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Resource and Technical AdvanceIn-Press PreviewInfectious diseasePulmonology Open Access | 10.1172/jci.insight.201739

Early cell-autonomous and niche-mediated epithelial response to influenza infection in primary alveolar organoids

Amber Elitz,1 Sharlene Fernandes,1 Kathleen C.S. Cook,1 Helen I Warheit-Niemi,1 Barbara Zhao,1 Andrea Toth,1 Amanda L. Zacharias,1 and William J. Zacharias2

1Division of Pulmonary Biology, University of Cincinnati College of Medicine, Cincinnati, United States of America

2Division of Pulmonary, Critical Care and Sleep Medicine, University of Cincinnati College of Medicine, Cincinnati, United States of America

Find articles by Elitz, A. in: PubMed | Google Scholar

1Division of Pulmonary Biology, University of Cincinnati College of Medicine, Cincinnati, United States of America

2Division of Pulmonary, Critical Care and Sleep Medicine, University of Cincinnati College of Medicine, Cincinnati, United States of America

Find articles by Fernandes, S. in: PubMed | Google Scholar

1Division of Pulmonary Biology, University of Cincinnati College of Medicine, Cincinnati, United States of America

2Division of Pulmonary, Critical Care and Sleep Medicine, University of Cincinnati College of Medicine, Cincinnati, United States of America

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1Division of Pulmonary Biology, University of Cincinnati College of Medicine, Cincinnati, United States of America

2Division of Pulmonary, Critical Care and Sleep Medicine, University of Cincinnati College of Medicine, Cincinnati, United States of America

Find articles by Warheit-Niemi, H. in: PubMed | Google Scholar

1Division of Pulmonary Biology, University of Cincinnati College of Medicine, Cincinnati, United States of America

2Division of Pulmonary, Critical Care and Sleep Medicine, University of Cincinnati College of Medicine, Cincinnati, United States of America

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1Division of Pulmonary Biology, University of Cincinnati College of Medicine, Cincinnati, United States of America

2Division of Pulmonary, Critical Care and Sleep Medicine, University of Cincinnati College of Medicine, Cincinnati, United States of America

Find articles by Toth, A. in: PubMed | Google Scholar

1Division of Pulmonary Biology, University of Cincinnati College of Medicine, Cincinnati, United States of America

2Division of Pulmonary, Critical Care and Sleep Medicine, University of Cincinnati College of Medicine, Cincinnati, United States of America

Find articles by Zacharias, A. in: PubMed | Google Scholar

1Division of Pulmonary Biology, University of Cincinnati College of Medicine, Cincinnati, United States of America

2Division of Pulmonary, Critical Care and Sleep Medicine, University of Cincinnati College of Medicine, Cincinnati, United States of America

Find articles by Zacharias, W. in: PubMed | Google Scholar

Published July 2, 2026 - More info

JCI Insight. https://doi.org/10.1172/jci.insight.201739.
Copyright © 2026, Elitz et al. This work is licensed under the Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.
Published July 2, 2026 - Version history
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Abstract

Influenza A virus (IAV) infection is a major cause of morbidity and mortality for patients worldwide. Alveolar type 2 (AT2) cells are the preferential target of IAV as part of the pathogenesis of viral pneumonia and acute respiratory distress syndrome (ARDS). Early IAV infection of alveolar cells has been challenging to model both in vitro and in vivo. To address this challenge, we used a combination of murine and human primary alveolar organoids to define methods for robust IAV infection and evaluated cell-autonomous consequences of IAV using a temporal series of multiome paired single nuclei RNA and ATAC sequencing assays. Infected AT2 cells demonstrated conserved changes defined by early loss of surfactant secretion, decreased lipid biogenesis, a rapid burst of antiviral response, and late viral-mediated suppression. Surprisingly, uninfected AT2 cells underwent substantial transcriptional and epigenomic changes in IAV-treated cultures, leading to transition to damage-associated cell states within hours via a process driven by the inflammatory milieu of murine organoids. Together, these data provide new methods for high-fidelity modeling of IAV infection in alveolar cells and defined a conserved AT2 cell response signature to IAV with implications for ARDS pathogenesis.

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