SARS-CoV-2 infection produces chronic pulmonary epithelial and immune cell dysfunction with fibrosis in mice

Author:

Dinnon Kenneth H.1ORCID,Leist Sarah R.2ORCID,Okuda Kenichi3ORCID,Dang Hong3ORCID,Fritch Ethan J.1ORCID,Gully Kendra L.2ORCID,De la Cruz Gabriela4ORCID,Evangelista Mia D.4ORCID,Asakura Takanori3ORCID,Gilmore Rodney C.3ORCID,Hawkins Padraig3,Nakano Satoko3ORCID,West Ande2ORCID,Schäfer Alexandra2ORCID,Gralinski Lisa E.2ORCID,Everman Jamie L.5ORCID,Sajuthi Satria P.5ORCID,Zweigart Mark R.2,Dong Stephanie2ORCID,McBride Jennifer2ORCID,Cooley Michelle R.2ORCID,Hines Jesse B.6,Love Miriya K.3,Groshong Steve D.7ORCID,VanSchoiack Alison8ORCID,Phelan Stefan J.8ORCID,Liang Yan8ORCID,Hether Tyler8ORCID,Leon Michael8ORCID,Zumwalt Ross E.9,Barton Lisa M.10,Duval Eric J.10,Mukhopadhyay Sanjay11,Stroberg Edana10,Borczuk Alain12,Thorne Leigh B.13,Sakthivel Muthu K.14ORCID,Lee Yueh Z.1415ORCID,Hagood James S.316ORCID,Mock Jason R.317ORCID,Seibold Max A.51819ORCID,O’Neal Wanda K.3ORCID,Montgomery Stephanie A.413ORCID,Boucher Richard C.3ORCID,Baric Ralph S.1220ORCID

Affiliation:

1. Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.

2. Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.

3. Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.

4. Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.

5. Center for Genes, Environment, and Health, National Jewish Health, Denver, CO 80206, USA.

6. Golden Point Scientific Laboratories, Hoover, AL 35216, USA.

7. Division of Pathology, Department of Medicine, National Jewish Health, Denver, CO 80206, USA.

8. NanoString Technologies, Seattle, WA 98109, USA.

9. Department of Pathology and Laboratory Medicine, Mayo Clinic, Rochester, MN 55905, USA.

10. Office of the Chief Medical Examiner, Oklahoma City, OK 73105, USA.

11. Department of Pathology, Cleveland Clinic, Cleveland, OH 44195, USA.

12. Weill Cornell Medicine, New York, NY 10065, USA.

13. Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.

14. Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.

15. Biomedical Research Imaging Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.

16. Pulmonology Division and Program for Rare and Interstitial Lung Disease, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.

17. Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.

18. Department of Pediatrics, National Jewish Health, Denver, CO 80206, USA.

19. Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado-Anschutz Medical Campus, Aurora, CO 80045, USA.

20. Rapidly Emerging Antiviral Drug Discovery Initiative, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.

Abstract

A subset of individuals who recover from coronavirus disease 2019 (COVID-19) develop post-acute sequelae of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (PASC), but the mechanistic basis of PASC-associated lung abnormalities suffers from a lack of longitudinal tissue samples. The mouse-adapted SARS-CoV-2 strain MA10 produces an acute respiratory distress syndrome in mice similar to humans. To investigate PASC pathogenesis, studies of MA10-infected mice were extended from acute to clinical recovery phases. At 15 to 120 days after virus clearance, pulmonary histologic findings included subpleural lesions composed of collagen, proliferative fibroblasts, and chronic inflammation, including tertiary lymphoid structures. Longitudinal spatial transcriptional profiling identified global reparative and fibrotic pathways dysregulated in diseased regions, similar to human COVID-19. Populations of alveolar intermediate cells, coupled with focal up-regulation of profibrotic markers, were identified in persistently diseased regions. Early intervention with antiviral EIDD-2801 reduced chronic disease, and early antifibrotic agent (nintedanib) intervention modified early disease severity. This murine model provides opportunities to identify pathways associated with persistent SARS-CoV-2 pulmonary disease and test countermeasures to ameliorate PASC.

Publisher

American Association for the Advancement of Science (AAAS)

Subject

General Medicine

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