Reviewer #1 (Public review):
[Editors' note: The revised manuscript addressed the concerns of both reviewers, who have concluded that the manuscript is convincing and important. The manuscript can move towards the Version of Record.]
Summary:
This study is built on the emerging knowledge of trained immunity, where innate immune cells exhibit enhanced inflammatory responses upon challenged by a prior insult. Trained immunity is now a very fast-evolving field and has been explored in diverse disease conditions and immune cell types. Earhart and the team approached the topic from a novel angle and was the first to explore a potential link to the complement system.
The study focused on the central complement protein C3 and investigated how its signalling may modulate immune training in alveolar macrophages. The authors first performed in vivo experiments in C57BL mouse models to observe the presence of enhanced inflammation and C3a in BAL fluid following immune training. These changes were then compared with those from C3-deficient mice, which confirmed the involvement of C3a. This trained immunity was further validated in ex vivo experiments using primary alveolar macrophage, which was blunted in C3-deficiency, and, intriguingly, rescued by adding exogenous C3 protein, but not C3a. The genetic-based findings were supported by pharmacological experiments using the C3aR antagonist SB290157. Mechanistically, transcriptomic analyses suggested the involvement of metabolism-linked, particularly glycolytic, genes, which was in agreement with an upregulation of glycolytic flux in WT but not C3-deficient macrophages.
Collectively, these data suggest that C3, possible through engaging with C3aR, contributes to trained immunity in alveolar macrophages.
Strengths:
The conclusions reached were well supported by in vivo and ex vivo experiments, encompassing both genetic-knockout animal models and pharmacological tools.
The transcriptomic and cell metabolism studies provided valuable mechanistic insights.
Weaknesses:
For the in vivo experiments, the histopathological and other inflammatory markers (Fig 1.) were not directly linked to alveolar macrophages by experimental evidence. Other innate immune cells (e.g. dendritic cells, neutrophils) and endothelial cells could also be involved in immune training and contribute to the pathological outcomes. These cells were not examined or mentioned in the study.
For the ex vivo experiments assessing immune training in alveolar macrophages, only the release of selected inflammatory factors were measured. Macrophage activities constitute multiple aspects (e.g. phagocytosis, ROS production, microbe killing), which should also be considered to better depict the effect of trained immunity.
The proposed mechanism of C3 getting cleaved intracellularly then binding to lysosomal C3aR need to be further supported by experimental evidence.
There was an absence of any validation in human-based models.
Comments on the revised version.
The revised manuscript now encompasses a much wider scope and stronger evidence.
The authors have included the re-analysis of a recently published dataset of human volunteers who received aerosolized BCG exposure compared to saline. Although not proven causality, this data helped strengthen the human relevance of the findings presented in this research and directly rationalized the decision to focus on Ams. The persistence of elevated C3/C3aR1 expression to day 7 further supports the idea that complement‑associated reprogramming is not merely an acute inflammatory phenomenon. Whilst it may be outside of the scope of this current study, it would be helpful to clarify in future studies whether other complement components (C5, factor B, factor D) were also modulated in the dataset, to contextualize whether the response is uniquely centered on C3/C3aR1 or part of a broader complement activation program.
The authors have also expanded the functional characterization of trained alveolar macrophages by including phagocytosis and ROS generation measurements. It is intriguing that HKPA training did not markedly alter the phagocytosis and ROS production by alveolar macrophages relative to the control group, however, C3 deficiency significantly dampened these responses in both trained and untrained groups. This reduction is in congruence with the cytokine release data, but there could be other factors involved.
I appreciate the careful revision and much more expansive mechanistic interpretation regarding intracellular C3aR, and that further studies are underway to better understand the cell type-specific, subcellular localization of C3a-C3aR in alveolar macrophages.
Overall, the revised data interpretation and discussion significantly improved in balance and contextualization of the findings.