ORIGINAL RESEARCH article
Front. Immunol.
Sec. Comparative Immunology
High-Altitude Immune Remodeling in Children with Mycoplasma pneumoniae Pneumonia: a Multi-Center Transcriptomic Study
Provisionally accepted
- 1Qinghai University Affiliated Hospital, Xining, China
- 2Children's Hospital of Nanjing Medical University, Nanjing, China
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Abstract Introduction: A global outbreak of Mycoplasma pneumoniae pneumonia (MPP) emerged following the COVID-19 pandemic. Different altitudes significantly impact community-acquired pneumonia (CAP). Whether there are differences in the immune responses of children with MPP at different altitudes is unknown. Methods: This study collected bronchoalveolar lavage fluid (BALF) from children with MPP in Nanjing (altitude: 20m) or Qinghai (altitude: 4058.40m) for transcriptome sequencing analysis to investigate pulmonary immune responses in children with MPP at different altitudes. Results: Clinical manifestations of children with refractory Mycoplasma pneumoniae pneumonia (RMPP) in the plateau group were milder, with fewer fever days before admission, serum tissue injury markers, and incidence of atelectasis. Neutrophils and T cells in the lungs of the plain group were activated, along with the activation of NOD-like receptor signaling pathway or inhibition of PI3K-Akt signaling pathway. Immune cells of children with MPP in the plateau group showed adaptive changes, manifested as increased M2 polarization of macrophages, CD8+ T cells and B cells, and decreased neutrophils and CD4+ T cells. Conclusion: Excessive activation of the pulmonary immune response in children with MPP of the plain region may be related to the NOD-like receptor signaling pathway and PI3K-Akt signaling pathway. Adaptive changes in immune cells occurred in children with MPP of the plateau region.
Keywords: Mycoplasma pneumoniae pneumonia, Children, altitude, immune response, Transcriptome
Received: 16 Sep 2025; Accepted: 24 Nov 2025.
Copyright: © 2025 Luo, Hou, Lu, Cao, Hao, Zhang, Liu, Zhu and Ma. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Yifan Zhu, zhu1@njmu.edu.cn
Yanyan Ma, mayanyan_research@qhu.edu.cn
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