Background/Aim: A subset of neutrophils recruited into cystic fibrosis (CF) airways abundantly release tissue damaging neutrophil elastase (NE)1, causing lung damage2. Triggers of this subset are unknown, limiting intervention. Evidence points to respiratory viral-bacterial co-infections as a possible cause3, but this has not been directly studied. To explore this, we developed a laboratory model to characterise responses of airway tissue and neutrophils to virus and bacteria.
Methods: Differentiated primary airway epithelial cell cultures were challenged individually, or co-infected, with rhinovirus and bacteria representative of CF pathogens and airway microbes (Pseudomonas aeruginosa, Staphylococcus aureus, Neisseria lactamica, and Prevotella nigrescens). After infection, cultures were washed apically with medical saline to sample infection milieus. Washes were assessed for epithelial inflammatory signals, then applied to a published model of neutrophil transmigration to the airways1.
Results: Epithelial infection microenvironments were characterised by increased antiviral signals with exclusive rhinovirus infection, including MIG and IP-10, while P. aeruginosa uniquely increased pro-inflammatory cytokines IL-1α and β. Only neutrophils migrating into washes primed by P. aeruginosa and P. nigrescens had elevated CD63, a marker of granules that contain NE, and reduced CD16, a protein that allows neutrophils to engulf bacteria. These changes are reflective of neutrophils in CF airways1,2.
Conclusion: Our findings suggest both primary and secondary bacterial infections trigger the development of NE releasing neutrophils. Furthermore, different airway microbes variably prompted this neutrophil subset, suggesting CF airway dysbiosis may be a driver of neutrophil pathological activity. Further studies will characterise mechanisms of this process and identify potential therapeutic targets.