Abstract
The glycocalyx of human cells differs from that of many other mammals by the lack of the sialic acid N-glycolylneuraminic acid (Neu5Gc) and increased abundance of its precursor N-acetylneuraminic acid (Neu5Ac). Most humans also have circulating antibodies specifically targeting the non-human sialic acid Neu5Gc. Recently, several additional mammalian species have been found to also lack Neu5Gc. In all cases, loss-of-function mutations in the gene encoding the sialic acid-modifying enzyme CMAH are responsible for the drastic change in these species. Unlike other glycan antigens, Neu5Gc apparently cannot be produced by microbes, raising the question about the origin of these antibodies in humans. Dietary exposure and presentation on bacteria coating themselves with Neu5Gc from the diet are distinct possibilities. However, the majority of the non-human species that lack Neu5Gc do not consume diets rich in Neu5Gc, making it unlikely that they will have been immunized against this sialic acid. A notable exception are mustelids (ferrets, martens and their relatives) known for preying on various small mammal species rich in Neu5Gc. No studies exist on levels of anti-Neu5Gc antibodies in non-human species. Evolutionary scenarios for the repeated, independent fixation of CMAH loss-of-function mutations at various time points in the past include strong selection by parasites, especially enveloped viruses, stochastic effects of genetic drift, and directional selection via female immunity to paternal Neu5Gc. Convergent evolution of losses of the vertebrate-specific self-glycan Neu5Gc are puzzling and may represent a prominent way in which glycans become agents of evolutionary change in their own right. Such change may include the reconfiguration of innate immune lectins that use self-sialic acids as recognition patterns.
Introduction
The glycocalyx of all vertebrate cells is decorated with abundant terminal sialic acids. These acidic nine-carbon backbone sugars cap the ends of tens to hundreds of millions of glycan chains per cell. In mammalian species and other vertebrates, the sialic acids N-acetylneuraminic acid (Neu5Ac) and its derivative N-glycolylneuraminic acid (Neu5Gc) are the two most common forms, each a family of molecules with various modifications of the canonical, 9-carbon monosaccharide (). Until recently, humans were the only mammalian species known to lack the sialic acid Neu5Gc, as our lineage fixed the loss-of-function mutation affecting the single copy CMAH gene that encodes the sialic acid-modifying enzyme CMAH over 2 million years ago in the lineage leading to H. sapiens (, ). More recently, several other species of mammals have been documented to also lack Neu5Gc due to ancient mutations fixed over 30 million years ago in these lineages (–). The loss of function of the CMAH enzyme prevents the modification of the precursor monosaccharide to the derived sialic acid Neu5Gc (in their respective sugar-nucleotide form, CMP-Neu5Ac and CMP-Neu5Gc). As illustrated in Figure 1, the lack of this enzymatic function can lead to drastic changes in the molecular composition of the glycocalyx of cells throughout the body. Recent evidence has shown that humans are not alone in this loss, instead several other species of mammals have independently fixed different loss-of-function mutations of their Cmah gene at various time depths during evolution, leading to loss of Neu5Gc in entire lineages or just individual species (). These losses have occurred through exon deletion, premature stop codons, or frameshift mutations in the gene encoding the CMAH enzyme (–). The picture emerging is that of a phylogeny of mammals punctuated with taxa that have lost the capacity to synthesize Neu5Gc (Figure 2). These taxa include New World primates (>100 species of South and Central American primates known as Platyrrhynes), Mustelidae (57 species of small carnivores including ferrets, martens and weasels), pinnipeds (33 species comprising seals, sea-lions and walruses), Procyonidae (~15 species including racoons, ring-tails and coatis,) hedgehogs (17 species), bats from at least two different lineages, sperm whale (a single species), and white-tailed deer (a single species) (–). For most of these groups, only a few representative taxa and a few individuals have been studied at the genomic level, and so there is the possibility that the Cmah gene remained intact or polymorphic in some of the taxa.
Figure 1
Figure 2

Parallel evolution and loss of an innate self-signal. Humans cannot synthesize Neu5Gc, because human CMAH was inactivated over two million years ago (red). The inactivating mutation apparently fixed rapidly after originating, which suggests that the loss could have been adaptive—driven by pathogen avoidance, reproductive conflict, or a combination of the two. Independent losses of Cmah function have recently been found in New World Primates, Mustelids and several other groups. Figure modified from Springer and Gagneux (
An obvious prediction is that additional taxa with inactivated Cmah genes will be discovered as additional complete genome sequences are obtained. These cases of convergent molecular evolution result in an overall reconfiguration of the outermost layer of the glycocalyx, now lacking Neu5Gc and carrying an excess of Neu5Ac, given that human and non-human cells retain comparable levels of sialic acid (
Another potential consequence are autoreactive antibodies produced against the lost sialic acid. Indeed, despite the absence of endogenous Neu5Gc, experimental studies in humans and in Cmah(−/−) mice have revealed that dietary Neu5Gc, in both free and glycoconjugate-bound forms, can become incorporated into tissues in trace amounts. This incorporation occurs especially in tissues with rapid growth and/or turnover rates, including epithelia, endothelia, fetal tissues, and carcinomas (
How ingested Neu5Gc becomes incorporated into the human body remains incompletely understood. There is evidence that Neu5Gc is converted to GalNGc and can then be incorporated into the glycosaminoglycan chondroitin sulfate, an important component of extra-cellular matrices and skeletal bone (
Natural Immunization Against NEU5GC-glycans
There are four main differences between immunization against Neu5Gc and other xenoglycans, such as the disaccharide alpha-Gal, or alloglycans such as ABO oligosaccharide antigens. First, in the case of other xenoglycans, immunization against the missing, terminal “self”-glycan is thought to be caused by encounters with microbial glycans with the same structure (
While humans have many dietary sources for Neu5Gc, among the New World primates, there are very few species that eat vertebrate meat. Capuchin monkeys (genera Cebus and Sapajou) are known to prey on young coati (40), relatives of racoons belonging to the family of Procyonidae, and on lizards or birds, but these prey species all lack endogenous Neu5Gc (
Evolutionary Mechanisms for the Fixation of Loss-of-function Mutation
The loss-of-function mutations of the Cmah gene are by definition recessive, as one copy of the functional gene suffices to generate a Neu5Gc positive phenotype in a diploid organism.
Balancing Selection Maintaining Polymorphisms
Some animals, including several dog and cat breeds, are polymorphic for Neu5Gc expression. While overall tissue expression is thought to be low, expression on blood cells in these animals can be high (47, 48). Polymorphisms involving Neu5Gc on the ganglioside GD3 exist in felids and are called AB blood groups in domestic cats (not related to primate ABO blood groups), where cats lacking Neu5Gc-GD3 have circulating antibodies specific for Neu5Gc (47). Dog breeds also differ in their expression of Neu5Gc on red blood cell glycolipids (48).
Due to the recessive nature of loss of function mutations, their increase in frequency within a population must be mediated by selection on homozygous carriers, who have fitness advantages conferring higher survival and/or reproductive success. For example, selection for polymorphisms involving a loss-of-function mutation could be based on the accompanying ablation of the glycan used as a receptor by pathogens (49–52).
Examples of Neu5Gc specific pathogens abound including the protozoan malaria parasite P. reichenowi (53), the swine pathogen E. coli K99 (54) and the macaque monkey virus SV40 (55).
In contrast a number of human-specific pathogens evolved specificity for Neu5Ac, including the causative agent of human malignant malaria P. falciparum,the toxins of cholera agent V. cholerae (56) and typhoid fever agent S. typhi (57), and most influenza A viruses (58). Loss-of-function mutations, especially in polymorphic populations, could also provide partial protection from enveloped viruses that bear the antigenic glycan acquired from the cell membrane of the previous, Neu5Gc positive host. The latter mechanism would be analogous to such protection in alpha-Gal negative Old World primates (59–61) and across ABO mismatched humans (62–65). Such protective mechanisms are thus observed both, between species and within species with existing (balanced) polymorphisms. Balanced polymorphisms are maintained by frequency-dependent selection, i.e., selection favoring the rare variants, thus preventing their extinction but also preventing their fixation (see Figure 3) (66). Such dynamic co-evolutionary processes between pathogens and their hosts are the inspiration behind the terms evolutionary arms race and Red-Queen effects (
Figure 3

Schematic of the interplay of natural and sexual selection acting on cell-surface sialic acids. (A) Natural selection by pathogens recognizing and exploiting Neu5Gc (blue diamond) as a receptor on host target cells can select for mutant CMAH(−) alleles that abolish expression of Neu5Gc in homozygote individuals and prevent infection. Such homozygous null individuals have only Neu5Ac on their cells (red diamonds) and at higher frequencies would be targeted by other pathogens adapted or adapting to the host glycan change (magenta). This equilibrium would result in maintenance of glycan polymorphism by balancing selection. (B) Anti-Neu5Gc antibody-expressing CMAH(−/−) females, immunized by dietary consumption of Neu5Gc rich food (red meat) or by sperm antigens containing Neu5Gc, favor loss-of-function alleles on sperm due to reproductive incompatibility with CMAH(−/+) or CMAH(+/+) males expressing Neu5Gc on their sperm. Once the frequency of the CMAH(−) allele reaches a certain level, this process can drive the fixation of the CMAH(−) allele in a population via directional selection. Figure modified from Ghaderi et al. (
Fixation of the loss-of-function allele, on the other hand, could happen either via directional selection or genetic drift, where small founder populations consist mostly of homozygous carriers of the loss-of-function mutation. First defined using plants in 1962 (68) and recently applied to primates by Galili (65), the idea of “catastrophic selection” combines these ideas with very strong selection. It is not clear how such “catastrophic selection” differs from short episodes of strong selection, possibly accompanied by demographic bottlenecks, which could also result in the fixation of loss-of-function mutations. Alternatively, selective pressure for Cmah loss-of-function could occur through reproductive conflict as discussed below.
Female Immune-Mediated Selection Against Paternal Neu5Gc
Mammalian sperm are highly sialylated as a mechanism to enhance sperm survival and function along the perilous journey through the female reproductive tract to the site of fertilization in the oviduct (69–71). Mammals make anti-sperm antibodies when directly exposed to sperm (72). Major human sperm antigens include, highly sialylated GPI-anchored glycoproteins such as CD52 (73, 74), which in males that have a functional CMAH allele, carry Neu5Gc (75). Theoretically, immunization of females homozygous for the loss-of-function allele of Cmah could occur via insemination by males that have Neu5Gc-bearing sperm. Indeed, we have shown experimentally, using Cmah(−/−) mice immunized against Neu5Gc, that their immune response against Neu5Gc bearing sperm severely reduces female fertility (
In addition to blocking fertilization, it is possible that anti-Neu5Gc immunity from a primed CMAH(−/−)mother (
Reproductive xenosialitis could thus be a plausible mechanism mediating directional selection, leading to the fixation of the loss-of-function allele in the population, irrespective of the mechanism(s) involved for the initial selection favoring the mutation (see Figure 4).
Figure 4

Exogenous (dietary) Neu5Gc and anti-Neu5Gc antibody as contributing factors to unexplained human infertility. The combination of incorporated dietary xenoglycan Neu5Gc (even in trace amounts) from red meat and milk products including cow milk-based infant formula and anti-Neu5Gc antibodies in males or females (A) could have deleterious consequences on human fertility via a number of potentially additive mechanisms which include: (B) coating of sperm by male and/or female anti-Neu5Gc antibodies, interference with sperm function, including passage through cervical mucins and/or other restrictive parts of the female reproductive tract such as the utero-tubal junction, (C) increased sperm death via female cellular and humoral immunity, where most sperm are killed by female immunity, (D) interference with sperm capacitation when sperm membranes get dynamically reconfigured, (E) interference with sperm penetration of vestment, interference with sperm-egg interactions, (F) interference with endometrial decidualization and receptivity resulting in reduced success of implantation. Figure modified from Ma et al. (75) with permission.
Conclusions and Perspectives
It is interesting that watershed events, such as the loss of Neu5Gc from the glycocalyx of human cells have occurred numerous times in many mammalian and other vertebrate species. These cases of convergent evolution represent precious opportunities for increased understanding of evolutionary processes. In some respects, Neu5Gc is an ideal self-molecule as it is “private” to vertebrates and, based on current data, has yet to be successfully mimicked by microbes. Against the background of this benefit, the loss of Neu5Gc appears paradoxical and may implicate strong selective regimes, either catastrophically caused by pathogens, or under directional sexual selection via female immunity to paternal xenoglycans. Massive genetic drift, or combinations of milder selection and founder events, can also not be excluded.
More information on species expected to encounter Neu5Gc in their diets, i.e., mustelids, pinnipeds, and humans, is needed to begin answering several outstanding questions in the field: For instance, what are the potential protective functions of anti-Neu5Gc antibodies in species that lack this sialic acid, especially as regards ongoing protection from cross-species infections by enveloped viruses bearing Neu5Gc on their viral envelopes? Or on the flip-side, what are the potential liabilities of anti-Neu5Gc antibodies due to autoimmunity against incorporated dietary Neu5Gc? Evolutionary events such as the ones discussed here exemplify how glycans, rather than representing the end result of different evolutionary histories and contingencies, can become an evolutionary force of their own and constrain future evolution of entire lineages including subsequent compensatory evolution of glycan binding immune receptors (
Statements
Author contributions
MA and PG did the research and wrote the paper. PG produced the figures.
Funding
Mathers Charitable Foundation, Mizutani Foundation for Glycosciences, Grant 170174.
Conflict of interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
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Summary
Keywords
sialic acid, Neu5Gc, Neu5Ac, xenoglycan, anti-glycan antibodies, xeno-antigen
Citation
Altman MO and Gagneux P (2019) Absence of Neu5Gc and Presence of Anti-Neu5Gc Antibodies in Humans—An Evolutionary Perspective. Front. Immunol. 10:789. doi: 10.3389/fimmu.2019.00789
Received
13 January 2019
Accepted
25 March 2019
Published
30 April 2019
Volume
10 - 2019
Edited by
Vered Padler-Karavani, Tel Aviv University, Israel
Reviewed by
Amanda L. Lewis, Washington University in St. Louis, United States; Yaqing Qie, Mayo Clinic Florida, United States; Paul Crocker, University of Dundee, United Kingdom
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Copyright
© 2019 Altman and Gagneux.
This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). 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.
*Correspondence: Pascal Gagneux pgagneux@ucsd.edu
This article was submitted to Nutritional Immunology, a section of the journal Frontiers in Immunology
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