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Jacobs ER, Ross GR, Padilla N, Pan AY, Liegl M, Puzyrenko A, Lai S, Dai Q, Uche N, Rubenstein JC, North PE, Ibrahim ESH, Sun Y, Felix JC, Rui H, Benjamin IJ. Profibrotic COVID-19 subphenotype exhibits enhanced localized ER-dependent HSP47 + expression in cardiac myofibroblasts in situ. J Mol Cell Cardiol 2023; 185:1-12. [PMID: 37839656 PMCID: PMC11000691 DOI: 10.1016/j.yjmcc.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 09/07/2023] [Accepted: 10/10/2023] [Indexed: 10/17/2023]
Abstract
We recently described a subgroup of autopsied COVID-19 subjects (∼40%), termed 'profibrotic phenotype,' who exhibited clusters of myofibroblasts (Mfbs), which were positive for the collagen-specific chaperone heat shock protein 47 (HSP47+) in situ. This report identifies increased, localized (hot spot restricted) expression of αSMA, COLα1, POSTN and FAP supporting the identity of HSP47+ cells as myofibroblasts and characterizing a profibrotic extracellular matrix (ECM) phenotype. Coupled with increased GRP78 in COVID-19 subjects, these data could reflect induction of the unfolded protein response for mitigation of proteostasis (i.e., protein homeostasis) dysfunction in discrete clusters of cells. ECM shifts in selected COVID-19 subjects occur without significant increases in either global trichrome positive staining or myocardial injury based quantitively on standard H&E scoring. Our findings also suggest distinct mechanism(s) for ECM remodeling in the setting of SARS-CoV-2 infection. The ratio of CD163+/CD68+ cells is increased in hot spots of profibrotic hearts compared with either controls or outside of hot spots in COVID-19 subjects. In sum, matrix remodeling of human COVID-19 hearts in situ is characterized by site-restricted profibrotic mediated (e.g., HSP47+ Mfbs, CD163+ Mφs) modifications in ECM (i.e., COLα1, POSTN, FAP), with a strong correlation between COLα1 and HSP47+cells within hot spots. Given the established associations of viral infection (e.g., human immunodeficiency virus; HIV), myocardial fibrosis and sudden cardiac death, early screening tools (e.g., plasma biomarkers, noninvasive cardiac magnetic resonance imaging) for diagnosis, monitoring and treatment of fibrotic ECM remodeling are warranted for COVID-19 high-risk populations.
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Affiliation(s)
- Elizabeth R Jacobs
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, United States of America; Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI, United States of America; Department of Physiology, Medical College of Wisconsin, Milwaukee, WI, United States of America; Clement J. Zablocki VA Medical Center, Milwaukee, WI, United States of America
| | - Gracious R Ross
- Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Nathan Padilla
- Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Amy Y Pan
- Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI, United States of America; Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, United States of America; Children's Research Institute, Milwaukee, WI, United States of America
| | - Melodee Liegl
- Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI, United States of America; Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, United States of America; Children's Research Institute, Milwaukee, WI, United States of America
| | - Andrii Puzyrenko
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Shuping Lai
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, United States of America; Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Qiang Dai
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, United States of America; Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Nnamdi Uche
- Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI, United States of America; Department of Physiology, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Jason C Rubenstein
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, United States of America; Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Paula E North
- Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI, United States of America; Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, United States of America; Children's Research Institute, Milwaukee, WI, United States of America
| | - El-Sayed H Ibrahim
- Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI, United States of America; Department of Radiology, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Yunguang Sun
- Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI, United States of America; Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Juan C Felix
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Hallgeir Rui
- Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI, United States of America; Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Ivor J Benjamin
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, United States of America; Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI, United States of America; Department of Physiology, Medical College of Wisconsin, Milwaukee, WI, United States of America; Department of Cell Biology, Neuroanatomy and Anatomy, Medical College of Wisconsin, Milwaukee, WI, United States of America.
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