Tulane National Primate Research Center, Covington, LA 70433, USA.
Department of Immunology and Microbiology, Tulane University School of Medicine, New Orleans, LA 70112, USA.
Theranostics. 2021 Jul 6;11(16):8076-8091. doi: 10.7150/thno.61810. eCollection 2021.
: Pulmonary vascular endotheliitis, perivascular inflammation, and immune activation are observed in COVID-19 patients. While the initial SARS-CoV-2 infection mainly infects lung epithelial cells, whether it also infects endothelial cells (ECs) and to what extent SARS-CoV-2-mediated pulmonary vascular endotheliitis is associated with immune activation remain to be determined. : To address these questions, we studied SARS-CoV-2-infected () mice, a severe COVID-19 mouse model, as well as lung samples from SARS-CoV-2-infected nonhuman primates (NHP) and patient deceased from COVID-19. We used immunostaining, RNAscope, and electron microscopy to analyze the organs collected from animals and patient. We conducted bulk and single cell (sc) RNA-seq analyses, and cytokine profiling of lungs or serum of the severe COVID-19 mice. : We show that SARS-CoV-2-infected mice develop severe COVID-19, including progressive body weight loss and fatality at 7 days, severe lung interstitial inflammation, edema, hemorrhage, perivascular inflammation, systemic lymphocytopenia, and eosinopenia. Body weight loss in mice correlated with the severity of pneumonia, but not with brain infection. We also observed endothelial activation and dysfunction in pulmonary vessels evidenced by the up-regulation of VCAM1 and ICAM1 and the downregulation of VE-cadherin. We detected SARS-CoV-2 in capillary ECs, activation and adhesion of platelets and immune cells to the vascular wall of the alveolar septa, and increased complement deposition in the lungs, in both COVID-19-murine and NHP models. We also revealed that pathways of coagulation, complement, K-ras signaling, and genes of ICAM1 and VCAM1 related to EC dysfunction and injury were upregulated, and were associated with massive immune activation in the lung and circulation. : Together, our results indicate that SARS-CoV-2 causes endotheliitis via both infection and infection-mediated immune activation, which may contribute to the pathogenesis of severe COVID-19 disease.
新型冠状病毒感染患者的肺部血管内皮炎、血管周围炎症和免疫激活。虽然最初的 SARS-CoV-2 感染主要感染肺上皮细胞,但它是否也感染内皮细胞(EC)以及 SARS-CoV-2 介导的肺血管内皮炎与免疫激活的程度仍有待确定。为了解决这些问题,我们研究了 SARS-CoV-2 感染的()小鼠,这是一种严重的 COVID-19 小鼠模型,以及 SARS-CoV-2 感染的非人灵长类动物(NHP)和死于 COVID-19 的患者的肺组织。我们使用免疫染色、RNAscope 和电子显微镜分析从动物和患者身上采集的器官。我们对严重 COVID-19 小鼠的肺部或血清进行了 bulk 和单细胞(sc)RNA-seq 分析以及细胞因子谱分析。我们发现,感染 SARS-CoV-2 的 小鼠会发展为严重的 COVID-19,包括第 7 天体重逐渐减轻和死亡、严重的肺间质炎症、水肿、出血、血管周围炎症、全身淋巴细胞减少和嗜酸性粒细胞减少。小鼠的体重减轻与肺炎的严重程度相关,但与脑部感染无关。我们还观察到肺部血管内皮的激活和功能障碍,表现为 VCAM1 和 ICAM1 的上调以及 VE-cadherin 的下调。我们在 COVID-19 小鼠和 NHP 模型中均检测到毛细血管内皮细胞中的 SARS-CoV-2、血小板和免疫细胞对肺泡隔血管壁的激活和黏附,以及补体在肺部的沉积增加。我们还揭示了与 EC 功能障碍和损伤相关的凝血、补体、K-ras 信号通路以及 ICAM1 和 VCAM1 基因的途径上调,并与肺部和循环中大量免疫激活相关。总之,我们的结果表明,SARS-CoV-2 通过感染和感染介导的免疫激活引起内皮炎,这可能导致严重 COVID-19 疾病的发病机制。
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