27 of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555-0435 28 #d Current Address: Department of Physiology, OUHSC, 940 Stanton Young Blvd., Oklahoma 29 City, OK 73104-5042 30 31 32 33 * Corresponding Authors: Jinjun Liu: jupet@163.com; Lynn Soong: lysoong@utmb.edu 34 35 36 Abstract 38Orientia tsutsugamushi infection can cause acute lung injury and high mortality in humans; 39 however, the underlying mechanisms are unclear. Here, we tested a hypothesis that dysregulated 40 pulmonary inflammation and Tie2-mediated endothelial malfunction contribute to lung damage. 41 Using a murine model of lethal O. tsutsugamushi infection, we demonstrated pathological 42 characteristics of vascular activation and tissue damage: 1) a significant increase of ICAM-1, 43 VEGFR2, and angiopoietin-2 (Ang2) proteins in inflamed tissues and lung-derived endothelial 44 cells (EC), 2) a progressive loss of endothelial quiescent and junction proteins (Ang1, VE-45 cadherin/CD144, occuludin), and 3) a profound impairment of Tie2 receptor at the 46 transcriptional and functional levels. In vitro infection of primary human EC cultures and serum 47 52 (CD206 + CD64 + CD11b + Ly6G -) cells. In vitro studies indicated extensive bacterial replication in 53 M2-type, but not M1-type, MΦs, implying the protective and pathogenic roles of M1-skewed 54 responses. This is the first detailed investigation of lung cellular immune responses during acute 55 O. tsutsugamushi infection. It uncovers specific biomarkers for vascular dysfunction and M1-56 skewed inflammatory responses, highlighting future therapeutic research for the control of this 57 neglected tropical disease.58 59 4 Author Summary 60Scrub typhus is a life-threatening disease, infecting an estimated one million people yearly.
61Acute lung injury is the most common clinical observation; however, its pathogenic biomarkers 62 and mechanisms of progression remain unknown. Here, we used a lethal infection mouse model 63 that parallels certain aspects of severe scrub typhus, primary human endothelial cell cultures, and 64 patient sera to define pathogenic biomarkers following Orientia tsutsugamushi infections. We 65 found a significant increase in the levels of endothelial activation/stress markers (angiopoietins 66 and ICAM-1) in infected mouse lungs and in patient sera, but a progressive loss of endothelium-67 specific Tie2 receptor and junction proteins (VE-cadherin), at severe stages of disease. These 68 signs of vasculature disruption positively correlated with the timing and magnitude of 69 recruitment/activation of proinflammatory MΦ subsets in infected lungs. Bacterial growth in 70 vitro was favored in M2-like, but not in M1-like, MΦs. This study, for the first time, reveals 71 endothelial malfunction and dysregulated inflammatory responses, suggesting potential 72 therapeutic targets to ameliorate tissue damage and pathogenesis. 73 74 Scrub typhus is a febrile and potentially lethal illness that infects an estimated one million 75 individuals per year [1]. The disease is ca...