Flagellin nebulization enhances respiratory immune responses in the porcine model

Abstract

Respiratory delivery of the Toll-like receptor 5 agonist FLAMOD, a recombinant flagellin, offers a promising approach for treating bacterial pneumonia. FLAMOD stimulates the airway epithelium, mobilizing and activating immune cells and effectors to combat infections. While previous evidences were obtained in mouse models, this study represents the first comprehensive assessment of FLAMOD delivered by nebulization in pigs. Our results demonstrate that a single nebulization of FLAMOD did not cause any adverse effects on clinical parameters. Histological analysis supported that FLAMOD treatment led to immune cell infiltration in the lung tissue, indicative of an active immune response. Flow cytometry confirmed granulocyte recruitment in conducting airways. RNA sequencing established immune activation across the respiratory tract, from the nose, trachea, bronchi to the lungs, highlighting innate immunity, bacterial defense, cytokine and chemokine signaling, and granulocyte chemotaxis as key biological pathways. These findings demonstrated the capacity of FLAMOD to induce a robust and common immune response throughout the porcine respiratory system as well as specific compartmentalized immune signatures. This study establishes FLAMOD as a potent activator of innate immunity, providing a proof-of-concept for inhalation-based therapeutic strategies to combat bacterial pneumonia in the clinical setting.