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Romero MJ, Yue Q, Singla B, Hamacher J, Sridhar S, Moseley AS, Song C, Mraheil MA, Fischer B, Zeitlinger M, Chakraborty T, Fulton D, Gan L, Annex BH, Csanyi G, Eaton DC, Lucas R. Direct endothelial ENaC activation mitigates vasculopathy induced by SARS-CoV2 spike protein. Front Immunol 2023; 14:1241448. [PMID: 37638055 PMCID: PMC10449264 DOI: 10.3389/fimmu.2023.1241448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 07/25/2023] [Indexed: 08/29/2023] Open
Abstract
Introduction Although both COVID-19 and non-COVID-19 ARDS can be accompanied by significantly increased levels of circulating cytokines, the former significantly differs from the latter by its higher vasculopathy, characterized by increased oxidative stress and coagulopathy in lung capillaries. This points towards the existence of SARS-CoV2-specific factors and mechanisms that can sensitize the endothelium towards becoming dysfunctional. Although the virus is rarely detected within endothelial cells or in the circulation, the S1 subunit of its spike protein, which contains the receptor binding domain (RBD) for human ACE2 (hACE2), can be detected in plasma from COVID-19 patients and its levels correlate with disease severity. It remains obscure how the SARS-CoV2 RBD exerts its deleterious actions in lung endothelium and whether there are mechanisms to mitigate this. Methods In this study, we use a combination of in vitro studies in RBD-treated human lung microvascular endothelial cells (HL-MVEC), including electrophysiology, barrier function, oxidative stress and human ACE2 (hACE2) surface protein expression measurements with in vivo studies in transgenic mice globally expressing human ACE2 and injected with RBD. Results We show that SARS-CoV2 RBD impairs endothelial ENaC activity, reduces surface hACE2 expression and increases reactive oxygen species (ROS) and tissue factor (TF) generation in monolayers of HL-MVEC, as such promoting barrier dysfunction and coagulopathy. The TNF-derived TIP peptide (a.k.a. solnatide, AP301) -which directly activates ENaC upon binding to its a subunit- can override RBD-induced impairment of ENaC function and hACE2 expression, mitigates ROS and TF generation and restores barrier function in HL-MVEC monolayers. In correlation with the increased mortality observed in COVID-19 patients co-infected with S. pneumoniae, compared to subjects solely infected with SARS-CoV2, we observe that prior intraperitoneal RBD treatment in transgenic mice globally expressing hACE2 significantly increases fibrin deposition and capillary leak upon intratracheal instillation of S. pneumoniae and that this is mitigated by TIP peptide treatment.
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Affiliation(s)
- Maritza J. Romero
- Vascular Biology Center, Medical College of Georgia at Augusta University, Augusta, GA, United States
- Department of Pharmacology and Toxicology, Medical College of Georgia at Augusta University, Augusta, GA, United States
| | - Qian Yue
- Department of Medicine, School of Medicine, Emory University, Atlanta, GA, United States
| | - Bhupesh Singla
- Vascular Biology Center, Medical College of Georgia at Augusta University, Augusta, GA, United States
| | - Jürg Hamacher
- Pneumology, Clinic for General Internal Medicine, Lindenhofspital, Bern, Switzerland
- Lungen-und Atmungsstiftung, Bern, Switzerland
- Medical Clinic V—Pneumology, Allergology, Intensive Care Medicine, and Environmental Medicine, Faculty of Medicine, Saarland University, University Medical Centre of the Saarland, Homburg, Germany
| | - Supriya Sridhar
- Vascular Biology Center, Medical College of Georgia at Augusta University, Augusta, GA, United States
| | - Auriel S. Moseley
- Department of Medicine, School of Medicine, Emory University, Atlanta, GA, United States
| | - Chang Song
- Department of Medicine, School of Medicine, Emory University, Atlanta, GA, United States
| | - Mobarak A. Mraheil
- Institute for Medical Microbiology, German Centre for Infection Giessen-Marburg-Langen Site, Faculty of Medicine, Justus-Liebig University, Giessen, Germany
| | | | - Markus Zeitlinger
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Trinad Chakraborty
- Institute for Medical Microbiology, German Centre for Infection Giessen-Marburg-Langen Site, Faculty of Medicine, Justus-Liebig University, Giessen, Germany
| | - David Fulton
- Vascular Biology Center, Medical College of Georgia at Augusta University, Augusta, GA, United States
- Department of Pharmacology and Toxicology, Medical College of Georgia at Augusta University, Augusta, GA, United States
| | - Lin Gan
- Department of Neuroscience and Regenerative Medicine, Medical College of Georgia at Augusta University, Augusta, GA, United States
| | - Brian H. Annex
- Department of Medicine, Medical College of Georgia at Augusta University, Augusta, GA, United States
| | - Gabor Csanyi
- Vascular Biology Center, Medical College of Georgia at Augusta University, Augusta, GA, United States
- Department of Pharmacology and Toxicology, Medical College of Georgia at Augusta University, Augusta, GA, United States
| | - Douglas C. Eaton
- Department of Medicine, School of Medicine, Emory University, Atlanta, GA, United States
| | - Rudolf Lucas
- Vascular Biology Center, Medical College of Georgia at Augusta University, Augusta, GA, United States
- Department of Pharmacology and Toxicology, Medical College of Georgia at Augusta University, Augusta, GA, United States
- Department of Medicine, Medical College of Georgia at Augusta University, Augusta, GA, United States
- Division of Pulmonary and Critical Care Medicine, Medical College of Georgia at Augusta University, Augusta, GA, United States
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