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CD14
CD14
CD14
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CD14
Available structures
PDBOrtholog search: PDBe RCSB
Identifiers
AliasesCD14, entrez:929, CD14 molecule
External IDsOMIM: 158120; MGI: 88318; HomoloGene: 493; GeneCards: CD14; OMA:CD14 - orthologs
Orthologs
SpeciesHumanMouse
Entrez

929

12475

Ensembl

ENSG00000170458

ENSMUSG00000051439

UniProt

P08571

P10810

RefSeq (mRNA)

NM_001174105
NM_000591
NM_001040021
NM_001174104

NM_009841

RefSeq (protein)

NP_000582
NP_001035110
NP_001167575
NP_001167576

NP_033971

Location (UCSC)Chr 5: 140.63 – 140.63 MbChr 18: 36.86 – 36.86 Mb
PubMed search[3][4]
Wikidata
View/Edit HumanView/Edit Mouse

CD14 (cluster of differentiation 14) is a human protein made mostly by macrophages as part of the innate immune system.[5][6] It helps to detect bacteria in the body by binding lipopolysaccharide (LPS), a pathogen-associated molecular pattern (PAMP).

CD14 exists in two forms, one anchored to the membrane by a glycosylphosphatidylinositol (GPI) tail (mCD14), the other a soluble form (sCD14). Soluble CD14 either appears after shedding of mCD14 (48 kDa) or is directly secreted from intracellular vesicles (56 kDa).[7]

The x-ray crystal structure of human CD14 reveals a monomeric, bent solenoid structure containing a hydrophobic amino-terminal pocket.[8]

CD14 was the first described pattern recognition receptor.

Function

[edit]

CD14 acts as a co-receptor (along with the Toll-like receptor TLR 4 and MD-2) for the detection of bacterial lipopolysaccharide (LPS).[9][10] CD14 can bind LPS only in the presence of lipopolysaccharide-binding protein (LBP). Although LPS is considered its main ligand, CD14 also recognizes other pathogen-associated molecular patterns such as lipoteichoic acid.[11] Cluster of differentiation CD14 is a receptor for a very wide range of microbial products including lipopolysaccharide (released from Gram-negative bacteria), peptidoglycans, and lipoteichoic acid (constituents of Gram-positive bacteria).[12]

Signaling pathway of toll-like receptors. Dashed grey lines represent unknown associations

Tissue distribution

[edit]

CD14 is expressed mainly by macrophages and (at 10-times lesser extent) by neutrophils. It is also expressed by dendritic cells. The soluble form of the receptor (sCD14) is secreted by the liver and monocytes and is sufficient in low concentrations to confer LPS-responsiveness to cells not expressing CD14. mCD14 and sCD14 are also present on enterocytes.[13] sCD14 is also present in human milk, where it is believed to regulate microbial growth in the infant gut.

Differentiation

[edit]

CD14+ monocytes can differentiate into a host of different cells, including dendritic cells, a differentiation pathway encouraged by cytokines, including GM-CSF and IL-4.

Interactions

[edit]

CD14 has been shown to interact with lipopolysaccharide-binding protein.[14][15]

References

[edit]
[edit]
Revisions and contributorsEdit on WikipediaRead on Wikipedia

CD14

View on Grokipedia
from Grokipedia
CD14 is a multifunctional and that serves as a key co-receptor in the , primarily expressed on the surface of monocytes, macrophages, and neutrophils, where it recognizes and binds pathogen-associated molecular patterns such as (LPS) from to initiate inflammatory responses. It exists in two main forms: a membrane-bound isoform (mCD14) anchored to the cell surface via a (GPI) linkage and a soluble isoform (sCD14) released into circulation, both contributing to immune surveillance and signaling. The CD14 gene, located on chromosome 5q31.3 in humans (NCBI Gene ID: 929), encodes this 375-amino-acid protein, which is heavily glycosylated and plays a central role in bridging microbial detection to downstream immune activation. Structurally, CD14 adopts a compact, bent conformation consisting of 10 leucine-rich repeats that form a hydrophobic N-terminal ideal for binding moieties of microbial ligands. It features two conserved N- sites—Asn151 and Asn282—with the former bearing complex glycans that facilitate interactions with like galectin-4, aiding in processes such as differentiation, while the latter contains oligomannose glycans essential for proper and . This influences not only stability but also the receptor's ability to traffic ligands and modulate immune cell functions. Functionally, CD14 enhances the sensitivity of immune cells to LPS by cooperating with lipopolysaccharide-binding protein (LBP) in serum, which extracts monomeric LPS from bacterial membranes; the CD14-LPS-LBP complex then transfers LPS to the (TLR4)-MD-2 signaling complex on the cell surface, triggering activation and the release of pro-inflammatory cytokines including TNF-α, IL-1β, and IL-6. This interaction activates both MyD88-TIRAP-dependent pathways, leading to rapid inflammation, and TRAM-TRIF-dependent pathways, promoting type I production and adaptive immunity priming. Beyond LPS, CD14 recognizes other acylated microbial products from and damage-associated molecular patterns (DAMPs), thereby participating in responses to a broad range of infections, sterile inflammation, and tissue repair. Dysregulation of CD14 expression or function has been implicated in various human diseases, including —where elevated sCD14 levels correlate with poor outcomes due to excessive —and chronic conditions such as , metabolic disorders like and non-alcoholic , autoimmune disorders, and certain cancers including colorectal and gastric carcinomas, highlighting its dual role in protective immunity and pathological .

Molecular Biology

Gene Characteristics

The CD14 gene is located on the long arm of human at cytogenetic band 5q31.3, spanning approximately 1.97 kb of genomic DNA from positions 140,631,732 to 140,633,701 on the GRCh38.p14. It consists of three exons, with the coding sequence distributed across these exons to produce a mature mRNA that encodes a 375-amino-acid precursor protein. Multiple transcript variants (up to four) have been identified, all encoding the identical , with transcript variant 1 representing the predominant form. The includes a proximal promoter that regulates its tissue-specific expression, particularly in monocytic cells. This promoter contains multiple s for the , which binds to three distinct regions and is essential for basal and monocytic-specific transcription. The major Sp1 at position -110 bp relative to the transcription start site plays a critical role; mutations here significantly reduce promoter activity in myeloid cell lines while having minimal impact in non-myeloid cells. The CD14 gene exhibits evolutionary conservation across mammalian species, reflecting its fundamental role in innate immunity. Orthologs are present in diverse mammals, including the (Cd14 gene on ), where it shares high similarity in the coding region and functional domains such as leucine-rich repeats. This conservation extends to the broader (LPS) receptor system, involving coordinated interactions with proteins like TLR4 and MD-2, which have been maintained in amniotes for over 320 million years to facilitate pathogen recognition. analyses of CD14 coding s from 14 mammalian species reveal leucine-rich repeats as the most conserved , underscoring adaptive evolution in immune response while preserving core functionality. A notable genetic variation in the CD14 gene is the C-159T single nucleotide polymorphism (rs2569190) in the promoter region, located 159 bp upstream of the major transcription start site. This polymorphism disrupts a putative binding site for the transcription factor Sp1 in the C allele, leading to allele-specific differences in transcriptional efficiency. The T allele is associated with enhanced promoter activity, resulting in higher steady-state mRNA levels and elevated circulating soluble CD14 protein concentrations, which may influence susceptibility to inflammatory and atopic conditions. Population studies have linked the TT genotype to increased risk of atopy and altered immune responses to environmental allergens, highlighting its functional implications in human disease.

Protein Structure

CD14 is a encoded by a single on 5q31.3, consisting of 375 in its precursor form, including a 19-amino-acid N-terminal that is cleaved to yield the mature protein. The mature membrane-bound form (mCD14) spans 356 and has a calculated molecular weight of approximately 37 for the unglycosylated polypeptide, but post-translational modifications increase its apparent mass to about 55 . In contrast, the soluble isoform (sCD14) typically exhibits a lower apparent molecular weight of around 48-56 , depending on and proteolytic processing. The three-dimensional structure of human CD14, determined by X-ray crystallography at 2.0 resolution for the soluble form (PDB: 4GLP), reveals a monomeric protein adopting a bent conformation characteristic of (LRR) proteins. This horseshoe-shaped architecture is composed of 11 tandem LRRs, each approximately 20-29 long, forming a concave β-sheet that curves into a right-handed with a central hydrophobic core. The structure spans residues 20-347, featuring an amino-terminal hydrophobic pocket presumed to accommodate lipid moieties of ligands, and the overall fold aligns closely with other LRR family members such as Toll-like receptors, sharing conserved repeat motifs for structural integrity. Comparisons to related LRR proteins, like TLRs and NLRs, highlight CD14's unique elongated horseshoe without additional domains, emphasizing its role as a soluble or anchored adaptor in immune recognition. CD14 features two primary N-linked glycosylation sites at Asn132 and Asn261, which contribute to its heterogeneity and functional stability by influencing , , and resistance to . These modifications, along with O-linked glycans, add significant mass and protect against degradation, while also modulating affinity by altering surface charge and conformation. Additionally, the protein contains 16 cysteine residues forming eight intramolecular disulfide bonds (e.g., Cys25-Cys36, Cys34-Cys51, Cys187-Cys217, Cys241-Cys272, and others), which rigidly stabilize the LRR scaffold and maintain the horseshoe essential for proper assembly and function. The membrane-bound isoform (mCD14) is anchored to the cell surface via a (GPI) moiety attached to the C-terminal residue (Ser352) after processing of a hydrophobic tail, enabling its localization on myeloid cells. In contrast, sCD14 arises primarily through phospholipase-mediated cleavage of mCD14 or alternative mRNA splicing that excludes the GPI-anchor signal, resulting in a secreted form lacking the C-terminal 15-20 residues but retaining the core LRR domain for interaction. Full atomic coordinates from crystallographic studies confirm high structural similarity between isoforms, with the soluble form providing a model for the extracellular portion of mCD14.

Expression and Regulation

Cellular and Tissue Distribution

CD14 is predominantly expressed on cells of the myeloid lineage, serving as a key surface marker for these populations in the . It is highly expressed on , with nearly all peripheral blood displaying high levels of membrane-bound CD14, particularly on classical (CD14++-) that constitute 80-90% of circulating . Macrophages, derived from differentiation, also exhibit robust CD14 expression across classical subsets, including pro-inflammatory M1 and anti-inflammatory M2 phenotypes. Dendritic cells, especially those of myeloid origin, similarly show CD14 on their surface, facilitating and pathogen recognition. Expression levels are notably lower on other immune cells such as neutrophils, where CD14 is present but at reduced density compared to monocytes (approximately 3% of monocyte levels based on flow cytometric quantification of ~3,300 vs. ~110,000 surface molecules per cell), and on B cells, with minimal detection in resting states. Epithelial cells in select tissues, including hepatocytes in the liver, alveolar cells in the lung, and cells in the spleen, display low to moderate CD14 expression, often confirmed through immunohistochemistry revealing sparse positivity in non-myeloid compartments. In contrast, CD14 is absent on T cells and the majority of non-immune cells, underscoring its myeloid-restricted profile in steady-state conditions. In tissues, CD14 distribution aligns with immune surveillance sites, showing elevated presence in the , liver (via Kupffer cells), and (via alveolar macrophages), as demonstrated by immunohistochemical staining patterns. It is particularly enriched at inflammatory locales, such as atherosclerotic plaques where CD14+ monocyte-derived macrophages accumulate, comprising a significant proportion of plaque-infiltrating cells (up to 20-30% in advanced lesions per analyses), and on mucosal surfaces like the , where CD14+ cells contribute to barrier defense. A soluble form of CD14 (sCD14) circulates in serum and plasma at concentrations of 2-5 μg/mL in healthy individuals, contrasting with the GPI-anchored membrane-bound isoform. This sCD14 arises primarily from proteolytic shedding of surface CD14 by enzymes like or from direct secretion by s and macrophages without the GPI anchor, as evidenced by biochemical assays distinguishing the two forms.

Regulation During Differentiation

CD14 was first identified in the as a differentiation specific to s using monoclonal antibodies, such as MY4, which recognized a surface on human s and macrophages. This discovery facilitated the use of to distinguish monocyte subsets, notably the classical CD14++CD16- s from intermediate (CD14++CD16+) and non-classical (CD14+CD16++) populations, highlighting CD14's role as a key marker in monocyte maturation. During monopoiesis in the , CD14 expression emerges as a marker in late-stage precursors, distinguishing committed myeloid cells from earlier progenitors. This upregulation is induced by cytokines such as (M-CSF) and interleukin-3 (IL-3), which promote the differentiation of + hematopoietic progenitors into a homogeneous population of CD14+ monocytes. Upon differentiation into , CD14 expression is notably increased on M1 (pro-inflammatory) subsets compared to more modest levels on () subsets, reflecting distinct polarization states. Transcriptional control of CD14 in these cells involves the myeloid transcription factors PU.1 and C/EBP family members, which bind to the CD14 promoter to drive expression during macrophage commitment and polarization. CD14 expression is further modulated by environmental signals, with lipopolysaccharide (LPS) and interferon-γ (IFN-γ) enhancing it through activation, creating a loop in innate immune responses. In contrast, glucocorticoids suppress CD14 surface expression and release, contributing to their effects by reducing responsiveness to LPS. Epigenetic regulation, including acetylation at the CD14 promoter, also plays a critical role in maintaining accessible for transcription during monocyte-to-macrophage differentiation.

Biological Function

Ligand Recognition

CD14 primarily recognizes (LPS), a major component of the outer membrane of , as its key ligand in innate immune detection. This recognition is greatly facilitated by the formation of a complex with lipopolysaccharide-binding protein (LBP), a serum protein that extracts LPS monomers from bacterial aggregates and presents them to CD14 with enhanced efficiency. The effective binding affinity of this LPS-LBP complex to CD14 is in the low nanomolar range, significantly improving sensitivity compared to LPS binding to CD14 alone, which exhibits micromolar affinity (Kd ≈ 8.7 μM as measured by ). LBP acts catalytically in this process, with a 1:1 for LPS:LBP, accelerating the association rate without forming a stable ternary complex detectable under standard conditions. The molecular mechanism involves the portion of LPS inserting into a large hydrophobic pocket located at the N-terminal end of CD14's (LRR) domain, which adopts a curved horseshoe-like structure. This pocket, lined by conserved hydrophobic residues, stabilizes the amphipathic through non-polar interactions, while positively charged regions nearby may interact with the negatively charged groups. Soluble CD14 (sCD14), from cell surfaces, can bind LPS via this mechanism and subsequently transfer it to membrane-anchored receptors on target cells, amplifying immune responses in CD14-low environments. The of CD14 confirms this pocket's role, measuring approximately 10 deep and capable of accommodating a single LPS . Beyond LPS, CD14 recognizes other microbial patterns, including (PGN) and lipoteichoic acid (LTA) from , with direct binding affinities in the nanomolar range (e.g., Kd ≈ 25 nM for soluble PGN to sCD14). LBP similarly enhances PGN and LTA binding to CD14, promoting their presentation. CD14 also interacts with fungal β-glucans, particulate or soluble forms of which bind via CD14 in cooperation with β2- on , facilitating uptake and activation. Non-microbial ligands include exposed (PS) on apoptotic cells, where CD14 mediates recognition and by bridging PS to integrins on macrophages. Binding kinetics are characterized by rapid association, often complete within minutes at physiological temperatures (4–37°C), and are optimal at neutral , with reduced efficiency in acidic conditions mimicking endosomal environments. Cooperative enhancement by LBP increases the on-rate by over 100-fold, as demonstrated in binding assays. Specific anti-CD14 monoclonal antibodies, targeting epitopes near the hydrophobic , inhibit LPS, PGN, and LTA binding, confirming CD14's direct involvement. Experimental validation comes from techniques like for endpoint quantification and (SPR) for real-time kinetic measurements.

Innate Immune Activation

CD14 serves as a critical co-receptor in the innate immune response by facilitating the presentation of lipopolysaccharide (LPS) from Gram-negative bacteria to the Toll-like receptor 4 (TLR4)/MD-2 complex on the cell surface of myeloid cells such as monocytes and macrophages. This interaction enhances LPS binding affinity, leading to receptor dimerization and recruitment of adaptor proteins that amplify signaling cascades, ultimately promoting the translocation of nuclear factor kappa B (NF-κB) to the nucleus and the transcription of pro-inflammatory genes. In vitro studies demonstrate that CD14-dependent LPS presentation is essential for efficient signal amplification, as cells lacking CD14 exhibit markedly reduced responsiveness to low LPS concentrations. Upon activation, CD14 initiates robust cellular responses in innate immune cells, particularly the induction of pro-inflammatory cytokines such as tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), and interleukin-1 beta (IL-1β) in monocytes and macrophages. These cytokines orchestrate the recruitment and activation of immune cells to combat infection. In endothelial cells, CD14-mediated LPS signaling triggers the expression of adhesion molecules, including , intercellular adhesion molecule-1 (), and vascular cell adhesion molecule-1 (), facilitating leukocyte adhesion and transmigration across the vascular barrier. Additionally, CD14 mediates the switch between Fas-mediated and pro-inflammatory signaling by internalizing the , determining the inflammatory output of immune cells. Soluble CD14 (sCD14), released from activated monocytes, extends LPS responsiveness to CD14-negative cells such as endothelial and epithelial cells by shuttling LPS-LPS-binding protein (LBP) complexes to TLR4/MD-2, thereby enabling inflammatory signaling in non-myeloid tissues. This mechanism is particularly important in , where sCD14 amplifies responses in diverse cell types without requiring membrane-bound CD14. The activation process is dose-dependent, with a sensitivity threshold around 10 pg/mL LPS for CD14-expressing cells, below which responses are negligible, as shown in monocyte culture models. Repeated LPS exposure induces endotoxin tolerance through CD14 downregulation on the cell surface, reducing subsequent inflammatory outputs and preventing excessive release. Studies in mice confirm these roles, revealing hyporesponsiveness to LPS challenge, with diminished production and protection from endotoxic shock compared to wild-type controls.

Protein Interactions

Key Binding Partners

CD14 primarily interacts with lipopolysaccharide-binding protein (LBP) to facilitate the capture and transfer of (LPS) from bacterial aggregates to CD14, forming a key complex for innate immune recognition. This interaction enables LBP to catalyze the binding of LPS monomers to CD14, enhancing the efficiency of LPS presentation to downstream receptors. Additionally, CD14 associates with (TLR4) and MD-2 to transfer LPS into the signaling-competent TLR4/MD-2 complex, where CD14 acts as a co-receptor essential for LPS delivery. The (GPI) anchor at the of membrane-bound CD14 localizes it to lipid rafts, where it associates with caveolin-1, facilitating compartmentalization of immune signaling components. Other notable interactors include the CD11b/CD18 (Mac-1), which cooperates with CD14 to enhance non-opsonic of certain pathogens, such as strains. Soluble CD14 (sCD14), released from cells or present in plasma, binds LPS and shuttles it to (HDL) particles for lipid transport and , mitigating excessive . Key interaction sites on CD14 include the N-terminal leucine-rich repeats (LRRs), which form a hydrophobic pocket critical for LBP- and LPS-binding, accommodating the acyl chains of LPS. The C-terminal GPI anchor mediates membrane attachment and raft localization. The CD14-TLR4 interaction reflects transient but specific docking during LPS transfer. The tripartite LPS-CD14-LBP complex assembles sequentially, with LBP extracting LPS and transferring it to CD14, followed by docking of the CD14-LPS moiety to the TLR4/MD-2 heterodimer to initiate signaling. Structural models derived from cryo-electron and related techniques reveal the dynamic interface, highlighting how CD14 bridges LPS delivery to the TLR4/MD-2 pocket for dimerization and activation.

Downstream Signaling Pathways

Upon recognition of lipopolysaccharide (LPS) by the CD14-TLR4-MD-2 complex at the plasma membrane, the canonical MyD88-dependent pathway is initiated, wherein MyD88 is recruited to the Toll/interleukin-1 receptor (TIR) domain of TLR4, forming a complex that activates interleukin-1 receptor-associated kinases (IRAKs). IRAK4 phosphorylates IRAK1, leading to its ubiquitination and association with tumor necrosis factor receptor-associated factor 6 (TRAF6), which undergoes K63-linked ubiquitination to activate the transforming growth factor-β-activated kinase 1 (TAK1) complex. TAK1 then phosphorylates the IκB kinase (IKK) complex, resulting in the degradation of IκB and nuclear translocation of NF-κB, which drives transcription of pro-inflammatory genes such as those encoding TNF-α and IL-6. Concurrently, TAK1 activates mitogen-activated protein kinases (MAPKs), including p38, JNK, and ERK, further amplifying inflammatory responses through AP-1 transcription factor activation. In parallel, the non-canonical TRIF-dependent pathway is engaged following CD14-mediated of the TLR4 complex into early endosomes, where TRIF-related adaptor molecule () bridges TLR4 to TIR-domain-containing adapter-inducing interferon-β (TRIF). TRIF recruits TRAF6 and () to activate TAK1 and subsequently TBK1/IKKε, which phosphorylate (). Phosphorylated dimerizes and translocates to the nucleus, inducing type I (IFN-α/β) production and late-phase activation for sustained cytokine expression. This endosomal signaling is distinct from the plasma membrane-localized MyD88 pathway, allowing compartmentalized control of antiviral and inflammatory outputs. Signaling through these pathways is modulated by negative regulators to prevent excessive inflammation; for instance, phosphatidylinositol 3-kinase (PI3K)/Akt activation downstream of CD14-TLR4 inhibits NF-κB by promoting IκB stability and FOXO3a-mediated transcription of anti-inflammatory genes. Single-cell phosphoproteomics studies reveal dynamic phosphorylation kinetics, with peak activation of key nodes like p65 NF-κB occurring within 15-60 minutes post-LPS stimulation, correlating with TNF-α secretion peaking at 2-4 hours in human macrophages. Negative feedback is further enforced by SIGIRR, which competes for IRAK-TRAF6 interactions to attenuate MyD88 signaling, and SOCS1, which ubiquitinates TRAF6 and inhibits JAK-STAT crosstalk for dampened cytokine production. Species-specific variations in CD14-mediated signaling influence outcomes; in , CD14 is more critical for endosomal TRIF pathway compared to humans, where plasma membrane signaling predominates in dendritic cells. CD14-deficient models exhibit markedly reduced responses to LPS, including lower TNF-α and IL-6 levels, conferring protection against endotoxin-induced shock and storms in models.

Clinical and Pathological Roles

Involvement in Diseases

CD14 plays a in the of and endotoxemia, where dysregulation amplifies inflammatory responses to bacterial lipopolysaccharides (LPS). Elevated levels of soluble CD14 (sCD14) in plasma are strongly correlated with disease severity. Genetic polymorphisms in the CD14 gene, such as the C-159T variant, further exacerbate risk, conferring approximately a 2-fold increased susceptibility to Gram-negative infections like through enhanced activation and production. In chronic inflammatory conditions, CD14 contributes to disease progression by facilitating monocyte differentiation into pro-inflammatory foam cells. In atherosclerosis, CD14 expression on macrophages promotes oxidized LDL uptake and foam cell formation, which destabilizes plaques by driving matrix metalloproteinase release and necrotic core expansion. Similarly, in (IBD), CD14 is upregulated on colonic macrophages, enhancing LPS-mediated inflammation and disrupting epithelial barrier integrity in affected tissues. CD14 also links to neurodegenerative pathology in , where it mediates microglial activation in response to amyloid-β fibrils, exacerbating and plaque-associated neuronal damage. Beyond these, CD14 variants influence respiratory disorders, including , where polymorphisms like C-159T modulate airway hyperresponsiveness and allergen-induced , altering endotoxin tolerance and IgE responses. In , studies from 2020 to 2023 highlight sCD14 as a prognostic marker for severe outcomes, with elevated levels (e.g., >3 μg/mL) associated with worse prognosis including and progression to (ARDS) in critically ill patients. Experimental evidence from large-scale human cohort studies, including those with over 500 sepsis patients, underscores CD14's pathological impact, showing that high sCD14 correlates with multi-organ failure and 28-day mortality. In animal models of polymicrobial , CD14 blockade using monoclonal antibodies significantly reduces mortality by 30-50% and attenuates thrombo-inflammation, , and release, supporting its therapeutic targeting.

Diagnostic and Therapeutic Potential

Soluble CD14 subtype (sCD14-ST), also known as presepsin, serves as a for diagnosis, with plasma levels measurable via . A and of 30 studies reported pooled sensitivity of 78% and specificity of 83% for presepsin in distinguishing from non-infectious . Elevated presepsin levels are particularly indicative of bacterial infections, aiding differentiation from viral etiologies in emergency settings, where bacterial cases show significantly higher concentrations compared to viral infections. Therapeutically, anti-CD14 monoclonal antibodies like IC14 have been investigated to mitigate excessive immune activation in inflammatory conditions. In a phase I trial involving endotoxemia models, IC14 significantly inhibited (LPS)-induced proinflammatory release, including tumor necrosis factor-alpha and interleukin-6, while attenuating clinical symptoms. A phase II randomized, double-blind, placebo-controlled trial in hospitalized patients with (ARDS) due to severe demonstrated that IC14 reduced markers, with numerical improvements in 28-day mortality among those with high baseline presepsin levels. Extracorporeal therapies targeting endotoxin, which interacts with CD14 to drive endotoxemia, have shown promise in management by adsorbing circulating LPS, thereby indirectly neutralizing CD14-mediated responses. CD14 exhibits prognostic value in various diseases, particularly through soluble forms and monocyte expression levels. In chronic lymphocytic leukemia (CLL), elevated serum sCD14 correlates with advanced disease stage and poorer survival, serving as an independent prognostic marker beyond traditional factors like absolute count. Similarly, increased CD14+ subsets in are associated with disease progression and worse outcomes. In neurodegeneration, higher plasma sCD14 levels predict incident ; a across two population-based cohorts found that each standard deviation increase in sCD14 was linked to a 12% higher risk ( 1.12, 95% CI 1.01-1.25). Experimental models further support this, showing that CD14 deficiency delays pathology by influencing microglial responses.

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