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<journal-meta>
<journal-id journal-id-type="publisher-id">Front. Cell. Infect. Microbiol.</journal-id>
<journal-title-group>
<journal-title>Frontiers in Cellular and Infection Microbiology</journal-title>
<abbrev-journal-title abbrev-type="pubmed">Front. Cell. Infect. Microbiol.</abbrev-journal-title>
</journal-title-group>
<issn pub-type="epub">2235-2988</issn>
<publisher>
<publisher-name>Frontiers Media S.A.</publisher-name>
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<article-meta>
<article-id pub-id-type="doi">10.3389/fcimb.2026.1787137</article-id>
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<article-categories>
<subj-group subj-group-type="heading">
<subject>Review</subject>
</subj-group>
</article-categories>
<title-group>
<article-title>Molecular evolution and adaptations of <italic>Legionella pneumophila</italic> from amoebae hosts to macrophages</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name><surname>Shin</surname><given-names>Cheon Jee</given-names></name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
<uri xlink:href="https://loop.frontiersin.org/people/3127696/overview"/>
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<role vocab="credit" vocab-identifier="https://credit.niso.org/" vocab-term="Writing &#x2013; review &amp; editing" vocab-term-identifier="https://credit.niso.org/contributor-roles/writing-review-editing/">Writing &#x2013; review &amp; editing</role>
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<contrib contrib-type="author" corresp="yes">
<name><surname>Abu Kwaik</surname><given-names>Yousef</given-names></name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
<xref ref-type="aff" rid="aff2"><sup>2</sup></xref>
<xref ref-type="corresp" rid="c001"><sup>*</sup></xref>
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<aff id="aff1"><label>1</label><institution>Department of Microbiology and Immunology, University of Louisville</institution>, <city>Louisville</city>, <state>KY</state>,&#xa0;<country country="us">United States</country></aff>
<aff id="aff2"><label>2</label><institution>Center for Predictive Medicine, University of Louisville</institution>, <city>Louisville</city>, <state>KY</state>,&#xa0;<country country="us">United States</country></aff>
<author-notes>
<corresp id="c001"><label>*</label>Correspondence: Yousef Abu Kwaik, <email xlink:href="mailto:abukwaik@louisville.edu">abukwaik@louisville.edu</email></corresp>
</author-notes>
<pub-date publication-format="electronic" date-type="pub" iso-8601-date="2026-02-19">
<day>19</day>
<month>02</month>
<year>2026</year>
</pub-date>
<pub-date publication-format="electronic" date-type="collection">
<year>2026</year>
</pub-date>
<volume>16</volume>
<elocation-id>1787137</elocation-id>
<history>
<date date-type="received">
<day>13</day>
<month>01</month>
<year>2026</year>
</date>
<date date-type="accepted">
<day>02</day>
<month>02</month>
<year>2026</year>
</date>
<date date-type="rev-recd">
<day>30</day>
<month>01</month>
<year>2026</year>
</date>
</history>
<permissions>
<copyright-statement>Copyright &#xa9; 2026 Shin and Abu Kwaik.</copyright-statement>
<copyright-year>2026</copyright-year>
<copyright-holder>Shin and Abu Kwaik</copyright-holder>
<license>
<ali:license_ref start_date="2026-02-19">https://creativecommons.org/licenses/by/4.0/</ali:license_ref>
<license-p>This is an open-access article distributed under the terms of the <ext-link ext-link-type="uri" xlink:href="https://creativecommons.org/licenses/by/4.0/">Creative Commons Attribution License (CC BY)</ext-link>. The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.</license-p>
</license>
</permissions>
<abstract>
<p><italic>Legionella pneumophila</italic> is an environmental bacterium that emerged from a prolonged co-evolution and adaptation to free-living amoebae as the natural hosts. Within these protozoan hosts, <italic>L. pneumophila</italic> evolved to evade amoebae predation and remodel their vacuoles into endoplasmic reticulum (ER)-derived vacuoles that evade phagosomal-lysosomal fusion. The <italic>L. pneumophila</italic>-amoebae co-evolution fortuitously has facilitated infection of human alveolar macrophages, resulting in pneumonia known as Legionnaires&#x2019; Disease. Intracellular replication and host manipulation are orchestrated by the Dot/Icm Type IV Secretion System (T4SS), which translocate more than 350 effectors that remodel host membrane trafficking, metabolism, and immune signaling, and by the Type II Secretion System, which releases &#x2248;120 hydrolytic enzymes that promote nutrient acquisition and environmental persistence. The extraordinary diversity and redundancy of these effectors reflect evolutionary pressures within diverse protozoan reservoirs that have sculpted an arsenal capable of subverting numerous eukaryotic processes in diverse environmental hosts and is obvious from genomic plasticity. Adaptation of <italic>L. pneumophila</italic> to the intracellular life within unicellular phagocytic amoebae has played a major role in host expansion to human macrophages that share numerous conserved processes with amoebae, which are thought to be their ancestors. However, since <italic>Legionella</italic> modulate various mammalian-specific processes not present in unicellular amoebae, it is also likely that <italic>Legionella</italic> has also evolved through interaction with multi-cellular eukaryotic environmental hosts prior the infection of humans. It is also possible that many of the mammalian-specific processes modulated by effectors of <italic>Legionella</italic> can be an accidental host response to amoebae-adapted effectors rather than specific adaptation. This is a comprehensive review that synthesizes advances in our knowledge of ecology, epidemiology, metabolism, secretion systems, and host-pathogen interactions of <italic>L. pneumophila</italic>, highlighting how environmental selection and co-evolution with protozoan hosts drive genomic evolution and expansion of the host range from unicellular eukaryotic amoebae to humans.</p>
</abstract>
<kwd-group>
<kwd>bacterial pathogenesis</kwd>
<kwd>effector</kwd>
<kwd>evolution</kwd>
<kwd>genomics</kwd>
<kwd>host-pathogen interactions</kwd>
<kwd>protozoa</kwd>
<kwd>type II secretion system (T2SS)</kwd>
<kwd>type IV secretion system (T4SS)</kwd>
</kwd-group>
<funding-group>
<funding-statement>The author(s) declared that financial support was received for this work and/or its publication. The YA lab is supported by Public Health Service Awards R01AI140195 from the NIAID and by the Commonwealth of Kentucky Research Challenge Trust Fund.</funding-statement>
</funding-group>
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<fig-count count="2"/>
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<ref-count count="410"/>
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<custom-meta-group>
<custom-meta>
<meta-name>section-at-acceptance</meta-name>
<meta-value>Bacteria and Host</meta-value>
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</front>
<body>
<sec id="s1" sec-type="intro">
<label>1</label>
<title>Introduction</title>
<sec id="s1_1">
<label>1.1</label>
<title>History of Legionnaires&#x2019; disease</title>
<p>The first publicized outbreak of <italic>Legionella</italic> was in summer of 1976 at the annual American Legion Convention that was held at the Bellevue-Stratford hotel in Philadelphia, Pennsylvania (<xref ref-type="bibr" rid="B134">Fraser et&#xa0;al., 1977</xref>). There was a large outbreak of a mysterious pulmonary disease soon after the convention, and at least 182 attendees suffered from pneumonia-like symptoms and 29 of them succumbed to disease. In addition to the convention attendees, several pedestrians and bus drivers that passed by the hotel&#x2019;s frontage also fell ill, resulting in a total of 221 patients that contracted the disease with 34 deaths (<xref ref-type="bibr" rid="B134">Fraser et&#xa0;al., 1977</xref>; <xref ref-type="bibr" rid="B255">McDade et&#xa0;al., 1977</xref>; <xref ref-type="bibr" rid="B188">Honigsbaum, 2016</xref>). The causative agent was unknown as the disease symptoms were not caused by any known microorganisms or toxins at the time. Bacteriologists, virologists, parasitologists, epidemiologists, and toxicologists were recruited at the Centers for Disease Control and Prevention (CDC) to collaborate and identify the responsible pathogen (<xref ref-type="bibr" rid="B255">McDade et&#xa0;al., 1977</xref>; <xref ref-type="bibr" rid="B132">Fraser, 2005</xref>).</p>
<p>The causative agent was finally identified by examining liver sections of guinea pigs that were inoculated with lung tissue samples from patients. It took six months from the outbreak to identify the pathogen due to its fastidious nutrient requirements for culture and growth (<xref ref-type="bibr" rid="B255">McDade et&#xa0;al., 1977</xref>). In addition, isolation of the bacterium was also difficult as it only replicated within alveolar macrophages of human and guinea pigs, making it difficult to isolate viable and culturable bacteria from host lung tissue samples or study in simpler animal models like mouse (<xref ref-type="bibr" rid="B255">McDade et&#xa0;al., 1977</xref>). In 1979, the rod-shaped bacteria that caused the mysterious pulmonary disease were given the name <italic>Legionella pneumophila</italic> due to the severe pneumonia outbreak it caused that affected many of the attendees of the American Legion Convention and the associated respiratory illness, Legionnaire&#x2019; disease (<xref ref-type="bibr" rid="B48">Brenner et&#xa0;al., 1979</xref>; <xref ref-type="bibr" rid="B134">Fraser et&#xa0;al., 1977</xref>; <xref ref-type="bibr" rid="B255">McDade et&#xa0;al., 1977</xref>). The source of <italic>L. pneumophila</italic> from the first publicized outbreak was unknown at the time as environmental testing could not identify the source of transmission, but epidemiological studies suggest that the air conditioning and cooling tower at the Bellevue-Stratfor Hotel were contaminated with the bacteria (<xref ref-type="bibr" rid="B266">Muder et&#xa0;al., 1986</xref>).</p>
<p><italic>Legionella pneumophila</italic> are Gram-negative facultative intracellular bacterial pathogens belonging to the family Legionellaceae (<xref ref-type="bibr" rid="B48">Brenner et&#xa0;al., 1979</xref>). <italic>L. pneumophila</italic> is uni-flagellated bacilli that may adopt filamentous or cocci-like forms under certain growth conditions (<xref ref-type="bibr" rid="B320">Rodgers et&#xa0;al., 1980</xref>; <xref ref-type="bibr" rid="B65">Chandler et&#xa0;al., 1980</xref>; <xref ref-type="bibr" rid="B292">Pine et&#xa0;al., 1979</xref>; <xref ref-type="bibr" rid="B208">Katz et&#xa0;al., 1984</xref>; <xref ref-type="bibr" rid="B290">Piao et&#xa0;al., 2006</xref>). There are more than 60 <italic>Legionella</italic> species identified, and about 50% of these species are known to cause disease. <italic>L. pneumophila</italic> is responsible for approximately 90% of the Legionnaires&#x2019; Disease cases (<xref ref-type="bibr" rid="B256">Meier-Kolthoff et&#xa0;al., 2022</xref>; <xref ref-type="bibr" rid="B265">Muder and Yu, 2002</xref>; <xref ref-type="bibr" rid="B276">Newton et&#xa0;al., 2010</xref>). <italic>L. pneumophila</italic> can be subdivided into 16 serogroups based on antigenicity of the lipopolysaccharide (LPS) O-antigen (<xref ref-type="bibr" rid="B214">Khan et&#xa0;al., 2013</xref>). By far, serogroup 1 is most commonly associated with disease, causing more than 80% of laboratory confirmed cases of legionellosis (<xref ref-type="bibr" rid="B403">Yu et&#xa0;al., 2002</xref>; <xref ref-type="bibr" rid="B284">Palusinska-Szysz et&#xa0;al., 2019</xref>). Interestingly, <italic>L. longbeachae</italic>, which is present in the soil, is responsible for approximately 50% of the Legionnaires&#x2019; Disease cases in Australia and New Zealand (<xref ref-type="bibr" rid="B170">Ha et&#xa0;al., 2024</xref>).</p>
</sec>
<sec id="s1_2">
<label>1.2</label>
<title>Transmission</title>
<p><italic>L. pneumophila</italic> is considered as an environmental bacteria that have co-evolved with amoebae hosts and seems to follow the prevailing dogma that the mode of transmission is from an environmental source to the dead-end human host (<xref ref-type="bibr" rid="B27">Baskerville et&#xa0;al., 1981</xref>; <xref ref-type="bibr" rid="B409">Zuravleff et&#xa0;al., 1983</xref>). There had only been one unusual, reported case of a person-to-person transmission of <italic>L. pneumophila</italic> (<xref ref-type="bibr" rid="B85">Correia et&#xa0;al., 2016</xref>; <xref ref-type="bibr" rid="B41">Borges et&#xa0;al., 2016</xref>). Studies have revealed that emergence of outbreaks of <italic>L. pneumophila</italic> in the last half of 20<sup>th</sup> century is due to human alteration of the environment and generation of aerosols by new equipment such as cooling towers, air conditioning systems, pools, hot tubs, showers, misting machines, and humidifiers (<xref ref-type="bibr" rid="B123">Fields et&#xa0;al., 2002</xref>). Inhalation of contaminated aerosolized water droplets has been traced to human-made aquatic environments (<xref ref-type="bibr" rid="B123">Fields et&#xa0;al., 2002</xref>; <xref ref-type="bibr" rid="B30">Berendt et&#xa0;al., 1980</xref>; <xref ref-type="bibr" rid="B93">Davis et&#xa0;al., 1982</xref>; <xref ref-type="bibr" rid="B174">Hambleton et&#xa0;al., 1983</xref>; <xref ref-type="bibr" rid="B266">Muder et&#xa0;al., 1986</xref>). Left in the natural aquatic environment, <italic>L. pneumophila</italic> would be an extremely rare cause of human disease.</p>
<p>While <italic>L. pneumophila</italic> evolved within natural aquatic ecosystems, contemporary legionellosis is overwhelmingly linked to engineered water systems rather than pristine freshwater habitats. Plumbing networks, cooling towers, hot-water distribution systems, and healthcare water infrastructure generate warm, stagnant, biofilm-rich environments that promote amoebal proliferation and <italic>L. pneumophila</italic> amplification (<xref ref-type="bibr" rid="B156">Gleason and Cohn, 2022</xref>). Within these systems, biofilms concentrate nutrients and microbial biomass while limiting disinfectant penetration, thereby stabilizing niches in which amoeba-associated <italic>L. pneumophila</italic> can persist. Mechanistic modeling and field-based studies further demonstrate that hydraulic residence time, temperature stratification, pipe materials, and disinfectant decay collectively govern <italic>L. pneumophila</italic> persistence and outbreak risk in the engineered water environments (<xref ref-type="bibr" rid="B283">Ortiz et&#xa0;al., 2025</xref>). These observations underscore that modern <italic>L. pneumophila</italic> transmission is largely an emergent property of engineered ecological niches rather than a direct consequence of natural environmental exposure.</p>
<p>In addition to direct release of <italic>L. pneumophila</italic> following amoebal lysis or exocytosis, extracellular vesicles (EVs) have emerged as an underappreciated mechanism contributing to pathogen persistence and dissemination in protozoan-pathogen systems. Protozoa are capable of releasing membrane-bound vesicles containing host-derived lipids, proteins, and microbial cargo that can protect enclosed material from environmental stressors and facilitate intercellular communication (<xref ref-type="bibr" rid="B12">Alvarado-Ocampo et&#xa0;al., 2024</xref>). Notably, early experimental studies demonstrated that <italic>Legionella-</italic>infected amoebae can actively expel micrometer-scale membrane-bound vesicles containing viable <italic>L. pneumophila</italic>, which persist in aquatic environments and remain respirable, suggesting a direct role for amoebae-derived vesicles in environmental dissemination and transmission (<xref ref-type="bibr" rid="B331">Rowbotham, 1986</xref>; <xref ref-type="bibr" rid="B33">Berk et&#xa0;al., 1998</xref>; <xref ref-type="bibr" rid="B42">Bouyer et&#xa0;al., 2007</xref>) Although EV-mediated processes remain incompletely characterized for <italic>L. pneumophila</italic> at the molecular level, observations from other protozoan systems suggest that vesicle-associated bacteria or bacterial components can contribute to biofilm formation, environmental persistence, and delivery of virulence factors into new protozoan or mammalian host cells (<xref ref-type="bibr" rid="B377">Twu et&#xa0;al., 2013</xref>; <xref ref-type="bibr" rid="B344">Schwechheimer and Kuehn, 2015</xref>). By contrast, the contribution of host-derived EVs as a mechanism for <italic>L. pneumophila</italic> persistence, dissemination, or immune modulation during macrophage infection remains largely unexplored. Together, these findings support a model in which amoeba-derived vesicles, ranging from expelled bacteria-containing vesicles to smaller EV-like structures, may represent protective and communicative intermediates that bridge environmental survival, biofilm ecology, and intracellular pathogenesis in aquatic environments subject to fluctuating physical and chemical stressors.</p>
</sec>
<sec id="s1_3">
<label>1.3</label>
<title>Clinical manifestations</title>
<p><italic>L. pneumophila</italic> infections result in two distinct clinical manifestations: Legionnaires&#x2019; Disease or Pontiac Fever (<xref ref-type="bibr" rid="B134">Fraser et&#xa0;al., 1977</xref>; <xref ref-type="bibr" rid="B88">Cunha et&#xa0;al., 2016</xref>; <xref ref-type="bibr" rid="B133">Fraser et&#xa0;al., 1979</xref>). Pontiac fever, named after the first publicized outbreak in Pontiac, Michigan, is a mild, flu-like illness that typically resolves within 5 days and does not progress to pneumonia (<xref ref-type="bibr" rid="B133">Fraser et&#xa0;al., 1979</xref>; <xref ref-type="bibr" rid="B209">Kaufmann et&#xa0;al., 1981</xref>; <xref ref-type="bibr" rid="B52">Burillo et&#xa0;al., 2017</xref>). Symptoms of Pontiac fever usually appear 5&#x2013;72 hours after exposure (<xref ref-type="bibr" rid="B374">Tossa et&#xa0;al., 2006</xref>). Legionnaires&#x2019; Disease is the pneumonic form of legionellosis, with a fatality rate of ~10% in healthy individuals and more than 25% in high-risk patients (<xref ref-type="bibr" rid="B52">Burillo et&#xa0;al., 2017</xref>). Risk factors include elderly (age &gt; 60), smoking, chronic illnesses, and immunosuppression (<xref ref-type="bibr" rid="B104">Doebbeling and Wenzel, 1987</xref>; <xref ref-type="bibr" rid="B115">England et&#xa0;al., 1981</xref>; <xref ref-type="bibr" rid="B309">Radaelli et&#xa0;al., 1991</xref>; <xref ref-type="bibr" rid="B249">Marston et&#xa0;al., 1994</xref>; <xref ref-type="bibr" rid="B276">Newton et&#xa0;al., 2010</xref>; <xref ref-type="bibr" rid="B169">Gump and Keegan, 1986</xref>).</p>
<p>Symptoms of Legionnaires&#x2019; Disease usually begin 2&#x2013;10 days after exposure to environmental bacteria, with an average onset of 5&#x2013;6 days (<xref ref-type="bibr" rid="B112">Egan et&#xa0;al., 2011</xref>). Symptoms include high fever, cough, headache, and fatigue (<xref ref-type="bibr" rid="B134">Fraser et&#xa0;al., 1977</xref>). In severe cases, Legionnaires&#x2019; Disease may present with loss of appetite, occasional diarrhea, renal failure, encephalopathy, and pericarditis (<xref ref-type="bibr" rid="B88">Cunha et&#xa0;al., 2016</xref>; <xref ref-type="bibr" rid="B52">Burillo et&#xa0;al., 2017</xref>). Patients who succumb to the disease usually die as a result of multi organ failure or respiratory shock (<xref ref-type="bibr" rid="B249">Marston et&#xa0;al., 1994</xref>). There are no vaccines currently available to protect against legionellosis, but infection can be treated with recommended classes of antibiotics including fluoroquinolones, tetracycline, and macrolides, while <italic>L. pneumophila</italic> is naturally resistant to penicillin and &#x3b2;-lactams (<xref ref-type="bibr" rid="B288">Pedro-Botet and Yu, 2006</xref>; <xref ref-type="bibr" rid="B40">Bopp et&#xa0;al., 2011</xref>; <xref ref-type="bibr" rid="B106">DumarcetAgence Francaise De Securite Sanitaire Des Produits DE, 2012</xref>).</p>
<p>Among the leading pathogens responsible for community-acquired pneumonia, Legionnaires&#x2019; pneumonia consistently ranks within the top three causes of pneumonia-associated hospitalizations (<xref ref-type="bibr" rid="B165">Graham et&#xa0;al., 2020</xref>; <xref ref-type="bibr" rid="B26">Bartlett, 2011</xref>). However, cases of pneumonia caused by Legionnaires&#x2019; Disease are likely underdiagnosed and under-reported in many countries due to lack of diagnostics and surveillance systems. Studies have suggested that cases of Legionnaires&#x2019; Disease that are reported to the CDC represent less than 5% of actual Legionnaires&#x2019; Disease patients (<xref ref-type="bibr" rid="B52">Burillo et&#xa0;al., 2017</xref>; <xref ref-type="bibr" rid="B289">Phin et&#xa0;al., 2014</xref>; <xref ref-type="bibr" rid="B147">Garrison et&#xa0;al., 2014</xref>). This is further supported by the data from the United States indicating that there was a 249% increase in estimated incidence of Legionnaires&#x2019; Disease from 2000&#x2013;2011 due to continued efforts to actively report incidences (<xref ref-type="bibr" rid="B105">Dooling et&#xa0;al., 2015</xref>). Although sensitive diagnostic tools such as urine antigen ELISA and sequence-based assays are available to detect <italic>Legionella</italic> infections and determine strains, there is a lack of consistent patient testing and absence of standardized protocols for accurately estimating the annual incidence of confirmed Legionnaires&#x2019; Disease cases (<xref ref-type="bibr" rid="B246">Mangiafico et&#xa0;al., 1981</xref>; <xref ref-type="bibr" rid="B248">Mao, 1988</xref>; <xref ref-type="bibr" rid="B230">Leland and Kohler, 1991</xref>; <xref ref-type="bibr" rid="B311">Ratcliff, 2013</xref>).</p>
<p>From a public health perspective, <italic>Legionella</italic> represents a major cause of community-acquired pneumonia (CAP) responsible for at least 10-15% of cases. Global meta-analyses indicate that <italic>Legionella</italic> accounts for a substantial fraction of hospitalized CAP cases, particularly severe pneumonia. However, true incidence is likely highly underestimated due to widespread reliance on laboratory diagnosis using the urinary antigen testing (UAT), which primarily detects <italic>L. pneumophila</italic> serogroup 1 but fails to detect other serogroups strains or other pathogenic species of <italic>Legionella</italic> (<xref ref-type="bibr" rid="B164">Graham et&#xa0;al., 2022</xref>; <xref ref-type="bibr" rid="B64">Chambers et&#xa0;al., 2021</xref>). In addition, large number of CAP patients are treated with antibiotics without the laboratory diagnosis of the causative agent.</p>
<p>Recognition of engineered water systems as long-term selective environments has prompted growing interest in ecological control strategies that move beyond chemical disinfection alone. Probiotic and microbiome-informed approaches aimed at reshaping aquatic microbial communities to suppress <italic>L. pneumophila</italic> growth have shown promise in experimental and pilot-scale systems (<xref ref-type="bibr" rid="B62">Cavallaro et&#xa0;al., 2022</xref>). At the same time, chronic exposure to sublethal concentrations of disinfectants, metals, and other chemical stressors within plumbing systems is increasingly recognized as a driver of antimicrobial resistance development within biofilms and amoeba-associated bacteria (<xref ref-type="bibr" rid="B182">Hayward et&#xa0;al., 2025</xref>). These environments may therefore function as reservoirs of resistance traits with potential implications for clinical management of legionellosis. Accordingly, forward-looking frameworks emphasize integrated, ecology-informed interventions that incorporate microbial community dynamics, infrastructure design, and system maintenance rather than reliance on biocides alone (<xref ref-type="bibr" rid="B177">Hammes et&#xa0;al., 2025</xref>).</p>
</sec>
</sec>
<sec id="s2">
<label>2</label>
<title>Environmental niche and ecology</title>
<p>One of the hallmark characteristics of <italic>L. pneumophila</italic> is that it proliferates within a wide range of unicellular eukaryotes as its natural aquatic hosts (<xref ref-type="bibr" rid="B298">Price et&#xa0;al., 2024</xref>; <xref ref-type="bibr" rid="B35">Best and Abu Kwaik, 2018</xref>). It has been shown that <italic>Legionella</italic> can replicate in at least 30 species of protozoan hosts across multiple phyla (<xref ref-type="bibr" rid="B122">Fields, 1996</xref>; <xref ref-type="bibr" rid="B47">Breiman et&#xa0;al., 1990</xref>; <xref ref-type="bibr" rid="B124">Fields et&#xa0;al., 1989</xref>, <xref ref-type="bibr" rid="B125">Fields et&#xa0;al., 1984</xref>; <xref ref-type="bibr" rid="B173">Hagele et&#xa0;al., 2000</xref>; <xref ref-type="bibr" rid="B275">Newsome et&#xa0;al., 1985</xref>; <xref ref-type="bibr" rid="B330">Rowbotham, 1980</xref>, <xref ref-type="bibr" rid="B331">Rowbotham, 1986</xref>; <xref ref-type="bibr" rid="B351">Smith-Somerville et&#xa0;al., 1991</xref>; <xref ref-type="bibr" rid="B354">Solomon et&#xa0;al., 2000</xref>; <xref ref-type="bibr" rid="B378">Tyndall and Domingue, 1982</xref>; <xref ref-type="bibr" rid="B216">Kikuhara et&#xa0;al., 1994</xref>; <xref ref-type="bibr" rid="B380">Tyson et&#xa0;al., 2014</xref>; <xref ref-type="bibr" rid="B310">Rasch et&#xa0;al., 2016</xref>; <xref ref-type="bibr" rid="B336">Scheikl et&#xa0;al., 2016</xref>; <xref ref-type="bibr" rid="B298">Price et&#xa0;al., 2024</xref>; <xref ref-type="bibr" rid="B362">Swart et&#xa0;al., 2018</xref>). These diverse interactions predominantly occur in aquatic and soil environments, where free-living protozoan hosts are commonly found (<xref ref-type="bibr" rid="B390">Wang et&#xa0;al., 2025</xref>; <xref ref-type="bibr" rid="B347">Shames, 2023</xref>). Early studies have laid the groundwork for establishing <italic>L. pneumophila</italic> as a model system for studying bacteria-protozoa interactions, yielding insights into host adaptation, intracellular parasitism, and pathogen evolution in natural reservoirs (<xref ref-type="bibr" rid="B298">Price et&#xa0;al., 2024</xref>). Many other bacterial pathogens have been shown to evade amoeba predation, including <italic>Chlamydia</italic>, <italic>Coxiella</italic>, <italic>Rickettssia</italic>, <italic>Francisella</italic>, <italic>Mycobacteria</italic>, <italic>Salmonella</italic>, <italic>Bartonella</italic>, <italic>Rhodococcus</italic>, <italic>Pseudomonas</italic>, <italic>Vibrio</italic>, <italic>Helicobacter</italic>, <italic>Campylobacter</italic>, and <italic>Aliarcobacter</italic>, and these have been recently reviewed (<xref ref-type="bibr" rid="B298">Price et&#xa0;al., 2024</xref>).</p>
<p>Protozoan hosts also play a crucial role in biofilm formation, further promoting <italic>L. pneumophila</italic> persistence in water systems. Interestingly, the density of <italic>L. pneumophila</italic> within biofilms correlates with protozoan biomass as several amoeba species are also associated with biofilm communities (<xref ref-type="bibr" rid="B234">Liu et&#xa0;al., 2012</xref>; <xref ref-type="bibr" rid="B368">Taylor et&#xa0;al., 2009</xref>). The structure or composition of the biofilm makes <italic>L. pneumophila</italic> containing biofilms extremely resistant to biocide treatments in man-made water systems (<xref ref-type="bibr" rid="B114">Emtiazi et&#xa0;al., 2004</xref>).</p>
<p><italic>L. pneumophila</italic> found within biofilms or exposed to environmental stress may enter a viable but non-culturable (VBNC) state, which is characterized by low metabolic activity and resistance to standard culturing methods (<xref ref-type="bibr" rid="B116">Epalle et&#xa0;al., 2015</xref>; <xref ref-type="bibr" rid="B100">Dietersdorfer et&#xa0;al., 2018</xref>). The VBNC state has been shown to protect <italic>L. pneumophila</italic> from chlorination, and these VBNC forms can be resuscitated upon co-culture with protozoa, representing an additional survival mechanism under disinfection stress (<xref ref-type="bibr" rid="B100">Dietersdorfer et&#xa0;al., 2018</xref>; <xref ref-type="bibr" rid="B116">Epalle et&#xa0;al., 2015</xref>; <xref ref-type="bibr" rid="B145">Garcia et&#xa0;al., 2007</xref>).</p>
<p>The intracellular replication of <italic>L. pneumophila</italic> within free-living amoebae serves not only as a survival strategy in the environments but also as a critical biological training ground that enhances the pathogen&#x2019;s virulence potential in mammalian hosts (<xref ref-type="bibr" rid="B298">Price et&#xa0;al., 2024</xref>). Studies comparing amoeba-grown and <italic>in vitro</italic> cultured <italic>L. pneumophila</italic> have confirmed that amoeba-grown bacteria to be more infectious and cause more severe disease in animal models (<xref ref-type="bibr" rid="B20">Barker et&#xa0;al., 1992</xref>, <xref ref-type="bibr" rid="B21">Barker et&#xa0;al., 1993</xref>, <xref ref-type="bibr" rid="B22">Barker et&#xa0;al., 1995</xref>; <xref ref-type="bibr" rid="B3">Abu Kwaik et&#xa0;al., 1997</xref>). In addition, studies have demonstrated that <italic>L. pneumophila</italic> grown within amoebae exhibits markedly greater infectivity in human macrophages compared to bacteria cultured in axenic media, with high motility, increased resistance to antibiotics, biocides, and disinfectants (<xref ref-type="bibr" rid="B80">Cirillo et&#xa0;al., 1994</xref>; <xref ref-type="bibr" rid="B57">Byrne and Swanson, 1998</xref>; <xref ref-type="bibr" rid="B175">Hammer and Swanson, 1999</xref>; <xref ref-type="bibr" rid="B304">Pruckler et&#xa0;al., 1995</xref>). These observations underscore the critical role of protozoan hosts not only in amplification of <italic>L. pneumophila</italic> but also in priming the pathogen for successful infection of evolutionarily distant mammalian cells.</p>
<p>Amoeba may serve as vectors for transmission. The <italic>L. pneumophila</italic>-infected amoebae can become aerosolized via water droplets or soil particles. Upon inhalation, these infected protozoa may facilitate delivery of <italic>L. pneumophila</italic> directly to the lower respiratory tract, where the bacteria can infect alveolar macrophages. This potential &#x201c;Trojan horse&#x201d; mechanism can enable <italic>L. pneumophila</italic> to bypass the initial host immune defenses, shielding the pathogen from both environmental insults and host surveillance systems, while simultaneously delivering it into a niche conducive to replication (<xref ref-type="bibr" rid="B75">Cianciotto, 2001</xref>; <xref ref-type="bibr" rid="B298">Price et&#xa0;al., 2024</xref>). This potential mode of bacterial transmission underscores the multifaceted importance of amoebae in <italic>L. pneumophila</italic>&#x2019;s natural ecology and transmission dynamics (<xref ref-type="fig" rid="f1"><bold>Figure&#xa0;1</bold></xref>).</p>
<fig id="f1" position="float">
<label>Figure&#xa0;1</label>
<caption>
<p>Environmental life cycle, transmission, and human infection of <italic>L. pneumophila</italic>. <italic>L. pneumophila</italic> alternates between intracellular replication within protozoa and a transmissive extracellular phase in aquatic environments. (1) Free <italic>L. pneumophila</italic> are phagocytosed by environmental protozoa such as <italic>Acanthamoeba</italic> or <italic>Vermameoba</italic> spp. (2) Inside the environmental hosts, <italic>L. pneumophila</italic> quickly intercepts the ER-derived vesicles and decorates its phagosome into a <italic>Legionella-</italic>containing vacuole (LCV) that evades endosomal-lysosomal degradation. (3) <italic>L. pneumophila</italic> successfully replicate within the LCV. (4) Upon nutrient depletion, <italic>L. pneumophila</italic> differentiate into the transmissive phase characterized by motility, stress resistance, and virulence factor expression and fill up the host cell cytosol. Upon host cell lysis or exocytosis, <italic>L. pneumophila</italic> is released into the environment as free bacteria, packaged in secreted vesicles from the host, or within infected protozoan hosts, enhancing survival in biofilms and water systems. Transmission to humans occurs via inhalation of contaminated aerosols generated from man-made water systems, including showers, fountains, and cooling towers. Once inhaled, <italic>L. pneumophila</italic> reach to alveoli of lungs, where they are engulfed by alveolar macrophages. In this new host, <italic>L. pneumophila</italic> establishes an LCV similar to that formed in protozoa, initiating intracellular replication.</p>
</caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fcimb-16-1787137-g001.tif">
<alt-text content-type="machine-generated">Diagram illustrates Legionella pneumophila life cycle in environmental protozoa, its release, and transmission via man-made water systems like showers, fountains, and cooling towers leading to human infection, where alveolar macrophages are infected in the lungs.</alt-text>
</graphic></fig>
<p>Amoebae undergo differentiation between two developmental stages, a metabolically active trophozoite stage and a dormant cyst stage. In response to environmental stressors, including nutrient limitation, temperature shifts, osmotic stress, or chemical stress, amoebae undergo encystation, from the trophozoite into the cyst stage (<xref ref-type="bibr" rid="B42">Bouyer et&#xa0;al., 2007</xref>). Trophozoite stage of amoebae is permissive for <italic>L. pneumophila</italic> replication while the cyst stage restricts bacterial proliferation, but <italic>L. pneumophila</italic> remains viable for months within the cyst (<xref ref-type="bibr" rid="B167">Greub and Raoult, 2004</xref>; <xref ref-type="bibr" rid="B281">Ohno et&#xa0;al., 2008</xref>; <xref ref-type="bibr" rid="B38">Boamah et&#xa0;al., 2017</xref>; <xref ref-type="bibr" rid="B4">Abu Kwaik et&#xa0;al., 1998</xref>; <xref ref-type="bibr" rid="B299">Price et&#xa0;al., 2021</xref>; <xref ref-type="bibr" rid="B217">Kilvington and Price, 1990</xref>). Thus, encystation represents a survival mechanism for the protozoan host but restricts intracellular replication of <italic>L. pneumophila</italic>. For an intracellular pathogen like <italic>L. pneumophila</italic>, encystation poses a barrier to continued intracellular proliferation.</p>
<p>Several studies have demonstrated that <italic>L. pneumophila</italic> can persist within mature amoebal cyst for prolonged periods, up to six months or longer, without loss of viability (<xref ref-type="bibr" rid="B4">Abu Kwaik et&#xa0;al., 1998</xref>; <xref ref-type="bibr" rid="B299">Price et&#xa0;al., 2021</xref>; <xref ref-type="bibr" rid="B281">Ohno et&#xa0;al., 2008</xref>; <xref ref-type="bibr" rid="B217">Kilvington and Price, 1990</xref>). These bacteria remain metabolically quiescent and are protected from desiccation, heat, chlorine, and other common disinfectants (<xref ref-type="bibr" rid="B281">Ohno et&#xa0;al., 2008</xref>; <xref ref-type="bibr" rid="B217">Kilvington and Price, 1990</xref>; <xref ref-type="bibr" rid="B316">Richards et&#xa0;al., 2013</xref>). Once the cyst differentiates into a trophozoite stage, <italic>L. pneumophila</italic> resumes active replication, thus completing a cycle of persistence and proliferation that enables long-term environmental survival. Understanding these interactions at the molecular level may yield new targets for disrupting the persistence cycle of <italic>L. pneumophila</italic> in man-made aquatic environments. This ability to persist within cysts, resist disinfection, and subvert amoebal encystation not only explains the remarkable environmental resilience of <italic>L. pneumophila</italic> but also complicates public health efforts to eradicate the bacterium from engineered water systems.</p>
<p>Glycogen serves as a primary source for synthesis of the amoebal cyst cell wall, which is composed of cellulose or chitin (<xref ref-type="bibr" rid="B56">Byers et&#xa0;al., 1991</xref>; <xref ref-type="bibr" rid="B238">Lorenzo-Morales et&#xa0;al., 2008</xref>; <xref ref-type="bibr" rid="B118">Faber et&#xa0;al., 2017</xref>; <xref ref-type="bibr" rid="B263">Moon et&#xa0;al., 2014</xref>; <xref ref-type="bibr" rid="B334">Schaap and Schilde, 2018</xref>). A particularly striking example of interference with amoebal encystation by <italic>L. pneumophila</italic> involves the effector protein LamA, a Type IV secretion system (T4SS)-injected amylase that degrades host glycogen (<xref ref-type="bibr" rid="B300">Price et&#xa0;al., 2020</xref>). By abolishing glycogen stores in the amoeba host, LamA interferes with encystation, prolonging the window during which <italic>L. pneumophila</italic> can replicate within its amoebal host in the trophozoite stage (<xref ref-type="bibr" rid="B300">Price et&#xa0;al., 2020</xref>). Interestingly, when LamA is injected in human macrophages, it results a paradoxical pro-inflammatory response, which is an accidental macrophage response to an amoebae-adapted effector (<xref ref-type="bibr" rid="B300">Price et&#xa0;al., 2020</xref>).</p>
<sec id="s2_1">
<label>2.1</label>
<title>Environmental complexity beyond protozoan hosts</title>
<p>Free-living amoebae that serve as natural hosts of <italic>L. pneumophila</italic> are rarely axenic organisms but instead represent complex intracellular ecosystems that frequently harbor additional bacterial symbionts acquired during grazing on bacteria (<xref ref-type="bibr" rid="B313">Rayamajhee et&#xa0;al., 2021</xref>; <xref ref-type="bibr" rid="B167">Greub and Raoult, 2004</xref>; <xref ref-type="bibr" rid="B44">Bozzaro and Eichinger, 2011</xref>; <xref ref-type="bibr" rid="B298">Price et&#xa0;al., 2024</xref>). Studies on <italic>Acanthamoeba</italic> have demonstrated that clinical isolates commonly contain <italic>Chlamydia</italic> spp., <italic>Ricketsiales</italic>, <italic>Pseudomonas</italic> spp., and <italic>Mycobacterium</italic> spp., whereas environmental isolates commonly contain <italic>Legionella, Candidatus</italic> spp., and other obligate or facultative intracellular bacteria (<xref ref-type="bibr" rid="B313">Rayamajhee et&#xa0;al., 2021</xref>). These co-resident microbes can influence host vacuolar trafficking, alter nutrient availability, and modulate cellular stress responses, thereby reshaping the intracellular niche encountered by <italic>L. pneumophila</italic> (<xref ref-type="bibr" rid="B167">Greub and Raoult, 2004</xref>; <xref ref-type="bibr" rid="B313">Rayamajhee et&#xa0;al., 2021</xref>; <xref ref-type="bibr" rid="B370">Thomas et&#xa0;al., 2010</xref>; <xref ref-type="bibr" rid="B298">Price et&#xa0;al., 2024</xref>; <xref ref-type="bibr" rid="B340">Schmitz-Esser et&#xa0;al., 2008</xref>). In addition, recent drinking-water microcosm studies provide compelling evidence that such microbial interactions can directly influence <italic>Legionella</italic> population dynamics, as illustrated by an apparent antagonistic relationship between <italic>Neochlamydia</italic> and <italic>Legionella</italic>, where the presence of one correlates with suppression of the other (<xref ref-type="bibr" rid="B324">Roman et&#xa0;al., 2025</xref>). Collectively, these observations indicate that the selective pressures shaping <italic>L. pneumophila</italic> evolution extend beyond amoebal predation alone and include competition with other intracellular microbes within protozoan hosts.</p>
<p>Beyond free-living protozoa, <italic>Legionella</italic> spp. are embedded within complex aquatic ecosystems that include multicellular eukaryotes, which commonly coexist with amoebae and diverse biofilm-associated microbial communities (<xref ref-type="bibr" rid="B167">Greub and Raoult, 2004</xref>; <xref ref-type="bibr" rid="B123">Fields et&#xa0;al., 2002</xref>). Although these multicellular organisms are not established hosts for <italic>L. pneumophila</italic>, their grazing, filter-feeding, and biofilm-associated lifestyles can directly or indirectly influence <italic>Legionella</italic> ecology and evolution by concentrating protozoa, organic matter, and microbial biomass within localized aquatic niches (<xref ref-type="bibr" rid="B38">Boamah et&#xa0;al., 2017</xref>; <xref ref-type="bibr" rid="B96">Declerck, 2010</xref>). Multicellular aquatic eukaryotes, such as snails, bivalves, and insect larvae, may act as ecological contexts and potential hosts that support environmental persistence of <italic>Legionella</italic> as direct or indirect hosts that have contributed to evolution of <italic>Legionella</italic> to infect humans (<xref ref-type="bibr" rid="B123">Fields et&#xa0;al., 2002</xref>). Consequently, while protozoa remain the well-established primary biological drivers of <italic>L. pneumophila</italic> evolution and intracellular adaptation, repeated exposure and possible adaptation to multi-cellular eukaryotic hosts may directly or indirectly reinforce pathogenic evolution of <italic>Legionella</italic>, and subsequent infection of human macrophages (<xref ref-type="bibr" rid="B298">Price et&#xa0;al., 2024</xref>; <xref ref-type="bibr" rid="B347">Shames, 2023</xref>). As discussed later in this review, ability of specific <italic>Legionella</italic> injected effectors to modulate various host processes of multi-cellular eukaryotes that are absent from unicellular eukaryotic hosts (such as NF-&#x3ba;B modulation by multiple specific effectors) may support the concept of adaptation of <italic>Legionella</italic> to multi-cellular eukaryotic environmental hosts prior to its infection of humans.</p>
</sec>
</sec>
<sec id="s3">
<label>3</label>
<title>Molecular regulation of the bi-phasic lifecycle of <italic>L. pneumophila</italic></title>
<p><italic>L. pneumophila</italic> undergoes a tightly regulated biphasic life cycle that enables it to transition between two distinct physiological and morphological states: a replicative, non-motile phase and a transmissive, motile, and virulence phase (<xref ref-type="bibr" rid="B57">Byrne and Swanson, 1998</xref>). These phases are tightly controlled by environmental cues, particularly nutrient availability, and are central to the intracellular lifecycle and ecological persistence of <italic>L. pneumophila</italic> (<xref ref-type="bibr" rid="B262">Molofsky and Swanson, 2004</xref>; <xref ref-type="bibr" rid="B51">Bruggemann et&#xa0;al., 2006b</xref>; <xref ref-type="bibr" rid="B119">Faulkner and Garduno, 2002</xref>). During nutrient-rich conditions, <italic>L. pneumophila</italic> adopts a replicative form characterized by a non-flagellated, metabolically active, and non-cytotoxic phenotype (<xref ref-type="bibr" rid="B262">Molofsky and Swanson, 2004</xref>). Cells are long, rod-shaped, non-flagellated, and characterized by thin, wavy cell walls (<xref ref-type="bibr" rid="B119">Faulkner and Garduno, 2002</xref>). This stage is associated with exponential replication <italic>in vitro</italic> and within the <italic>Legionella</italic>-containing vacuole (LCV) (<xref ref-type="bibr" rid="B276">Newton et&#xa0;al., 2010</xref>; <xref ref-type="bibr" rid="B199">Isberg et&#xa0;al., 2009</xref>; <xref ref-type="bibr" rid="B231">Lifshitz et&#xa0;al., 2013</xref>; <xref ref-type="bibr" rid="B195">Hubber and Roy, 2010</xref>). The traits that are related to virulence and transmission are downregulated as those traits are not needed during this metabolically active replicative phase. During the exponential phase, the bacteria down-regulate transmission activators and up-regulate a repressor of transmission traits (<xref ref-type="bibr" rid="B57">Byrne and Swanson, 1998</xref>; <xref ref-type="bibr" rid="B261">Molofsky and Swanson, 2003</xref>).</p>
<p>Once the environment becomes nutrient-limited, particularly amino acid depletion, and disadvantageous for <italic>L. pneumophila</italic> replication, the bacterium initiates a tightly regulated developmental transition into the transmissive phase (<xref ref-type="bibr" rid="B175">Hammer and Swanson, 1999</xref>; <xref ref-type="bibr" rid="B89">Dalebroux et&#xa0;al., 2009</xref>; <xref ref-type="bibr" rid="B332">Sahr et&#xa0;al., 2017</xref>; <xref ref-type="bibr" rid="B282">Oliva et&#xa0;al., 2018</xref>). Interestingly, <italic>L. pneumophila</italic> undergo dramatic morphological changes including becoming shorter, thicker with smooth cell wall, and formation of inclusions of poly-3-hydroxybutyrate (PHB) (<xref ref-type="bibr" rid="B119">Faulkner and Garduno, 2002</xref>; <xref ref-type="bibr" rid="B51">Bruggemann et&#xa0;al., 2006b</xref>; <xref ref-type="bibr" rid="B146">Garduno et&#xa0;al., 2002</xref>).</p>
<p>The switch from replicative phase to transmissive phase at the post-exponential phase is mediated by the stringent response, triggered by the accumulation of guanosine 3, 5-bispyrophosphate (ppGpp) synthesized by synthetase enzyme RelA (<xref ref-type="bibr" rid="B175">Hammer and Swanson, 1999</xref>). In addition, fatty acid depletion leads to accumulation of ppGpp by SpoT (<xref ref-type="bibr" rid="B89">Dalebroux et&#xa0;al., 2009</xref>). Accumulation of ppGpp activates a transcriptional reprogramming cascade involving alternative sigma factors (RpoS and FliA), which in turn triggers the two-component regulatory system (LetA/LetS), and both RelA and Rpos are required for optimal intracellular replication of <italic>L. pneumophila</italic> (<xref ref-type="bibr" rid="B176">Hammer et&#xa0;al., 2002</xref>; <xref ref-type="bibr" rid="B410">Zusman et&#xa0;al., 2002</xref>; <xref ref-type="bibr" rid="B17">Bachman and Swanson, 2004</xref>; <xref ref-type="bibr" rid="B5">Abu-Zant et&#xa0;al., 2006</xref>). LetA activates non-coding RNAs (RsmY and RsmZ) that sequester CsrA, a post-transcriptional repressor of transmission traits, which induces expression of virulence genes, motility-associated proteins (flagella and pili), and transmission traits while repressing replication-associated genes (<xref ref-type="bibr" rid="B51">Bruggemann et&#xa0;al., 2006b</xref>; <xref ref-type="bibr" rid="B111">Edwards et&#xa0;al., 2010</xref>; <xref ref-type="bibr" rid="B332">Sahr et&#xa0;al., 2017</xref>; <xref ref-type="bibr" rid="B372">Tiaden et&#xa0;al., 2007</xref>; <xref ref-type="bibr" rid="B342">Schulz et&#xa0;al., 2012</xref>). This form, during the intracellular infection, can exit the host cell either through lysis mediated by cytolysins such as RtxA and MspA, or through non-lytic exocytosis mechanisms facilitated by effector proteins such as LepA and LepB (<xref ref-type="bibr" rid="B70">Chen et&#xa0;al., 2004</xref>; <xref ref-type="bibr" rid="B113">Eisenreich and Heuner, 2016</xref>). Once released, transmissive <italic>L. pneumophila</italic> can infect new hosts, persist as planktonic forms, or embed into biofilms (<xref ref-type="bibr" rid="B146">Garduno et&#xa0;al., 2002</xref>; <xref ref-type="bibr" rid="B186">Hilbi and Haas, 2012</xref>; <xref ref-type="bibr" rid="B199">Isberg et&#xa0;al., 2009</xref>; <xref ref-type="bibr" rid="B318">Robertson et&#xa0;al., 2014</xref>; <xref ref-type="bibr" rid="B404">Zhang et&#xa0;al., 2018</xref>). In response to extreme conditions, <italic>L. pneumophila</italic> may transition into a VBNC state or the mature infectious form (MIF), which is a highly differentiated, spore-like variant adapted for survival and infectivity in hostile environments (<xref ref-type="bibr" rid="B146">Garduno et&#xa0;al., 2002</xref>; <xref ref-type="bibr" rid="B100">Dietersdorfer et&#xa0;al., 2018</xref>; <xref ref-type="bibr" rid="B116">Epalle et&#xa0;al., 2015</xref>; <xref ref-type="bibr" rid="B318">Robertson et&#xa0;al., 2014</xref>). The life cycle is not merely a binary switch but a dynamic, highly coordinated process that reflects the bacterium&#x2019;s adaptability to fluctuating environments.</p>
</sec>
<sec id="s4">
<label>4</label>
<title>Metabolic regulation in response to environmental cues</title>
<p>To proliferate within the confines of the LCV, <italic>L. pneumophila</italic> have evolved a highly flexible and adaptive metabolic strategy aligned with its invasion of diverse protozoan hosts and intracellular lifecycle. Early efforts to cultivate <italic>L. pneumophila</italic> in chemically defined media revealed that the bacterium relies primarily on amino acids, rather than sugars, for carbon and energy sources (<xref ref-type="bibr" rid="B369">Tesh et&#xa0;al., 1983</xref>; <xref ref-type="bibr" rid="B117">Eylert et&#xa0;al., 2010</xref>; <xref ref-type="bibr" rid="B228">Kunze et&#xa0;al., 2021</xref>; <xref ref-type="bibr" rid="B181">H&#xe4;uslein et&#xa0;al., 2017</xref>; <xref ref-type="bibr" rid="B292">Pine et&#xa0;al., 1979</xref>; <xref ref-type="bibr" rid="B150">George et&#xa0;al., 1980</xref>; <xref ref-type="bibr" rid="B317">Ristroph et&#xa0;al., 1981</xref>). <italic>L. pneumophila</italic> can access and degrade host glycogen via a eukaryotic-like glucoamylase (GamA), expressed during intracellular replication (<xref ref-type="bibr" rid="B50">Bruggemann et&#xa0;al., 2006a</xref>; <xref ref-type="bibr" rid="B184">Herrmann et&#xa0;al., 2011</xref>). Notably, <italic>L. pneumophila</italic> does not generate ATP via classical glycolytic flux, but glucose metabolism occurs via the Entner-Doudoroff (ED) and pentose phosphate (PPP) pathways, supporting histidine and mannose biosynthesis (<xref ref-type="bibr" rid="B117">Eylert et&#xa0;al., 2010</xref>; <xref ref-type="bibr" rid="B180">Hauslein et&#xa0;al., 2016</xref>; <xref ref-type="bibr" rid="B179">Harada et&#xa0;al., 2010</xref>). Interestingly, despite lacking key canonical glycolytic enzymes, <italic>L. pneumophila</italic> retains gluconeogenic capacity (<xref ref-type="bibr" rid="B213">Keen and Hoffman, 1984</xref>; <xref ref-type="bibr" rid="B113">Eisenreich and Heuner, 2016</xref>; <xref ref-type="bibr" rid="B163">Gorke and Stulke, 2008</xref>). Energy production is mainly driven by the tricarboxylic acid (TCA) cycle, which functions as the central metabolic hub fueled by amino acid and fatty acid catabolism rather than glycolysis (<xref ref-type="bibr" rid="B117">Eylert et&#xa0;al., 2010</xref>; <xref ref-type="bibr" rid="B113">Eisenreich and Heuner, 2016</xref>; <xref ref-type="bibr" rid="B181">H&#xe4;uslein et&#xa0;al., 2017</xref>). <italic>L. pneumophila</italic> preferentially metabolizes serine, cysteine, threonine, and branched-chain amino acids (<xref ref-type="bibr" rid="B127">Fonseca and Swanson, 2014</xref>; <xref ref-type="bibr" rid="B176">Hammer et&#xa0;al., 2002</xref>; <xref ref-type="bibr" rid="B117">Eylert et&#xa0;al., 2010</xref>; <xref ref-type="bibr" rid="B155">Gillmaier et&#xa0;al., 2016</xref>; <xref ref-type="bibr" rid="B180">Hauslein et&#xa0;al., 2016</xref>). Simultaneously, utilization of glucose is primarily channeled into anabolic pathways rather than energy production. Glycerol is similarly metabolized via gluconeogenesis and the PPP, with limited flux through the TCA cycle (<xref ref-type="bibr" rid="B180">Hauslein et&#xa0;al., 2016</xref>).</p>
<p>Among amino acids, serine and threonine were identified as key energy substrates, while cysteine was shown to be essential for growth, and ferric pyrophosphate had a stimulatory effect (<xref ref-type="bibr" rid="B292">Pine et&#xa0;al., 1979</xref>; <xref ref-type="bibr" rid="B150">George et&#xa0;al., 1980</xref>; <xref ref-type="bibr" rid="B317">Ristroph et&#xa0;al., 1981</xref>). This preference reflects adaptation to the host, which is rich in free amino acids but comparatively low in free sugars (<xref ref-type="bibr" rid="B369">Tesh et&#xa0;al., 1983</xref>; <xref ref-type="bibr" rid="B117">Eylert et&#xa0;al., 2010</xref>). This amino acid-centric metabolic program reflects both environmental adaptation and genetic constraint, as <italic>L. pneumophila</italic> is auxotrophic for many amino acids including arginine, cysteine, isoleucine, leucine, methionine, threonine, and valine, which is synchronous with amino acid auxotrophy of amoeba hosts such as <italic>Acanthamoeba</italic> (<xref ref-type="bibr" rid="B292">Pine et&#xa0;al., 1979</xref>; <xref ref-type="bibr" rid="B150">George et&#xa0;al., 1980</xref>; <xref ref-type="bibr" rid="B317">Ristroph et&#xa0;al., 1981</xref>; <xref ref-type="bibr" rid="B302">Price et&#xa0;al., 2014b</xref>). Transcriptomic and metabolic studies confirmed that <italic>L. pneumophila</italic> upregulate expression of genes consistent with aerobic metabolism and robust amino acid catabolism during exponential replication (<xref ref-type="bibr" rid="B333">Sauer et&#xa0;al., 2005</xref>; <xref ref-type="bibr" rid="B51">Bruggemann et&#xa0;al., 2006b</xref>).</p>
<p>Isotopologue labeling experiments revealed a bipartite metabolic model in which serine serves as the primary carbon, nitrogen, and energy source during exponential growth, entering the TCA cycle via conversion to pyruvate and subsequently to acetyl-CoA (<xref ref-type="bibr" rid="B117">Eylert et&#xa0;al., 2010</xref>; <xref ref-type="bibr" rid="B155">Gillmaier et&#xa0;al., 2016</xref>; <xref ref-type="bibr" rid="B180">Hauslein et&#xa0;al., 2016</xref>). Consistent with a non-glycolytic metabolic architecture, carbon flux is routed into the TCA cycle, reinforcing the TCA cycle as the primary engine of ATP generation and precursor biosynthesis during replication (<xref ref-type="bibr" rid="B117">Eylert et&#xa0;al., 2010</xref>; <xref ref-type="bibr" rid="B282">Oliva et&#xa0;al., 2018</xref>). Notably, more than 50% of labeled serine is incorporated into proteinogenic amino acids and PHB, a carbon storage polymer (<xref ref-type="bibr" rid="B117">Eylert et&#xa0;al., 2010</xref>). Isotopologue studies further confirm that glucose contributes to PHB and anabolic synthesis during intracellular growth, even though its addition in broth culture does not enhance growth rate (<xref ref-type="bibr" rid="B369">Tesh et&#xa0;al., 1983</xref>; <xref ref-type="bibr" rid="B117">Eylert et&#xa0;al., 2010</xref>). Saturated fatty acids, such as palmitate, are also used as carbon sources in the post-exponential phase and feed into energy production and PHB biosynthesis (<xref ref-type="bibr" rid="B181">H&#xe4;uslein et&#xa0;al., 2017</xref>). As nutrient availability declines <italic>in vitro</italic> or within the LCV, carbon flux from serine is redirected toward storage compound production, particularly PHB and fatty acids (<xref ref-type="bibr" rid="B200">James et&#xa0;al., 1999</xref>; <xref ref-type="bibr" rid="B180">Hauslein et&#xa0;al., 2016</xref>). To support long-term persistence in nutrient-deprived environments, <italic>L. pneumophila</italic> catabolizes PHB to sustain essential energy needs, contributing to long-term persistence in environmental reservoirs such as aquatic system (<xref ref-type="bibr" rid="B155">Gillmaier et&#xa0;al., 2016</xref>; <xref ref-type="bibr" rid="B200">James et&#xa0;al., 1999</xref>). This storage strategy enhances environmental resilience and may contribute to the establishment of VBNC states.</p>
<p>Myo-inositol represents a valuable host-derived carbon source for <italic>L. pneumophila</italic> because it is abundant in eukaryotic membranes, particularly within phosphoinositides such as PI, PI4P, and PI(4,5)P<sub>2</sub> (<xref ref-type="bibr" rid="B18">Balla, 2013</xref>; <xref ref-type="bibr" rid="B103">Di Paolo and De Camilli, 2006</xref>). Genomic and biochemical studies have shown that <italic>L. pneumophila</italic> encodes a complete inositol (iol) catabolic operon enabling degradation of myo-inositol into central carbon metabolites, providing alternative carbon and energy source when amino acids become limiting (<xref ref-type="bibr" rid="B247">Manske et&#xa0;al., 2016</xref>). Disruption of the <italic>iol</italic> pathway significantly impairs intracellular replication in both amoebae and macrophages, demonstrating that access to this host-derived carbon pool is not merely supplemental but directly required for optimal intracellular growth (<xref ref-type="bibr" rid="B247">Manske et&#xa0;al., 2016</xref>). In parallel, nutrient liberation in the host is supported by the Type II secretion system (T2SS), which exports degradative enzymes including phosphatases, proteases, lipases, and nucleases that remodel the extracellular and vacuolar milieu (<xref ref-type="bibr" rid="B95">Debroy et&#xa0;al., 2006b</xref>; <xref ref-type="bibr" rid="B77">Cianciotto, 2009</xref>). Collectively, these metabolic adaptations, ranging from preferential amino acid usage, bipartite carbon metabolism, and PHB storage, to iron scavenging and host manipulation, underscore the nutritional versatility of <italic>L. pneumophila</italic> to adapt to the intracellular niche of protozoan and mammalian cells. This metabolic flexibility is tightly coupled to the pathogen&#x2019;s biphasic life cycle and is essential to its ecological success as a facultative intracellular pathogen and resilient environmental survivor.</p>
<sec id="s4_1">
<label>4.1</label>
<title>Amino acid acquisition</title>
<p>To support amino acid acquisition, <italic>L. pneumophila</italic> employs multiple strategies to increase levels of amino acids in the host. The Dot/Icm-secreted effector AnkB promotes polyubiquitination and proteasomal degradation of host proteins, thereby generating a surplus of host amino acids, which is essential for intracellular replication (<xref ref-type="bibr" rid="B296">Price et&#xa0;al., 2009</xref>; <xref ref-type="bibr" rid="B236">Lomma et&#xa0;al., 2010</xref>; <xref ref-type="bibr" rid="B297">Price et&#xa0;al., 2011</xref>). Additional effectors in the Lgt and SidE families modulate the host&#x2019;s mTORC1 pathway to inhibit host protein synthesis, releasing free amino acids (<xref ref-type="bibr" rid="B98">De Leon et&#xa0;al., 2017</xref>). Transcriptomic studies during intracellular growth revealed upregulation of ABC transporters, amino acid permeases, proteases, and phospholipases that liberate and import host-derived nutrients (<xref ref-type="bibr" rid="B51">Bruggemann et&#xa0;al., 2006b</xref>). Infected human monocytic cells, Mono Mac 6 (MM6), up-regulate the neutral amino acid transporter SLC1A5, and inhibition or knockdown of SLC1A5 impairs intracellular replication of <italic>L. pneumophila</italic>, indicating exploitation of host amino acid import pathways (<xref ref-type="bibr" rid="B399">Wieland et&#xa0;al., 2005</xref>). In addition, <italic>L. pneumophila</italic> expresses its own phagosomal threonine transporter (PhtA), and deletion of <italic>phtA</italic> results in a threonine-auxotrophic phenotype and abrogates intracellular replication during primary murine bone marrow-derived macrophages (<xref ref-type="bibr" rid="B333">Sauer et&#xa0;al., 2005</xref>). Isotopologue profiling of bacterial and amoebal proteins confirmed that <italic>L. pneumophila</italic> imports and catabolizes host-derived amino acids during intracellular replication (<xref ref-type="bibr" rid="B343">Schunder et&#xa0;al., 2014</xref>; <xref ref-type="bibr" rid="B297">Price et&#xa0;al., 2011</xref>).</p>
</sec>
<sec id="s4_2">
<label>4.2</label>
<title>Iron acquisition</title>
<p>Iron acquisition is another critical metabolic adaptation to the intracellular life cycle of <italic>L. pneumophila</italic>, which encodes at least four distinct iron acquisition systems that allow import of ferric and ferrous iron, heme, iron-loaded peptides, and iron-loaded siderophores (<xref ref-type="bibr" rid="B68">Chatfield et&#xa0;al., 2011</xref>; <xref ref-type="bibr" rid="B319">Robey and Cianciotto, 2002</xref>; <xref ref-type="bibr" rid="B385">Viswanathan et&#xa0;al., 2000</xref>; <xref ref-type="bibr" rid="B278">O&#x2019;Connell et&#xa0;al., 1996</xref>; <xref ref-type="bibr" rid="B185">Hickey and Cianciotto, 1997</xref>; <xref ref-type="bibr" rid="B280">O&#x2019;Connor et&#xa0;al., 2016</xref>). It also secretes the iron-reducing pigment pyomelanin to enhance iron solubilization and uptake under limiting conditions (<xref ref-type="bibr" rid="B67">Chatfield and Cianciotto, 2007</xref>). Key iron acquisition genes such as lbtA (rhizoferrin biosynthesis) and feoB (ferrous iron uptake) are expressed during intracellular replication, contributing to bacterial fitness in both protozoan and mammalian hosts (<xref ref-type="bibr" rid="B237">Lopez et&#xa0;al., 2023</xref>). Although many Gram-negative bacteria energize outer-membrane uptake through the TonB-ExbB-ExbD motor, <italic>L. pneumophila</italic> lacks TonB homologs, the inner membrane protein that typically powers outer membrane iron transport and utilizes TonB-independent receptors such as LbtU for legiobactin uptake (<xref ref-type="bibr" rid="B68">Chatfield et&#xa0;al., 2011</xref>; <xref ref-type="bibr" rid="B46">Braun et&#xa0;al., 2023</xref>). This receptor operates with inner-membrane ABC/MFS transporters to complete iron acquisition, a configuration that represents an atypical mechanism for coupling energy to outer-membrane transport (<xref ref-type="bibr" rid="B68">Chatfield et&#xa0;al., 2011</xref>, <xref ref-type="bibr" rid="B69">Chatfield et&#xa0;al., 2012</xref>; <xref ref-type="bibr" rid="B78">Cianciotto, 2015</xref>). The pathogen also deploys T4SS effector MavN, a vacuolar iron transporter that localizes to the LCV and mediates iron import to sustain bacterial replication (<xref ref-type="bibr" rid="B294">Portier et&#xa0;al., 2015</xref>; <xref ref-type="bibr" rid="B198">Isaac et&#xa0;al., 2015</xref>).</p>
</sec>
</sec>
<sec id="s5">
<label>5</label>
<title>Pathogenic evolution</title>
<p>Unicellular phagocytic amoebae are considered the evolutionary ancestors of macrophages, with highly conserved eukaryotic processes such as phagocytosis and vesicle traffic (<xref ref-type="bibr" rid="B44">Bozzaro and Eichinger, 2011</xref>; <xref ref-type="bibr" rid="B86">Cosson and Soldati, 2008</xref>). The evolutionary trajectory of <italic>L. pneumophila</italic> to infect macrophages has been profoundly shaped by its repeated and prolonged interactions with diverse protozoan hosts, which provide both ecological niches for replication and selective pressures that have driven the acquisition, diversification, and maintenance of an unusually large and complex arsenal of effectors (<xref ref-type="bibr" rid="B35">Best and Abu Kwaik, 2018</xref>; <xref ref-type="bibr" rid="B298">Price et&#xa0;al., 2024</xref>). The genome of <italic>L. pneumophila</italic> is highly modular and mosaic, consisting of a conserved core genome interspersed with genomic islands acquired via horizontal gene transfer (HGT) (<xref ref-type="bibr" rid="B279">O&#x2019;Connor et&#xa0;al., 2011</xref>). These genomic islands often encode effector proteins, many of which contain eukaryotic-like domains, including ankyrin repeats, F-box motifs, and U-boxes, which have been acquired via interkingdom HGT from various protozoan hosts (<xref ref-type="bibr" rid="B157">Gomez-Valero and Buchrieser, 2019</xref>; <xref ref-type="bibr" rid="B53">Burstein et&#xa0;al., 2016</xref>; <xref ref-type="bibr" rid="B97">De Felipe et&#xa0;al., 2005</xref>; <xref ref-type="bibr" rid="B243">Lurie-Weinberger et&#xa0;al., 2010</xref>). These eukaryotic-like proteins mimic host cellular factors and are believed to enhance bacterial ability to hijack host cellular processes, such as vesicle traffic, signal transduction, and protein degradation pathways (<xref ref-type="bibr" rid="B297">Price et&#xa0;al., 2011</xref>; <xref ref-type="bibr" rid="B392">Weber and Faris, 2018</xref>; <xref ref-type="bibr" rid="B187">Hochstrasser and Hilbi, 2017</xref>). Comparative genomics of <italic>Legionella</italic> species further supports this model of evolution by environmental selection. Effectors that are required for replication in amoebae are often required for infection in mammalian macrophages (<xref ref-type="bibr" rid="B286">Park et&#xa0;al., 2020b</xref>). However, some amoeba-adapted effectors may have accidental effects on replication in mammalian cells, highlighting the context-specific nature of virulence and the trade-offs associated with broad host adaptability (<xref ref-type="bibr" rid="B159">Gomez-Valero et&#xa0;al., 2009</xref>; <xref ref-type="bibr" rid="B91">David et&#xa0;al., 2016</xref>; <xref ref-type="bibr" rid="B348">Shames et&#xa0;al., 2017</xref>). This evolutionary framework emphasizes that pathogenic evolution of <italic>L. pneumophila</italic> in humans is not the result of direct selection in human hosts, but rather a consequence of environmental adaptation to unicellular amoebae and most likely some various environmental multicellular eukaryotes. Understanding how interactions with amoebae shape pathogenic evolution to infect macrophages provides a powerful lens for dissecting pathogenic mechanisms and strategies for interrupting the transmission cycle.</p>
</sec>
<sec id="s6">
<label>6</label>
<title>Type IVB secretion system</title>
<p>The Dot/Icm Type IVB secretion system (T4BSS) represents one of the most extensively studied and biologically impactful secretion systems in Gram-negative intracellular pathogens. The Dot/Icm T4BSS itself likely evolved from conjugative machinery and exhibits features related to both type IVA (<italic>Agrobacterium</italic> VirB/D4) and type VI secretion systems (<xref ref-type="bibr" rid="B74">Christie and Vogel, 2000</xref>; <xref ref-type="bibr" rid="B226">Kubori and NAGAI, 2016</xref>). In <italic>L. pneumophila</italic>, the Dot/Icm T4BSS is the primary virulence determinant, governing nearly most aspects of intracellular parasitism, from host cell entry and vacuolar remodeling to immune subversion and replication within amoebae hosts and macrophages. Unlike other pathogens that encode smaller effector repertoires, <italic>L. pneumophila</italic> utilizes the Dot/Icm T4BSS to translocate ~350 confirmed effector proteins into host cells, which accounts for more than 11% of its genome coding capacity, making it the bacterium with the largest known effector arsenal, followed by <italic>C. burnetiii</italic> which harbors ~120 putative effector proteins (<xref ref-type="bibr" rid="B87">Crabill et&#xa0;al., 2018</xref>; <xref ref-type="bibr" rid="B53">Burstein et&#xa0;al., 2016</xref>; <xref ref-type="bibr" rid="B160">Gomez-Valero et&#xa0;al., 2019b</xref>; <xref ref-type="bibr" rid="B231">Lifshitz et&#xa0;al., 2013</xref>; <xref ref-type="bibr" rid="B407">Zhu et&#xa0;al., 2011</xref>). The Dot/Icm system is a biological molecular nano syringe spanning both bacterial membranes and projecting into the host cytoplasm via contact with the LCV membrane (<xref ref-type="bibr" rid="B151">Ghosal et&#xa0;al., 2017</xref>; <xref ref-type="bibr" rid="B109">Durie et&#xa0;al., 2020</xref>; <xref ref-type="bibr" rid="B39">Bock et&#xa0;al., 2021</xref>).</p>
<p>The Dot/Icm apparatus comprises ~27 essential components encoded by <italic>dot</italic> (defective in organelle trafficking) and <italic>icm</italic> (intracellular multiplication) genes, and the apparatus is organized into functional subcomplexes that coordinate substrate recognition, energy generation, and effector translocation (<xref ref-type="bibr" rid="B295">Prashar and Terebiznik, 2015</xref>; <xref ref-type="bibr" rid="B39">Bock et&#xa0;al., 2021</xref>; <xref ref-type="bibr" rid="B15">Andrews et&#xa0;al., 1998</xref>; <xref ref-type="bibr" rid="B31">Berger and Isberg, 1993</xref>; <xref ref-type="bibr" rid="B32">Berger et&#xa0;al., 1994</xref>; <xref ref-type="bibr" rid="B45">Brand et&#xa0;al., 1994</xref>; <xref ref-type="bibr" rid="B305">Purcell and Shuman, 1998</xref>; <xref ref-type="bibr" rid="B345">Segal and Shuman, 1997</xref>; <xref ref-type="bibr" rid="B386">Vogel et&#xa0;al., 1998</xref>). The core transmembrane complex includes DotC, DotD, DotF (IcmG), DotG (IcmE), and DotH (IcmK), which form the secretion channel through both the inner membrane and outer membrane (<xref ref-type="bibr" rid="B158">Gomez-Valero et&#xa0;al., 2019a</xref>; <xref ref-type="bibr" rid="B383">Vincent et&#xa0;al., 2006</xref>; <xref ref-type="bibr" rid="B55">Buscher et&#xa0;al., 2005</xref>; <xref ref-type="bibr" rid="B161">Gomis-Ruth et&#xa0;al., 2002</xref>; <xref ref-type="bibr" rid="B358">Sutherland et&#xa0;al., 2012</xref>). DotC amd DotD are crucial for localization of DotH to the OM, while DotF is responsible for energy transduction through DotG (<xref ref-type="bibr" rid="B358">Sutherland et&#xa0;al., 2012</xref>; <xref ref-type="bibr" rid="B161">Gomis-Ruth et&#xa0;al., 2002</xref>; <xref ref-type="bibr" rid="B383">Vincent et&#xa0;al., 2006</xref>; <xref ref-type="bibr" rid="B55">Buscher et&#xa0;al., 2005</xref>). These components assemble to form a stable channel structurally characterized by a central secretion chamber with 13-fold symmetry and a funnel-like architecture (<xref ref-type="bibr" rid="B383">Vincent et&#xa0;al., 2006</xref>; <xref ref-type="bibr" rid="B152">Ghosal et&#xa0;al., 2019a</xref>; <xref ref-type="bibr" rid="B71">Chetrit et&#xa0;al., 2018</xref>; <xref ref-type="bibr" rid="B285">Park et&#xa0;al., 2020a</xref>). A second cytoplasmic subcomplex comprises DotL (IcmO), DotM (IcmP), DotN (IcmJ), and the chaperones IcmS, IcmW, and LvgA (<xref ref-type="bibr" rid="B158">Gomez-Valero et&#xa0;al., 2019a</xref>; <xref ref-type="bibr" rid="B383">Vincent et&#xa0;al., 2006</xref>; <xref ref-type="bibr" rid="B55">Buscher et&#xa0;al., 2005</xref>; <xref ref-type="bibr" rid="B161">Gomis-Ruth et&#xa0;al., 2002</xref>; <xref ref-type="bibr" rid="B358">Sutherland et&#xa0;al., 2012</xref>). These proteins constitute the coupling complex responsible for substrate recognition and delivery to the translocation channel (<xref ref-type="bibr" rid="B257">Meir et&#xa0;al., 2018</xref>; <xref ref-type="bibr" rid="B271">Nagai and Kubori, 2011</xref>; <xref ref-type="bibr" rid="B277">Ninio et&#xa0;al., 2005</xref>; <xref ref-type="bibr" rid="B384">Vincent et&#xa0;al., 2012</xref>; <xref ref-type="bibr" rid="B58">Cambronne and Roy, 2007</xref>). DotL is a Type IV coupling protein (T4CP) with nucleotide-binding and &#x3b1;-helical domains, providing ATPase activity essential for energizing substrate export (<xref ref-type="bibr" rid="B358">Sutherland et&#xa0;al., 2012</xref>; <xref ref-type="bibr" rid="B384">Vincent et&#xa0;al., 2012</xref>; <xref ref-type="bibr" rid="B55">Buscher et&#xa0;al., 2005</xref>; <xref ref-type="bibr" rid="B161">Gomis-Ruth et&#xa0;al., 2002</xref>). Additional subunits, including DotU, IcmF, DotK, IcmR, and IcmQ, contribute to polar localization, assembly fidelity, and structural stabilization of the apparatus (<xref ref-type="bibr" rid="B39">Bock et&#xa0;al., 2021</xref>; <xref ref-type="bibr" rid="B158">Gomez-Valero et&#xa0;al., 2019a</xref>; <xref ref-type="bibr" rid="B383">Vincent et&#xa0;al., 2006</xref>; <xref ref-type="bibr" rid="B161">Gomis-Ruth et&#xa0;al., 2002</xref>; <xref ref-type="bibr" rid="B55">Buscher et&#xa0;al., 2005</xref>). The apparatus is anchored at one pole of the bacterium, and its proper localization is necessary for LCV formation and host cell modulation (<xref ref-type="bibr" rid="B201">Jeong et&#xa0;al., 2017</xref>; <xref ref-type="bibr" rid="B31">Berger and Isberg, 1993</xref>; <xref ref-type="bibr" rid="B305">Purcell and Shuman, 1998</xref>).</p>
<p>Protein substrates are generally targeted to the secretion system via C-terminal translocation signals that are located at the last ~20&#x2013;35 amino acids, which often contain glutamic acid-rich E-block motifs or other signals that bind the chaperone IcmSW (<xref ref-type="bibr" rid="B231">Lifshitz et&#xa0;al., 2013</xref>; <xref ref-type="bibr" rid="B269">Nagai et&#xa0;al., 2005</xref>; <xref ref-type="bibr" rid="B224">Kubori et&#xa0;al., 2008</xref>; <xref ref-type="bibr" rid="B54">Burstein et&#xa0;al., 2009</xref>; <xref ref-type="bibr" rid="B194">Huang et&#xa0;al., 2011</xref>; <xref ref-type="bibr" rid="B58">Cambronne and Roy, 2007</xref>). Effector delivery is highly dynamic and temporally regulated through cyclic-di-GMP signaling, with Lpl0780/Lpp0809 and diguanylate cyclase enzymes modulating effector release kinetics (<xref ref-type="bibr" rid="B11">Allombert et&#xa0;al., 2021</xref>). Some effectors are injected upon bacterial contact with the host cell plasma membrane, while others are injected by intra-vacuolar bacteria (<xref ref-type="bibr" rid="B107">Dumenil et&#xa0;al., 2004</xref>; <xref ref-type="bibr" rid="B82">Conover et&#xa0;al., 2003</xref>; <xref ref-type="bibr" rid="B66">Charpentier et&#xa0;al., 2009</xref>; <xref ref-type="bibr" rid="B233">Liu et&#xa0;al., 2008</xref>). Translocation of AnkB by attached extracellular bacteria upon contact with human macrophage and <italic>A. polyphaga</italic> serves as an example of translocation upon bacterial contact to the host plasma membrane (<xref ref-type="bibr" rid="B296">Price et&#xa0;al., 2009</xref>). Some substrates such as SidM/DrrA and the SidE family are translocated early in the LCV and disappear as infection progresses, while others like LepB remain associated with the LCV throughout (<xref ref-type="bibr" rid="B197">Ingmundson et&#xa0;al., 2007</xref>; <xref ref-type="bibr" rid="B273">Neunuebel et&#xa0;al., 2011</xref>; <xref ref-type="bibr" rid="B19">Bardill et&#xa0;al., 2005</xref>). This temporal hierarchy aligns with the temporal functional requirements during the infection cycle, including Rab1 activation and deactivation via SidM, SidD, and LepB at various stages of the infection (<xref ref-type="bibr" rid="B273">Neunuebel et&#xa0;al., 2011</xref>).</p>
<sec id="s6_1">
<label>6.1</label>
<title>Biogenesis of the LCV in amoebae hosts and macrophages</title>
<p><italic>L. pneumophila</italic> has evolved mechanisms to evade amoebae predation and persist intracellularly, evolving from a prey into a predator, becoming a facultative intracellular bacterium. Following uptake by amoebae, the Dot/Icm Type IV Secretion System of <italic>L. pneumophila</italic> functions as a biological nano-syringe to inject ~350 different effector proteins into the host cell (<xref ref-type="bibr" rid="B195">Hubber and Roy, 2010</xref>; <xref ref-type="bibr" rid="B295">Prashar and Terebiznik, 2015</xref>; <xref ref-type="bibr" rid="B271">Nagai and Kubori, 2011</xref>). <italic>L. pneumophila</italic> utilizes these effector proteins to intercept ER secretory vesicles to remodel its phagosome into an ER-derived vacuole that evades the endosomal-lysosomal degradation pathway, which is designated as the LCV (<xref ref-type="bibr" rid="B298">Price et&#xa0;al., 2024</xref>; <xref ref-type="bibr" rid="B210">Kawabata et&#xa0;al., 2021</xref>; <xref ref-type="bibr" rid="B190">Horwitz, 1983a</xref>; <xref ref-type="bibr" rid="B199">Isberg et&#xa0;al., 2009</xref>; <xref ref-type="bibr" rid="B191">Horwitz, 1983b</xref>; <xref ref-type="bibr" rid="B123">Fields et&#xa0;al., 2002</xref>; <xref ref-type="bibr" rid="B359">Swanson and Hammer, 2000</xref>; <xref ref-type="bibr" rid="B361">Swanson and Sturgill-Koszycki, 2000</xref>; <xref ref-type="bibr" rid="B282">Oliva et&#xa0;al., 2018</xref>) (<xref ref-type="fig" rid="f1"><bold>Figure&#xa0;1</bold></xref>). Following ~4-hour lag phase within the LCV, bacteria replicate every &#x2248;60 minutes until the host cell is either lysed or bacteria are exocytosed by the amoeba into the environment (<xref ref-type="bibr" rid="B141">Gao and Abu Kwaik, 1999a</xref>, <xref ref-type="bibr" rid="B142">GaoAbu Kwaik, 1999b</xref>; <xref ref-type="bibr" rid="B172">H&#xe4;gele et&#xa0;al., 1998</xref>). A full intracellular cycle of LCV remodeling, intracellular replication, and release following phagocytosis is highly orchestrated event that occurs within &#x2248;18 hours under controlled laboratory condition (<xref ref-type="bibr" rid="B172">H&#xe4;gele et&#xa0;al., 1998</xref>; <xref ref-type="bibr" rid="B13">Amer and Swanson, 2002</xref>; <xref ref-type="bibr" rid="B260">Molmeret et&#xa0;al., 2004</xref>; <xref ref-type="bibr" rid="B262">Molofsky and Swanson, 2004</xref>). The length of the life cycle in various environments is likely to be different from laboratory conditions.</p>
<p>Once inhaled, <italic>L. pneumophila</italic> is taken up by alveolar macrophages (<xref ref-type="bibr" rid="B282">Oliva et&#xa0;al., 2018</xref>; <xref ref-type="bibr" rid="B123">Fields et&#xa0;al., 2002</xref>; <xref ref-type="bibr" rid="B298">Price et&#xa0;al., 2024</xref>; <xref ref-type="bibr" rid="B43">Bozue and Johnson, 1996</xref>; <xref ref-type="bibr" rid="B192">Horwitz, 1984</xref>). Similar to the protozoan hosts, <italic>L. pneumophila</italic> coordinates delivery of the ~350 effectors to establish the vacuole which subverts lysosomal fusion and intercepts ER-to-Golgi vesicle traffic, to become an ER-derived LCV (<xref ref-type="bibr" rid="B361">Swanson and Sturgill-Koszycki, 2000</xref>; <xref ref-type="bibr" rid="B223">Ku et&#xa0;al., 2012</xref>; <xref ref-type="bibr" rid="B123">Fields et&#xa0;al., 2002</xref>; <xref ref-type="bibr" rid="B360">Swanson and Isberg, 1995</xref>; <xref ref-type="bibr" rid="B191">Horwitz, 1983b</xref>; <xref ref-type="bibr" rid="B400">Wilson et&#xa0;al., 1994</xref>; <xref ref-type="bibr" rid="B373">Tisdale et&#xa0;al., 1992</xref>) (<xref ref-type="fig" rid="f1"><bold>Figure&#xa0;1</bold></xref>). Among the earliest events of LCV biogenesis is recruitment of secretory vesicles derived from the ER and ER-Golgi intermediate compartment (ERGIC), a process initiated in part by the guanine-exchange factor RalF, which activates host Arf1 to promote docking and fusion of ER-derived vesicles to the LCV (<xref ref-type="bibr" rid="B270">Nagai et&#xa0;al., 2002</xref>). A central regulatory node in LCV biogenesis is Rab1, a master GTPase governing ER-Golgi anterograde trafficking (<xref ref-type="bibr" rid="B197">Ingmundson et&#xa0;al., 2007</xref>). Rab1 is targeted on the LCV membrane through a temporally controlled effector cascade. The SidM (DrrA) effector on the LCV membrane recruits and activates Rab1 while locking it in an active state through non-canonical AMPylation (<xref ref-type="bibr" rid="B268">Muller et&#xa0;al., 2010</xref>; <xref ref-type="bibr" rid="B207">Kagan and Roy, 2002</xref>). The GTP-bound Rab1 is stabilized by LidA by preventing its extraction from membranes, amplifying vesicle tethering and ER factor recruitment (<xref ref-type="bibr" rid="B274">Neunuebel et&#xa0;al., 2012</xref>). Inactivation of Rab1 signaling is equally critical for vacuole maturation and is mediated by SidD, a specific de-AMPylase that restores Rab1 to conventional regulatory cycling, followed by LepB, a Rab1 GAP that drives GTP hydrolysis to complete Rab1 inactivation and progression of the trafficking program (<xref ref-type="bibr" rid="B274">Neunuebel et&#xa0;al., 2012</xref>; <xref ref-type="bibr" rid="B365">Tan and Luo, 2011</xref>; <xref ref-type="bibr" rid="B259">Mishra et&#xa0;al., 2013</xref>).</p>
<p>Parallel to diverting early secretory traffic, <italic>L. pneumophila</italic> actively blocks endosomal maturation and retrograde fusion events that would otherwise lead to vacuole acidification and lysosomal delivery. The VipD effector, a unique patatin-like phospholipase, selectively hydrolyzes phosphatidylinositol lipids on endosomal membranes and functionally antagonizes Rab5 and Rab22, two GTPases required for early endosome motility and fusion, thereby preventing LCV interception by the canonical endocytic pathway (<xref ref-type="bibr" rid="B223">Ku et&#xa0;al., 2012</xref>; <xref ref-type="bibr" rid="B148">Gaspar and Machner, 2014</xref>). In addition, RidL directly binds vacuolar protein sorting protein (VPS29), a core retromer subunit essential for endosome-trans-Golgi retrieval, disabling retromer assembly and hindering retrograde vesicle exchange with lysosomal or Golgi-connected compartments that could compromise vacuolar integrity (<xref ref-type="bibr" rid="B126">Finsel et&#xa0;al., 2013</xref>; <xref ref-type="bibr" rid="B325">Romano-Moreno et&#xa0;al., 2017</xref>). Collectively, these effectors create a LCV that simultaneously mimics an ER-secretory vesicle/organelle while being insulated from degradative trafficking.</p>
<p>The ability of <italic>L. pneumophila</italic> to replicate within a broad range of hosts, from freshwater amoebae to human macrophages, is further supported by its capacity to modulate host cell responses beyond phagosome remodeling, such as manipulation of autophagy, host sphingolipid metabolism, and NF-&#x3ba;B and various innate immune responses (<xref ref-type="bibr" rid="B72">Choy et&#xa0;al., 2012</xref>; <xref ref-type="bibr" rid="B321">Rolando et&#xa0;al., 2016</xref>). Thus, the intracellular life cycle of <italic>L. pneumophila</italic> in macrophages reflects a successful evolutionary repurposing of mechanisms initially developed to colonize protozoa, representing a striking case of environmental selection pressures shaping pathogenesis in an accidental human host. However, modulation of mammalian-specific processes that are absent in unicellular amoebae indicate adaptation of <italic>L. pneumophila</italic> to unknown multicellular eukaryotes prior to human infections.</p>
</sec>
<sec id="s6_2">
<label>6.2</label>
<title>The perplexing dispensability of most effectors for intracellular replication</title>
<p>Genetic screens and bioinformatics have revealed that many Dot/Icm substrates contain eukaryotic-like domains, suggesting their acquisition via interkingdom HGT from amoebal hosts or their endosymbionts (<xref ref-type="bibr" rid="B160">Gomez-Valero et&#xa0;al., 2019b</xref>; <xref ref-type="bibr" rid="B63">Cazalet et&#xa0;al., 2004</xref>; <xref ref-type="bibr" rid="B131">Franco et&#xa0;al., 2009</xref>; <xref ref-type="bibr" rid="B243">Lurie-Weinberger et&#xa0;al., 2010</xref>). Phylogenetic analyses date the last common ancestor of <italic>Legionella</italic> (LLCA) to ~1.89 billion years ago, indicating early co-evolution with protozoan hosts upon the emergence of eukaryotes (<xref ref-type="bibr" rid="B196">Hugoson et&#xa0;al., 2022</xref>). The combination of intra- and inter-kingdom HGT, competence of natural DNA transformation by <italic>L. pneumophila</italic>, and adaptation to various environmental host species has resulted in acquisition of remarkable genome plasticity, including more than 18,000 putative effector genes across the <italic>Legionella</italic> genus (<xref ref-type="bibr" rid="B160">Gomez-Valero et&#xa0;al., 2019b</xref>). These effectors are essentially a toolbox for <italic>L. pneumophila</italic> where certain effectors are needed in a certain host but not others (<xref ref-type="bibr" rid="B35">Best and Abu Kwaik, 2018</xref>; <xref ref-type="bibr" rid="B298">Price et&#xa0;al., 2024</xref>).</p>
<p>Despite the vast effector repertoire, deletion of most individual effectors often fails to result in a detectable defective phenotype in intracellular replication. Even deletion of 31% of known effectors results in only modest replication defects (<xref ref-type="bibr" rid="B279">O&#x2019;Connor et&#xa0;al., 2011</xref>). A possible reason for this is redundancy, which can be explained by overlaps in pathways, targets, cellular functions, and even molecular mechanisms (<xref ref-type="bibr" rid="B154">Ghosh and O&#x2019;Connor, 2017</xref>). Effector redundancy in <italic>L. pneumophila</italic> most likely reflects the adaptation to diverse protozoan hosts (<xref ref-type="bibr" rid="B298">Price et&#xa0;al., 2024</xref>; <xref ref-type="bibr" rid="B35">Best and Abu Kwaik, 2018</xref>). The SidE family (SidE, SdeA, SdeB, SdeC) exemplifies this redundancy. These effectors are dispensable when deleted individually, but collectively they are essential for robust intracellular replication due to their role in ubiquitinating host proteins like Reticulon 4 and Rab33b (<xref ref-type="bibr" rid="B241">Luo and Isberg, 2004</xref>; <xref ref-type="bibr" rid="B221">Kotewicz et&#xa0;al., 2017</xref>; <xref ref-type="bibr" rid="B308">Qiu et&#xa0;al., 2016</xref>; <xref ref-type="bibr" rid="B382">Vanrheenen et&#xa0;al., 2006</xref>). Functions of <italic>L. pneumophila</italic> effectors have been discussed in recent reviews (<xref ref-type="bibr" rid="B166">Graham et&#xa0;al., 2024</xref>; <xref ref-type="bibr" rid="B326">Romanov and O&#x2019;connor, 2024</xref>).</p>
</sec>
<sec id="s6_3">
<label>6.3</label>
<title>Core effectors of <italic>L. pneumophila</italic></title>
<p>Comparative genomics analyses indicate that among the &#x2248;18,000 effectors in <italic>Legionella</italic> species, only 9 core effectors are conserved across all 59 sequenced <italic>Legionella</italic> species, and these are MavN, VipF, RavC, CetLp1, Lpg2832, Lpg3000, AnkH/LegA3, LceA, and LceB (<xref ref-type="bibr" rid="B394">Wexler et&#xa0;al., 2022</xref>; <xref ref-type="bibr" rid="B53">Burstein et&#xa0;al., 2016</xref>; <xref ref-type="bibr" rid="B160">Gomez-Valero et&#xa0;al., 2019b</xref>). This underscores the existence of a small subset of effectors that likely perform non-redundant, indispensable functions across diverse ecological niche in all <italic>Legionella</italic> species (<xref ref-type="bibr" rid="B35">Best and Abu Kwaik, 2018</xref>). Strikingly, several of these core effectors are also conserved in <italic>Coxiella</italic> and <italic>Rickettsiella</italic>, which are phylogenetically related to <italic>Legionella</italic> and encode a functional Dot/Icm system, despite having diverged from <italic>Legionella</italic> &#x2248;1.89 billion years ago (<xref ref-type="bibr" rid="B196">Hugoson et&#xa0;al., 2022</xref>). This evolutionary conservation indicates that the Dot/Icm system and a minimal number of core effector toolkit were already established prior to the radiation of modern <italic>Legionella</italic> species &#x2248;1.89 billion years ago and were retained in <italic>Coxiella</italic> and <italic>Rickettsiella</italic> that adapted to distinct intracellular lifestyles. Among these conserved effectors, MavN mediates iron acquisition by the LCV, and its homologs are also present in <italic>C. burnetii</italic> and <italic>R. grylli</italic> (<xref ref-type="bibr" rid="B198">Isaac et&#xa0;al., 2015</xref>; <xref ref-type="bibr" rid="B73">Christenson et&#xa0;al., 2019</xref>). Similarly, VipF, a tandem GNAT-family acetyltransferase with two catalytic GNAT domains, targets the host translation factor eIF3K, modulating translation inhibition (<xref ref-type="bibr" rid="B363">Syriste et&#xa0;al., 2024</xref>). The AnkH core effector is also conserved in <italic>C. burnetii</italic> and <italic>R. grylli</italic> and interacts with the highly conserved host LARP7 components of the host 7SK snRNP complex, thereby interfering with transcription elongation (<xref ref-type="bibr" rid="B53">Burstein et&#xa0;al., 2016</xref>; <xref ref-type="bibr" rid="B160">Gomez-Valero et&#xa0;al., 2019b</xref>). Together, these findings indicate that core effectors target highly conserved eukaryotic processes, such as nutrient acquisition, transcriptional regulation, and protein synthesis. The host target and biological function of other core effectors are yet to be discovered.</p>
</sec>
<sec id="s6_4">
<label>6.4</label>
<title>Metaeffectors of <italic>L. pneumophila</italic></title>
<p><italic>L. pneumophila</italic> encodes a specialized regulatory layer of &#x201c;metaeffectors&#x201d;, which are bacterial effectors that post-translationally control the activity, localization, or stability of other Dot/Icm effectors, thereby preserving temporal precision and functional inactivation of effector activity. A hallmark example is SidJ, a calmodulin-dependent polyglutamylase that modifies the catalytic glutamate residue of the SidE family, inhibiting NAD-dependent ubiquitin ligase activity once Rab1 recruitment and ER remodeling are established on the LCV (<xref ref-type="bibr" rid="B36">Black et&#xa0;al., 2019</xref>; <xref ref-type="bibr" rid="B140">Gan et&#xa0;al., 2019b</xref>). This delayed translocation of the SidJ metaeffector ensures that SidE effectors function temporarily and transiently during early vacuole biogenesis but are subsequently inactivated to prevent excessive ubiquitin signaling (<xref ref-type="bibr" rid="B36">Black et&#xa0;al., 2019</xref>; <xref ref-type="bibr" rid="B140">Gan et&#xa0;al., 2019b</xref>). Similarly, the E3 ubiquitin ligase LubX metaeffector targets the effector SidH for K48-linked ubiquitination and subsequent proteasomal degradation, directly controlling effector abundance and mitigating SidH-associated toxicity during later stages of infection (<xref ref-type="bibr" rid="B227">Kubori et&#xa0;al., 2010</xref>). Another regulatory axis involves MesI, a metaeffector that binds to the glycosyl hydrolase SidI, suppressing its protein synthesis inhibitory activity to prevent premature translational arrest and host cell death (<xref ref-type="bibr" rid="B204">Joseph et&#xa0;al., 2020</xref>).</p>
<p>Additional metaeffector-effector pairs further illustrate the diversity of regulatory strategies employed by <italic>L. pneumophila.</italic> The de-ubiquitinase LupA metaeffector counteracts ubiquitin-dependent toxicity of the SNARE-mimic effector LegC3, while the ankyrin-repeat protein AnkJ metaeffector suppresses the translation- and actin-inhibitory effector SidL through direct binding (<xref ref-type="bibr" rid="B381">Urbanus et&#xa0;al., 2016</xref>; <xref ref-type="bibr" rid="B244">Machtens et&#xa0;al., 2025</xref>; <xref ref-type="bibr" rid="B205">Joseph and Shames, 2021</xref>). Likewise, the SidP metaeffector binds and suppresses the phosphoinositide kinase MavQ independently of its own PI3P phosphatase activity, highlighting that metaeffectors may regulate effectors through non-enzymatic mechanisms (<xref ref-type="bibr" rid="B381">Urbanus et&#xa0;al., 2016</xref>; <xref ref-type="bibr" rid="B205">Joseph and Shames, 2021</xref>). Collectively, these regulatory circuits ensure that effector functions are restricted to precise temporal windows during infection, avoiding fatal damage to the replication niche. Indeed, temporal translocation profiling demonstrates that early effector delivery is dominated by host permissiveness, while late-stage effectors and metaeffectors dampen earlier virulence programs to restore host homeostasis and permit bacterial egress (<xref ref-type="bibr" rid="B227">Kubori et&#xa0;al., 2010</xref>; <xref ref-type="bibr" rid="B202">Jeong et&#xa0;al., 2015</xref>; <xref ref-type="bibr" rid="B306">Qiu and Luo, 2017a</xref>).</p>
</sec>
<sec id="s6_5">
<label>6.5</label>
<title>Para-effectors of <italic>L. pneumophila</italic></title>
<p>Beyond classical effector redundancy and the hierarchical regulation imposed by effector metaeffectors pairs, <italic>L. pneumophila</italic> deploys sets of para-effectors, which are independently translocated effectors that target the same host protein target of the bacterial effector through distinct biochemical mechanisms. This is an additional layer for robust control of key host processes to remodel diverse protozoan hosts into proliferative niches. A well-characterized example of host target modulated by para-effectors is the manipulation of the Rab1 GTPase cycle by para-effectors (SidM, SidD, LepB, AnkX and Lem3). The Rab1-directed para-effector module consists of multiple translocated effectors that modify Rab1 through distinct biochemical mechanisms. The para-effector SidM activates and AMPylates Rab1 to promote ER-derived vesicle recruitment, whereas the de-AMPylase para-effector SidD removes this modification to terminate Rab1 signaling (<xref ref-type="bibr" rid="B197">Ingmundson et&#xa0;al., 2007</xref>; <xref ref-type="bibr" rid="B268">Muller et&#xa0;al., 2010</xref>; <xref ref-type="bibr" rid="B273">Neunuebel et&#xa0;al., 2011</xref>). In parallel, para-effector LepB functions as a Rab1 GAP to accelerate GTP hydrolysis, while para-effector AnkX phosphocholinates Rab1, and the counteracting Lem3 subsequently removes this modification (<xref ref-type="bibr" rid="B197">Ingmundson et&#xa0;al., 2007</xref>; <xref ref-type="bibr" rid="B267">Mukherjee et&#xa0;al., 2011</xref>; <xref ref-type="bibr" rid="B364">Tan et&#xa0;al., 2011</xref>). Although these Rab1-targeting effectors do not directly regulate one another, unlike metaeffectors, SidM, SidD, LepB, AnkX, and Lem3 collectively function as para-effectors that modify host targets, ensuring that Rab1 cycling is tightly controlled even under heterogeneous host conditions.</p>
<p>Similar para-effector networks shape phosphoinositide homeostasis on the LCV. The PI(4)P-binding ubiquitin ligases SidC/SdcA, the PI(3)P-binding protein LpnE, the dual PI phospholipase VipD, and the phosphoinositide phosphatase SidF all are para-effectors that act independently yet converge on stabilizing ER-like membrane identity and evading endosomal-lysosomal fusion of the LCV (<xref ref-type="bibr" rid="B193">Hsu et&#xa0;al., 2014</xref>; <xref ref-type="bibr" rid="B393">Weber et&#xa0;al., 2006</xref>; <xref ref-type="bibr" rid="B148">Gaspar and Machner, 2014</xref>). In addition, parallelism also exists in ubiquitin signaling. The ubiquitin-modulating six para-effectors LegU1, AnkB, MavC, MvcA, LegK1, and RavZ each reshape ubiquitin-mediated regulation through biochemically distinct modification of host targets (<xref ref-type="bibr" rid="B224">Kubori et&#xa0;al., 2008</xref>; <xref ref-type="bibr" rid="B296">Price et&#xa0;al., 2009</xref>; <xref ref-type="bibr" rid="B139">Gan et&#xa0;al., 2019a</xref>, <xref ref-type="bibr" rid="B138">Gan et&#xa0;al., 2020</xref>; <xref ref-type="bibr" rid="B149">Ge et&#xa0;al., 2009</xref>; <xref ref-type="bibr" rid="B72">Choy et&#xa0;al., 2012</xref>).</p>
<p>A distinct form of para-effector pair is shown by the chromatin-modifying effectors RomA and LphD (<xref ref-type="bibr" rid="B335">Schator et&#xa0;al., 2023</xref>). RomA, a SET-domain methyltransferase, tri-methylates histone H3 at lysine 14 (H3K14), while LphD is a eukaryotic-like histone deacetylase that specifically removes H3K14 acetylation, thereby enabling RomA-mediated methylation (<xref ref-type="bibr" rid="B335">Schator et&#xa0;al., 2023</xref>). Unlike other para-effector networks, RomA and LphD display strong functional interdependence that arises from sequential modification of the same host residue rather than direct effector-effector regulation. Loss of either effector impairs intracellular replication of <italic>L. pneumophila</italic> during infection of THP-1 macrophages and <italic>A. castellanii</italic>, whereas a double knockout strain partially restores bacterial growth defect, defining a unique para-effector relationship based on cooperative chromatin remodeling (<xref ref-type="bibr" rid="B335">Schator et&#xa0;al., 2023</xref>). Together, these para-effector systems enable <italic>L. pneumophila</italic> to stabilize key host trafficking, membrane identity, ubiquitin signaling, and chromatin states that are required for LCV maturation and sustained intracellular replication to adapt to diverse protozoan reservoirs and mammalian macrophage hosts.</p>
</sec>
</sec>
<sec id="s7">
<label>7</label>
<title>Type II secretion system</title>
<p>Despite the conservation of T2SS architecture among Proteobacteria, the output and substrate repertoire of the system vary markedly between species. Some substrates appear to be conserved across the genus and are thought to have arisen in a common ancestor of <italic>Legionella</italic> and its closest relative <italic>Aquicella</italic> (<xref ref-type="bibr" rid="B396">White and Cianciotto, 2019</xref>). This mosaic evolutionary origins likely reflects the selective pressures exerted by the intracellular environment and host-pathogen interactions over a long evolutionary time. Although T2SSs are not universal among Gram-negative bacteria, they are widely distributed among the &#x3b3;-Proteobacteria and found in both animal and plant pathogens, including <italic>Pseudomonas aeruginosa</italic>, <italic>Klebsiella pneumoniae</italic>, <italic>Yersinia enterocolitica</italic>, <italic>Vibrio cholerae</italic>, and <italic>Erwinia amylovora</italic> (<xref ref-type="bibr" rid="B79">Cianciotto and White, 2017</xref>; <xref ref-type="bibr" rid="B396">White and Cianciotto, 2019</xref>; <xref ref-type="bibr" rid="B206">Jyot et&#xa0;al., 2011</xref>; <xref ref-type="bibr" rid="B402">Yang et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B388">Von Tils et&#xa0;al., 2012</xref>; <xref ref-type="bibr" rid="B315">Reichow et&#xa0;al., 2010</xref>; <xref ref-type="bibr" rid="B405">Zhao et&#xa0;al., 2005</xref>). In these organisms, T2SSs facilitate a broad array of virulence-related functions, such as tissue degradation, biofilm formation, evasion of host defenses, and host colonization. Interestingly, despite the vast functional repertoire of T2SS, they have not been implicated in interbacterial competition. Unlike the Type VI Secretion System (T6SS), which is used for contact-dependent killing of competing bacteria, the T2SS appears specialized for secretion into the extracellular milieu or host interface, emphasizing its roles in environmental adaptation and host manipulation rather than bacterial antagonism (<xref ref-type="bibr" rid="B396">White and Cianciotto, 2019</xref>; <xref ref-type="bibr" rid="B346">Shaliutina-Loginova et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B272">Naskar et&#xa0;al., 2021</xref>; <xref ref-type="bibr" rid="B79">Cianciotto and White, 2017</xref>).</p>
<p>The T2SS is a multi-protein complex and plays a pivotal role in environmental persistence, adaptation to host cells, and pathogenesis of <italic>L. pneumophila</italic> (<xref ref-type="bibr" rid="B220">Korotkov et&#xa0;al., 2012</xref>; <xref ref-type="bibr" rid="B77">Cianciotto, 2009</xref>). Evolutionarily related to the type IV pilus machinery, the T2SS operates as a sophisticated two-step secretion system that translocates folded proteins across the cytoplasmic and outer membranes into the extracellular space (<xref ref-type="bibr" rid="B220">Korotkov et&#xa0;al., 2012</xref>; <xref ref-type="bibr" rid="B219">Korotkov and Sandkvist, 2019</xref>; <xref ref-type="bibr" rid="B153">Ghosal et&#xa0;al., 2019b</xref>; <xref ref-type="bibr" rid="B398">White et&#xa0;al., 2019</xref>; <xref ref-type="bibr" rid="B396">White and Cianciotto, 2019</xref>; <xref ref-type="bibr" rid="B327">Rossier et&#xa0;al., 2008</xref>, <xref ref-type="bibr" rid="B329">Rossier et&#xa0;al., 2004</xref>; <xref ref-type="bibr" rid="B353">Soderberg et&#xa0;al., 2008</xref>; <xref ref-type="bibr" rid="B395">White and Cianciotto, 2016</xref>; <xref ref-type="bibr" rid="B79">Cianciotto and White, 2017</xref>; <xref ref-type="bibr" rid="B95">Debroy et&#xa0;al., 2006b</xref>; <xref ref-type="bibr" rid="B137">Galka et&#xa0;al., 2008</xref>; <xref ref-type="bibr" rid="B375">Truchan et&#xa0;al., 2017</xref>; <xref ref-type="bibr" rid="B77">Cianciotto, 2009</xref>). The T2SS apparatus in <italic>L. pneumophila</italic> consists of 12 core proteins (T2S C, D, E, F, G, H, I, J, K, L, M, and O), which assemble into four functional subcomplexes (<xref ref-type="bibr" rid="B396">White and Cianciotto, 2019</xref>; <xref ref-type="bibr" rid="B153">Ghosal et&#xa0;al., 2019b</xref>; <xref ref-type="bibr" rid="B79">Cianciotto and White, 2017</xref>; <xref ref-type="bibr" rid="B287">Peabody et&#xa0;al., 2003</xref>). The first subcomplex is an outer membrane secretin, which is a multimeric ring of D proteins that forms the final secretion pore in the outer membrane. This channel serves as the exit site for mature substrates destined for the extracellular environment or bacterial surface (<xref ref-type="bibr" rid="B153">Ghosal et&#xa0;al., 2019b</xref>). The second is an inner membrane platform, composed of F, L, and M proteins that are anchored in the inner membrane, spanning the periplasmic space, and acts as a scaffold for the entire secretion system. This platform interfaces directly with the secretin and provides docking sites for other subunits, including the ATPase motor (<xref ref-type="bibr" rid="B153">Ghosal et&#xa0;al., 2019b</xref>). The third is a periplasmic pseudopilus that functions analogously to a piston or Archimedean screw. This pilus-like structure is composed of a major pseudopilin (G) and minor pseudopilins (H, I, J, and K) (<xref ref-type="bibr" rid="B76">Cianciotto, 2005</xref>; <xref ref-type="bibr" rid="B153">Ghosal et&#xa0;al., 2019b</xref>; <xref ref-type="bibr" rid="B79">Cianciotto and White, 2017</xref>). It undergoes polymerization-driven extension to push substrates through the secretin pores. The O protein cleaves and methylates pseudopilin precursors prior to their incorporation into the pseudopilus, facilitating precise assembly and function (<xref ref-type="bibr" rid="B76">Cianciotto, 2005</xref>; <xref ref-type="bibr" rid="B153">Ghosal et&#xa0;al., 2019b</xref>; <xref ref-type="bibr" rid="B79">Cianciotto and White, 2017</xref>; <xref ref-type="bibr" rid="B287">Peabody et&#xa0;al., 2003</xref>). The fourth is a cytoplasmic ATPase, which is a hexamer of E component recruited to the inner membrane platform. It hydrolyzes ATP to provide energy necessary for pseudopilus extension and substrate translocation. The activity of this ATPase is essential for the dynamic motion of the piston mechanism (<xref ref-type="bibr" rid="B153">Ghosal et&#xa0;al., 2019b</xref>; <xref ref-type="bibr" rid="B396">White and Cianciotto, 2019</xref>). Coupling of the outer membrane and inner membrane complexes is mediated by the clamp C protein component, which also contributes to substrate recognition by coordinating substrate handoff from the periplasm to the pseudopilus machinery (<xref ref-type="bibr" rid="B153">Ghosal et&#xa0;al., 2019b</xref>; <xref ref-type="bibr" rid="B396">White and Cianciotto, 2019</xref>). The secretion process begins with substrate recognition via the Sec or Tat translocon pathways, which transport unfolded proteins bearing N-terminal signal peptides across the inner membrane into the periplasm (<xref ref-type="bibr" rid="B376">Tsirigotaki et&#xa0;al., 2017</xref>; <xref ref-type="bibr" rid="B34">Berks, 2015</xref>). There, the signal peptides are cleaved, allowing the substrate proteins to fold into their active tertiary conformation. These folded proteins are then recognized by the T2SS apparatus (<xref ref-type="bibr" rid="B219">Korotkov and Sandkvist, 2019</xref>; <xref ref-type="bibr" rid="B293">Pineau et&#xa0;al., 2021</xref>).</p>
<p>There are approximately 120 proteins that are predicted to be secreted via the T2SS in <italic>L. pneumophila</italic>, with at least 27 confirmed substrates displaying over 20 distinct enzymatic activities, including lipases, proteases, glycosidases, nucleases, and phosphatases (<xref ref-type="bibr" rid="B8">Adams et&#xa0;al., 2025</xref>; <xref ref-type="bibr" rid="B329">Rossier et&#xa0;al., 2004</xref>; <xref ref-type="bibr" rid="B79">Cianciotto and White, 2017</xref>; <xref ref-type="bibr" rid="B397">White et&#xa0;al., 2018</xref>; <xref ref-type="bibr" rid="B77">Cianciotto, 2009</xref>; <xref ref-type="bibr" rid="B95">Debroy et&#xa0;al., 2006b</xref>; <xref ref-type="bibr" rid="B94">Debroy et&#xa0;al., 2006a</xref>). These enzymes contribute to the degradation of host macromolecules, nutrient acquisition, and remodeling of the vacuolar niche. Several substrates also exhibit structural and functional mimicry of eukaryotic proteins, suggesting evolutionary adaptation to intracellular life. For example, ProA is a zinc metalloprotease that degrades complement proteins and extracellular matrix components, promoting tissue invasion and immune evasion (<xref ref-type="bibr" rid="B338">Scheithauer et&#xa0;al., 2021</xref>, <xref ref-type="bibr" rid="B339">Scheithauer et&#xa0;al., 2022</xref>, <xref ref-type="bibr" rid="B337">Scheithauer et&#xa0;al., 2025</xref>). ChiA is a chitinase that enhances lung persistence, likely by degrading mucins or host glycoproteins (<xref ref-type="bibr" rid="B314">Rehman et&#xa0;al., 2020</xref>). PlaC is an acyltransferase involved in phospholipid modification (<xref ref-type="bibr" rid="B397">White et&#xa0;al., 2018</xref>). SrnA is a ribonuclease with potential roles in modulating host RNA stability (<xref ref-type="bibr" rid="B328">Rossier et&#xa0;al., 2009</xref>). NttA and NttC are novel T2SS-secreted proteins required for optimal infection of certain amoebae species (<xref ref-type="bibr" rid="B380">Tyson et&#xa0;al., 2014</xref>). Many of these substrates, including ProA and ChiA, localize outside the LCV and form distinctive ring-like patterns surrounding the vacuole membrane in host cells, implying they function in modifying the host cytosolic environment or vacuolar interface (<xref ref-type="bibr" rid="B375">Truchan et&#xa0;al., 2017</xref>; <xref ref-type="bibr" rid="B395">White and Cianciotto, 2016</xref>).</p>
<p>The T2SS is crucial for ability of <italic>L. pneumophila</italic> to infect both amoebae hosts and mammalian cells, form biofilms, modulate immune responses, and survive in aquatic environments (<xref ref-type="bibr" rid="B327">Rossier et&#xa0;al., 2008</xref>, <xref ref-type="bibr" rid="B329">Rossier et&#xa0;al., 2004</xref>; <xref ref-type="bibr" rid="B353">Soderberg et&#xa0;al., 2008</xref>; <xref ref-type="bibr" rid="B395">White and Cianciotto, 2016</xref>; <xref ref-type="bibr" rid="B79">Cianciotto and White, 2017</xref>; <xref ref-type="bibr" rid="B95">Debroy et&#xa0;al., 2006b</xref>; <xref ref-type="bibr" rid="B254">Mccoy-Simandle et&#xa0;al., 2011</xref>; <xref ref-type="bibr" rid="B245">Mallama et&#xa0;al., 2017</xref>). Studies have shown that mutants deficient in T2SS components are severely impaired in their ability to replicate within amoebae such as <italic>A. castellanii</italic> and <italic>V. vermiformis</italic> (<xref ref-type="bibr" rid="B379">Tyson et&#xa0;al., 2013</xref>). Other studies have also shown that T2SS is essential in intracellular replication of macrophages (<xref ref-type="bibr" rid="B395">White and Cianciotto, 2016</xref>). These impairments underscore the central role of the T2SS in facilitating intracellular survival and replication. Beyond intracellular infection, the T2SS contributes significantly to <italic>L. pneumophila</italic>&#x2019;s environmental resilience, as it plays roles in sliding motility, biofilm formation, and survival in water at low temperatures (4-25 &#xb0;C) (<xref ref-type="bibr" rid="B353">Soderberg et&#xa0;al., 2008</xref>; <xref ref-type="bibr" rid="B352">Soderberg and Cianciotto, 2008</xref>; <xref ref-type="bibr" rid="B108">Duncan et&#xa0;al., 2011</xref>; <xref ref-type="bibr" rid="B355">Stewart et&#xa0;al., 2009</xref>).</p>
</sec>
<sec id="s8">
<label>8</label>
<title>The innate immune response to <italic>L. pneumophila</italic></title>
<p>The innate immune system is the first line of defense against <italic>L. pneumophila</italic>, and this response is multifaceted, involving several pattern recognition receptors (PRRs) (<xref ref-type="bibr" rid="B341">Schuelein et&#xa0;al., 2011</xref>; <xref ref-type="bibr" rid="B252">Massis and Zamboni, 2011</xref>). Although <italic>L. pneumophila</italic> has evolved an extensive effector repertoire while adapting to protozoan hosts, these adaptations were not shaped by sustained selection to evade vertebrate PRR, and as a result the bacterium remains susceptible to PRR-mediated restriction in mammalian macrophages (<xref ref-type="bibr" rid="B49">Brown et&#xa0;al., 2017</xref>; <xref ref-type="bibr" rid="B168">Grigoryeva and Cianciotto, 2021</xref>). This is particularly evident in murine models, which does not occur in humans. For instance, while A/J mice is the only inbred strain permissive to <italic>L. pneumophila</italic>, all other inbred strains such as C57BL/6 and BALB/c are non-permissive to infection due to rapid pyroptotic death of macrophages (<xref ref-type="bibr" rid="B357">Susa et&#xa0;al., 1998</xref>; <xref ref-type="bibr" rid="B9">Akamine et&#xa0;al., 2007</xref>; <xref ref-type="bibr" rid="B81">Coers et&#xa0;al., 2007</xref>; <xref ref-type="bibr" rid="B99">Deng et&#xa0;al., 2001</xref>; <xref ref-type="bibr" rid="B366">Tateda et&#xa0;al., 1998</xref>; <xref ref-type="bibr" rid="B121">Fernandez-Serrano et&#xa0;al., 2003</xref>; <xref ref-type="bibr" rid="B101">Dietrich et&#xa0;al., 1995</xref>; <xref ref-type="bibr" rid="B102">Diez et&#xa0;al., 2003</xref>). Flagellin of <italic>L. pneumophila</italic> is sensed by the cytosolic neuronal apoptosis inhibitory protein 5 (Naip5), which forms a complex with NLRC4 to activate the inflammasome (<xref ref-type="bibr" rid="B101">Dietrich et&#xa0;al., 1995</xref>; <xref ref-type="bibr" rid="B102">Diez et&#xa0;al., 2003</xref>; <xref ref-type="bibr" rid="B401">Wright et&#xa0;al., 2003</xref>; <xref ref-type="bibr" rid="B130">Fortier et&#xa0;al., 2007</xref>). This Dot/Icm-dependent sensing mechanism results in caspase-1 activation, pyroptotic cell death, and the release of proinflammatory cytokines such as IL-1&#x3b2; and IL-18 (<xref ref-type="bibr" rid="B250">Mascarenhas et&#xa0;al., 2017</xref>; <xref ref-type="bibr" rid="B60">Case and Roy, 2011</xref>).</p>
<p>Caspase-7 is activated downstream of canonical inflammasome signaling during <italic>L. pneumophila</italic> infection and functions as a downstream executioner that reinforces macrophage death and bacterial restriction. NLRC4-dependent caspase-1 activity leads to caspase-7 activation during <italic>L. pneumophila</italic> infection, and loss of caspase-7 increases mice permissiveness to bacterial replication in mouse macrophages (<xref ref-type="bibr" rid="B10">Akhter et&#xa0;al., 2009</xref>). Combined loss of gasdermin-D (GSDMD) and caspase-7 in mice phenocopies NLRC4 deficiency in permitting replication, indicating that caspase-7 acts in parallel with gasdermin-mediated pyroptosis to enforce robust restriction (<xref ref-type="bibr" rid="B162">Goncalves et&#xa0;al., 2019</xref>). Thus, caspase-7 should be viewed as a downstream amplifier of inflammasome-driven cell death and inflammation that collaborates with, but is mechanistically distinct from, caspase-1 and caspase-11 pathways in shaping the macrophage response to <italic>L. pneumophila</italic> in mice.</p>
<p>In mammalian macrophages, <italic>L. pneumophila</italic> activates the non-canonical inflammasome through an interferon-licensed pathway in which the guanylate-binding proteins (GBPs) destabilize the LCV, allowing cytosolic exposure of bacterial LPS and subsequent activation of caspase-4/5 in humans/caspase-11 in mice (<xref ref-type="bibr" rid="B1">Aachoui et&#xa0;al., 2015</xref>; <xref ref-type="bibr" rid="B28">Bass et&#xa0;al., 2023</xref>). Signaling through TRIF and IFN-dependent pathways induces transcriptional upregulation of pro-caspase-11, licensing cells for non-canonical inflammasome activation in mice (<xref ref-type="bibr" rid="B312">Rathinam et&#xa0;al., 2012</xref>; <xref ref-type="bibr" rid="B1">Aachoui et&#xa0;al., 2015</xref>). IFN-inducible guanylate-binding proteins (GBPs) are rapidly mobilized to pathogen-containing vacuoles to destabilize vacuolar membranes, which are essential for cytosolic LPS surveillance in infected cells that lead to a second pathway of pyroptosis (<xref ref-type="bibr" rid="B2">Aachoui et&#xa0;al., 2013</xref>; <xref ref-type="bibr" rid="B59">Case et&#xa0;al., 2013</xref>; <xref ref-type="bibr" rid="B291">Pilla et&#xa0;al., 2014</xref>; <xref ref-type="bibr" rid="B303">Price et&#xa0;al., 2019</xref>; <xref ref-type="bibr" rid="B1">Aachoui et&#xa0;al., 2015</xref>)-. Upon infection, IFN-induced GBPs are recruited to intracellular pathogen vacuoles, including the LCV, where they promote vacuolar membrane disruption and facilitate inflammasome access to bacterial products (<xref ref-type="bibr" rid="B28">Bass et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B120">Feeley et&#xa0;al., 2017</xref>). Disruption of LCV integrity enables bacterial LPS to enter the host cytosol, where it directly binds and activates caspase-11, independently of TLR4 signaling (<xref ref-type="bibr" rid="B171">Hagar et&#xa0;al., 2013</xref>; <xref ref-type="bibr" rid="B212">Kayagaki et&#xa0;al., 2011</xref>). Activated caspase-11 cleaves GSDMD, triggering pore formation in the host membrane and pyroptotic cell death, which can synergize with secondary NLRP3&#x2013;caspase-1 activation to amplify IL-1&#x3b2; release (<xref ref-type="bibr" rid="B349">Shi et&#xa0;al., 2015</xref>; <xref ref-type="bibr" rid="B211">Kayagaki et&#xa0;al., 2015</xref>). Thus, in IFN-primed macrophages in both mice and humans, caspase-11 and caspase-4 activation during <italic>Legionella</italic> infection is driven not by a dedicated effector-triggered mechanism, but by GBP-dependent destabilization of the LCV that permits cytosolic exposure of LPS. In addition to mice caspase-11- and human caspse-4-driven non-canonical inflammasome activation, downstream executioner caspases further enforce macrophage cell death during infection.</p>
<sec id="s8_1">
<label>8.1</label>
<title>Opposing effects of <italic>Legionella</italic> effectors on host translation</title>
<p>Despite the reported global reprogramming of the host transcriptome, at least in part by AnkH and RomA nucleomodulins of <italic>L. pneumophila</italic>, multiple effectors, including RavX, SidI, SidL, LegK4, and the Lgt family (Lgt1, Lgt2, and Lgt3), inhibit host protein translation by targeting elongation factors and ribosomes (<xref ref-type="bibr" rid="B387">Von Dwingelo et&#xa0;al., 2019</xref>; <xref ref-type="bibr" rid="B322">Rolando et&#xa0;al., 2013</xref>, <xref ref-type="bibr" rid="B323">Rolando et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B235">Lockwood et&#xa0;al., 2022</xref>; <xref ref-type="bibr" rid="B84">Copenhaver et&#xa0;al., 2014</xref>, <xref ref-type="bibr" rid="B83">Copenhaver et&#xa0;al., 2015</xref>). However, several lines of evidence from various research groups demonstrate that this translational blockade is not global (<xref ref-type="bibr" rid="B235">Lockwood et&#xa0;al., 2022</xref>; <xref ref-type="bibr" rid="B300">Price et&#xa0;al., 2020</xref>; <xref ref-type="bibr" rid="B348">Shames et&#xa0;al., 2017</xref>; <xref ref-type="bibr" rid="B215">Khweek et&#xa0;al., 2013</xref>; <xref ref-type="bibr" rid="B128">Fontana et&#xa0;al., 2011</xref>; <xref ref-type="bibr" rid="B24">Barry et&#xa0;al., 2017</xref>; <xref ref-type="bibr" rid="B129">Fontana et&#xa0;al., 2012</xref>; <xref ref-type="bibr" rid="B350">Shin et&#xa0;al., 2008</xref>; <xref ref-type="bibr" rid="B6">Abu-Zant et&#xa0;al., 2007</xref>; <xref ref-type="bibr" rid="B239">Losick et&#xa0;al., 2010</xref>; <xref ref-type="bibr" rid="B16">Asrat et&#xa0;al., 2014</xref>; <xref ref-type="bibr" rid="B240">Losick and Isberg, 2006</xref>; <xref ref-type="bibr" rid="B25">Bartfeld et&#xa0;al., 2009</xref>; <xref ref-type="bibr" rid="B232">Liu et&#xa0;al., 2020</xref>; <xref ref-type="bibr" rid="B83">Copenhaver et&#xa0;al., 2015</xref>; <xref ref-type="bibr" rid="B61">Casson et&#xa0;al., 2017</xref>; <xref ref-type="bibr" rid="B251">Mascarenhas et&#xa0;al., 2015</xref>; <xref ref-type="bibr" rid="B23">Barry et&#xa0;al., 2013</xref>). Unlike a universal translational arrest, selective host proteins continue to be translated and upregulated.</p>
<p>Strikingly, several <italic>L. pneumophila</italic> effectors themselves counteract the translational blockade to actively promote production of host immune proteins. The LegA9 and LegC4 effectors augment translation of pro-inflammatory cytokines, while the LamA effector drives robust M1 pro-inflammatory polarization through up-regulation of host glycolysis and induction of inflammatory mediators (<xref ref-type="bibr" rid="B235">Lockwood et&#xa0;al., 2022</xref>; <xref ref-type="bibr" rid="B300">Price et&#xa0;al., 2020</xref>; <xref ref-type="bibr" rid="B348">Shames et&#xa0;al., 2017</xref>; <xref ref-type="bibr" rid="B215">Khweek et&#xa0;al., 2013</xref>). In addition, macrophages infected with <italic>L. pneumophila</italic> also undergo enhanced translation of IL-1&#x3b1; and IL-23&#x3b1;, along with sustained activation of MAPK signaling and both canonical and non-canonical NF-&#x3ba;B pathways (<xref ref-type="bibr" rid="B235">Lockwood et&#xa0;al., 2022</xref>; <xref ref-type="bibr" rid="B128">Fontana et&#xa0;al., 2011</xref>; <xref ref-type="bibr" rid="B24">Barry et&#xa0;al., 2017</xref>; <xref ref-type="bibr" rid="B129">Fontana et&#xa0;al., 2012</xref>; <xref ref-type="bibr" rid="B350">Shin et&#xa0;al., 2008</xref>; <xref ref-type="bibr" rid="B6">Abu-Zant et&#xa0;al., 2007</xref>; <xref ref-type="bibr" rid="B239">Losick et&#xa0;al., 2010</xref>; <xref ref-type="bibr" rid="B16">Asrat et&#xa0;al., 2014</xref>; <xref ref-type="bibr" rid="B240">Losick and Isberg, 2006</xref>; <xref ref-type="bibr" rid="B25">Bartfeld et&#xa0;al., 2009</xref>). Consistent with this, IL-1&#x3b1; is selectively upregulated, which triggers the cells, leading to activation of bystander myeloid cells (<xref ref-type="bibr" rid="B16">Asrat et&#xa0;al., 2014</xref>; <xref ref-type="bibr" rid="B232">Liu et&#xa0;al., 2020</xref>; <xref ref-type="bibr" rid="B83">Copenhaver et&#xa0;al., 2015</xref>; <xref ref-type="bibr" rid="B61">Casson et&#xa0;al., 2017</xref>; <xref ref-type="bibr" rid="B24">Barry et&#xa0;al., 2017</xref>; <xref ref-type="bibr" rid="B251">Mascarenhas et&#xa0;al., 2015</xref>; <xref ref-type="bibr" rid="B23">Barry et&#xa0;al., 2013</xref>).</p>
<p>In addition, ribosomal perturbation caused by translational inhibition activates stress kinases and ribotoxic stress responses that function as danger signals to amplify immunity (<xref ref-type="bibr" rid="B128">Fontana et&#xa0;al., 2011</xref>). This phenomenon, whereby pathogen-encoded effectors stimulate host defense rather than suppress it, aligns with the emerging paradigm of Effector-Triggered Immunity (ETI) (<xref ref-type="bibr" rid="B128">Fontana et&#xa0;al., 2011</xref>; <xref ref-type="bibr" rid="B356">Subramanian et&#xa0;al., 2023</xref>). Deletion of ETI-inducing effectors such as LegA9, LegC4, LamA results in increased bacterial replication in macrophages and murine infection models, demonstrating that these &#x201c;virulence&#x201d; factors paradoxically serve host-protective roles during infection (<xref ref-type="bibr" rid="B348">Shames et&#xa0;al., 2017</xref>; <xref ref-type="bibr" rid="B286">Park et&#xa0;al., 2020b</xref>). It is possible that these effectors are amoebae-adapted effectors with accidental effects on human macrophages.</p>
<p>Although complete translational shutdown in eukaryotic cells typically induces autophagy, cellular dysfunction, and cell death within hours, <italic>L. pneumophila</italic>-infected macrophages remain viable for 24&#x2013;72 hours, indicating that a substantial subset of host proteins continues to be translated to maintain cellular integrity (<xref ref-type="bibr" rid="B7">Acevo-Rodriguez et&#xa0;al., 2020</xref>; <xref ref-type="bibr" rid="B90">Dang and Back, 2021</xref>). This supports a model in which translational regulation during infection is highly and selectively modulated, rather than globally repressed. The precise temporal and spatial control of this antagonistic effector network remains unresolved, but it is clear that host translation is both selectively suppressed and selectively activated (<xref ref-type="bibr" rid="B235">Lockwood et&#xa0;al., 2022</xref>; <xref ref-type="bibr" rid="B16">Asrat et&#xa0;al., 2014</xref>; <xref ref-type="bibr" rid="B29">Belyi et&#xa0;al., 2008</xref>). Collectively, the data indicate that <italic>L. pneumophila</italic> does not trigger global translational arrest, but instead rewires host translation through competing effector functions, some enforcing inhibition, others restoring or enhancing translation of certain proteins. This places <italic>L. pneumophila</italic> alongside <italic>Pseudomonas syringae</italic> as a key model for studying ETI, where bacterial effectors operate simultaneously as virulence factors and innate immune agonists, shaping the outcome of infection through a dynamic, antagonistic regulatory network (<xref ref-type="bibr" rid="B37">Block and Alfano, 2011</xref>).</p>
</sec>
<sec id="s8_2">
<label>8.2</label>
<title>Authophagy and mitochondrial immune checkpoint interference</title>
<p>Autophagy is another arm of the host defense system that <italic>L. pneumophila</italic> must circumvent, and mitochondrial physiology is critical upstream regulator of this pathway (<xref ref-type="bibr" rid="B14">Amer and Swanson, 2005</xref>; <xref ref-type="bibr" rid="B72">Choy et&#xa0;al., 2012</xref>; <xref ref-type="bibr" rid="B189">Horenkamp et&#xa0;al., 2015</xref>; <xref ref-type="bibr" rid="B371">Thomas et&#xa0;al., 2020</xref>). While some effectors trigger autophagic recognition, like LegA9, others actively inhibit the process (<xref ref-type="bibr" rid="B215">Khweek et&#xa0;al., 2013</xref>). The RavZ effector cleaves lipidated Atg8/LC3, thereby irreversibly blocking autophagosome maturation and fusion with lysosomes (<xref ref-type="bibr" rid="B72">Choy et&#xa0;al., 2012</xref>). This not only prevents bacterial degradation but may also limit the presentation of bacterial antigens to the adaptive immune system.</p>
<p>In addition, the pathogen manipulates mitochondrial function through effectors that either modulate mitochondrial dynamics or directly alter respiration to suppress autophagy. Mitochondrial stress signals, such as loss of membrane potential, reactive oxygen species (ROS), and energy imbalance, are major triggers for AMPK-ULK1 autophagy induction and PINK1-Parkin mitophagy (<xref ref-type="bibr" rid="B218">Kim et&#xa0;al., 2011</xref>; <xref ref-type="bibr" rid="B203">Jin and Youle, 2012</xref>; <xref ref-type="bibr" rid="B406">Zhou et&#xa0;al., 2022</xref>). Mitochondrial function is regulated by ADP-ribosylation via the Ceg3 and Lpg0081 effectors, which modulate the host ADP/ATP translocase (<xref ref-type="bibr" rid="B136">Fu et&#xa0;al., 2022</xref>). The actin cytoskeleton is manipulated via proteins that target Arp2/3 and microtubules, further enhancing pathogen survival and replication (<xref ref-type="bibr" rid="B258">Michard et&#xa0;al., 2015</xref>). The Lpg0080 and Lpg0081 effectors function as ADP-ribosyl transferases and hydrolases targeting the mitochondrial ADP/ATP translocase, modulating energy availability and suppressing mitochondrial immunity (<xref ref-type="bibr" rid="B225">Kubori et&#xa0;al., 2022</xref>; <xref ref-type="bibr" rid="B136">Fu et&#xa0;al., 2022</xref>). By dampening mitochondrial-driven autophagy signals and simultaneously blocking LC3-mediated autophagosome maturation, <italic>L. pneumophila</italic> effectively cripples both autophagy initiation and execution, reinforcing intracellular survival while minimizing mitochondrial-encoded danger signals that could amplify inflammation.</p>
</sec>
<sec id="s8_3">
<label>8.3</label>
<title>Role of neutrophil in early host defense</title>
<p>While <italic>L. pneumophila</italic> preferentially infects macrophages, neutrophils are essential to the early innate immune response. Neutrophils are heavily recruited to the lungs in experimental models in guinea pigs and A/J mice (<xref ref-type="bibr" rid="B92">Davis et&#xa0;al., 1983</xref>; <xref ref-type="bibr" rid="B357">Susa et&#xa0;al., 1998</xref>; <xref ref-type="bibr" rid="B9">Akamine et&#xa0;al., 2007</xref>; <xref ref-type="bibr" rid="B81">Coers et&#xa0;al., 2007</xref>; <xref ref-type="bibr" rid="B99">Deng et&#xa0;al., 2001</xref>). Histologically, this is reflected by intense intra-alveolar inflammation, with polymorphonuclear leukocytes, macrophages, and necrotic debris filing the alveolar spaces (<xref ref-type="bibr" rid="B229">Lattimer et&#xa0;al., 1979</xref>; <xref ref-type="bibr" rid="B367">Tateda et&#xa0;al., 2001</xref>). Mechanistic studies in mouse models have shown that IL-1 receptor-MyD88 signaling and NOD1/2 pathways drive chemokine production and neutrophil recruitment, and that this recruitment is required for efficient pulmonary clearance of <italic>L. pneumophila</italic> (<xref ref-type="bibr" rid="B135">Frutuoso et&#xa0;al., 2010</xref>; <xref ref-type="bibr" rid="B251">Mascarenhas et&#xa0;al., 2015</xref>). Neutrophils, along with alveolar macrophages, are among the first cells to receive Dot/Icm-translocated effectors <italic>in vivo</italic> and constitute major early sources of TNF and IL-1&#x3b1;, positioning them as both an intracellular niche and a key effector population during acute infection (<xref ref-type="bibr" rid="B84">Copenhaver et&#xa0;al., 2014</xref>). In A/J mice, neutrophils cooperate with monocytes and innate lymphocytes to produce IL-12 and IFN-&#x3b3;, shaping a protective cytokine milieu that restricts bacterial replication (<xref ref-type="bibr" rid="B61">Casson et&#xa0;al., 2017</xref>). Consistent with this, neutrophil-derived ROS and TNF are essential for early control of lung infection in resistant mouse strains (<xref ref-type="bibr" rid="B408">Ziltener et&#xa0;al., 2016</xref>). Whether these events occur in human neutrophils remains unknown.</p>
<p>More recent work has clarified that neutrophils rapidly restrict <italic>L. pneumophila</italic> in a Dot/Icm-dependent manner (<xref ref-type="bibr" rid="B299">Price et&#xa0;al., 2021</xref>). Human neutrophils respond to the T4SS-injected LamA effector with upregulated glycolysis, granule fusion to the <italic>Legionella</italic>-containing phagosome (LCP), and ROS production, resulting in swift bacterial killing (<xref ref-type="bibr" rid="B299">Price et&#xa0;al., 2021</xref>). Human neutrophils also form NETs and produce IL-1&#x3b2; in response to <italic>L. pneumophila</italic>, supporting a broader role in immunopathology as well as bacterial control (<xref ref-type="bibr" rid="B222">Koutantou et&#xa0;al., 2025</xref>). Interestingly, <italic>L. longbeachae</italic> evades neutrophil microbicidal responses, underscoring species-specific strategies to modulate this early barrier (<xref ref-type="bibr" rid="B178">Hanford et&#xa0;al., 2025</xref>). These experimental data place neutrophils alongside alveolar macrophages as central players in shaping early innate immunity and determining the outcome of <italic>L. pneumophila</italic> lung infection.</p>
</sec>
<sec id="s8_4">
<label>8.4</label>
<title>Comparative host responses in amoebae and human macrophages</title>
<p>Although <italic>L. pneumophila</italic> exploits conserved eukaryotic processes to establish a replication-permissive vacuole, the outcome of infection differs substantially between protozoan hosts and mammalian macrophages (<xref ref-type="bibr" rid="B359">Swanson and Hammer, 2000</xref>; <xref ref-type="bibr" rid="B298">Price et&#xa0;al., 2024</xref>; <xref ref-type="bibr" rid="B167">Greub and Raoult, 2004</xref>; <xref ref-type="bibr" rid="B347">Shames, 2023</xref>). Amoebae lack canonical caspase-dependent inflammatory cell death pathways, and <italic>L. pneumophila</italic> replication within protozoan hosts is therefore not associated with pyroptosis or cytokine-driven immune signaling (<xref ref-type="bibr" rid="B144">Gao and Abu Kwaik, 2000b</xref>; <xref ref-type="bibr" rid="B347">Shames, 2023</xref>; <xref ref-type="bibr" rid="B167">Greub and Raoult, 2004</xref>; <xref ref-type="bibr" rid="B143">Gao and Abu Kwaik, 2000a</xref>). Instead, bacterial replication within amoebae is primarily constrained by nutrient availability, encystation, and non-inflammatory host stress responses that permit long-term bacterial persistence without host cell lysis (<xref ref-type="bibr" rid="B217">Kilvington and Price, 1990</xref>; <xref ref-type="bibr" rid="B38">Boamah et&#xa0;al., 2017</xref>). In contrast, infection of mammalian macrophages triggers layered innate immune pathways, including caspase-1-dependent inflammasome activation, species-specific noncanonical inflammasome signaling, NF-&#x3ba;B-driven transcriptional programs, and perturbations of host cell cycle and metabolic state, many of which restrict bacterial replication while simultaneously contribute to inflammatory pathology (<xref ref-type="bibr" rid="B347">Shames, 2023</xref>; <xref ref-type="bibr" rid="B10">Akhter et&#xa0;al., 2009</xref>; <xref ref-type="bibr" rid="B59">Case et&#xa0;al., 2013</xref>; <xref ref-type="bibr" rid="B149">Ge et&#xa0;al., 2009</xref>; <xref ref-type="bibr" rid="B28">Bass et&#xa0;al., 2023</xref>). Importantly, several of these mammalian responses may or may not have evolved from dedicated adaptation of <italic>L. pneumophila</italic> to vertebrate immunity, but from the translocation of amoeba-adapted effector activities within an evolutionarily divergent host context. This possibility underscores how protozoan selection has shaped bacterial virulence mechanisms that manifest as either permissive or restrictive outcomes depending on host immune architecture (<xref ref-type="bibr" rid="B359">Swanson and Hammer, 2000</xref>; <xref ref-type="bibr" rid="B298">Price et&#xa0;al., 2024</xref>, <xref ref-type="bibr" rid="B300">Price et&#xa0;al., 2020</xref>; <xref ref-type="bibr" rid="B347">Shames, 2023</xref>).</p>
</sec>
</sec>
<sec id="s9" sec-type="conclusions">
<label>9</label>
<title>Conclusions</title>
<p><italic>L. pneumophila</italic> is an environmentally trained intracellular predator whose virulence traits emerged through sustained interactions and long-term co-evolution with protozoa (<xref ref-type="bibr" rid="B264">Mraz and Weir, 2022</xref>; <xref ref-type="bibr" rid="B326">Romanov and O&#x2019;connor, 2024</xref>; <xref ref-type="bibr" rid="B298">Price et&#xa0;al., 2024</xref>). This ecological perspective explains the organism&#x2019;s sophisticated intracellular lifecycle, biphasic differentiation, metabolic plasticity, and vast secretory capacity, all of which are pre-optimized for survival in unicellular phagocytic amoebae hosts (<xref ref-type="bibr" rid="B264">Mraz and Weir, 2022</xref>; <xref ref-type="bibr" rid="B326">Romanov and O&#x2019;connor, 2024</xref>; <xref ref-type="bibr" rid="B38">Boamah et&#xa0;al., 2017</xref>). At the core of its intracellular program is the Dot/Icm T4SS, which translocates ~350 effectors to orchestrate host vesicle trafficking, translation, autophagy, phosphoinositide signaling, ER remodeling, and ubiquitin-mediated control of immunity (<xref ref-type="bibr" rid="B110">Du Toit, 2019</xref>; <xref ref-type="bibr" rid="B307">Qiu and Luo, 2017b</xref>; <xref ref-type="bibr" rid="B53">Burstein et&#xa0;al., 2016</xref>) (<xref ref-type="fig" rid="f2"><bold>Figure&#xa0;2</bold></xref>). The co-existence of para-effectors targeting the same host pathway and metaeffectors imposing temporal control underscores that robust intracellular survival has been the primary selective pressure. Although most effectors have little impact in macrophages when deleted individually, this dispensability is precisely what one would expect from a system honed to function across diverse amoebae hosts. in humans, these amoeba-adapted repertoires collide with innate immune networks that <italic>L. pneumophila</italic> never evolved to counter, shaping both protection and immunopathology during infection. Complementing its intracellular arsenal, the T2SS mediates extracellular proteolysis, acquisition of host nutrients, transfer to secondary hosts, protozoan exit, and non-phagosomal effector export, reinforcing the concept that <italic>Legionella</italic> pathogenesis spans both intracellular and extracellular phases (<xref ref-type="bibr" rid="B396">White and Cianciotto, 2019</xref>; <xref ref-type="bibr" rid="B94">Debroy et&#xa0;al., 2006a</xref>; <xref ref-type="bibr" rid="B95">Debroy et&#xa0;al., 2006b</xref>). The coordination of these secretion systems reveals that virulence is not restricted to vacuolar replication, but includes environmental survival, transmission, and community-level persistence.</p>
<fig id="f2" position="float">
<label>Figure&#xa0;2</label>
<caption>
<p><italic>L. pneumophila</italic> effector targets in macrophage. Following translocation via the Dot/Icm Type IV Secretion System (T4SS), <italic>L. pneumophila</italic> injects over 350 effectors that remodel the host cell environment to promote LCV biogenesis, immune evasion, and nutrient acquisition. Effectors modulate diverse host processes including membrane trafficking and ER recruitment, inhibition of endosomal-lysosomal degradation pathway, and cytoskeleton remodeling. Despite the vast amount of research characterizing the effectors that are shown here, these only represent about 20% of all effectors.</p>
</caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fcimb-16-1787137-g002.tif">
<alt-text content-type="machine-generated">Diagram illustrates various cellular processes manipulated by Legionella effectors, including cytoskeleton remodeling, proteasomal turnover, glycolysis, endosomal and lysosomal fusion, autophagy, and lipid metabolism, with each process linked to specific effector proteins labeled in colored text.</alt-text>
</graphic></fig>
<p>Host exploitation by <italic>L. pneumophila</italic> also operates strongly at the metabolic level. The LCV has emerged as a dynamically remodeled nutrient acquisition hub and vesicle traffic that is regulated by both bacterial secretion programs and host metabolic rewiring (<xref ref-type="bibr" rid="B391">Wang et&#xa0;al., 2024</xref>; <xref ref-type="bibr" rid="B113">Eisenreich and Heuner, 2016</xref>; <xref ref-type="bibr" rid="B301">Price et&#xa0;al., 2014a</xref>). Amino-acid auxotrophy, iron acquisition, carbon redistribution, and PHB storage are tightly coupled to its virulence lifecycle, positioning nutritional virulence as a co-equal pillar to effector biology (<xref ref-type="bibr" rid="B391">Wang et&#xa0;al., 2024</xref>; <xref ref-type="bibr" rid="B113">Eisenreich and Heuner, 2016</xref>). In human infection, this metabolic flexibility may contributes to prolonged intracellular survival, persistence within alveolar macrophages, and the capacity to withstand nurtient limitation imposed by the immune response. Future work that couples effectors genetics with spatially resolved metabolomics and flux analyses will be essential to define which metabolic circuits represent true vulnerabilities versus environmentally entrenched necessities.</p>
<p>In amoebae hosts, <italic>L. pneumophila</italic> exploits highly efficient phagocytic machinery and establishes a replication-permissive vacuole within a cellular environment that lacks inflammasome, caspase-dependent cell death pathways, cytokine signaling, and other defining features of mammalian innate immunity (<xref ref-type="bibr" rid="B173">Hagele et&#xa0;al., 2000</xref>; <xref ref-type="bibr" rid="B359">Swanson and Hammer, 2000</xref>; <xref ref-type="bibr" rid="B38">Boamah et&#xa0;al., 2017</xref>). However, studies in mammalian macrophages indicate that <italic>L. pneumophila</italic> is detected and constrained by mammalian innate immune pathways. Murine studies reveal strong inflammasome-mediated restriction through NAIP5/NLRC4, caspases-1/7, and caspase-11-dependent non-canonical pathways, whereas human macrophages rely on distinct PRR combinations, IRF-driven responses, GBP-mediated vacuolar disruption, and cytokine circuits that differ fundamentally from those in mice (<xref ref-type="bibr" rid="B10">Akhter et&#xa0;al., 2009</xref>; <xref ref-type="bibr" rid="B59">Case et&#xa0;al., 2013</xref>; <xref ref-type="bibr" rid="B28">Bass et&#xa0;al., 2023</xref>). Although human macrophages initially support <italic>L. pneumophila</italic> replication, subsequent selective translation blockade, selective cytokine upregulation, metabolic reprogramming, and IL-1R-dependent bystander activation reveal how amoeba-adapted virulence mechanisms trigger vertebrate innate immune defenses to generate a highly layered host response.</p>
<p>In addition, many Dot/Icm effectors directly modulate NF-&#x3ba;B signaling in mammalian cells while the NF-&#x3ba;B pathways do not exist in amoebae (<xref ref-type="bibr" rid="B149">Ge et&#xa0;al., 2009</xref>; <xref ref-type="bibr" rid="B239">Losick et&#xa0;al., 2010</xref>). Effectors such as LegK1 and LnaB activate NF-&#x3ba;B signaling while MavC and RavD inhibit NF-&#x3ba;B signaling pathways (<xref ref-type="bibr" rid="B149">Ge et&#xa0;al., 2009</xref>; <xref ref-type="bibr" rid="B239">Losick et&#xa0;al., 2010</xref>; <xref ref-type="bibr" rid="B139">Gan et&#xa0;al., 2019a</xref>; <xref ref-type="bibr" rid="B389">Wan et&#xa0;al., 2019</xref>). A possible interpretation may be that these proteins originally evolved to manipulate amoebal cellular pathways that share architectural motifs with mammalian NF-&#x3ba;B networks (<xref ref-type="bibr" rid="B300">Price et&#xa0;al., 2020</xref>). In macrophages, these same activities intersect with inflammatory transcription and cell survival programs, producing outcomes that are sometimes beneficial for the bacterium or sometimes strongly host-protective. Thus, modulation of various mammalian-specific processes, which do not exist in unicellular amoebae, by <italic>Legionella</italic> may be an accidental host response to amoebae-adapted effectors, such as the LamA effector that interferes with amoebae encystation but once injected into human macrophages, it triggers a paradoxical pro-inflammatory response. However, it is likely that some of the effectors that target mammalian-specific processes have evolved through interaction of <italic>Legionella</italic> with multi-cellular eukaryotic hosts in the environment prior to adaptation to mammalian hosts. Identifying the amoeba host targets of the effectors will uncover the two possibilities and shed further light on evolution of <italic>Legionella</italic> to infect human macrophages.</p>
<p>Moving forward, the field must pivot toward systems-resolution infection biology, integrating single-cell infection heterogeneity, spatial proteomics at the LCV, time-resolved hierarchical effector secretion mapping, and isotope-traced metabolomics across both protozan and mammalian hosts. Notably, domains from Dot/Icm effectors such as SidC, SidK, AnkX, and others have already been adapted as fluorescent biosensors and protein labeling systems, highlighting the experimental tractability through this approach (<xref ref-type="bibr" rid="B242">Luo et&#xa0;al., 2015</xref>; <xref ref-type="bibr" rid="B253">Maxson et&#xa0;al., 2022</xref>; <xref ref-type="bibr" rid="B183">Heller et&#xa0;al., 2015</xref>). Dissecting virulence at this multi-layered resolution will redefine how other amoebae hosts interpret effector essentiality, reveal host-specific vulnerabilities, and expose metabolic bottlenecks that sustain the replicative niche. <italic>L. pneumophila</italic> pathogenesis represents an emergent property of section-driven cellular remodeling, metabolism-driven niche adaptation, and ecology-driven evolutionary selection. Understanding the organism at these intersections, rather than through isolated pathways, will accelerate translational strategies in therapeutic targeting, water-system risk monitoring, and predictive outbreak prevention. More broadly, <italic>L. pneumophila</italic> serves as a model for understanding how environmental pathogen evolve complex intracellular lifestyles that accidentally translate into human virulence, and how innate immunity responds to a pathogen whose evolution occurred largely outside vertebrate hosts.</p>
</sec>
</body>
<back>
<sec id="s10" sec-type="author-contributions">
<title>Author contributions</title>
<p>CS: Writing &#x2013; original draft, Writing &#x2013; review &amp; editing. YA: Writing &#x2013; review &amp; editing, Writing &#x2013; original draft.</p></sec>
<sec id="s12" sec-type="COI-statement">
<title>Conflict of interest</title>
<p>The author(s) declared that this work was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.</p>
<p>The author YA declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision.</p></sec>
<sec id="s13" sec-type="ai-statement">
<title>Generative AI statement</title>
<p>The author(s) declared that generative AI was not used in the creation of this manuscript.</p>
<p>Any alternative text (alt text) provided alongside figures in this article has been generated by Frontiers with the support of artificial intelligence and reasonable efforts have been made to ensure accuracy, including review by the authors wherever possible. If you identify any issues, please contact us.</p></sec>
<sec id="s14" sec-type="disclaimer">
<title>Publisher&#x2019;s note</title>
<p>All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.</p></sec>
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<p>Edited by: <ext-link ext-link-type="uri" xlink:href="https://loop.frontiersin.org/people/15591">Amal O. Amer</ext-link>, The Ohio State University, United States</p></fn>
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<p><ext-link ext-link-type="uri" xlink:href="https://loop.frontiersin.org/people/476507">Ascel Samba-Louaka</ext-link>, University of Poitiers, France</p></fn>
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