Abstract
BackgroundSepsis is defined as a life-threatening organ dysfunction caused by a dysregulated host response to infection. Numerous studies have explored the complex and dynamic transcriptome modulations observed in sepsis patients, but a large fraction of the transcriptome remains unexplored. This fraction could provide information to better understand sepsis pathophysiology. Multiple levels of interaction between human endogenous retroviruses (HERV) and the immune response have led us to hypothesize that sepsis is associated with HERV transcription and that HERVs may contribute to a signature among septic patients allowing stratification and personalized management.MethodsWe used a high-density microarray and RT-qPCR to evaluate the HERV and Mammalian Apparent Long Terminal Repeat retrotransposons (MaLR) transcriptome in a pilot study that included 20 selected septic shock patients, stratified on mHLA-DR expression, with samples collected on day 1 and day 3 after inclusion. We validated the results in an unselected, independent cohort that included 100 septic shock patients on day 3 after inclusion. We compared septic shock patients, according to their immune status, to describe the transcriptional HERV/MaLR and conventional gene expression. For differential expression analyses, moderated t tests were performed and Wilcoxon signed-rank tests were used to analyze RT-qPCR results.ResultsWe showed that 6.9% of the HERV/MaLR repertoire was transcribed in the whole blood, and septic shock was associated with an early modulation of a few thousand of these loci, in comparison to healthy volunteers. We provided evidence that a subset of HERV/MaLR and conventional genes were differentially expressed in septic shock patients, according to their immune status, using monocyte HLA-DR (mHLA-DR) expression as a proxy. A group of 193 differentially expressed HERV/MaLR probesets, tested in an independent septic shock cohort, identified two groups of patients with different immune status and severity features.ConclusionWe demonstrated that a large, unexplored part of our genome, which codes for HERV/MaLR, may be linked to the host immune response. The identified set of HERV/MaLR probesets should be evaluated on a large scale to assess the relevance of these loci in the stratification of septic shock patients. This may help to address the heterogeneity of these patients.
Highlights
Sepsis is defined as a life-threatening organ dysfunction caused by a dysregulated host response to infection
Using the human endogenous retroviruses (HERV)-V3 microarray, which allows the measurement of HERV/Mammalian Apparent Long Terminal Repeat retrotransposons (MaLR) at the individual locus level [22], we have shown that HERV/MaLR are tightly modulated in peripheral blood mononuclear cells (PBMCs)
We aimed to identify whether a subset of HERV/MaLR was expressed in septic shock patients, according to their immune status, as estimated by monocyte HLA-DR (mHLA-DR) expression
Summary
Sepsis is defined as a life-threatening organ dysfunction caused by a dysregulated host response to infection. Due in large part to source control with antibiotics and early initiation of intensive care therapy, sepsis remains a major health issue, with a high worldwide prevalence and high mortality rate It is characterized by immune dysfunctions with concomitant excessive pro- and anti-inflammatory responses, which can lead to organ failure, immunoparalysis, and secondary infections. While an immune dysregulated host response is clearly part of the pathophysiology, the complex interactions between the immune response and other key physiological systems, such as the autonomous nervous system, coagulation, or cellular bioenergetics, are still poorly understood [3, 4] This translates into an apparent heterogeneity observed in patients, which makes the selection of appropriate therapeutic care a major clinical challenge. The decreased expression of mHLA-DR has been repeatedly associated with mortality and secondary infections and remains an independent predictor of a poor outcome after sepsis [4, 6,7,8,9,10]
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