Tolerance to Lung Infection in TWIK2 K⁺ Efflux Mediated Macrophage Trained Immunity

Reviewer #1 (Public review):

Summary:

Alveolar macrophages (AMs) are key sentinel cells in the lungs, representing the first line of defense against infections. There is growing interest within the scientific community in the metabolic and epigenetic reprogramming of innate immune cells following an initial stress, which alters their response upon exposure to a heterologous challenge. In this study, the authors show that exposure to extracellular ATP can shape AM functions by activating the P2X7 receptor. This activation triggers the relocation of the potassium channel TWIK2 to the cell surface, placing macrophages in a heightened state of responsiveness. This leads to the activation of the NLRP3 inflammasome and, upon bacterial internalization, to the translocation of TWIK2 to the phagosomal membrane, enhancing bacterial killing through pH modulation. Through these findings, the authors propose a mechanism by which ATP acts as a danger signal to boost the antimicrobial capacity of AMs.

Strengths:

This is a fundamental study in a field of great interest to the scientific community. A growing body of evidence has highlighted the importance of metabolic and epigenetic reprogramming in innate immune cells, which can have long-term effects on their responses to various inflammatory contexts. Exploring the role of ATP in this process represents an important and timely question in basic research. The study combines both in vitro and in vivo investigations and proposes a mechanistic hypothesis to explain the observed phenotype.

Weaknesses:

First, the concept of training or trained immunity refers to long-term epigenetic reprogramming in innate immune cells, resulting in a modified response upon exposure to a heterologous challenge. The investigations presented demonstrate phenotypic alterations in AMs seven days after ATP exposure; however, they do not assess whether persistent epigenetic remodeling occurs with lasting functional consequences. Therefore, a more cautious and semantically precise interpretation of the findings would be appropriate.

Furthermore, the in vivo data should be strengthened by additional analyses to support the authors' conclusions. The authors claim that susceptibility to Pseudomonas aeruginosa infection differs depending on the ATP-induced training effect. Statistical analyses should be provided for the survival curves, as well as additional weight curves or clinical assessments. Moreover, it would be appropriate to complement this clinical characterization with additional measurements, such as immune cell infiltration analysis (by flow cytometry), and quantification of pro-inflammatory cytokines in bronchoalveolar lavage fluid and/or lung homogenates.

Moreover, the authors attribute the differences in resistance to P. aeruginosa infection to the ATP-induced training effect on AMs, based on a correlation between in vivo survival curves and differences in bacterial killing capacity measured in vitro. These are correlative findings that do not establish a causal role for AMs in the in vivo phenotype. ATP-mediated effects on other (i.e., non-AM) cell populations are omitted, and the possibility that other cells could be affected should be, at least, discussed. Adoptive transfer experiments using AMs would be a suitable approach to directly address this question.

Reviewer #2 (Public review):

Summary:

In this manuscript, Thompson et al. investigate the impact of prior ATP exposure on later macrophage functions as a mechanism of immune training. They describe that ATP training enhances bactericidal functions, which they connect to the P2x7 ATP receptor, Nlrp3 inflammasome activation, and TWIK2 K+ movement at the cell surface and subsequently at phagosomes during bacterial engulfment. With stronger methodology, these findings could provide useful insight into how ATP can modulate macrophage immune responses, though they are generally an incremental addition to existing literature. The evidence supporting their conclusions is currently inadequate. Gaps in explaining methodology are substantial enough to undermine trust in much of the data presented. Some assays may not be designed rigorously enough for interpretation.

Strengths:

The authors demonstrate two novel findings that have sufficient rigor to assess:

(1) prolonged persistence of TWIK2 at the macrophage plasma membrane following ATP, and can translocate to the phagosome during particle engulfment, which builds upon their prior report of ATP-driven 'training' of macrophages.

(2) administering mice intra-nasal ATP to 'train' lungs to protect mice from otherwise fatal bacterial infection.

Weaknesses:

(1) Missing details from methods/reported data: Substantial sections of key methods have not been disclosed (including anything about animal infection models, RNA-sequencing, and western blotting), and the statistical methods, as written, only address two-way comparisons, which would mean analysis was improperly performed. In addition, there is a general lack of transparency - the methods state that only representative data is included in the manuscript, and individual data points are not shown for assays.

(2) Poor experimental design including missing controls: Particularly problematic are the Seahorse assay data (requires normalization to cell numbers to interpret this bulk assay - differences in cell growth/loss between conditions would confound data interpretation) and bacterial killing assays (as written, this method would be heavily biased by bacterial initial binding/phagocytosis which would confound assessment of killing). Controls need to be included for subcellular fractionating to confirm pure fractions and for dye microscopy to show a negative background. Conclusions from these assays may be incorrect, and in some cases, the whole experiment may be uninterpretable.

(3) The conclusions overstate what was tested in the experiments: Conceptually, there are multiple places where the authors draw conclusions or frame arguments in ways that do not match the experiments used. Particularly:
a) The authors discuss their findings in the context of importance for AM biology during respiratory infection but in vitro work uses cells that are well-established to be poor mimics of resident AMs (BMDM, RAW), particularly in terms of glycolytic metabolism.
b) In vivo work does not address whether immune cell recruitment is triggered during training.
c) Figure 3 is used to draw conclusions about K+ in response to bacterial engulfment, but actually assesses fungal zymosan particles.
d) Figure 5 is framed in bacterial susceptibility post-viral infection, but the model used is bacterial post-bacterial.
e) In their discussion, the authors propose to have shown TWIK2-mediated inflammasome activation. They link these separately to ATP, but their studies do not test if loss of TWIK2 prevents inflammasome activation in response to ATP (Figure 4E does not use TWIK2 KO).

In summary, this work contains some useful data showing how ATP can 'train' macrophages. However, it largely lacks the expected level of rigor. For this work to be valuable to the field, it is likely to need substantial improvement in methods reporting, inclusion of missing assay controls, may require repeating key experiments that were run with insufficient methodology (or providing details and supplemental data to prove that methodology was sufficient), and should either add additional experiments that properly test their experimental question or rewrite their conclusions.