Myocarditis and neutrophil-mediated vascular leakage but not cytokine storm associated with fatal murine leptospirosis

Abstract

Leptospirosis is a neglected re-emerging zoonosis caused by Leptospira spirochetes. Its pathophysiology remains mysterious, especially in the case of severe infection with L. interrogans. In the field of infectious diseases, the cause of death is rarely investigated in preclinical models. Here, for the first time, we identified unanticipated organ failures associated with death in a murine model of acute leptospirosis. Despite clinical similarities between bacterial sepsis and leptospirosis, striking differences were observed. Neither lung, liver, or kidney injury nor cytokine storm, or massive necroptosis could explain death. In contrast, severe leptospirosis was associated with high serum levels of the anti-inflammatory cytokine IL-10 and the chemokine RANTES, neutrophilia, pancreatitis and vascular damage. Unexpectedly, we demonstrated neutrophil-induced vascular permeability, making neutrophils a potential new therapeutic target. Strikingly, the main cause of death was myocarditis, an overlooked complication of human leptospirosis. These features are also found in patients, making this model a paradigm for better understanding human leptospirosis and designing novel therapeutic strategies.