How Pseudomonas aeruginosa Hijacks Protective T Cells to Fuel Cystic Fibrosis Lung Damage

Cystic fibrosis has long been understood as a disease of defective chloride channels, thick mucus and relentless bacterial infection. But a new study published in Nature Microbiology reveals a far more insidious mechanism at work: the bacterium Pseudomonas aeruginosa, the dominant pathogen in cystic fibrosis airways, does not merely evade the immune system. It actively reprograms a protective arm of adaptive immunity into a destructive force that directly tears apart the lung’s epithelial barrier and sustains chronic inflammation. The findings, from a multidisciplinary team spanning the University of Milan, Humanitas Research Hospital, Telethon Institute of Genetics and Medicine and the Danish cystic fibrosis cohort, offer the most detailed picture yet of how a single bacterial species can subvert mucosal immunity and lock the lung into a self-perpetuating cycle of damage.

The research focuses on a family of CD4-positive helper T cells known as Th17 cells, which have occupied an ambiguous position in cystic fibrosis immunology for over a decade. Elevated levels of interleukin-17, the signature cytokine of this lineage, were initially interpreted as a hallmark of pathology, since IL-17 drives neutrophil recruitment and tissue-destructive inflammation. Later work complicated that picture by showing that Th17 cells are functionally heterogeneous. Conventional Th17 cells, which co-produce IL-17 alongside the anti-inflammatory cytokine IL-10 and the epithelial-supporting IL-22, actually promote mucosal homeostasis and barrier integrity. By contrast, a distinct pro-inflammatory population, termed Th1/17 for its co-expression of interferon-gamma and IL-17 in the absence of IL-10, has been implicated in chronic inflammatory diseases ranging from multiple sclerosis to Crohn’s disease. Which of these faces Th17 presents in the cystic fibrosis lung remained an open question.

To resolve it, the team analysed T cells isolated from explanted lungs and blood of people with cystic fibrosis, alongside non-CF lung tissue and healthy donor blood. Using high-dimensional flow cytometry and unsupervised clustering based on chemokine receptor expression, they identified two pathogenic subsets, CCR5-positive Th1/17 cells and pro-inflammatory CCR5-positive Th17 cells, that were markedly enriched in cystic fibrosis lungs compared with both patient blood and non-CF lungs. Critically, this enrichment was not a general feature of the disease. The pathogenic subsets expanded selectively in lungs chronically colonized by Pseudomonas aeruginosa, irrespective of whether other pathogens such as Staphylococcus aureus were also present. In Pseudomonas-negative patients, protective conventional Th17 cells predominated instead, pointing to the bacterium itself as the upstream driver of the pathological shift.

The functional consequences of this shift were striking. In an air-liquid interface model of primary human bronchial epithelium, a laboratory system that recapitulates the differentiated, ciliated airway lining, activated Th1/17 and pro-inflammatory Th17 cells caused extensive disruption of epithelial integrity. Immunofluorescence staining for zonula occludens-1, a core component of tight junctions, revealed discontinuous, fragmented junctional patterns in cultures exposed to these subsets, while conventional Th17 cells left the barrier largely intact. Quantitative artificial intelligence-assisted image analysis confirmed the selective loss of junctional continuity. The pathogenic subsets also provoked a significantly stronger inflammatory response from epithelial cells, which released elevated amounts of cytokines and chemokines including IL-8, IL-6, CCL20 and RANTES, molecules that in turn recruit further immune cells to the airway wall.

Transcriptomic profiling by RNA sequencing deepened the picture. Pulmonary Th1/17 and pro-inflammatory Th17 cells from Pseudomonas-infected cystic fibrosis lungs displayed a distinctive signature of 210 upregulated and 40 downregulated genes compared with the same subsets in blood and non-CF lungs. Gene set enrichment analysis showed that lung-resident pathogenic cells upregulated 21 pathways linked to bacterial response, inflammation and tissue remodelling, with high-ranking genes including PPARG, CEBPD and IRAK2, transcriptional regulators known to shape Th17 differentiation and function. Peripheral counterparts of the same subsets showed a largely repressed programme, indicating that the lung environment itself actively reconfigures these cells rather than merely recruiting pre-formed effectors from the circulation.

T cell receptor sequencing added a crucial layer of evidence. The researchers found a significant expansion of private clonotypes, receptor sequences unique to individual patients, within cystic fibrosis lungs, accounting for 45.8 percent of the Th1/17 repertoire compared with roughly 22 percent in non-CF lungs. Among the most expanded clonotypes, some were shared between Th1/17 and pro-inflammatory Th17 cells but minimally represented in Th1 or conventional Th17 populations, suggesting a common antigenic experience driving functional convergence. Partial overlap between the receptor repertoires of pathogenic subsets and conventional Th17 cells, but not Th1 cells, provided a molecular fingerprint of lineage relationships that the team then tested experimentally.

That experimental work centred on dendritic cells, the antigen-presenting sentinels that instruct T cell fate. The team exposed human monocyte-derived dendritic cells to 26 clinical Pseudomonas aeruginosa strains isolated longitudinally from Danish cystic fibrosis patients, spanning early isolates taken at disease onset and late isolates collected after years of chronic colonization. Late strains were internalized more efficiently and persisted longer inside dendritic cells than the reference laboratory strain PAO1. More importantly, clinical isolates skewed the dendritic cell cytokine output toward a polarizing cocktail of IL-1β and IL-23, the two cytokines known to drive interferon-gamma-producing Th17 differentiation, while relatively suppressing IL-12, the canonical Th1-polarizing signal. IL-1β secretion correlated with intracellular bacterial persistence, and clinical strains also triggered strong release of CCL20, the chemokine that recruits CCR6-positive Th17 cells to sites of infection.

In antigen-specific co-culture assays, the researchers then demonstrated that conventional Th17 cells, not Th1 cells, are the precursors of the pathogenic populations. After ten days of co-culture with Pseudomonas-infected dendritic cells, sorted conventional Th17 cells acquired robust interferon-gamma and IL-17 co-expression, whereas Th1 cells never converted. Unexpectedly, early clinical isolates lacking the classic adaptations of chronic infection, such as reduced motility and biofilm formation, were at least as effective as late isolates at inducing this conversion, and some strains exceeded the levels seen with PAO1. The reprogramming extended to transcription factors: converted cells upregulated C/EBPδ and PPARγ, and in some cases BATF3, mirroring the profile of lung-resident pathogenic Th17 cells from patients. This indicates that the immunostimulatory virulence determinants responsible are present from the earliest stages of colonization and retained throughout bacterial adaptation to the cystic fibrosis lung.

The study thereby rewrites a long-standing paradigm. Adaptive immune dysfunction in cystic fibrosis was widely assumed to emerge only in late-stage disease, but the new data show that Pseudomonas aeruginosa can corrupt protective Th17 immunity from the moment it establishes infection, creating a self-sustaining immunopathological loop in which reprogrammed T cells damage the epithelium, epithelial cells release chemokines that recruit more Th17 cells, and the resulting inflammation further impairs bacterial clearance. The findings carry direct therapeutic implications. IL-1 receptor blockade with anakinra has already been shown to mitigate Pseudomonas-driven airway inflammation in cystic fibrosis, and IL-23 inhibitors are clinically established in other chronic inflammatory diseases, although safety concerns about prolonged IL-1β blockade and the need to preserve protective mucosal immunity remain. The authors caution that their lung cohort reflects advanced disease and that the specific bacterial or host antigens driving the T cell skewing are still unknown. Even so, selectively depleting Th1/17 and pro-inflammatory Th17 cells, or blocking their generation from conventional Th17 precursors, now stands as a credible precision immunomodulatory strategy, one that could address the inflammation that persists even in patients receiving CFTR modulator therapy.

Subject of Research: Pseudomonas aeruginosa-driven reprogramming of Th17 cells in cystic fibrosis lung immunopathology

Article Title: Pseudomonas aeruginosa induces the generation of pathogenic IFNγ+Th17 cells that promote lung damage and chronic inflammation in cystic fibrosis

Article References: Dusetti, I., Conte, G., Chiara, M., Puccio, S., Guidone, D., Ricciardelli, E., Cibella, J., Ronzio, M., Dolfini, D., Rossi, E., Landini, P., Ascagni, M., Orlandi, R., Damarco, F., Palleschi, A., Gramegna, A., Blasi, F., Lugli, E., Galietta, L. J., … Paroni, M. (2026). Pseudomonas aeruginosa induces the generation of pathogenic IFNγ+Th17 cells that promote lung damage and chronic inflammation in cystic fibrosis. Nature Microbiology. https://doi.org/10.1038/s41564-026-02469-2

Image Credits: AI Generated

DOI: 10.1038/s41564-026-02469-2

Keywords: cystic fibrosis, Pseudomonas aeruginosa, Th17 cells, interferon-gamma, dendritic cells, IL-23, IL-1β, epithelial barrier, T cell receptor, mucosal immunity, chronic inflammation, immunotherapy