INTRODUCTION: Investigating mechanisms of how intracellular bacterial pathogens such as Mycobacterium. avium (M. avium) evade the host immune response and replicate within macrophages is crucial to devising rational targets for host-directed therapies (HDT) against these associated diseases. This studied utilized the congenic mouse strain B6.Sst1S, which contains the super-susceptibility to tuberculosis (TB) allele. Among murine models of TB, this strain uniquely replicates human disease because mice develop granulomas with central caseous necrosis. Utilizing a susceptible model for M. avium infection, this study investigated the effect of mycobacterial pathogenesis on altering macrophage phenotypes and T cells distribution in areas of pulmonary granulomatous inflammation. METHODS:12 formalin fixed paraffin embedded (FFPE) lung sections from M. avium infected B6.Sst1S and B6 mice were examined microscopically (12 weeks post infection (wpi) n=5, 16 wpi=7). A targeted histology approach was initiated by using MRI coordinates to dictate the depths at which formalin fixed paraffin embedded (FFPE) lung samples were sectioned. Since interpretation of MRI images displayed no evidence of 2 discrete necrotizing granulomas, lungs were cut at sections representative of diffuse pathology at 2 mm into FFPE blocks. Using the Opal MethodTM (Akoya Biosciences), 6- plex immunohistochemical staining was performed with Arginase-1 (Arg1), inducible nitric oxide synthase (iNOS), CD68, CD3, M. tuberculosis antigen (cross-reacts with M. avium) and DAPI to segment nuclei. Slides were digitized by a Vectra PolarisTM fluorescent whole slide scanner. Autofluorescence was removed by InFormTM, and image analysis (IA) was conducted using HaloTM IA software. Statistical analysis was conducted using GraphPad PrismTM 8.0. RESULTS: Sst1 mediated susceptibility was statistically evident at 16 wpi but not at 12 wpi. B6.Sst1S mice showed a statistically significant (P <0.05) increase in M. avium+ cell expression in the non-inoculated lung lobes, but not the inoculated lung lobes. Pulmonary lesions within the inoculated and non-inoculated lung lobes contain different immune signatures. The predominately primary lesions of the inoculated lung lobes were associated with increased CD3+, M. avium+, and iNOS+ cell levels. When controlling for level of infection, there was lower levels of CD3+ cells within granulomatous lesions of B6.Sst1S mice, especially in the non-inoculated lung lobe. Controlling for level of infection also revealed elevated iNOS+ M. avium- cell expression in B6 mice. We observed elevated Arg1+ cell expression near iNOS+ M. avium+ cells, and, qualitatively, around larger lesions. T cell proximity analysis was contradictory and offers lessons for future the development of future IA modules. CONCLUSIONS: Sst1 mediated susceptibility was evident at 16 wpi and predominately mediated through secondary, metastatic lesions. Sst1 mediated susceptibility was also associated with fewer supportive cells (T cells and iNOS+ M. avium- cells) within granulomatous lesions. Future studies are necessary to evaluate to what degree granulomatous lesion Arg1+ cell expression and CD3+ proximity correlate to susceptibility.