Induction and characterisation of a 25-hydroxycholesterol associated immune response to Gram positive and negative bacteria in a whole blood model of sepsis

Early diagnosis and treatment of sepsis is one of the biggest challenges to ICU clinicians. Globally, 19 million cases occur annually and it is the third biggest cause of death in the UK. Sepsis is characterised by an uncontrollable, non-specific immune response to an infection, and as a result is difficult to diagnose. Recent research has found that 25-hydroxycholesterol (25-HC) plays a crucial role in the immune response to viral infection. Less is known about the role of sepsis-associated bacteria in this response. To identify novel biomarkers in bacterial sepsis a whole blood model was used and the cellular and molecular responses measured to well-characterised bacteria (Escherichia coli K12 and Staphylococcus epidermidis RP62A) using flow cytometry, ELISA and high performance liquid chromatography-mass spectrometry (LC-MS). Following bacterial infection, mononuclear cells and granulocytes decrease rapidly in response to both K12 and RP62A. This corresponds to a concomitant increase in total CD45 and CD19 expression and the concentration of the proinflammatory cytokines IL-6, CCL3 and CCL20. Proinflammatory responses were significantly more pronounced in K12 infection. There were significant increases in 25-HC in response to K12 infection, and this effect was partially blocked through inhibition of TLR2 or TLR4. Our results suggest the importance of using both cellular and humoral screening to identify unique pathways induced by sepsis causing bacteria. In addition, the current study provides some of the first evidence that 25-HC may be involved in a bacterial driven immune response. This study has importance when designing novel biomarkers to predict sepsis.