SARS-CoV-2 infects blood monocytes to activate NLRP3 and AIM2 inflammasomes, pyroptosis and cytokine release

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Abstract

SARS-CoV-2 causes acute respiratory distress that can progress to multiorgan failure and death in some patients. Although severe COVID-19 disease is linked to exuberant inflammation, how SARS-CoV-2 triggers inflammation is not understood. Monocytes are sentinel blood cells that sense invasive infection to form inflammasomes that activate caspase-1 and gasdermin D (GSDMD) pores, leading to inflammatory death (pyroptosis) and processing and release of IL-1 family cytokines, potent inflammatory mediators. Here we show that ~10% of blood monocytes in COVID-19 patients are dying and infected with SARS-CoV-2. Monocyte infection, which depends on antiviral antibodies, activates NLRP3 and AIM2 inflammasomes, caspase-1 and GSDMD cleavage and relocalization. Signs of pyroptosis (IL-1 family cytokines, LDH) in the plasma correlate with development of severe disease. Moreover, expression quantitative trait loci (eQTLs) linked to higher GSDMD expression increase the risk of severe COVID-19 disease (odds ratio, 1.3, p<0.005). These findings taken together suggest that antibody-mediated SARS-CoV-2 infection of monocytes triggers inflammation that contributes to severe COVID-19 disease pathogenesis.

Antibody-mediated SARS-CoV-2 infection of monocytes activates inflammation and cytokine release.

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  1. SciScore for 10.1101/2021.03.06.21252796: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementConsent: All summary data used in this work are publicly available, together with a description of relevant participant consent and ethical approval secured in the original investigation.
    RandomizationMendelian randomization is a form of instrumental variable analysis that exploits the random allocation of alleles at meiosis to draw causal inferences using observational data by attempting to emulate randomization procedures that would be adopted in a clinical trial.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.
    Cell Line Authenticationnot detected.

    Table 2: Resources

    Antibodies
    SentencesResources
    Monocytes were then blocked for 30 min with PBS + 5% FBS, washed twice and then stained with unconjugated primary antibodies for ASC (1:200, mouse or rabbit), NLRP3 (1:200, goat), AIM2 (1:200, mouse), GSDMD (1:200, mouse), pyrin (1:200, rabbit), dsRNA (J2, mouse) (1:500) or SARS-CoV-2 nucleocapsid protein (1:500, rabbit) for 2 h, followed by 3 washes with PBS + 3% FBS.
    ASC
    suggested: None
    NLRP3
    suggested: None
    AIM2
    suggested: None
    GSDMD
    suggested: None
    SARS-CoV-2 nucleocapsid protein
    suggested: (Bioss Cat# bsm-41414M, RRID:AB_2848129)
    After washing with 1x Annexin V buffer, cells were blocked for 10 min with anti-CD32 (1:100) in PBS + 3% FBS, and then stained for 15 min on ice with a cocktail of antibodies to identify lymphocyte and myeloid cell subsets (all 1:200 except CD19 BV650, CD123 PerCP-Cy5.5 and CD56 APC-Cy7, 1:100)
    CD123
    suggested: (BD Biosciences Cat# 557939, RRID:AB_2802162)
    PerCP-Cy5.5
    suggested: (Thermo Fisher Scientific Cat# A14940, RRID:AB_2534378)
    CD56
    suggested: None
    APC-Cy7
    suggested: (StressMarq Biosciences Cat# SMC-100B-APCCY7, RRID:AB_2820311)
    Purified monocytes and an A549 cell line overexpressing ACE2 were blocked with anti-CD32, then stained with primary antibodies for ACE2 (1:100) for 15 min on ice.
    anti-CD32
    suggested: None
    ACE2
    suggested: None
    Cells were stained with primary antibodies for dsRNA (J2, mouse) (1:500), then stained with secondary antibody (donkey anti-mouse conjugated with AlexaFluor 647, at 1:500) and anti-CD14 PE-Cy7.
    J2
    suggested: None
    anti-mouse
    suggested: None
    anti-CD14
    suggested: None
    The viral inoculum was treated with 10 μg/ml of antibody (isotype control mAb114, anti-Spike C1A-H12, or anti-Spike C1A-B12), or 10% HD or COVID-19 patient pooled plasma (heat inactivated or not; Ig-depleted or not, as indicated) before infection with SARS-CoV-2 for 30 min at room temperature.
    anti-Spike C1A-H12
    suggested: None
    anti-Spike C1A-B12
    suggested: None
    C1A-B12 and C1A-H12, two SARS-CoV-2 Spike-targeting human monoclonal antibodies, were produced as previously described (49). qRT-PCR: RNA extracted from HD monocytes (stimulated or not with LPS (100 ng/ml for 16 h), or COVID-19 patient monocytes was reverse transcribed using a High Capacity cDNA Reverse Transcription Kit (Applied Biosystems) and the cDNA was analyzed by qRT-PCR using the Sso Fast™ EvaGreen® Supermix (BioRad) (30 sec at 95°C, 40 cycles (3 sec at 95°C; 3 sec at 54 °C) for both ACE2 and BSG (CD147)) using a CFX96 Touch Real-Time PCR Detection System (BioRad)
    C1A-B12
    suggested: None
    BSG
    suggested: None
    CD147
    suggested: None
    Experimental Models: Cell Lines
    SentencesResources
    Monocyte treatment and culture: Purified monocytes and THP-1 cells (ATCC) as controls, were cultured in RPMI + 10% FBS + 1% Pen/Strep for 30 min at 37°C in the presence or absence of 20 µM nigericin.
    THP-1
    suggested: None
    Purified monocytes and an A549 cell line overexpressing ACE2 were blocked with anti-CD32, then stained with primary antibodies for ACE2 (1:100) for 15 min on ice.
    A549
    suggested: None
    Software and Algorithms
    SentencesResources
    GSDMD was measured in the same samples using the Human GSDMD ELISA kit (MyBiosource) following the manufacturer’s instructions, and LDH activity was measured using the CytoTox 96® Non-Radioactive Cytotoxicity Assay (Promega).
    CytoTox
    suggested: None
    Cells were acquired using a FACS Canto II or LSR II and data were analyzed using FlowJo Version 10.
    FlowJo
    suggested: (FlowJo, RRID:SCR_008520)
    Uncorrelated single-nucleotide polymorphisms (SNPs) (r2 < 0.001 in European ancestry individuals in the 1000 Genomes Project, Phase 3 release) were associated with whole-blood RNA expression of GSDMD and other immune genes at genome-wide significance (P<5×10−8) from the eQTLGen consortium (22).
    1000 Genomes Project
    suggested: (1000 Genomes Project and AWS, RRID:SCR_008801)
    CrossMap (68) was used to convert genomic positions from hg38 (as reported in the COVID-19 GWAS) to hg19 using the UCSC liftover chain file to ensure both the exposure and outcome datasets were reported on the same genome assembly.
    CrossMap
    suggested: (CrossMap, RRID:SCR_001173)
    Statistical Analysis: Statistical analysis was performed using GraphPad Prism V7.0.
    GraphPad Prism
    suggested: (GraphPad Prism, RRID:SCR_002798)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).


    Results from LimitationRecognizer: An explicit section about the limitations of the techniques employed in this study was not found. We encourage authors to address study limitations.

    Results from TrialIdentifier: No clinical trial numbers were referenced.


    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.


    Results from JetFighter: We did not find any issues relating to colormaps.


    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a protocol registration statement.

    About SciScore

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