Xiao, W.; Sawyer, A. J.; Mo, S.; Bai, X.; Yang, Q.; Gao, Y.; Fielder, T.; Zhang, Y.; Dai, Y.; Yang, Q.; Cai, Y.; Ding, G.; Deng, G.; Fu, L.; Quek, C.; Wilmott, J.; Palendira, U.; Britton, W.; Barber, D. L.; Ernst, J. D.; Patrick, E.; Feng, C.; Chen, X.

The immune response to human tuberculosis (TB), particularly in the context of complex lung pathology, remains incompletely understood. Here, we employed whole-slide spatial proteomics to map immune cell organization in TB-affected human lung tissues. Our analysis revealed pronounced spatial segregation of major immune cell populations in non-necrotizing TB lesions. At the tissue level, macrophages and lymphocytes formed distinct cellular communities associated with specific pathological features. At the lesion level, macrophages and B cells showed an inverse relationship in both abundance and spatial distribution. Proinflammatory T cells preferentially accumulated in macrophage-rich lesions but remained largely separated from macrophages. Interestingly, lesions exhibiting clear segregation between T cells and macrophages were more common in subclinical TB than in active disease. These findings suggest that spatial isolation of macrophages from effector lymphocytes may help temper inflammation and potentially prevent lesion progression to necrosis, while also enabling immune evasion by Mycobacterium tuberculosis.