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Blood, 15 February 2008, Vol. 111, No. 4, pp. 2122-2131.
Prepublished online as a Blood First Edition Paper on December 4, 2007; DOI 10.1182/blood-2007-06-097782.
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Submitted June 25, 2007
Accepted November 29, 2007
Soluble MD-2 is an acute phase protein and an opsonin for Gram-negative bacteria
Pierre Tissieres, Irene Dunn-Siegrist, Michela Schappi, Greg Elson, Rachel Comte, Vandack Nobre, and Jerome Pugin*
Department of Anesthesiology, Pharmacology and Intensive Care, University Hospitals of Geneva, Geneva, Switzerland
Department of Pediatrics, Children's Hospital of Geneva, Geneva, Switzerland
NovImmune SA, Geneva, Switzerland
* Corresponding author; email: jerome.pugin{at}medecine.unige.ch.
MD-2 is a lipopolysaccharide (LPS)-binding protein usually co-expressed with and binding to Toll-like receptor 4 (TLR4), conferring LPS responsiveness of immune cells. MD-2 is also found as a soluble protein. Soluble MD-2 (sMD-2) levels are markedly elevated in plasma from patients with severe infections, and in other fluids from inflamed tissues. We show that sMD-2 is a type II acute phase protein (APP). Soluble MD-2 mRNA and protein levels are up-regulated in mouse liver after the induction of an acute phase response. It is secreted by human hepatocytic cells and up-regulated by interleukin-6. Soluble MD-2 binds to Gram-negative but not Gram-positive bacteria, and sMD-2 secreted by hepatocytic cells is an essential co-factor for the activation of TLR4-expressing cells by Gram-negative bacteria. Soluble MD-2 opsonization of Gram-negative bacteria accelerates and enhances phagocytosis, principally by polymorphonuclear neutrophils. In summary, our results demonstrate that sMD-2 is a newly recognized type II acute phase reactant, an opsonin for Gram-negative bacteria, and a co-factor essential for the activation of TLR4-expressing cells. This suggests that sMD-2 plays a key role in the host innate immune response to Gram-negative infections.

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