The receptor for advanced glycation end products (RAGE) plays an important role in host defense against bacterial infection. In the present experiments, we investigated the mechanisms by which RAGE contributes to the ability of neutrophils to eradicate bacteria. Wild-type (RAGE ϩ/ϩ ) neutrophils demonstrated significantly greater ability to kill Eschericia coli compared with RAGE Ϫ/Ϫ neutrophils. After intraperitoneal injection of E. coli, increased numbers of bacteria were found in the peritoneal fluid from RAGE Ϫ/Ϫ as compared with RAGE ϩ/ϩ mice. Exposure of neutrophils to the protypical RAGE ligand AGE resulted in activation of nicotinamide adenine dinucleotide phosphate (NA-DPH) oxidase and enhanced killing of E. coli, and intraperitoneal injection of AGE enhanced bacterial clearance during peritonitis. However, incubation of neutrophils with high mobility group box 1 protein (HMGB1), which also binds to RAGE, diminished E. coliinduced activation of NADPH oxidase in neutrophils and bacterial killing both in vitro and in vivo. Deletion of the COOH-terminal tail of HMGB1, a region necessary for binding to RAGE, abrogated the ability of HMGB1 to inhibit bacterial killing. Incubation of neutrophils with HMGB1 diminished bacterial or AGE-dependent activation of NADPH oxidase. The increase in phosphorylation of the p40 phox subunit of NADPH oxidase that occurred after culture of neutrophils with E. coli was inhibited by exposure of the cells to HMGB1. These results showing that HMGB1, through RAGE-dependent mechanisms, diminishes bacterial killing by neutrophils as well as NADPH oxidase activation provide a novel mechanism by which HMGB1 can potentiate sepsis-associated organ dysfunction and mortality.receptor for advanced glycation end products; nicotinamide adenine dinucleotide phosphate oxidase; peritonitis; sepsis; inflammation; Eschericia coli NEUTROPHILS play central roles in acute inflammatory and innate immune responses through producing anti-bacterial peptides, cytokines, and other proinflammatory mediators, including reactive oxygen intermediates, and contributing to the formation of extracellular traps (8,22,33). Nicotinamide adenine dinucleotide phosphate (NADPH) oxidase, a high-output, superoxide-generating system, is an important source of the reactive oxygen intermediates produced by activated neutrophils. Deficiency in NADPH oxidase is associated with diminished ability of neutrophils to effectively kill bacteria. There is increased susceptibility to infection with Staphylococci and other extracellular bacteria in patients with chronic granulomatous disease, a condition associated with a hereditary defect of NADPH oxidase (14,15,17,18).The receptor for advanced glycation end products (RAGE) recognizes a diverse spectrum of ligands, including nonenzymatically modified glycoproteins such as advanced glycation end products (AGE) (31, 32), as well as high mobility group box 1 protein (HMGB1) and calgranulin (calcium binding cellular factors, S100B) (19,20). Cellular activation through RAGE engagement i...