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Metabolite, protein, and tissue dysfunction associated with COVID-19 disease severity. Sci Rep 2022; 12:12204. [PMID: 35842456 PMCID: PMC9288092 DOI: 10.1038/s41598-022-16396-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 07/08/2022] [Indexed: 01/09/2023] Open
Abstract
Proteins are direct products of the genome and metabolites are functional products of interactions between the host and other factors such as environment, disease state, clinical information, etc. Omics data, including proteins and metabolites, are useful in characterizing biological processes underlying COVID-19 along with patient data and clinical information, yet few methods are available to effectively analyze such diverse and unstructured data. Using an integrated approach that combines proteomics and metabolomics data, we investigated the changes in metabolites and proteins in relation to patient characteristics (e.g., age, gender, and health outcome) and clinical information (e.g., metabolic panel and complete blood count test results). We found significant enrichment of biological indicators of lung, liver, and gastrointestinal dysfunction associated with disease severity using publicly available metabolite and protein profiles. Our analyses specifically identified enriched proteins that play a critical role in responses to injury or infection within these anatomical sites, but may contribute to excessive systemic inflammation within the context of COVID-19. Furthermore, we have used this information in conjunction with machine learning algorithms to predict the health status of patients presenting symptoms of COVID-19. This work provides a roadmap for understanding the biochemical pathways and molecular mechanisms that drive disease severity, progression, and treatment of COVID-19.
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deKay JT, Emery IF, Rud J, Eldridge A, Lord C, Gagnon DJ, May TL, Herrera VLM, Ruiz-Opazo N, Riker RR, Sawyer DB, Ryzhov S, Seder DB. DEspR high neutrophils are associated with critical illness in COVID-19. Sci Rep 2021; 11:22463. [PMID: 34789851 PMCID: PMC8599677 DOI: 10.1038/s41598-021-01943-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 11/08/2021] [Indexed: 12/15/2022] Open
Abstract
SARS-CoV-2 infection results in a spectrum of outcomes from no symptoms to widely varying degrees of illness to death. A better understanding of the immune response to SARS-CoV-2 infection and subsequent, often excessive, inflammation may inform treatment decisions and reveal opportunities for therapy. We studied immune cell subpopulations and their associations with clinical parameters in a cohort of 26 patients with COVID-19. Following informed consent, we collected blood samples from hospitalized patients with COVID-19 within 72 h of admission. Flow cytometry was used to analyze white blood cell subpopulations. Plasma levels of cytokines and chemokines were measured using ELISA. Neutrophils undergoing neutrophil extracellular traps (NET) formation were evaluated in blood smears. We examined the immunophenotype of patients with COVID-19 in comparison to that of SARS-CoV-2 negative controls. A novel subset of pro-inflammatory neutrophils expressing a high level of dual endothelin-1 and VEGF signal peptide-activated receptor (DEspR) at the cell surface was found to be associated with elevated circulating CCL23, increased NETosis, and critical-severity COVID-19 illness. The potential to target this subpopulation of neutrophils to reduce secondary tissue damage caused by SARS-CoV-2 infection warrants further investigation.
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Affiliation(s)
- Joanne T deKay
- Maine Medical Center Research Institute, 81 Research Drive, Scarborough, ME, 04074, USA
| | - Ivette F Emery
- Maine Medical Center Research Institute, 81 Research Drive, Scarborough, ME, 04074, USA
| | - Jonathan Rud
- Department of Critical Care Services, Maine Medical Center, 22 Bramhall St, Portland, ME, 04105, USA
| | - Ashley Eldridge
- Department of Critical Care Services, Maine Medical Center, 22 Bramhall St, Portland, ME, 04105, USA
| | - Christine Lord
- Department of Critical Care Services, Maine Medical Center, 22 Bramhall St, Portland, ME, 04105, USA
| | - David J Gagnon
- Maine Medical Center Research Institute, 81 Research Drive, Scarborough, ME, 04074, USA
- Department of Critical Care Services, Maine Medical Center, 22 Bramhall St, Portland, ME, 04105, USA
- Tufts University School of Medicine, Boston, MA, USA
| | - Teresa L May
- Maine Medical Center Research Institute, 81 Research Drive, Scarborough, ME, 04074, USA
- Department of Critical Care Services, Maine Medical Center, 22 Bramhall St, Portland, ME, 04105, USA
| | - Victoria L M Herrera
- Whitaker Cardiovascular Institute and Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Nelson Ruiz-Opazo
- Whitaker Cardiovascular Institute and Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Richard R Riker
- Department of Critical Care Services, Maine Medical Center, 22 Bramhall St, Portland, ME, 04105, USA
| | - Douglas B Sawyer
- Maine Medical Center Research Institute, 81 Research Drive, Scarborough, ME, 04074, USA
- Department of Critical Care Services, Maine Medical Center, 22 Bramhall St, Portland, ME, 04105, USA
| | - Sergey Ryzhov
- Maine Medical Center Research Institute, 81 Research Drive, Scarborough, ME, 04074, USA.
| | - David B Seder
- Maine Medical Center Research Institute, 81 Research Drive, Scarborough, ME, 04074, USA.
- Department of Critical Care Services, Maine Medical Center, 22 Bramhall St, Portland, ME, 04105, USA.
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Defendi F, Leroy C, Epaulard O, Clavarino G, Vilotitch A, Le Marechal M, Jacob MC, Raskovalova T, Pernollet M, Le Gouellec A, Bosson JL, Poignard P, Roustit M, Thielens N, Dumestre-Pérard C, Cesbron JY. Complement Alternative and Mannose-Binding Lectin Pathway Activation Is Associated With COVID-19 Mortality. Front Immunol 2021; 12:742446. [PMID: 34567008 PMCID: PMC8461024 DOI: 10.3389/fimmu.2021.742446] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 08/23/2021] [Indexed: 12/19/2022] Open
Abstract
Background The SARS-CoV-2 infection triggers excessive immune response resulting in increased levels of pro-inflammatory cytokines, endothelial injury, and intravascular coagulopathy. The complement system (CS) activation participates to this hyperinflammatory response. However, it is still unclear which activation pathways (classical, alternative, or lectin pathway) pilots the effector mechanisms that contribute to critical illness. To better understand the immune correlates of disease severity, we performed an analysis of CS activation pathways and components in samples collected from COVID-19 patients hospitalized in Grenoble Alpes University Hospital between 1 and 30 April 2020 and of their relationship with the clinical outcomes. Methods We conducted a retrospective, single-center study cohort in 74 hospitalized patients with RT-PCR-proven COVID-19. The functional activities of classical, alternative, and mannose-binding lectin (MBL) pathways and the antigenic levels of the individual components C1q, C4, C3, C5, Factor B, and MBL were measured in patients' samples during hospital admission. Hierarchical clustering with the Ward method was performed in order to identify clusters of patients with similar characteristics of complement markers. Age was included in the model. Then, the clusters were compared with the patient clinical features: rate of intensive care unit (ICU) admission, corticoid treatment, oxygen requirement, and mortality. Results Four clusters were identified according to complement parameters. Among them, two clusters revealed remarkable profiles: in one cluster (n = 15), patients exhibited activation of alternative and lectin pathways and low antigenic levels of MBL, C4, C3, Factor B, and C5 compared to all the other clusters; this cluster had the higher proportion of patients who died (27%) and required oxygen support (80%) or ICU care (53%). In contrast, the second cluster (n = 19) presented inflammatory profile with high classical pathway activity and antigenic levels of complement components; a low proportion of patients required ICU care (26%) and no patient died in this group. Conclusion These findings argue in favor of prominent activation of the alternative and MBL complement pathways in severe COVID-19, but the spectrum of complement involvement seems to be heterogeneous requiring larger studies.
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Affiliation(s)
- Federica Defendi
- Laboratoire d’Immunologie, Institut de Biologie et Pathologie, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Corentin Leroy
- Cellule d’Ingénierie des Données, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
- Centre d’Investigation Clinique de l’Innovation et de la Technologie (CIC-IT), Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Olivier Epaulard
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
- Université Grenoble Alpes, TIMC-IMAG, Grenoble, France
| | - Giovanna Clavarino
- Laboratoire d’Immunologie, Institut de Biologie et Pathologie, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Antoine Vilotitch
- Cellule d’Ingénierie des Données, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Marion Le Marechal
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Marie-Christine Jacob
- Laboratoire d’Immunologie, Institut de Biologie et Pathologie, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Tatiana Raskovalova
- Laboratoire d’Immunologie, Institut de Biologie et Pathologie, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Martine Pernollet
- Laboratoire d’Immunologie, Institut de Biologie et Pathologie, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Audrey Le Gouellec
- Université Grenoble Alpes, TIMC-IMAG, Grenoble, France
- Laboratoire de Biochimie, Institut de Biologie et Pathologie, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | | | - Pascal Poignard
- Université Grenoble Alpes, CNRS, CEA, Institut de Biologie Structurale (IBS), Grenoble, France
- Laboratoire de Virologie, Institut de Biologie et Pathologie, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Matthieu Roustit
- Département de Pharmacologie Clinique INSERM CIC 1406, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
- Université Grenoble Alpes, UMR 1042-HP2, INSERM, Grenoble, France
| | - Nicole Thielens
- Université Grenoble Alpes, CNRS, CEA, Institut de Biologie Structurale (IBS), Grenoble, France
| | - Chantal Dumestre-Pérard
- Laboratoire d’Immunologie, Institut de Biologie et Pathologie, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
- Université Grenoble Alpes, CNRS, CEA, Institut de Biologie Structurale (IBS), Grenoble, France
| | - Jean-Yves Cesbron
- Laboratoire d’Immunologie, Institut de Biologie et Pathologie, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
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Sajdel-Sulkowska EM. A Dual-Route Perspective of SARS-CoV-2 Infection: Lung- vs. Gut-specific Effects of ACE-2 Deficiency. Front Pharmacol 2021; 12:684610. [PMID: 34177593 PMCID: PMC8226136 DOI: 10.3389/fphar.2021.684610] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 05/21/2021] [Indexed: 12/11/2022] Open
Abstract
SARS-CoV-2, primarily considered a respiratory virus, is increasingly recognized as having gastrointestinal aspects based on its presence in the gastrointestinal (GI) tract and feces. SARS-CoV-2 uses as a receptor angiotensin-converting enzyme 2 (ACE-2), a critical member of the renin-angiotensin-aldosterone system (RAAS) involved in the regulation of blood pressure and fluid system. In addition to the systemic endocrine functions, RAAS components are also involved in intracrine and organ-specific local functions. The angiotensin-converting enzyme 2 (ACE-2) is a key component of RAAS and a receptor for SARS-CoV-2. It is expressed in many tissues with gastrointestinal (GI) tract ACE-2 levels far exceeding those in the respiratory tract. SARS-CoV-2 binding to its receptor results in a deficiency of ACE-2 activity in endocrine, intracrine, and local lung and GI tract ACE-2. The local ACE-2 has different organ-specific functions, including hypertension-independent activities; dysregulations of these functions may contribute to multiorgan COVID-19 pathology, its severity, long-term effects, and mortality. We review supporting evidence from this standpoint. Notably, COVID-19 comorbidities involving hypertension, obesity, heart disease, kidney disease, and diabetes are associated with gastrointestinal problems and display ACE-2 deficits. While RAAS inhibitors target both endocrine and intracrine ACE-2 activity, the deficit of the local ACE-2 activity in the lungs and more so in the gut have not been targeted. Consequently, the therapeutic approach to COVID-19 should be carefully reconsidered. Ongoing clinical trials testing oral probiotic bound ACE-2 delivery are promising.
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