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Proc Natl Acad Sci U S A. 2019 Feb 5;116(6):2200-2209. doi: 10.1073/pnas.1820704116. Epub 2019 Jan 23.

Specific sequences of infectious challenge lead to secondary hemophagocytic lymphohistiocytosis-like disease in mice.

Author information

1
Department of Medicine (Rheumatology), Yale University School of Medicine, New Haven, CT 06520; andrew.wang@yale.edu ruslan.medzhitov@yale.edu.
2
Department of Immunobiology, Yale University School of Medicine, New Haven, CT 06520.
3
Howard Hughes Medical Institute, Yale University School of Medicine, New Haven, CT 06520.
4
Department of Medicine (Rheumatology), Yale University School of Medicine, New Haven, CT 06520.
5
Department of Comparative Medicine, Yale University School of Medicine, New Haven, CT 06520.
6
Department of Immunobiology, Yale University School of Medicine, New Haven, CT 06520; andrew.wang@yale.edu ruslan.medzhitov@yale.edu.

Abstract

Secondary hemophagocytic lymphohistiocytosis (sHLH) is a highly mortal complication associated with sepsis. In adults, it is often seen in the setting of infections, especially viral infections, but the mechanisms that underlie pathogenesis are unknown. sHLH is characterized by a hyperinflammatory state and the presence hemophagocytosis. We found that sequential challenging of mice with a nonlethal dose of viral toll-like receptor (TLR) agonist followed by a nonlethal dose of TLR4 agonist, but not other permutations, produced a highly lethal state that recapitulates many aspects of human HLH. We found that this hyperinflammatory response could be recapitulated in vitro in bone marrow-derived macrophages. RNA sequencing analyses revealed dramatic up-regulation of the red-pulp macrophage lineage-defining transcription factor SpiC and its associated transcriptional program, which was also present in bone marrow macrophages sorted from patients with sHLH. Transcriptional profiling also revealed a unique metabolic transcriptional profile in these macrophages, and immunometabolic phenotyping revealed impaired mitochondrial function and oxidative metabolism and a reliance on glycolytic metabolism. Subsequently, we show that therapeutic administration of the glycolysis inhibitor 2-deoxyglucose was sufficient to rescue animals from HLH. Together, these data identify a potential mechanism for the pathogenesis of sHLH and a potentially useful therapeutic strategy for its treatment.

KEYWORDS:

hemophagocytic lymphohistiocytosis; inflammation; sepsis

PMID:
30674681
PMCID:
PMC6369774
[Available on 2019-08-05]
DOI:
10.1073/pnas.1820704116
[Indexed for MEDLINE]

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