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Biological and clinical implications of a model of surveillance immunity
Katharina Willmann, Luis F. Moita
Katharina Willmann, Luis F. Moita
Published August 1, 2025
Citation Information: J Clin Invest. 2025;135(15):e191645. https://doi.org/10.1172/JCI191645.
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Biological and clinical implications of a model of surveillance immunity

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Abstract

The immune system must identify genuine threats and avoid reacting to harmless microbes because immune responses, while critical for organismal survival, can cause severe damage and use substantial energy resources. Models for immune response initiation have mostly focused on the direct sensing of microorganisms through pattern recognition receptors. Here, we summarize key features of the leading models of immune response initiation and identify issues they fail to solve individually, including how the immune system distinguishes between pathogens and commensals. We hypothesize and argue that surveillance of disruption to organismal homeostasis and core cellular activities is central to detecting and resolving relevant threats effectively, including infection. We propose that hosts use pattern recognition receptors to identify microorganisms and use sensing of homeostasis disruption to assess the level of threat they pose. We predict that both types of information can be integrated through molecular coincidence detectors (such as inflammasomes or others not yet discovered) and used to determine whether to initiate an immune response, its quality, and its magnitude. This conceptual framework may guide the identification of novel targets and therapeutic strategies to improve the progression and outcome of infection, cancer, autoimmunity, and chronic conditions in which inflammation plays a critical role.

Authors

Katharina Willmann, Luis F. Moita

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Figure 1

Models of innate immune initiation.

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Models of innate immune initiation.
(A) Pattern-triggered immunity (PTI)...
(A) Pattern-triggered immunity (PTI). Microbial structural molecules (PAMPs or MAMPs) are directly sensed by PRRs, which can activate transcriptional programs or effectors directly. MAMPs that are not conserved or are unknown to the host may not activate PTI. MAMPs may be shared between virulent and avirulent microorganisms (102). (B) PTI by infidelities (14). This model proposes that PRRs are predominantly byproducts of unsuccessful pathogens that lead to biochemical infidelities. This implies a high pressure on pathogens to minimize unsuccessful events and should result in a lower-than-observed ability to evolve and evade (14). Additionally, live-attenuated vaccines tend to have the highest efficiency and sensing of markers of live pathogens (vita-PAMPs) by the host (103). (C) Danger model (damage recognition) (16). PRRs are activated by sensing host molecular patterns released upon compromised tissues. The relevance of DAMPs in the context of infection has not been fully resolved in this model. (D) Effector-triggered immunity (ETI) (21). Virulence factors are sensed by “guard proteins” directly or indirectly by detecting changes or modifications in host proteins (“guardees”). (E) Surveillance immunity (3). Immune responses are triggered by disruption of core cellular functions or homeostasis parameters through stress pathways. Multiple input pathways synergize to generate an output tailored to the nature and level of threat. However, maladaptive responses cannot be fully avoided. Yellow symbols depict microbial factors; purple symbols depict host factors. HAMPs, homeostasis altering molecular processes.

Copyright © 2025 American Society for Clinical Investigation
ISSN: 0021-9738 (print), 1558-8238 (online)

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