Graduate Student Albany Med. Col. Albany, New York, United States
Disclosure(s):
Amber Bahr: No financial relationships to disclose
Introduction/Rationale: Sepsis survivors exhibit immune dysfunction and profound hematological changes that increase a patient’s risk for recurrent infections and hospital readmission.
Methods: Using a cecal-ligation and puncture model (CLP; causing 50-70% mortality), followed by Streptococcus pneumoniae (Spn) intranasal challenge, we evaluated mechanisms driving increased susceptibility to secondary infection.
Results: Sham-surgery controls uniformly survived Spn infection, whereas CLP survivors exhibited 100% morality when challenged day 20 or 40 post-surgery, revealing long-term susceptibility to Spn infection. Neutrophils were increased in the bronchoalveolar lavage fluid (BALF) of both sham and CLP mice, however, only CLP mice exhibited significantly increased neutrophils in the blood, spleen, and liver. Following challenge, CLP mice exhibited maladaptive emergency granulopoiesis evidenced by systemic neutrophilia, expansion of bone marrow (BM) hematopoietic stem and progenitor cells (HSPCs) and marked reduction of mature neutrophils in the BM. Using BM transplantation, we found that sepsis-induced alterations to the microenvironment were sufficient to promote maladaptive emergency granulopoiesis during intranasal Spn challenge. Sepsis survivors challenged with Spn exhibited increased stromal cell populations and osteoblastic progenitors, suggesting profound BM niche remodeling, that correlated with robust splenic extramedullary granulopoiesis. Susceptibility to pneumonia was not due to lung-specific damage as CLP survivors were unable to control intravenous Spn infection.
Conclusion: Therefore, despite robust granulopoiesis and increased neutrophils, particularly splenic neutrophils, sepsis results in long-term neutrophil dysfunction. Our data demonstrate that sepsis drives durable changes to the microenvironment that support maladaptive granulopoieses programs and increased susceptibility to Spn and pneumonia.
