Deciphering the immune-metabolic nexus in sepsis: a single-cell sequencing analysis of neutrophil heterogeneity and risk stratification.

Background: Metabolic dysregulation following sepsis can significantly compromise patient prognosis by altering immune-inflammatory responses. Despite its clinical relevance, the exact mechanisms of this perturbation are not yet fully understood. Methods: Single-cell RNA sequencing (scRNA-seq) was utilized to map the immune cell landscape and its association with metabolic pathways during sepsis. This study employed cell-cell interaction and phenotype profiling from scRNA-seq data, along with pseudotime trajectory analysis, to investigate neutrophil differentiation and heterogeneity. By integrating scRNA-seq with Weighted Gene Co-expression Network Analysis (WGCNA) and machine learning techniques, key genes were identified. These genes were used to develop and validate a risk score model and nomogram, with their efficacy confirmed through Receiver Operating Characteristic (ROC) curve analysis. The model's practicality was further reinforced through enrichment and immune characteristic studies based on the risk score and in vivo validation of a critical gene associated with sepsis. Results: The complex immune landscape and neutrophil roles in metabolic disturbances during sepsis were elucidated by our in-depth scRNA-seq analysis. Pronounced neutrophil interactions with diverse cell types were revealed in the analysis of intercellular communication, highlighting pathways that differentiate between proximal and core regions within atherosclerotic plaques. Insight into the evolution of neutrophil subpopulations and their differentiation within the plaque milieu was provided by pseudotime trajectory mappings. Diagnostic markers were identified with the assistance of machine learning, resulting in the discovery of PIM1, HIST1H1C, and IGSF6. The identification of these markers culminated in the development of the risk score model, which demonstrated remarkable precision in sepsis prognosis. The model's capability to categorize patient profiles based on immune characteristics was confirmed, particularly in identifying individuals at high risk with suppressed immune cell activity and inflammatory responses. The role of PIM1 in modulating the immune-inflammatory response during sepsis was further confirmed through experimental validation, suggesting its potential as a therapeutic target. Conclusion: The understanding of sepsis immunopathology is improved by this research, and new avenues are opened for novel prognostic and therapeutic approaches.

Prognostic stratification of sepsis through DNA damage response based RiskScore system: insights from single-cell RNA-sequencing and transcriptomic profiling.

Background: A novel risk scoring system, predicated on DNA damage response (DDR), was developed to enhance prognostic predictions and potentially inform the creation of more effective therapeutic protocols for sepsis. Methods: To thoroughly delineate the expression profiles of DDR markers within the context of sepsis, an analytical approach utilizing single-cell RNA-sequencing (scRNA-seq) was implemented. Our study utilized single-cell analysis techniques alongside weighted gene co-expression network analysis (WGCNA) to pinpoint the genes that exhibit the most substantial associations with DNA damage response (DDR). Through Cox proportional hazards LASSO regression, we distinguished DDR-associated genes and established a risk model, enabling the stratification of patients into high- and low-risk groups. Subsequently, we carried out an analysis to determine our model's predictive accuracy regarding patient survival. Moreover, we examined the distinct biological characteristics, various signal transduction routes, and immune system responses in sepsis patients, considering different risk categories and outcomes related to survival. Lastly, we conducted experimental validation of the identified genes through in vivo and in vitro assays, employing RT-PCR, ELISA, and flow cytometry. Results: Both single-cell RNA sequencing (scRNA-seq) and bulk transcriptomic analyses have demonstrated a strong correlation between DNA damage response (DDR) levels and sepsis prognosis. Specific cell subtypes, including monocytes, megakaryocytes, CD4+ T cells, and neutrophils, have shown elevated DDR activity. Cells with increased DDR scores exhibited more robust and numerous interactions with other cell populations. The weighted gene co-expression network analysis (WGCNA) and single-cell analyses revealed 71 DDR-associated genes. We developed a four-gene risk scoring system using ARL4C, CD247, RPL7, and RPL31, identified through univariate COX, LASSO COX regression, and log-rank (Mantel-Cox) tests. Nomograms, calibration plots, and decision curve analyses (DCA) regarding these specific genes have provided significant clinical benefits for individuals diagnosed with sepsis. The study suggested that individuals categorized as lower-risk demonstrated enhanced infiltration of immune cells, upregulated expression of immune regulators, and a more prolific presence of immune-associated functionalities and pathways. RT-qPCR analyses on a sepsis rat model revealed differential gene expression predominantly in the four targeted genes. Furthermore, ARL4C knockdown in sepsis model in vivo and vitro caused increased inflammatory response and a worse prognosis. Conclusion: The delineated DDR expression landscape offers insights into sepsis pathogenesis, whilst our riskScore model, based on a robust four-gene signature, could underpin personalized sepsis treatment strategies.