RESEARCH ARTICLE

Signaling through IL-17C/IL-17RE Is

Dispensable for Immunity to Systemic, Oral
and Cutaneous Candidiasis
Heather R. Conti1, Natasha Whibley1, Bianca M. Coleman1, Abhishek V. Garg1,
Jillian R. Jaycox2, Sarah L. Gaffen1*
1 University of Pittsburgh, Department of Medicine, Division of Rheumatology & Clinical Immunology,
Pittsburgh, PA, United States of America, 2 Carnegie Mellon University, Dept. of Biological Sciences,
Pittsburgh, PA, United States of America
* [email protected]

Abstract
OPEN ACCESS
Citation: Conti HR, Whibley N, Coleman BM, Garg
AV, Jaycox JR, Gaffen SL (2015) Signaling through
IL-17C/IL-17RE Is Dispensable for Immunity to
Systemic, Oral and Cutaneous Candidiasis. PLoS
ONE 10(4): e0122807. doi:10.1371/journal.
pone.0122807
Academic Editor: Julian R Naglik, King's College
London Dental Institute, UNITED KINGDOM
Received: November 26, 2014
Accepted: February 13, 2015
Published: April 7, 2015
Copyright: 2015 Conti et al. This is an open
access article distributed under the terms of the
Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any
medium, provided the original author and source are
credited.
Data Availability Statement: All relevant data are
within the paper.

Candida albicans is a commensal fungal microbe of the human orogastrointestinal tract and
skin. C. albicans causes multiple forms of disease in immunocompromised patients, including oral, vaginal, dermal and disseminated candidiasis. The cytokine IL-17 (IL-17A) and its
receptor subunits, IL-17RA and IL-17RC, are required for protection to most forms of candidiasis. The importance of the IL-17R pathway has been observed not only in knockout
mouse models, but also in humans with rare genetic mutations that impact generation of
Th17 cells or the IL-17 signaling pathway, including Hyper-IgE Syndrome (STAT3 or TYK2
mutations) or IL17RA or ACT1 gene deficiency. The IL-17 family of cytokines is a distinct
subclass of cytokines with unique structural and signaling properties. IL-17A is the bestcharacterized member of the IL-17 family to date, but far less is known about other IL-17related cytokines. In this study, we sought to determine the role of a related IL-17 cytokine,
IL-17C, in protection against oral, dermal and disseminated forms of C. albicans infection.
IL-17C signals through a heterodimeric receptor composed of the IL-17RA and IL-17RE
subunits. We observed that IL-17C mRNA was induced following oral C. albicans infection.
However, mice lacking IL-17C or IL-17RE cleared C. albicans infections in the oral mucosa,
skin and bloodstream at rates similar to WT littermate controls. Moreover, these mice demonstrated similar gene transcription profiles and recovery kinetics as WT animals. These
findings indicate that IL-17C and IL-17RE are dispensable for immunity to the forms of candidiasis evaluated, and illustrate a surprisingly limited specificity of the IL-17 family of cytokines with respect to systemic, oral and cutaneous Candida infections.

Funding: SLG was supported the by the National

Institutes of Health (R01-AI107825, R01-DE022550,
R01-DE023815). HRC was supported by F32DE023293. The funders had no role in study design,
data collection and analysis, decision to publish or
preparation of the manuscript.

Introduction

Competing Interests: SLG has received a research

grant, travel reimbursements and honoraria from
Novartis. SLG has also consulted for, received travel

The commensal fungus Candida albicans causes a wide spectrum of human pathologies, ranging from mild or chronic mucocutaneous infections to severe, often fatal disseminated disease.
Candida colonization at mucosal surfaces or skin can progress to candidiasis in settings of

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IL-17C and IL-17RE Are Dispensable for Some Candida Immunity

reimbursements and honoraria from Janssen, Eli Lilly,

Amgen and Pfizer. There are no other conflicts of
interest. This does not alter the authors' adherence to
PLOS ONE policies on sharing data and materials.

immunosuppression, barrier disruption or broad-spectrum antibiotic use [1, 2]. Disseminated

disease caused by C. albicans is the fourth most common nosocomial infection and is associated with a 2080% mortality rate. HIV+/AIDS patients are especially vulnerable to oropharyngeal candidiasis (OPC, thrush), indicating the particular importance of CD4+ T cells in
protection to this form of candidiasis [3]. Chronic mucocutaneous candidiasis (CMC) is a recurrent infection of skin, mucosae and nails (onychomycosis), frequently seen in individuals
with mutations that affect Th17 cells, the cytokines IL-17A and IL-17F, or their receptor IL17RA. Diseases associated with CMC include hyper-IgE syndrome (HIES, also known as Jobs
syndrome) caused by mutations in STAT3 or TYK2, or Autoimmune polyendocrinopathy syndrome (APS-1), caused by mutations in AIRE, or in genes impacting the IL-23/IL-17 signaling
axis such as IL12B, STAT1, IL17RA, IL17F, and ACT1 (reviewed in [4]).
In keeping with findings in humans, several studies demonstrated the importance of the
IL-23/IL-17 pathway in protection to candidiasis in mice. We showed that IL-23-, IL-17RA-,
IL-17RC- and Act1-deficient mice are all highly susceptible to OPC [58]. Similarly important roles for the IL-23/IL-17 signaling axis in controlling dermal and disseminated candidiasis in mouse models have also been described [911]. Collectively, these studies indicate that
the mouse is a faithful model for understanding the nature of the immune response to
Candida infections.
Biologic therapies targeting cytokines have shown considerable clinical efficacy in treating
rheumatoid arthritis, psoriasis, Crohns disease and other autoimmune conditions. Currently
there are FDA-approved monoclonal antibodies or soluble receptors that directly or indirectly
block the Th17/IL-17 axis, including agents that neutralize TNF-, IL-1, IL-6R and IL-12/
23p40. More recently, Phase II and III clinical trials testing biologics that directly target IL-17A
or IL-17RA have shown considerable promise in treating psoriasis, and are under evaluation
for a number of other rheumatologic conditions [1216]. Given the accumulating genetic evidence that the IL-17RA/RC complex is essential for protection from candidiasis, it is important
to understand the potential adverse side effects of anti-IL-17/IL-17RA therapy on immune responses that protect against opportunistic infections.
The IL-17 cytokine family consists of six related members: IL-17A, IL-17B, IL-17C, IL-17D,
IL-17E (IL-25) and IL-17F [17, 18]. To date, almost nothing is known about the antifungal
functions of IL-17 family cytokines apart from IL-17A and IL-17F. IL-17A and IL-17F signal
through a heterodimeric receptor composed of IL-17RA and IL-17RC [19, 20]. In addition, IL17RA partners with other members of the extended IL-17 receptor family to form binding
complexes for other IL-17-family cytokines [18], and thus is considered the common signaling
subunit of the IL-17 family. In particular, the cytokine IL-17C signals through a receptor complex containing IL-17RA paired with IL-17RE [21]. In contrast to IL-17A and IL-17F, which
are lymphocyte-derived, IL-17C is predominantly produced by epithelial cells and keratinocytes [21, 22]. Similar to IL-17A, IL-17C directs an immune response at mucosal surfaces and
skin by stimulating production of pro-inflammatory cytokines, chemokines and antimicrobial
peptides. The downstream genes induced by IL-17C show overlap with those regulated by IL17A [23] [24, 25]. It has been suggested that IL-17C amplifies the Th17 response by direct signaling on Th17 cells through IL-17RE/IL-17RA [26]. Several studies have indicated a protective
role for IL-17C in gut and skin [2729], but this cytokine is still remarkably poorly understood.
Because so little is known about the antifungal roles of other non-IL-17A family members such
as IL-17C, and because IL-17C signals through the shared receptor IL-17RA, we sought to determine the role of the IL-17C/IL-17RE signaling axis in immunity using three standard models of infectious candidiasis. Surprisingly, however, we detected no role for the IL-17C/IL-17RE
signaling axis in these forms of experimental candidiasis.

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Materials and Methods

Mice
C57BL/6 mice were from The Jackson Laboratory (Bar Harbor, Maine). IL-17RA-/- mice were
a kind gift from Amgen (Seattle, WA). IL-17RC-/-, IL-17C-/- and IL-17RE-/- mice were kindly
provided by Genentech (South San Francisco), produced in collaboration between Genentech
and Lexicon Pharmaceuticals to analyze the function of 500 secreted and transmembrane proteins [30]. All mice were bred at the University of Pittsburgh under a 12 hour light/dark cycle.
IL-17C-/- and IL-17RE-/- mice are on a mixed genetic background, so littermate controls were
used for experiments, as noted. Genotypes were verified for all animals by PCR of ear biopsies.
WT cohorts consisted of in-house bred littermate controls or C57BL/6 mice from The Jackson
Laboratory as appropriate for each experiment, with sample sizes based on power analyses calculated from previously published data [31]. Cohorts were selected randomly and were ageand sex-matched using both males and females at a range of 610 weeks. Mice were housed in
SPF conditions and provided with autoclaved food and water ad libitum. Mice were monitored
visually and weighed at least once daily. Mice were humanely sacrificed by CO2 inhalation at
the termination of each experiment or if animals exhibited >20% weight loss or showed signs
of pain or distress as delineated by the approved animal protocol. The University of Pittsburgh
Institutional Animal Care and Use Committee (IACUC) approved all animal protocols used in
this study (Animal welfare assurance number: A3187-01). All efforts were made to minimize
suffering, in accordance with recommendations in the Guide for the Care and Use of Laboratory Animals of the National Institutes of Health.

Oropharyngeal Candidiasis
Mice were pre-swabbed orally prior to each experiment to verify the absence of pre-existing
Candida colonization. Mice were inoculated sublingually for 75 mins under anesthesia (ketamine 100 mg/kg and xylazine 10 mg/kg) Candida albicans (strain CAF2-1) placed in an sterile
saturated 0.0025 mg cotton ball, as previously described [6, 32]. WT littermates were used as a
negative control as they are known to clear the infection fully by day 5 post-inoculation [6, 31].
At the end of the designated time course (45 d), tongue was homogenized using a Miltenyi
GentleMacs Dissociator (Miltenyi Biotec). Serial dilutions were plated in triplicate on YPD
agar plates, incubated at 30C for 48 h, and colony-forming units (CFU) were enumerated for
tissue fungal burden determination. Mice were weighed daily. Mice were sacrificed for humane
reasons if they lost more than 25% weight loss or exhibited other signs of pain or distress (however, in these experiments, no animals fell in this category). Each dot represents one mouse.
There were no severe adverse events in any group.

Disseminated Candidiasis
C. albicans (strain SC5314) was grown overnight in YPD at 30C with continuous agitation.
Age- and sex-matched mice were injected in the tail vein with 1-2x105 C. albicans cells suspended in 100ul PBS, as described [31, 33]. For injections, mice were briefly held in a commercial restraining apparatus (Braintree Scientific, Braintree MA). After 10 d or when when weight
loss exceeded 20% or showed other signs of distress such as severe hunching, shivering or loss
of righting, mice were humanely sacrificed by C02 inhalation followed by cervical dislocation.
There were no unexpected adverse events in any group. Kidney tissue was harvested and homogenized using C-tubes (Millipore) in 1 ml PBS. Homogenates were diluted and plated on
YPD-AMP agar in triplicate and CFU enumerated for fungal burden determination.

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Cutaneous Candidiasis
A suspension of C. albicans (strain CAF2-1) was cultured overnight in YPD agar with shaking
at 30C. Two hours before infection the C. albicans suspension was diluted to 5x106 cells/ml
and cells were transferred to YPD broth containing 10% FBS and incubated with shaking to induce hyphal formation. A 95% conversion to hyphae was confirmed microscopically. Mice
were intradermally inoculated with 50 ul of Candida hyphae in PBS as described previously
(ref). Mice were scored by blinded evaluators at least 3 times per week for the presence or complete absence of 4 clinical parameters: ulceration, crusting, erythema and nodule formation.
Mice were considered negative for healing if at least one parameter was present. There were no
severe adverse events in any group.

Real-time PCR
Total RNA was isolated using RNeasy Mini Kits (Qiagen). cDNA synthesis was performed
using Superscript III First Strand kits (Invitrogen, Carlsbad CA). Genes were measured by real
time-reverse transcriptase PCR (qPCR) using SYBR Green FastMix ROX from Quanta Biosciences (Gaithersburg, MD). PCR reactions were performed on a 7300 Real Time PCR Systems
instrument (Applied Biosystems, CA). Expression was normalized to Gapdh. Primers were
from Super Array Biosciences or QuantiTect Primer Assays (Qiagen).

Statistics
Data were analyzed by Kaplan-Meier, ANOVA, Mann-Whitney or unpaired Student's t test
using GraphPad Prism (La Jolla, CA). P values <0.05 were considered significant. All experiments were performed a minimum of twice to ensure reproducibility.

Results
IL-17C/ and IL-17RE are not required for protection against
oropharyngeal candidiasis (OPC)
As a first step to determining whether IL-17C participates in immunity to OPC, we determined
whether this cytokine was induced following oral C. albicans infection. WT mice were inoculated orally with C. albicans (CAF2-1) for 75 min under anesthesia per a standard protocol used
widely in the literature [32, 34]. As shown (Fig 1A), mRNA encoding IL-17C was not detectable at baseline but was markedly induced 2 days post infection. Il17c mRNA was also elevated
in IL-17RA-/- mice subjected to OPC, indicating that its expression is not downstream of IL17R signaling. This finding is consistent with published results showing that Il17a mRNA is
also strongly induced 2 days post-OPC [5, 35].
The fact that a gene is induced during an infection does not necessarily mean that it is required for effective immunity to that organism. Therefore, to determine whether IL-17C or its
receptor IL-17RE were needed to mediate protection against OPC, IL-17C-/- and IL-17RE-/mice were subjected to OPC and the oral fungal load was assessed after 5 days. Like healthy humans, WT mice are able to clear the infection fully within 5 days of exposure to C. albicans. Although immunosuppression with corticosteroids is often used as a positive control in this
model of OPC, we instead employed IL-17RA-/- mice as controls (without additional immunosuppression), since these mice are reproducibly susceptible to disease, judged by both fungal
burden and progressive weight loss [6, 8]. Indeed, as we have seen in numerous prior studies, 5
days post infection IL-17RA-/- mice exhibited a high fungal burden (~1x104 CFU/g tissue) and
showed a 20% weight loss, validating the importance of IL-17RA signaling in protection against
OPC [6, 8] (Fig 1B and 1C). In contrast, IL-17C-/- and IL-17RE-/- mice completely cleared the

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Fig 1. IL-17C-/- and IL-17RE-/- mice are resistant to oropharyngeal candidiasis. A. WT and IL-17RA-/- mice (n = 3 per group) were subjected to OPC and
IL-17C transcript levels assessed by qPCR. *p<0.05 with error bars indicating SEM. B. OPC was induced in the indicated mice (IL-17C-/- Sham, n = 2; IL17RE-/- Sham, n = 2; Infected: IL-17C+/+ n = 9; IL-17RE+/+, n = 6; IL-17C-/-, n = 9; IL-17RE-/-, n = 6; IL-17RA-/- n = 7). Tongue was harvested on day 5, and
CFU enumerated 48 h later by plating serial dilutions on YPD agar. Data presented as the geometric mean of CFU. Each data point represents one mouse,
and the graph depicts pooled data from two independent experiments (n = 2 for each sham-infected cohort and n6 total for each Candida-infected cohort).
*p<0.0001 by Mann Whitney U test. C. Weight loss was assessed daily and is presented as a percentage of starting weight. Error bars indicate SEM. D.
Indicated mice (n = 3 per group) were subjected to OPC and qPCR performed for Defb3 and Lcn2 genes on day 2. *p<0.05 by ANOVA and post-hoc Tukeys
test. Error bars indicate SEM.
doi:10.1371/journal.pone.0122807.g001

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infection by day 5, with no detectable fungal burden in the tongue (Fig 1B). Moreover, IL17C-/- and IL-17RE-/- mice fully regained weight after a transient weight loss due to the infection procedure, in a pattern identical to WT mice (Fig 1C and data not shown). Therefore,
whereas IL-17RA-/- mice were highly susceptible to OPC, IL-17C- and IL-17RE-deficient mice
were fully resistant.
A strong neutrophil response and production of antimicrobial proteins protect immunocompetent mice from C. albicans infection [1, 6, 36, 37]. We previously identified a panel of IL17RA-dependent signature genes that are induced after exposure to C. albicans that represent
the overall transcriptional response to infection [6]. Most of these genes are regulated by IL17RA signaling, including Lcn2 (encoding lipocalin-2, also known as 24p3) and Defb3 (encoding -defensin 3, also known as BD3), an antimicrobial peptide with direct anti-Candida activity [38, 39]. Consistent with their resistance to infection, WT littermate controls, IL-17C-/- and
IL-17RE-/- mice all exhibited similar gene profiles after inoculation, and representative genes
such as Defb3 and Lcn2 were strongly induced in each cohort (Fig 1D). In contrast, these transcripts were detected at significantly lower levels in IL-17RA-/- mice (Fig 1D), consistent with
our prior findings [6, 35]. In conclusion, these data indicate that, while IL-17A/IL-17RA signaling is essential for protection to OPC, IL-17C/IL-17RE signaling appears to be dispensable.

IL-17C- and IL-17RE-deficient mice are resistant to disseminated

candidiasis
In addition to a critical role in protecting against oral mucosal candidiasis, IL-17RA and IL17A are protective in an intravenous model of disseminated candidiasis [9, 10, 40]. We therefore assessed the importance of IL-17C and IL-17RE in protection from systemic candidiasis
by infecting mice in the tail vein with a standard dose of 2x105 C. albicans yeast cells (strain
SC5314, the strain most commonly employed in this model and which induces the same level
of disease as strain CAF2-1). As shown, there was no apparent role for IL-17C or IL-17RE signaling in host defense against systemic candidiasis, as IL-17C-/- and IL-17RE-/- mice followed
the same survival curve as littermate control mice (Fig 2A and 2B). The mice showed identical
weight loss profiles throughout the experiment (Fig 2C), and the mice did not exhibit any
other symptoms of disease that differed from the WT littermate controls (HRC and NW, unpublished observations). We also infected mice with a lower inoculum of C. albicans (1x105
yeast cells), in order to rule out a protective effect for IL-17C and IL-17RE in less severe disease.
Again, IL-17C-/- and IL-17RE-/- mice demonstrated the same susceptibility to disseminated disease as WT littermate controls, while IL-17RA-/- were reproducibly more susceptible to infection (Fig 2C and 2D) [10]. IL-17RE-deficient and WT mice also exhibited similar induction of
TNF after infection, a cytokine known to be important in mediating immunity to systemic
candidiasis (Fig 2E). Dissemination of C. albicans to visceral organs including brain, kidney,
liver and spleen was also similar in control mice and IL-17C-/- and IL-17RE-/- mice (Fig 2F).
These data indicate that, in contrast to IL-17A and IL-17RA, IL-17C and IL-17RE are not required for protection in disseminated candidiasis.

IL-17C and IL-17RE signaling are not required for resolution of

cutaneous candidiasis
Since IL-17C and IL-17RE are expressed in the skin and have been shown to be pathogenic in
mouse models of dermal inflammation [23, 29], we hypothesized that the most likely setting in
which the IL-17C/IL-17RE axis might participate in antifungal immunity would be in cutaneous C. albicans infections. Accordingly, IL-17RE-/- and littermate control mice were infected
intradermally with C. albicans hyphae (strain CAF2-1) using an infection model that

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Fig 2. IL-17C-/- and IL-17RE-/- mice are resistant to systemic candidiasis. A-C. IL-17RE-/- and IL-17RE+/+ littermate controls were subjected to systemic
candidiasis by tail vein injection of 2x105 C. albicans strain SC5314 (IL-17RE+/+ n = 11; IL-17RE-/-, n = 13; IL-17C+/+; n = 10; IL-17C-/- n = 11). Mice were
evaluated daily and time to sacrifice is presented. ns., not significant. Data are representative of 2 independent experiments. C-D. IL-17RE-/- mice (n = 7) and
IL-17C-/- (n = 5) mice were injected with 1x105 cells C. albicans as in panel A. WT littermates (IL-17C+/+, n = 4 and IL-17RE+/+, n = 5) and IL-17RA-/- mice
(n = 5) served as controls. ns., not significant. Data are representative of one independent experiment. E. Weight change assessments were made in all
cohorts after infection with 2x105 C. albicans cells, and presented as a percentage of starting weight. F. Kidneys were harvested from each cohort on day 2
after systeic infection and qperformed for the indicated genes. *p<0.05 by ANOVA and post-hoc Tukeys test. G. Indicated tissue types were harvested on
day 2 and tissue fungal burdens determined. Each data point represents one mouse. (IL-17RE+/+ Sham, n = 3; IL-17RE-/- Sham, n = 2; IL-17RE+/+ n = 9; IL17RE-/- n = 10). Pooled data from two independent experiments is shown.
doi:10.1371/journal.pone.0122807.g002

previously demonstrated an essential of IL-17RA in protection from dermal candidiasis [11].

In this model, the most consistent readout for disease progression is the rate of healing at the
site of injection. In the OPC model fungal tissue burden is highly consistent between replicates
and hence a good indicator of disease progression [32, 34]; in contrast, in the cutaneous model,
fungal burden determination and histology are highly variable and therefore are not considered
a reliable measure of disease. Accordingly, we scored mice for healing at the site of injection
based on four clinical parameters: (i) nodule formation, (ii) ulceration, (iii) crusting and (iii) erythema, as previously described [11, 31]. A mouse scored negatively for healing if at least one
symptom was noted. The IL-17RE-/- and WT littermate control mice followed indistinguishable healing curves, indicating that they are resistant to cutaneous candidiasis. Since it was
shown previously that IL-17RA is necessary for protection to dermal candidiasis, we tested susceptibility in IL-17RC-/- mice, lacking the essential co-receptor for IL-17A signaling [8, 19, 41].
In contrast to IL-17RE-/- mice, IL-17RC-/- mice showed significantly delayed healing (Fig 3A
and 3B), consistent with the importance of IL-17RA and IL-17A for immunity to dermal disease [11]. Fungal loads were also elevated in IL-17RC-/- mice compared to WT mice (data not
shown). The similarities between WT littermate controls and IL-17RE-/- mice indicate that IL17C signaling via IL-17RE is not essential for protection from or the resolution of cutaneous
candidiasis, whereas IL-17A signaling through IL-17RA/IL-17RC is nonredundant.

Discussion
IL-17A came into prominence with the discovery of the Th17 subpopulation of T cells [42].
Subsequent work from our group and others showed that the IL-17RA subunit is essential for
immunity to various forms of candidiasis, not only in experimental mouse models but also in
humans with genetic predispositions to CMC [6, 10, 11, 43]. A similar role in anti-Candida immunity was found for IL-17RC, the obligate co-receptor for IL-17A-mediated signaling [8, 19].
Comparisons of IL-17A and IL-17F generally indicate that IL-17A is more potent than IL-17F
in mediating immunity to candidiasis, though this issue is still not fully defined [40, 44]. Although the importance of IL-17RA/RC was clear, IL-17RA is used by other ligands including
IL-17C, leaving open the possibility that cytokines in addition to IL-17A might contribute to
immunity to candidiasis.
Of the other IL-17 family members, we considered that IL-17C and its receptor IL-17RE
were the most likely to be important in candidiasis, given the similarity of the IL-17A- and IL17C-induced downstream gene profiles and their common propensity to act at mucosal surfaces. Indeed, Il17c mRNA was strongly induced following Candida infection (Fig 1), in a manner similar to Il17a mRNA [5]. Therefore, it was surprising that IL-17C/IL-17RE signaling was
dispensable for the three forms of candidiasis evaluated here. Perhaps the most unexpected result was the absence of a role for IL-17C or IL-17RE in dermal candidiasis, since IL-17C is
pathogenic when overexpressed transgenically in skin [29], and elevated IL-17C is observed in
human psoriatic lesions [29, 45]. It may be that the effects of IL-17C are manifested

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Fig 3. IL-17RE-/- mice are resistant to cutaneous candidiasis. A. The indicated mice were subjected to dermal candidiasis by subcutaneous injection with
C. albicans strain CAF2-1 hyphae (IL-17RE+/+ Sham, n = 6; Infected: IL-17RC-/-, n = 5; C57BL/6 WT, n = 4; IL-17RE+/+, n = 21; IL-17RE-/-, n = 19). The
percent of mice positive for lesions over time is presented. *p<0.01 compared to WT by a Log-rank (Mantel Cox) test. Graph depicts pooled data from two
independent experiments. B. Ulceration (left panels) and nodule formation (right panels) are depicted in WT, IL-17RE-/- and IL-17RC-/- mice on days 4 and 6.
Data are representative of two independent experiments.
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predominantly in autoimmune disease rather than during infection settings. Along these lines,
IL-17C-/- mice are partially protected from experimental autoimmune encephalomyelitis
(EAE), the mouse model of multiple sclerosis and DSS colitis [22, 26, 46]. IL-17C is also associated with murine arthritis models [24]. In terms of host defense, IL-17C has been implicated in
protection against C. rodentium infections in the rodent GI tract, although its role in regulating
intestinal colonization of fungal species is unknown [21].
In this study, we used the most widely accepted models of oral, dermal and cutaneous candidiasis, none of which revealed a role for IL-17C or IL-17RE in host defense. However, other
variations of these models exist that employ other strains of Candida albicans, genetic backgrounds, or slightly different routes of Candida delivery, where it is possible that a role for IL17C/IL-17RE might be observed. Similarly, there may be a role for IL-17C/IL-17RE signaling
in other types of fungal infections. The role of IL-17 in vaginal candidiasis is controversial, but
some evidence suggests Th17 cells may contribute to immunity at this site [47, 48]. Clearly, future studies to define the biological activities of IL-17C signaling in vaginal candidiasis
are warranted.
IL-17A and IL-17F are produced by multiple cell types. Conventional Th17 cells are the
most well known source, but CD8+ cells also express IL-17. More recently, important innate
sources of IL-17A have been identified, including -T cells, natural Th17 (nTh17) cells and
group 3 innate lymphoid cells (ILC3) [49, 50]. In humans, the dominant CD4+ T cell response
to C. albicans occurs in the Th17 compartment [51], although the role of innate IL-17+ cells
in humans are not well understood. Similarly, in a mouse model of OPC, CD4+ Th17 cells are
generated in mice following a re-challenge infection [35, 52, 53]. In nave settings, the dominant source of IL-17A during a primary oral Candida infection in mice comes from -T cells
and nTh17 cells [5]. In skin, IL-17A also comes from -T cells in mouse models [11, 54, 55].
To date, the source of IL-17A during systemic candidiasis is not well defined in mice or humans, but is thought to be innate. IL-17C, in contrast, is produced by epithelial cells, not by
lymphocytes [25]. The induction of Il17c mRNA in the oral mucosa during OPC (Fig 1) was
the impetus for this study, but despite its induction at the mRNA level, mice lacking IL-17C
were resistant to the forms of candidiasis tested including OPC. However, this is not necessarily unexpected; a number of inflammatory factors are induced in OPC that are not required
for immune protection. For example, lipocalin 2 is a potent IL-17-target gene that is highly
upregulated in Candida-infected tongue tissue, but is not required for mediating immunity to
OPC, as Lcn2-/- mice are resistant to infection [7, 56]. Thus, this work identifies another setting in which induction of a gene (Il17c) does not necessarily imply a non-redundant role
in immunity.
IL-17A and IL-17RA are emerging as effective biologic targets for autoimmune conditions,
particularly psoriasis [14]. On the flip side, the clinical blockade of IL-17A or IL-17RA signaling is likely to cause complications for IL-17A-directed antifungal immune responses. Data
from individuals with mutations that affect the Th17/IL-17R pathway have provided evidence
that IL-17 deficiencies lead to CMC in humans [4]. A direct requirement for IL-17 was demonstrated in a patient with a homozygous mutation in IL17RA who presented with autosomal
recessive CMC [43]. Similarly, two individuals with mutations in ACT1, a signaling adaptor
almost entirely restricted to the IL-17 family [17], also experienced CMC [57]. More relevant
to clinical treatment, neutralizing autoantibodies against IL-17A and other Th17 cytokines
(IL-17F, IL-22) are produced by APS-1 patients, resulting in selective susceptibility to CMC
manifestations including OPC [58, 59]. It is not yet clear to what extent therapeutic manipulation of the IL-17RA pathway will cause candidiasis, but this issue is obviously of clinical
concern [16]. It is striking, however, that no patients with CMC have yet emerged with defects
in the IL-17C/IL-17RE pathway, whereas an ever-increasing number have been found that

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IL-17C and IL-17RE Are Dispensable for Some Candida Immunity

are impaired in the IL-17A/F-IL-17RA pathway [4]. Thus, the present study raises the possibility that future therapeutics for psoriasis could potentially target IL-17C selectively with a
lesser risk of susceptibility to C. albicans.

Supporting Information
S1 Checklist. ARRIVE Checklist.
(PDF)

Acknowledgments
We thank Amgen for IL-17RA-/- mice and Genentech for IL-17C-/-, IL-17RE-/- and IL-17RC-/mice. We thank R. Binder and A. Blauvelt for helpful suggestions. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National
Institutes of Health.

Author Contributions
Conceived and designed the experiments: SLG HRC NW. Performed the experiments: HRC
NW BMC AVG JRJ. Contributed reagents/materials/analysis tools: SLG HRC. Wrote the
paper: HRC SLG.

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