Pathogenic Mechanisms of Endothelial Damage in Severe Scrub Typhus

Abstract

Abstract Our newly established lethal and sublethal Orientia tsutsugamushi infection mouse models, which mimic clinical/pathologic features of human scrub typhus, are valuable for mechanistic studies. A hallmark of lethal Orientia infection is Th1-skewed, but Th2-impared, immune responses, accompanied with severe endothelial damage and acute tissue injury. Importantly, while tissue bacteria peak at disease onset (D6) in mice, neutrophil and CD8 T cell influx/activation reach peaks in the lungs around D10 (prior to host death). We hypothesize a two-stage-dysfunction loop for lethal infection: 1) Orientia replication in phagocytes and endothelial cells (EC) triggers inflammatory responses and host defense machinery; and 2) infection-mediated release of DAMP molecules exacerbates vascular dysfunction. This hypothesis was supported by immunofluorescent co-staining of bacteria with leukocyte/EC/platelet-specific markers, multi-color FACS, Western blot, and qRT-PCR. The progressive loss of vasculature and junction proteins (VE-cad, occludin) and reduction in vascular function (angiopoietin 1, Tie2, pTie2) and CD41+ platelets in the lungs were positively linked to neutrophil and CD8 T cell influx and activation, rather than to body bacterial loads. The mechanisms of immune dysregulation were further examined by using infected human endothelial cells and mouse primary macrophage and neutrophil cultures, as well as knockout mice. While Orientia infection directly altered the Ang-Tie2 axis in EC, activated IL-33/IL-36-like DAMP molecules further contributed to vascular/tissue injury. Our studies, for the first time, have revealed immune dysregulation and prognostic biomarkers in the context of scrub typhus pathogenesis.