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J Am Soc Nephrol. 2018 Jan;29(1):104-117. doi: 10.1681/ASN.2017060624. Epub 2017 Oct 10.

Endotoxin Preconditioning Reprograms S1 Tubules and Macrophages to Protect the Kidney.

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Departments of Medicine and
Departments of Medicine and.
Cellular and Integrative Physiology, Indiana University, Indianapolis, Indiana.
Roudebush Indianapolis Veterans Affairs Medical Center, Indianapolis, Indiana.
Department of Neurobiology, Duke University Medical School, Durham, North Carolina.
Miromatrix Medical Inc., Eden Prairie, Minnesota; and.
Institute of Molecular Medicine, Center for Stem Cell Research and Regenerative Medicine, University of Texas Health Science Center at Houston, Houston, Texas.


Preconditioning with a low dose of endotoxin confers unparalleled protection against otherwise lethal models of sepsis. The mechanisms of preconditioning have been investigated extensively in isolated immune cells such as macrophages. However, the role of tissue in mediating the protective response generated by preconditioning remains unknown. Here, using the kidney as a model organ, we investigated cell type-specific responses to preconditioning. Compared with preadministration of vehicle, endotoxin preconditioning in the cecal ligation and puncture mouse model of sepsis led to significantly enhanced survival and reduced bacterial load in several organs. Furthermore, endotoxin preconditioning reduced serum levels of proinflammatory cytokines, upregulated molecular pathways involved in phagocytosis, and prevented the renal function decline and injury induced in mice by a toxic dose of endotoxin. The protective phenotype involved the clustering of macrophages around S1 segments of proximal tubules, and full renal protection required both macrophages and renal tubular cells. Using unbiased S1 transcriptomic and tissue metabolomic approaches, we identified multiple protective molecules that were operative in preconditioned animals, including molecules involved in antibacterial defense, redox balance, and tissue healing. We conclude that preconditioning reprograms macrophages and tubules to generate a protective environment, in which tissue health is preserved and immunity is controlled yet effective. Endotoxin preconditioning can thus be used as a discovery platform, and understanding the role and participation of both tissue and macrophages will help refine targeted therapies for sepsis.


innate immunity; metabolomics; sepsis; tlr4; transcriptomics

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