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Clostridioides difficile infection (CDI) is a major cause of healthcare-associated gastrointestinal infections 1,2 . The exaggerated colonic inflammation caused by C. difficile toxins such as toxin B (TcdB) damages tissues and promotes C. difficile colonization 3-6 , but how TcdB causes inflammation is unclear. Here we report that TcdB induces neurogenic inflammation by targeting gut-innervating afferent neurons and pericytes through receptors, including the Frizzled receptors (FZD1, FZD2 and FZD7) in neurons and chondroitin sulfate proteoglycan 4 (CSPG4) in pericytes. TcdB stimulates the secretion of the neuropeptides substance P (SP) and calcitonin gene-related peptide (CGRP) from neurons and pro-inflammatory cytokines from pericytes. Targeted delivery of the TcdB enzymatic domain, through fusion with a detoxified diphtheria toxin, into peptidergic sensory neurons that express exogeneous diphtheria toxin receptor (an approach we term toxogenetics) is sufficient to induce neurogenic inflammation and recapitulates major colonic histopathology associated with CDI. Conversely, mice lacking SP, CGRP or the SP receptor (neurokinin 1 receptor) show reduced pathology in both models of caecal TcdB injection and CDI. Blocking SP or CGRP signalling reduces tissue damage and C. difficile burden in mice infected with a standard C. difficile strain or with hypervirulent strains expressing the TcdB2 variant. Thus, targeting neurogenic inflammation provides a host-oriented therapeutic approach for treating CDI., (© 2023. The Author(s), under exclusive licence to Springer Nature Limited.)

By its size and diversity, the cutaneous microbial flora is the second of the human body and there is a growing body of research showing its key role in cutaneous homeostasis. However, skin is also the first neuroendocrine organ and it is now demonstrated that bacteria can sense a multitude of human hormones and neurotransmitters. Then, besides of the intrinsic effect of their virulence factors on cutaneous neurogenic activity, recent data demonstrate that the virulence, invasion potential, and biofilm formation activity of some of the principal species of the cutaneous bacteria flora are directly controlled by neuropeptides released by sensory nerve endings including substance P and calcitonin gene-related peptide. Other factors involved in skin inflammation, such as atrial natriuretic peptides, vasoactive intestinal peptide, neuropeptide Y, and histamine should also directly and indirectly participate to the control of the cutaneous microbial flora. Herein, we highlight some of the more recent studies showing that the skin bacteria are interfering at multiple levels with cutaneous neurogenic inflammation. Understanding this mechanism was leading to the development of new cosmetic products, but this is also a promising route for novel therapeutic strategies for the care of cutaneous inflammatory diseases.

Early-life respiratory infection with Pseudomonas aeruginosa is common in children with cystic fibrosis or immune deficits. Although many of its clinical manifestations involve neural reflexes, little information is available on the peripheral nervous system of infected airways. This study sought to determine whether early-life infection triggers a neurogenic-mediated immunoinflammatory response, the mechanisms of this response, and its relationship with other immunoinflammatory pathways. Weanling and adult rats were inoculated with suspensions containing P. aeruginosa (PAO1) coated on alginate microspheres suspended in Tris-CaCl(2) buffer. Five days after infection, rats were injected with capsaicin to stimulate nociceptive nerves in the airway mucosa, and microvascular permeability was measured using Evans blue as a tracer. PAO1 increased neurogenic inflammation in the extra- and intrapulmonary compartments of weanlings but not in adults. The mechanism involves selective overexpression of NGF, which is critical for the local increase in microvascular permeability and for the infiltration of polymorphonuclear leukocytes into infected lung parenchyma. These effects are mediated in part by induction of downstream inflammatory cytokines and chemokines, especially IL-1beta, IL-18, and leptin. Our data suggest that neurogenic-mediated immunoinflammatory mechanisms play important roles in airway inflammation and hyperreactivity associated with P. aeruginosa when infection occurs early in life.