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ResearchIn-Press PreviewImmunologyInfectious disease
Open Access | 10.1172/JCI183541
1Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
2Department of Integrative Medicine and Neurobiology, School of Basic Medica, Shanghai Medical College, Fudan University, Shanghai, China
3Infectious Diseases Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
4Department of Anesthesiology and Hunan Province Key Laboratory of Brain Hom, Third Xiangya Hospital, Central South University, Hunan, China
5Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, United States of America
Find articles by Jiang, Y. in: PubMed | Google Scholar
1Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
2Department of Integrative Medicine and Neurobiology, School of Basic Medica, Shanghai Medical College, Fudan University, Shanghai, China
3Infectious Diseases Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
4Department of Anesthesiology and Hunan Province Key Laboratory of Brain Hom, Third Xiangya Hospital, Central South University, Hunan, China
5Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, United States of America
Find articles by Gao, S. in: PubMed | Google Scholar
1Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
2Department of Integrative Medicine and Neurobiology, School of Basic Medica, Shanghai Medical College, Fudan University, Shanghai, China
3Infectious Diseases Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
4Department of Anesthesiology and Hunan Province Key Laboratory of Brain Hom, Third Xiangya Hospital, Central South University, Hunan, China
5Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, United States of America
Find articles by Li, X. in: PubMed | Google Scholar
1Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
2Department of Integrative Medicine and Neurobiology, School of Basic Medica, Shanghai Medical College, Fudan University, Shanghai, China
3Infectious Diseases Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
4Department of Anesthesiology and Hunan Province Key Laboratory of Brain Hom, Third Xiangya Hospital, Central South University, Hunan, China
5Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, United States of America
Find articles by Sun, H. in: PubMed | Google Scholar
1Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
2Department of Integrative Medicine and Neurobiology, School of Basic Medica, Shanghai Medical College, Fudan University, Shanghai, China
3Infectious Diseases Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
4Department of Anesthesiology and Hunan Province Key Laboratory of Brain Hom, Third Xiangya Hospital, Central South University, Hunan, China
5Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, United States of America
Find articles by Wu, X. in: PubMed | Google Scholar
1Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
2Department of Integrative Medicine and Neurobiology, School of Basic Medica, Shanghai Medical College, Fudan University, Shanghai, China
3Infectious Diseases Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
4Department of Anesthesiology and Hunan Province Key Laboratory of Brain Hom, Third Xiangya Hospital, Central South University, Hunan, China
5Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, United States of America
Find articles by Gu, J. in: PubMed | Google Scholar
1Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
2Department of Integrative Medicine and Neurobiology, School of Basic Medica, Shanghai Medical College, Fudan University, Shanghai, China
3Infectious Diseases Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
4Department of Anesthesiology and Hunan Province Key Laboratory of Brain Hom, Third Xiangya Hospital, Central South University, Hunan, China
5Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, United States of America
Find articles by Chen, Z. in: PubMed | Google Scholar
1Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
2Department of Integrative Medicine and Neurobiology, School of Basic Medica, Shanghai Medical College, Fudan University, Shanghai, China
3Infectious Diseases Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
4Department of Anesthesiology and Hunan Province Key Laboratory of Brain Hom, Third Xiangya Hospital, Central South University, Hunan, China
5Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, United States of America
Find articles by Wu, H. in: PubMed | Google Scholar
1Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
2Department of Integrative Medicine and Neurobiology, School of Basic Medica, Shanghai Medical College, Fudan University, Shanghai, China
3Infectious Diseases Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
4Department of Anesthesiology and Hunan Province Key Laboratory of Brain Hom, Third Xiangya Hospital, Central South University, Hunan, China
5Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, United States of America
Find articles by Zhao, X. in: PubMed | Google Scholar
1Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
2Department of Integrative Medicine and Neurobiology, School of Basic Medica, Shanghai Medical College, Fudan University, Shanghai, China
3Infectious Diseases Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
4Department of Anesthesiology and Hunan Province Key Laboratory of Brain Hom, Third Xiangya Hospital, Central South University, Hunan, China
5Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, United States of America
Find articles by Zhang, T. in: PubMed | Google Scholar
1Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
2Department of Integrative Medicine and Neurobiology, School of Basic Medica, Shanghai Medical College, Fudan University, Shanghai, China
3Infectious Diseases Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
4Department of Anesthesiology and Hunan Province Key Laboratory of Brain Hom, Third Xiangya Hospital, Central South University, Hunan, China
5Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, United States of America
Find articles by Ben-Ami, R. in: PubMed | Google Scholar
1Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
2Department of Integrative Medicine and Neurobiology, School of Basic Medica, Shanghai Medical College, Fudan University, Shanghai, China
3Infectious Diseases Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
4Department of Anesthesiology and Hunan Province Key Laboratory of Brain Hom, Third Xiangya Hospital, Central South University, Hunan, China
5Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, United States of America
Find articles by Le, Y. in: PubMed | Google Scholar
1Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
2Department of Integrative Medicine and Neurobiology, School of Basic Medica, Shanghai Medical College, Fudan University, Shanghai, China
3Infectious Diseases Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
4Department of Anesthesiology and Hunan Province Key Laboratory of Brain Hom, Third Xiangya Hospital, Central South University, Hunan, China
5Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, United States of America
Find articles by Billiar, T. in: PubMed | Google Scholar
1Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
2Department of Integrative Medicine and Neurobiology, School of Basic Medica, Shanghai Medical College, Fudan University, Shanghai, China
3Infectious Diseases Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
4Department of Anesthesiology and Hunan Province Key Laboratory of Brain Hom, Third Xiangya Hospital, Central South University, Hunan, China
5Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, United States of America
Find articles by Miao, C. in: PubMed | Google Scholar
1Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
2Department of Integrative Medicine and Neurobiology, School of Basic Medica, Shanghai Medical College, Fudan University, Shanghai, China
3Infectious Diseases Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
4Department of Anesthesiology and Hunan Province Key Laboratory of Brain Hom, Third Xiangya Hospital, Central South University, Hunan, China
5Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, United States of America
Find articles by Zhang, J. in: PubMed | Google Scholar
1Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
2Department of Integrative Medicine and Neurobiology, School of Basic Medica, Shanghai Medical College, Fudan University, Shanghai, China
3Infectious Diseases Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
4Department of Anesthesiology and Hunan Province Key Laboratory of Brain Hom, Third Xiangya Hospital, Central South University, Hunan, China
5Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, United States of America
Find articles by Wang, J. in: PubMed | Google Scholar
1Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
2Department of Integrative Medicine and Neurobiology, School of Basic Medica, Shanghai Medical College, Fudan University, Shanghai, China
3Infectious Diseases Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
4Department of Anesthesiology and Hunan Province Key Laboratory of Brain Hom, Third Xiangya Hospital, Central South University, Hunan, China
5Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, United States of America
Find articles by Chen, W. in: PubMed | Google Scholar
Published September 2, 2025 - More info
Sepsis is a life-threatening disease caused by a dysfunctional host response to infection. During sepsis, inflammation-related immunosuppression is the critical factor causing secondary infection and multiple organ dysfunction syndrome. The regulatory mechanisms underlying regulatory T-cell (Treg) differentiation and function, which significantly contribute to septic immunosuppression, require further clarification. In this study, we found that neutrophil extracellular traps (NETs) participated in the development of sepsis-induced immunosuppression by enhancing Treg differentiation and function via direct interaction with CD4+ T cells. Briefly, NETs anchored enolase 1 (ENO1) on the membrane of CD4+ T cells through its key protein myeloperoxidase (MPO) and subsequently recruited interferon-induced transmembrane protein 2 (IFITM2). IFITM2 acted as a DNA receptor that sensed NETs-DNA and activated intracellular RAS-associated protein 1B (RAP1B) and its downstream extracellular signal-regulated kinase (ERK) signaling pathway to promote Treg differentiation and function. ENO1 inhibition significantly attenuated NETs-induced Treg differentiation and alleviated sepsis in mice. Overall, we demonstrated the role of NETs in sepsis-induced immunosuppression by enhancing Treg differentiation, identified ENO1 as an anchor of NETs-MPO, and elucidated the downstream molecular mechanism by which IFITM2-RAP1B-ERK regulated Treg differentiation. These findings improve our understanding of the immunopathogenesis of sepsis and provide potential therapeutic targets for sepsis-induced immunosuppression.