Journal of Leukocyte Biology

BackgroundNeutrophils play an important role in the immune system and sense environmental perturbations including pathogens. Upon pathogen detection, neutrophils extrude their chromatin, forming neutrophil extracellular traps (NETs) trapping and removing pathogens. Previous studies have shown that controlled chromatin decondensation occurs during NET formation, reflecting NET inducing pathways, and the cellular environment. While NET inducing stimuli like phorbol 12-myristate 13-acetate (PMA) is commonly used to study NET formation, it bypassing regulatory mechanisms, limiting insights. MethodsWe used the Assay for Transposase-Accessible Chromatin with sequencing (ATAC-Seq) to profile chromatin accessibility in neutrophils stimulated in whole blood with PMA and physiologically relevant inflammatory factors (NFs), including TNF-, GM-CSF, fMLP, C5a, and IL-1{beta}, alone and in combination. Chromatin responses were compared across conditions and integrated with publicly available transcriptomic sepsis cohorts. ResultsWe found that NF stimulation induced stimulus specific chromatin accessibility programs distinct from PMA. Individual NFs increased specific transcription factor (TF) motif enrichments in a stimulus dependent manner, with GM-CSF increasing STATs, TNF- increasing NF-{kappa}B, C5a/fMLP increasing AP-1, and Combined with a cooperative response including CEBP. Integration with sepsis transcriptomic datasets revealed that promoter accessibility changes within NF stimulations correspond to transcriptional states associated with sepsis disease severity, highlighting the upstream regulatory programs linked to clinical outcomes. ConclusionsThese findings demonstrate that NF stimulation in whole blood reveals chromatin accessibility programs in neutrophils that correlate with disease severity in sepsis. This approach provides a framework for linking cytokine driven neutrophil regulation to heterogenous inflammatory states in sepsis and other NET-associated diseases.

Tracking mature neutrophils remains challenging due to the lack of reliable cell surface markers. Although CD101 is a promising candidate for mature neutrophils, its stability under pathological conditions is unclear. Using a CD101-tdTomato reporter mouse model, we confirmed that the reporting system does not alter CD101 expression, and tdTomato fluorescence is predominantly expressed in mature neutrophils across peripheral tissues. Further analysis revealed that CD101+ and tdTomato+ neutrophils display identical characteristics of mature neutrophil, including poly-segmented nuclei, cell size, and key functions under homeostasis. By comparing tdTomato fluorescence with CD101 protein levels, we demonstrate that reduced CD101 expression under pathological states was not attributed to shedding or degradation. Our finding enhances CD101 as a robust and reliable marker of neutrophil maturity, providing a foundation for future applications in spatial transcriptomics and lineage tracing studies to dissect neutrophil heterogeneity and function. Highlights of the studyO_LIIn CD101-tdTomato homozygous mice, tdTomato is predominantly expressed in neutrophils and labels nearly 100% of mature neutrophils, aligning with the phenotype of CD101+ mature neutrophils; C_LIO_LIThe CD101-tdTomato reporting system does not interrupt CD101 expression or neutrophil functions; C_LIO_LICD101 remains a stable and reliable cell surface marker for labeling mature neutrophils, even under pathological conditions. C_LI

A role for substance P in promoting neurogenic inflammation and pain has been described in sickle cell disease (SCD). However its origin and contribution to SCD pathophysiology remain unclear. We measured substance P level in plasma from 225 patients with SCD and observed the highest concentrations during acute chest syndrome (ACS). Therefore, we tested the hypothesis that substance P may induce ACS. In transgenic sickle mice, unlike control mice, intravenous injection of substance P caused lethal crises with dose-dependent acute lung injuries. Activation of Fc{varepsilon}R1 with MAR-1 had similar effects, suggesting a role for mast cell or basophil activation and degranulation. Pretreatment of sickle mice with cromolyn, a stabilizer of mast cells and basophils, prevented lethal crisis and lung injuries induced by substance P injection. In SCD patients, blood cellular histamine levels and increased histidine decarboxylase activity were consistent with an involvement of circulating basophils. Flow cytometry analysis revealed higher basophil counts with increased activation and degranulation markers in patients compared with healthy controls. During vaso-occlusive crisis, absolute basophil counts tended to decrease, suggesting their recruitment outside the vascular compartment. The same results were observed in sickle mice after hypoxia-reoxygenation, intravenous hemin injection or substance P injection. Immunohistochemistry revealed the presence of mast cells and basophils in the lungs of sickle mice, but not in control mice, with further basophil recruitment and degranulation after intravenous substance P injection. In SCD patients, we observed extremely high levels of substance P in the sputum collected during ACS, consistently with mast cell and basophil degranulation in the lungs. In vitro, substance P was shown to be a potent chemoattractant for basophils via NK1R. Gene expression analysis on sorted circulating basophils from SCD patients revealed an increased expression of several chemokine receptors, including CCR3 and FPR1, which was confirmed by spectral flow cytometry and could contribute to the recruitment of basophils in the lungs. The two substance P receptors, NK1R and MRGPRX2, were also overexpressed, promoting the vicious cycle of substance P release and pain in SCD patients. Our results reveal a novel mechanism that contributes to the understanding of ACS pathogenesis and highlights the potential role of mast cells and basophils in SCD pathophysiology.

Pharmacological approaches to inhibit extracellular vesicle (EV) release in vivo are increasingly used, although the effects of such compounds on local cellular environments are not fully understood. In this study, we examined the impact of intraperitoneal (i.p.) administration of the neutral sphingomyelinase inhibitor GW4869 on EV levels in the peritoneal cavity. Repeated GW4869 i.p. injections elicited a marked local inflammatory response, reduced peritoneal macrophage numbers, and paradoxically increased EV concentrations 24 hours after treatment. Independent macrophage depletion reproduced this rise in EV levels, indicating that macrophage loss and associated cellular remodeling contribute substantially to EV accumulation. These observations indicate that GW4869 can perturb local immune homeostasis in vivo, a confound that must be considered when using this compound as a putative selective inhibitor of EV release.

The migration of polymorphonuclear neutrophils (PMN) into the site of infection such as lungs during pneumonia is a canonical feature of innate immunity. Formation of neutrophil-derived extracellular traps (NETs), web-like strands of varying lengths comprising DNA, histones, elastase, and myeloperoxidase, is an important determinant of PMN-mediated innate immunity. NETs form in microvessels, entrap bacteria and effete matter, and dampen PMN-mediated inflammatory injury at specific sites. However, studies have largely focused on NET release secondary to lytic NETosis and lysis of PMN. Far less is known about vital NETosis occurring in the absence of PMN rupture. As vital NETosis is characterized by generation of anuclear PMN termed cytoplasts (PMNcyto), we addressed the function of PMNcyto as a critical determinant of PMN-mediated innate immunity. Studies were made in mice challenged with live Pseudomonas aeruginosa (PA) i.t. to induce fulminant pneumonia characterized by tissue injury in which we determined the role of generated PMNcyto population. Using Tomato Red (tDTomato) transgenic mice to mark PMN, we observed PA pneumonia induced PMN transmigration leading to PMNcyto generation in the airspace. In contrast, PMNcyto transmigration, was minimal. PMNcyto accumulating in lung tissue actively phagocytosed and killed PA. Instillation of ex vivo generated PMNcyto also prevented PA-induced inflammatory lung injury and reduced mortality as compared to control mice. We demonstrated that the salutary effects of PMNcyto required functional microchondria. Proteomic analysis revealed that PMNcyto retained bactericidal and ROS generating pathways, consistent with an intact plasma membrane. Genetic deletion of peptidyl arginine deaminase 4 (PAD4), which mediates histone citrullination and promotes NETosis, facilitates PMNcyto generation and thereby abrogated pneumonia-induced mortality. Thus, we have identified the crucial host defense function of PMNcyto generated post-vital NETosis, suggesting that PMNcyto hold promise as cell based anti-bacterial therapy in pneumonia.

Rationale: Sepsis is a life-threatening syndrome causing significant morbidity and mortality especially in the aging population. Clonal hematopoiesis of indeterminate potential (CHIP) is an age-related condition of clonal expansion of hematopoietic stem cells harboring somatic mutations associated with increased incidence of chronic illness and all-cause mortality. Objective: Evaluate the association of pre-illness CHIP with mortality and morbidity in patients admitted to the ICU with sepsis. Methods: We performed a retrospective study using a de-identified electronic health record linked with a DNA biorepository. We identified adult patients with sepsis who had DNA collected prior to ICU admission. We tested the association between CHIP status, determined from whole-genome sequencing, and ICU mortality, organ support-free days, and long-term survival adjusting for age, sex, race and Sequential Organ Failure Assessment (SOFA) score on ICU admission. Measurements and Main Results: Pre-illness CHIP was associated with increased sepsis mortality (OR = 1.54, 95% CI 1.13 to 2.07, P = 0.005) and fewer days alive and free of organ support (-1.7 days, 95% CI -3.2 to -0.2, P = 0.028) after adjusting for age, sex, race, and SOFA score. In sepsis survivors, CHIP was also associated with increased long-term mortality after discharge (HR 1.40, 95% CI 1.01 to 1.93, P = 0.041). Conclusions: Pre-illness CHIP was independently associated with increased mortality and morbidity in critically-ill adults with sepsis. These findings suggest that CHIP is a risk factor for sepsis severity. Elucidating the mechanism underlying this association could uncover new therapeutic interventions for sepsis.

Expression of the Csf1r gene in cells of the mononuclear phagocyte lineage is regulated by a conserved enhancer, the fms-intronic regulatory element (FIRE). In mice with a germ-line deletion of FIRE (Fireko) CSF1R expression is undetectable in bone marrow progenitors and classical monocytes. Fireko mice lack subpopulations of macrophages in the brain and periphery but develop normally. Here we show that loss of CSF1R expression in Fireko mice is partly overcome by CSF2 in vitro and inflammatory recruitment in vitro. Analysis of heterozygous mutant mice and deletion of the conserved AP1 motif in FIRE provide evidence that continuous receptor synthesis determines CSF1 responsiveness. The absence of macrophages in kidney and heart of Fireko mice was not associated with detectable loss of physiological function. In a model of renal injury macrophage recruitment and histopathology were similar in WT and Fireko mice. Tissue resident macrophages that were depleted in Fireko mice, including microglia, were replaced by donor-derived cells following intraperitoneal adoptive transfer of wild-type bone marrow at weaning. The Fireko mouse provides a novel platform to dissect the functions of tissue resident macrophages in development, homeostasis and pathology. Summary StatementThis study describes a unique model of selective tissue resident macrophage deficiency arising from dysregulated expression of the mouse Csf1r gene.

Macrophages are innate immune cells contributing to tissue homeostasis and various pathologies. Signals from their environment can lead macrophages to adapt distinct functional phenotypes, a process called polarization. Because macrophages have been previously shown to degrade the nuclear envelope proteins lamin A/C upon pro-inflammatory polarization, and lamins are considered key determinants of nuclear deformability, we aimed to address the effect of pro-inflammatory stimulation on nuclear mechanics. We present the surprising finding that polarized bone marrow-derived macrophages have less deformable nuclei than unpolarized macrophages, despite their reduced lamin A/C levels. Furthermore, pro-inflammatory macrophages exhibited altered chromatin dynamics relative to unpolarized macrophages, including redistribution of trimethylated histone H3K9 (H3K9me3) from the nuclear periphery to the interior and increased chromatin compaction. Our findings suggest a model in which pro-inflammatory stimulation of macrophages induces chromatin changes that drive nuclear stiffening, and that in these cells, chromatin, rather than the nuclear lamina, is the major driver for resisting nuclear deformation. These findings may have functional relevance for the physiological function of polarized macrophages, as the mechanical properties of the nucleus can influence how these cells adapt and respond to their environments in the context of cell migration or inflammatory disease pathologies.

Complement component 3 (C3) is crucial for host defense against bacteria. While the liver is the primary source of circulating C3, local C3 production at barrier surfaces such as the lung is key in early responses. Yet, how local complement-mediated responses are initiated at mucosal barriers is unknown. This study investigates the kinetics and necessity of lung-derived C3 during the initial hours of an infection. Using models of bacterial pneumonia in ex vivo-perfused human lungs and mice deficient in liver-derived C3, we demonstrate that intrapulmonary C3 production and activation precedes the accumulation of circulating C3 into the bronchoalveolar space. Utilizing mice deficient in lung-derived C3, we demonstrate that epithelial cell-derived C3 is required for early neutrophil recruitment in pneumonia. Transcriptomic and proteomic analyses reveal that neutrophil chemotactic pathways such as C5a and CXCL2 depend on lung epithelial cell-derived C3. These findings demonstrate how lung epithelial-derived C3 influences early mucosal responses to infection via both canonical (direct) and non-canonical (indirect) pathways. SUMMARYAlburquerque et al show an initial, entirely local phase of complement-mediated mucosal protection before a subsequent, systemic response occurs in the setting of barrier disruption. Their work suggests that complement component C3 derived locally at a barrier from the epithelium influences early responses to infection by recruiting neutrophils via multiple pathways independent of circulating C3.

BackgroundPersistent inflammation is linked to poor outcomes in patients with chronic coronary syndrome (CCS). The inflammatory state in atherosclerotic disease has been associated with activation of neutrophils as well as with regulatory T cell (Treg) deficiency. The role of Tregs in the regulation of neutrophil survival has been postulated recently. Here, we investigated neutrophil apoptosis along with the potential impact of Tregs on neutrophil apoptosis in patients with CCS, compared to healthy controls. MethodsTwenty patients with CCS and 19 healthy controls were included. Neutrophil apoptosis was assessed after 5h culture with or without interleukin(IL-)10, TNF or LPS. Neutrophil phenotype was evaluated through flow cytometry analysis of surface receptors (CD66b and CXCR4) and ex vivo release of cytokines and granule proteins. The ability of Tregs to induce neutrophil apoptosis was examined in autologous neutrophil-Treg co-cultures. ResultsSpontaneous neutrophil apoptosis was significantly delayed in patients compared to controls (10.3% vs. 19.2%, p=0.025). Also, neutrophils from patients overexpressed CD66b and CXCR4 and were more prone to release proinflammatory mediators. Notably, Tregs induced neutrophil apoptosis in healthy subjects, but not in patients, indicating a loss of Treg-mediated regulation in the latter. There was no evidence that IL-10 had any influence on neutrophil apoptosis. However, cell-to-cell contact was found essential for Treg-induced neutrophil apoptosis. ConclusionsPatients with CCS display delayed neutrophil apoptosis and a pro-inflammatory neutrophil phenotype that is resistant to Treg-mediated apoptosis. Neutrophil dysfunction may contribute to persistent inflammation in patients with CCS, and as such constitute a novel therapeutic target.

BackgroundHumans and mice display elevated levels of IL-27, an immunosuppressive cytokine shown to increase during neonatal bacterial sepsis and compromise survival. This study explores two hypotheses for regulation of IL-27 expression: 1) decreased DNA methylation in newborns that contributes to increased expression of IL-27 genes; 2) neonatal hormones regulate IL-27 expression through upstream hormone response elements (HREs). MethodsWhole genome methyl-seq analysis of neonatal and adult blood-derived macrophages identified differentially methylated regions (DMRs) at steady-state. Quantitative PCR (qPCR) measured expression of IL-27 genes (IL27p28 and EBI3) in human and murine neonatal macrophages stimulated in vitro with synthetic glucocorticoid or progesterone. Confocal microscopy and chromatin immunoprecipitation (ChIP) of glucocorticoid receptor (GR) assessed translocation into the nucleus and binding to the EBI3 promoter. ResultsThe IL-27p28 promoter contained DMRs that were increased in the neonatal cohort. The analysis did not identify DMRs within the EBI3 promoter. Dexamethasone stimulation increased EBI3 gene expression in human and murine neonatal macrophages. GR localized to the nucleus in response to dexamethasone and was enriched at the EBI3 upstream regulatory region. ConclusionThese data suggest glucocorticoid (GC) signaling increases EBI3 expression. This has importance in the context of antenatal GC administration that may increase IL-27 levels. Impact Statement{blacksquare} Elevated expression of IL-27 in early life impairs the host response to invasive bacterial infection in neonates. {blacksquare}Understanding the regulatory mechanisms contributing to increased IL-27 during the neonatal period is necessary to reduce susceptibility to infection in this vulnerable population. {blacksquare}The methylation status of the IL-27 genes in macrophages from neonatal and adult blood donors does not suggest regulation of differential expression with age. {blacksquare}Glucocorticoids are a signal that can induce EBI3 gene expression in a GR-dependent manner. {blacksquare}Glucocorticoid therapy for premature infants may increase IL-27 expression and promote enhanced susceptibility to infection.

Immune memory responses are rapid and qualitatively distinct from primary responses. They typically develop in the presence of antigen-experienced memory T and B cells and pre-existing antibodies. Although the contribution of T and B cells to recall responses is well defined, the contribution of antibody "memory" and the mechanisms by which pre-existing antibodies modulate the development of germinal center and plasma cell responses is not precisely understood. Here we report on mechanisms that mediate antibody enhancement of germinal center (GC) and plasmablast (PB) compartments, and the parallel process by which they change the affinity threshold for B cell recruitment into immune responses. The data indicate that antibody-mediated enhancement of GC and PB responses is Fc gamma receptor (Fc{gamma}R) dependent and largely complement receptor 1 and 2 (CR1/2) independent. In contrast, the reduction in the affinity threshold for GC entry is independent of both Fc{gamma}Rs and CR1/2. SummaryCipolla et al. show that antibody can modulate immune responses via both Fc gamma receptor dependent and independent mechanisms. These mechanisms influence both the magnitude and composition of the germinal center response.

Mycobacterium tuberculosis (Mtb) primarily infects human lung macrophages, which serve as its major replication niche. Mtb can manipulate host macrophage cell death pathways to its advantage by inhibiting apoptosis and inducing necrotic cell death. However, the specific necrotic cell death pathway activated in human macrophages after Mtb infection remains unclear. Here, we used the THP-1 cell line and primary human monocyte-derived macrophage (hMDM) to analyze multiple programmed cell death pathways during days 1-3 after Mtb infection. Confocal microscopic analysis demonstrates that Mtb-infected THP-1 cells or hMDMs rarely exhibited apoptosis. Immunoblotting shows that Mtb induces significant CASP3 and GSDME activation in THP-1 cells, but not in hMDMs. We show that Mtb, in THP-1 cells but not hMDM, induces a significant increase in GSDMD cleavage, a hallmark of pyroptosis. MLKL phosphorylation was not observed in THP-1 cells or hMDMs during Mtb infections, indicating an absence of necroptosis. No changes in ferroptosis markers such as GPX4 expression or lipid peroxidation levels were detected. Time-lapse live-cell imaging revealed no lysosomal membrane permeabilization prior to plasma membrane rupture (PMR). However, we observed DNA release from Mtb-infected THP-1 cells and hMDMs after PMR. The DNA released from THP-1 cells exhibits low levels of myeloperoxidase and histone H3 citrullination. High-resolution confocal imaging shows that Mtb is associated with the released DNA. We demonstrate that pyroptosis induction in THP-1 cells is dispensable for the DNA release and cell death induction. In conclusion, our results reveal that Mtb-triggered cell death in hMDMs bypasses canonical cell death pathways like apoptosis, pyroptosis, necroptosis, and ferroptosis. Instead, cell death in both THP-1 cells and hMDMs correlates with DNA release, potentially through a pathway similar to NETosis in neutrophils.

Premature birth and cesarean section are major perinatal factors influencing immune development and are associated with increased morbidity and inflammatory diseases. However, their impact on neonatal immunity remains incompletely defined. To determine how gestational age and mode of delivery shape early immune programming, we analyzed CD4 T cells, central regulators of adaptive responses, from preterm neonates and full-term neonates born by cesarean section or natural birth. We performed transcriptomic profiling (mRNA-seq) and functional assessment of T cell activation, proliferation, and cytokine production following stimulation. The mode of delivery exerted a dominant effect on the CD4 T cell transcriptome and function. CD4 T cells from full-term neonates delivered by natural birth exhibited an immune activation signature, produced higher levels of multiple cytokines, but showed reduced proliferative capacity. In contrast, prematurity induced modest changes in basal gene expression relative to full- term cesarean section neonates. CD4+ T cells from preterm neonates displayed enhanced proliferation and increased secretion of inflammatory cytokines IL-13, TNF, IL-6, and IL- 17F upon stimulation, indicating heightened responsiveness. Collectively, our findings show that CD4 T cells from preterm neonates exhibit augmented inflammatory capacity, which becomes more regulated at term. The mode of delivery further refines this developmental trajectory: cesarean section is associated with a restrained functional profile, whereas natural birth is associated with an immune activation signature and increased responsiveness. These results provide evidence that neonatal CD4 T cell trajectories are established during fetal life and subsequently modulated at birth, underscoring the layered influence of perinatal factors on immune development.

Human eosinophils activated in suspension with IL5 or IL33 undergo morphological change prior to adhesion. Refractive granules, which contain major basic protein-1 and other toxic proteins, move to one side of the cell, the granulomere, and the two nuclear lobes move to the other. How these features persist when eosinophils become adherent and migrate is not known. We now compare behavior of activated eosinophils on surfaces coated with ITGAM/ITGB2-integrin ligands fibrinogen or periostin using live cell imaging of reporters of tubulin/actin organization and cell viability. We find that unlike eosinophils activated with IL5, IL33-activated eosinophils undergo two stages of activation; a preliminary pear-like activation in which the cell develops polarity, followed by a flattening of the eosinophil into a thin pancake-like morphology with less discrete polarization. IL5-treated eosinophils migrated persistently for more than an hour with nucleopod in the back. In contrast, IL33-treated eosinophils moved more slowly and within 30 min transitioned to a flattened morphology with nuclear lobes in the center and dispersed motile granules. Loss of cell viability after an hour, although variable, in all comparisons was greater among IL33-treated eosinophils on periostin. We sought to understand how cytoskeletal elements may drive these differences in morphology. Cytoskeletal elements had similar responses when activated with IL5/IL33; vimentin collapsed from a web-like network at the periphery of the cell and condensed adjacent to the nucleopod/nuclear interface, f-actin was found in the granulomere as well as the tip of the nucleopod and forward periphery, and microtubules radiated from the microtubule organizing center (MTOC) spanning both the nucleopod and the granulomere. The dynamic formation of microtubules correlated with cellular locomotion, suggesting mesenchymal migration within these cells. These in vitro findings suggest that adhesion plays an important role in determining functional morphology and demonstrates new insights into IL33-activated eosinophils. This work suggests roles for activators and adhesive substrates in regulating the behavior of activated eosinophils in tissues.

Macrophages are now recognised as key players in a range of tissues and biological processes, responding to injury and infection, and facilitating development and regeneration. As the importance of macrophage crosstalk within these processes has been revealed, so too has the significance of studying the spatial positioning of macrophages within the tissue of interest. As such, immunofluorescent microscopy-based analysis is becoming an increasingly attractive technique for immunology research. While tissue fixation preserves the tissue architecture and immobilises target antigens, prolonged fixation can negatively impact protein recognition. We report that prolonged exposure to a paraformaldehyde-based fixative profoundly impacts detection of cell surface markers that define macrophage subsets in the mouse submandibular gland, in contrast to epithelial cell markers which appear more robust. We find that this that this is not exclusive to the salivary gland, and similar effects are seen in the pancreas and kidney. Importantly, a short duration of fixation allowed the detection of macrophage subsets in both mouse and human tissue without compromising the detection of other markers. Adoption of a short fixation approach enables accurate detection of a wide range of cell types in tissues, and facilitates exploration of spatial positioning and cell proximity by immunofluorescent microscopy analysis.

Background/ObjectivesIdentification of prognostic biomarkers that capture biologically aggressive disease remains a major need in chronic lymphocytic leukemia (CLL). Aberrant calcium signaling contributes to leukemic survival; however, the clinical relevance of Ca{superscript 2}/calmodulin-dependent protein kinase kinase 2 (CaMKK2), a calcium-responsive kinase, has not been defined. This study evaluated CaMKK2 as a candidate prognostic biomarker and functional regulator in CLL. MethodsCaMKK2 expression was quantified in purified CD19 CLL cells from a clinically annotated cohort balanced by immunoglobulin heavy chain variable region (IGHV) mutation status. Associations with time-to-treatment and overall survival were analyzed. Functional relevance was assessed by pharmacologic inhibition of CaMKK2 in primary CLL cells using metabolic (MTS) and apoptosis (Annexin V/PI) assays. Correlations between CaMKK2 expression and inhibitor sensitivity were determined. The impact of CaMKK2 inhibition on nurse-like cell (NLC) differentiation and macrophage-mediated leukemic support was evaluated in ex vivo culture systems. ResultsElevated CaMKK2 expression was enriched in IGHV-unmutated CLL and associated with shorter time-to-treatment and inferior overall survival. CaMKK2 inhibition reduced primary CLL viability in a dose-dependent manner and induced apoptosis, with sensitivity correlating with CaMKK2 expression levels. Inhibition also attenuated CD163 macrophage polarization and impaired NLC-mediated support of leukemic cells. ConclusionsCaMKK2 expression identifies biologically aggressive CLL and functionally contributes to leukemic persistence. These findings position CaMKK2 as a prognostically relevant biomarker with therapeutic implications, supporting further evaluation of CaMKK2-targeted strategies in high-risk CLL. Sample SummaryChronic lymphocytic leukemia (CLL) shows marked variability in clinical outcome, highlighting the need for biomarkers that identify patients at higher risk of progression and guide therapeutic strategies. Calcium signaling supports leukemia cell survival, yet the clinical relevance of the calcium-responsive enzyme CaMKK2 has not been established. In this study, we demonstrate that elevated CaMKK2 expression in patient-derived leukemia cells is associated with more aggressive disease and earlier need for treatment. Laboratory experiments further show that inhibiting CaMKK2 reduces leukemia cell survival and disrupts supportive macrophage-like cells within the tumor microenvironment. These results position CaMKK2 as a candidate prognostic biomarker that reflects biologically high-risk disease and may inform therapeutic development. Future studies are warranted to determine whether CaMKK2-based risk stratification or targeted inhibition could improve management of patients with CLL.

Inter-alpha Inhibitor Proteins (IAIP) are serine protease inhibitors and a reliable inflammatory biomarker. We have demonstrated that IAIP levels decrease during sepsis in humans and animal models. Currently, enzyme-linked immunosorbent assay (ELISA) is the standard procedure to measure IAIP levels. We developed a lateral flow immunoassay (LFIA) that allows rapid, point of care detection. We compared IAIP levels in infants with sepsis and/or necrotizing enterocolitis (NEC) by ELISA and LFIA in a multi-center, cross-sectional study. Blood samples were collected from 47 infants with sepsis, 31 sepsis case controls, 52 gestational age (GA)-matched controls and 10 infants with culture-negative sepsis ("clinical sepsis"). We also collected samples from 17 infants with NEC, 7 NEC case controls and 15 GA controls. IAIP levels at presentation of acute events and over the next 72 hours were significantly reduced in infants with sepsis, NEC and culture negative sepsis when compared to controls. IAIP levels did not differ in patients with sepsis or culture negative sepsis. IAIP levels measured by ELISA and LFIA were highly correlated (R2 = 0.9326) and both showed reliable detection of neonatal sepsis, NEC and culture negative sepsis. IAIP levels were 80.0% sensitive and 92.3% specific using LFIA for the detection of neonatal sepsis. For detection of NEC, IAIP levels were 84.6% sensitive and 86.7% specific.

The host response to Neisseria gonorrhoeae is variable, and understanding its systemic and local components is critical to understanding anti-gonococcal immunity for vaccine development. We used a controlled human infection model of male gonococcal urethritis in naive volunteers in combination with multiplex cytokine analyte analysis of blood and urine specimens taken before infection, at the time of acute symptoms, and after curative treatment of N. gonorrhoeae to study responses to early infection. (This study utilized data and specimens from all 11 participants assigned to control arms of two previous randomized clinical trials). All 11 participants developed urethritis between 2 and 5 days post inoculation with N. gonorrhoeae strain FA1090, with a majority having visible discharge by day 3. In urine, we found increases in IL-1RA, G-CSF, and chemokines CXCL10, CCL4, CCL11, GRO/{beta}/{gamma}, and IL-8/CXCL8, with IL-1RA and CCL4 showing direct correlation with the degree of pyuria at the time of infection. Contrary to a prior study using the human challenge model and N. gonorrhoeae strain MS11mkC, we did not see similar increases in urine IL-6, TNF-, or IL-1{beta}, although differences in IL-6, TNF- were observed in participants with later development of infection. Additionally, plasma cytokine levels were unchanged in this cohort over the course of their infection, suggesting these infections were confined to the urethra. We propose that differences in strain virulence or the threshold to define a clinical case may be responsible for this discrepancy, meriting further study and continued use of non-invasive inflammatory markers to study local effects in addition to systemic effects of gonococcal infection. Author SummaryGonorrhea, caused by the bacterium Neisseria gonorrhoeae, remains a global public health concern, yet repeated infections are common and no vaccine is available. A key challenge for vaccine development is limited understanding of how the human immune system responds during early infection, when bacteria are confined to the urethra, vagina, or other mucosal sites. To address this gap, we studied immune responses in a controlled human infection model in which male volunteers with no prior exposure were experimentally infected with N. gonorrhoeae into their urethra. Immune signaling molecules were measured in urine and blood samples collected before infection, during symptoms, and after antibiotic treatment. All participants developed urethral inflammation within a few days of infection. We observed marked increases in multiple inflammatory cytokines in urine, some which correlated with the degree of neutrophils in their urine. In contrast, immune markers in the bloodstream remained largely unchanged. These findings suggest that early infection with the N. gonorrhoeae strain tested triggers a strong localized immune response without widespread systemic inflammation. Our results highlight the value of urine-based, non-invasive sampling and demonstrate the power of human challenge models for studying early immune responses that have been difficult to characterize in animal systems.

Sepsis is defined as a dysregulated response to infection, leading to life-threatening organ dysfunction that particularly affects parenchymal organs. Clinical studies remain inconclusive regarding the impact of biological sex on sepsis, and preclinical studies are predominantly performed in male animals. We examined early (8 h) septic responses in male and female mice using a fecal-induced peritonitis (FIP) model. Blood biochemical parameters, body temperature, and murine sepsis scores provided evidence of a septic response in animals randomized to FIP compared to controls, but showed no physiological differences between male and female mice. Transcriptomic analysis of the liver, kidney, and lung showed consistent inflammatory activation in response to sepsis as compared to controls. Notably, in the kidney and lung, female mice exhibited stronger immune activation and a heightened inflammatory response compared to males. Thus, biological sex differences in the septic response can be detected in early acute sepsis without apparent physiological differences.