue
6
Pages
737-748
ISSN
1931-3128 (ISSN-L)
OpenAlex
W2808070375
Cited by
190
References
135
Citations by year
2026: 14 · 2025: 19 · 2024: 21 · 2023: 22 · 2022: 29 · 2021: 29 · 2020: 31 · 2019: 16 · 2018: 9
FWCI
2.73
Type
journal article
Language
en
Open access
Locations
  • Cell Host & Microbe (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • Jane Coffin Childs Memorial Fund for Medical Research
  • National Institutes of Health (R01 AI073843, T32AI095202, R01 AI101171, R01 AI069233)
  • Burroughs Wellcome Fund
  • Simons Foundation
Topics
  • Health Sciences › Nursing › Nutrition and Dietetics › Trace Elements in Health
  • Health Sciences › Medicine › Hematology › Iron Metabolism and Disorders
  • Life Sciences › Immunology and Microbiology › Immunology › Immune Response and Inflammation
Keywords
host-microbe interactions, nutritional immunity, zinc, iron, manganese, metal sequestration, immune proteins, bacterial pathogenesis, host defense against bacteria
MeSH terms
Host Microbial Interactions, Animals, Bacteria, Diet, Humans, Immunity, Iron, Manganese, Metals, Molybdenum, Respiratory System, Virulence, Zinc, Gastrointestinal Tract, Host-Pathogen Interactions, Microbial Interactions, Microbiota

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-07.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-07.

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