Abstract

The ALDH2*2 (rs671) variant present in >500 million individuals reduces ALDH2 function, impairing aldehyde detoxification. While aldehyde accumulation in these individuals is associated with numerous negative health consequences, a previous study showed a cohort of ALDH2*2 carriers are less likely to develop active pulmonary tuberculosis. Here, we present additional human data that support this finding and show ALDH2-deficiency in mice provides a fitness advantage during bacterial infections. We found aldehydes normally detoxified by ALDH2 killed the bacterial pathogens Mycobacterium tuberculosis and Francisella tularensis. Infected macrophages from Aldh2-/-mice had higher levels of formaldehyde and 4-hydroxynonenal, which enhanced their microbicidal capacity. Aldh2-/- mice were more resistant to infection with Mycobacterium tuberculosis and Francisella tularensis than parental mice and displayed elevated inflammatory cytokine and chemokine levels, accompanied by an increased accumulation of inflammatory monocytes and macrophages. These findings support a model in which host-derived aldehydes are robust innate immune effectors, limiting bacterial infection through both direct microbicidal activity and immune modulation. Collectively, this work may explain why the ALDH2*2 allele was selected for in humans.