Gasdermin-D activation by SARS-CoV-2 triggers NET and mediate COVID-19 immunopathology

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Abstract

Background

The release of neutrophil extracellular traps (NETs) is associated with inflammation, coagulopathy, and organ damage found in severe cases of COVID-19. However, the molecular mechanisms underlying the release of NETs in COVID-19 remain unclear.

Objectives

We aim to investigate the role of the Gasdermin-D (GSDMD) pathway on NETs release and the development of organ damage during COVID-19.

Methods

We performed a single-cell transcriptome analysis in public data of bronchoalveolar lavage. Then, we enrolled 63 hospitalized patients with moderate and severe COVID-19. We analyze in blood and lung tissue samples the expression of GSDMD, presence of NETs, and signaling pathways upstreaming. Furthermore, we analyzed the treatment with disulfiram in a mouse model of SARS-CoV-2 infection.

Results

We found that the SARS-CoV-2 virus directly activates the pore-forming protein GSDMD that triggers NET production and organ damage in COVID-19. Single-cell transcriptome analysis revealed that the expression of GSDMD and inflammasome-related genes were increased in COVID-19 patients. High expression of active GSDMD associated with NETs structures was found in the lung tissue of COVID-19 patients. Furthermore, we showed that activation of GSDMD in neutrophils requires active caspase1/4 and live SARS-CoV-2, which infects neutrophils. In a mouse model of SARS-CoV-2 infection, the treatment with disulfiram inhibited NETs release and reduced organ damage.

Conclusion

These results demonstrated that GSDMD-dependent NETosis plays a critical role in COVID-19 immunopathology and suggests GSDMD as a novel potential target for improving the COVID-19 therapeutic strategy.

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  1. SciScore for 10.1101/2022.01.24.22269768: (What is this?)

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

    Table 1: Rigor

    EthicsConsent: The exclusion criteria were defined as diarrhea resulting in dehydration; pregnancy or lactation; metastatic cancer or immunosuppressive chemotherapy and inability to understand the consent form (Lopes et al., 2021).
    IRB: The study was approved by the National Ethics Committee, Brazil (CONEP, CAAE: 30248420.9.0000.5440).
    Sex as a biological variableEight-week-old male K18-hACE2 mice were infected with 2×104 PFU of SARS-CoV-2 (in 40 μL) by the intranasal route as previously described (Oladunni et al, 2020).
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Cell Line AuthenticationAuthentication: The dataset generated by authors is publicly available at https://covid19-balf.cells.ucsc.edu/.

    Table 2: Resources

    Antibodies
    SentencesResources
    The slides were overnight stained with the following antibodies: a) Mouse anti-myeloperoxidase (MPO, 2C7, Abcam, cat. ab25989, 1:500); B) Rabbit anti-GSDMD-NT (Abcam, cat. ab215203).
    anti-myeloperoxidase ( MPO
    suggested: (Antibodies-Online Cat# ABIN235893, RRID:AB_10764910)
    anti-GSDMD-NT
    suggested: None
    Next, the samples were incubated with alpaca anti-mouse IgG Alexa Fluor 488 (Jackson ImmunoResearch, cat. 615-545-214, 1:1000) or alpaca anti-rabbit IgG Alexa Fluor 594 (Jackson ImmunoResearch, cat. 611-585-215, 1:1000) secondary antibodies for 30 minutes.
    anti-mouse IgG
    suggested: (Jackson ImmunoResearch Labs Cat# 615-545-214, RRID:AB_2721889)
    anti-rabbit IgG
    suggested: (Jackson ImmunoResearch Labs Cat# 611-585-215, RRID:AB_2721875)
    tenofovir disoproxil fumarate) – CAS 202138-50-9 - (10 μM); neutralizing anti-hACE2 antibody - αACE2 - RheaBiotech; Cat.
    anti-hACE2
    suggested: None
    The membranes were incubated overnight at 4°C under mild agitation in 5% nonfat dry milk in 1X TBS-T buffer containing the following primary antibodies: mouse anti-Caspase-1 (p20) (mAb (Bally-1); Adipogen; AG-20B-0048-C100; 1:1000), mouse anti-Caspase-4 (MBL cat.
    anti-Caspase-1
    suggested: None
    anti-Caspase-4
    suggested: None
    Experimental Models: Cell Lines
    SentencesResources
    Vero-E6 cells were cultured in DMEM high glucose supplemented with 10% fetal bovine serum (FBS; HyClone, Logan,Utah) and 100 U/mL penicillin, and 1% μg/mL streptomycin (P/S Corning; cat. 30-002-CI), 1% glutamine (Corning; cat. 15718008), 1% hepes (Corning; cat.25-060-CI), and 1% fungizone (Gibco; cat. 15290-018) at 37°C in the 5% CO2 atmosphere.
    Vero-E6
    suggested: None
    Plaque Reduction Neutralization Test using disulfiram against SARS-CoV-2: A PRNT (Plaque Reduction Neutralization Test) was performed in VERO E6 cells on a cell-monolayer in 24-well plates to evaluate the effect of disulfiram on SARS-CoV-2 infection.
    VERO E6
    suggested: None
    Cytopathic effect of SARS-CoV-2 infected neutrophils on A549 and HUVECcell lines by flow cytometry: Neutrophils were isolated from healthy controls (1×106) incubated or not with disulfiram (10 μM) for 1 h.
    A549
    suggested: None
    Experimental Models: Organisms/Strains
    SentencesResources
    Mouse infection and treatment: To evaluate the effects of Disulfiram in vivo, we infected the K18-hACE2 humanized mice (B6.Cg-Tg(K18-ACE2)2Prlmn/J) (McCray et al., 2007; Oladunni et al., 2020; Bao et al., 2020).
    B6.Cg-Tg(K18-ACE2)2Prlmn/J
    suggested: RRID:IMSR_JAX:034860)
    Eight-week-old male K18-hACE2 mice were infected with 2×104 PFU of SARS-CoV-2 (in 40 μL) by the intranasal route as previously described (Oladunni et al, 2020).
    K18-hACE2
    suggested: RRID:IMSR_GPT:T037657)
    Software and Algorithms
    SentencesResources
    The blood cells were then resuspended in Hank’s balanced salt solution (Corning; cat. 21-022-CV), and the neutrophil population was isolated by Percoll (GE Healthcare; cat. 17-5445-01) density gradient (72%, 63%, 54%, and 45%).
    GE Healthcare
    suggested: (GE Healthcare, RRID:SCR_000004)
    This fluid was mixed 1:1 with 0.1 M dithiothreitol (Thermo Fisher Scientific; cat.
    Thermo Fisher Scientific
    suggested: (Thermo Fisher Scientific, RRID:SCR_008452)
    All images acquired were analyzed using Fiji by ImageJ.
    Fiji
    suggested: (Fiji, RRID:SCR_002285)
    ImageJ
    suggested: (ImageJ, RRID:SCR_003070)
    The acquisition of the cells was performed in a flow cytometer (FACS Verse) and the analyses were made using the FlowJo software (FlowCytometry Analysis Software v10).
    FlowJo
    suggested: (FlowJo, RRID:SCR_008520)
    Statistical analyses and graph plots were performed with GraphPad Prism 8.4.2 software.
    GraphPad Prism
    suggested: (GraphPad Prism, RRID:SCR_002798)

    Results from OddPub: Thank you for sharing your data.


    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 found bar graphs of continuous data. We recommend replacing bar graphs with more informative graphics, as many different datasets can lead to the same bar graph. The actual data may suggest different conclusions from the summary statistics. For more information, please see Weissgerber et al (2015).


    Results from JetFighter: Please consider improving the rainbow (“jet”) colormap(s) used on pages 33, 24, 26, 27, 29 and 30. At least one figure is not accessible to readers with colorblindness and/or is not true to the data, i.e. not perceptually uniform.


    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.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.


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