Several Questions Merit Investigation in Future Studies:
Is it non-cellular molecular recruitment or immune cell recognition that occurs first when a pathogen enters the bloodstream? In analogy to artificial nanoparticles, we have postulated that pathogens acquire a biocorona as they invade, circulate and reside in the host. It is plausible that this biocorona depends on the point of entry of the pathogen, i.e., depending on whether the pathogen invades the host through the blood, airways, or gastrointestinal system so will be the biomolecular composition of the acquired corona. Focusing on the non-cellular blood interactome as a major source of the biocorona components, the order and rate at which these components are adsorbed onto the pathogen surface warrants investigation. With silica nanoparticles in human plasma [
17], protein adsorption is detected in a few seconds; it is conceivable that a similarly fast rate of adsorption will be observed with pathogens. The development of the innate immune response is also rapid, typically within minutes to hours [
108]. We think that the non-cellular blood interactome should be viewed as an innate immune response that can impact the biological actions of pathogens and non-pathogenic invading entities (e.g., vaccine constructs) alike. What is the spatial architecture of the pathogen-attracted biomolecular corona? Future research may reveal whether distinct layers of biomolecules interact with the inherited pathogen biocorona, as it has been postulated that artificial nanoparticles may be covered by a (soft) protein corona located on top of an inner (hard) protein corona directly bound to the nanoparticle surface [
24]. It has also been postulated that the pathogen-protein interaction is established in the first 30 seconds, as proposed by Tenzer et al
. for artificial nanoparticle-protein interactions, and that the resulting pathogen interactome does not change in composition, but only in the quantity of proteins taken up over time [
17]. Those are areas warranting research as the proteins on the corona are susceptible to post-translational modifications, including the binding of lipids and carbohydrates.
The non-cellular blood interactome is likely to be host-specific and capable of modifying pathogen infectivity. How does this explain individual susceptibility to disease? Currently, it is impossible to answer this question. Blood protein composition may be influenced by innate factors such as age, nutritional status, genetics, immune competence, and underlying chronic diseases, and by extrinsic factors such as drug use, lifestyle and geographic origin [
110]. These factors could influence the composition of the host-specific non-cellular interactome of the pathogen. Changes in protein corona composition have been documented with artificial nanoparticles [
110,
111]. Proteins’ conformation may change in many diseases [
110] potentially altering the blood interactome of the pathogen. Like the proposal of a
“personalized
” protein corona which affects nanoparticles biochemistry and biology [
110,
111], we anticipate that the pathogen enters the host and circulates in association with a host-specific (
“personalized
”) non-cellular blood interactome. Hypothetically, the blood proteome and metabolome may differ in different disease states consistent with a state-specific blood interactome that forms the basis for the state- and host-specific acquired pathogen’s biocorona. State-specific post-translational modifications of blood proteins may affect the pathogen-associated non-cellular interactome. Proteins surrounding the pathogen surface may undergo misfolding and aggregation (protein unfolding has been reported in studies with artificial nanoparticles [
112]). Pathogen-protein interactions may induce the exposure of hidden protein epitopes (as happens with nanoparticle-denatured proteins [
18,
110]). This could enhance immunological responses and/or induce unwanted inflammatory responses. We postulate that the host-specific non-cellular blood interactome is an important external variable that can render the host susceptible or resilient to infectious diseases. Recognition of the non-cellular blood interactome as an innate immune response could help explain why an infectious agent that is virulent in one setting may be mild or harmless in another.
Do pathogens containing biologically active molecules differ from artificial nanoparticles in the way they form protein coronas? Bissantz et al
. and Zhou et al
. have discussed in great detail a variety of non-covalent chemical interactions that may exist between two partner molecules in biological systems, including van der Waals contact (less than 1 kcal/mol), hydrophobic force (1.5-2 kcal/mol), salt bridge (0.5-5 kcal/mol), π-π stacking (5-7 kcal/mol), electrostatic interaction (below 20 kcal/mol), hydrogen bonding (0.25-40 kcal/mol), and halogen bonding (1-40 kcal/mol) among others [
113,
114]. Hydrogen bonding, halogen bonding, salt bridge, and π-π stacking are enthalpy-driven, strong interaction forces [
114]. Halogen bonds are considerably weaker than hydrogen bonds. The gains in binding affinity they produce, however, can be substantial [
113]. Hydrogen bonding and halogen bonding are highly specific forces [
114]. Salt bridge and π-π stacking are moderate specific forces [
114]. Hydrophobic and van der Waals forces are weak in strength and have a low degree of specificity [
114]. The hydrophobic force is driven by entropy and the van der Waals force is driven by enthalpy [
114]. These interactions typically drive the formation of protein coronas on artificial nanoparticles [
114].
We hypothesize that similar biomolecular interaction types enable the formation of an acquired biocorona on pathogens and artificial nanoparticles. This latter notion could be testable for the case of pathogens through approaches analogous to those previously applied to nanoparticles [
23]. In vitro experiments have been useful in demonstrating that the ability of artificial nanoparticles to target cells, internalize cells, and cause cytotoxicity differs significantly depending on whether a protein corona is present or absent [
115]. In vitro studies cannot mimic the effects of inflammatory responses activated in the body after nanoparticle delivery [
23,
115]. Previous research on magnetic nanoparticles showed that these particles attract a different proteome under in vivo conditions than under in vitro conditions [
23,
116]. To better mimic in vivo conditions and determine the acquired (biological) identities of pathogens, ex-vivo studies could be performed with freshly prepared whole blood [
117].
Do post-translational modifications of the pathogen-attracted interactome affect innate immune responses to the pathogen? Answering this question would require detailed studies at the proteomics and metabolomics levels. Among the candidate post-translational modifications of biocorona components, lipid as well as sugars are commonly attached to proteins. In particular, sugars are attached to proteins by glycosylation (the enzymatic attachment of carbohydrates) or glycation (the non-enzymatic attachment of monosaccharides) [
118] as many blood proteins are glycosylated or glycated [
119,
120]. Glycosylation of immunoglobulin G (i.e., the enzyme-mediated addition of sugar molecules to IgG) is involved in humoral immune responses in aging, inflammation, responses to cancer cells, pathogen infections and autoimmune diseases [
118]. Diabetes can lead to glycation of blood proteins [
121]. It is plausible that the non-cellular interactome associated with pathogens involves proteins modified by either glycosylation or glycation. These modifications may affect (as well as being biomarkers of) the host susceptibility to severe disease induced by the pathogen.
Does the composition of the non-cellular blood interactome that associates with a pathogen change as a function of the pathogen entry route? The composition of proteins and other biological molecules varies among biological fluids. The biocorona acquired by pathogens is likely to vary among the point of invasion and the biological fluid(s) to which the pathogen encounters during invasion, circulation and residence in the host. For example, the human nasal secretions proteome differs in structure and post-translational modifications from the human blood proteome [
122]. While nasal secretions are made up of plasma components and serous fluid, they also contain mucus and secretions from distinct epithelial and immune cells [
122]. Gastrointestinal fluids contain diverse carbohydrates, phospholipids, and mucin expressed at levels not typical of the human blood [
123]. The fluid that lines the human airways (pulmonary surfactant) is also different from non-cellular interactome featured by human blood [
123]. Biomolecules present in biological fluids are potential interactors of artificial nanoparticles and pathogens alike and represent an extension of the biomolecular repertoire that is likely to constitute the biocorona predicted to associate with pathogens. Noteworthy, most earlier studies on nanoparticle biocorona have been conducted with blood proteins and very infrequently with other biological fluids [
23]. Our general hypothesis is that pathogens attract non-cellular interactomes from biological fluids (blood in particular) which depend on where or how they invade the host. A similar hypothesis has been proposed for the specific case of coronaviruses whose biocorona might differ depending on entry routes and environments (e.g., blood, nasal, oral, and respiratory mucosal tissues) [
47].