Title Cytokine storm-based mechanisms for extrapulmonary manifestations of SARS-CoV-2 infection.
Author Del Nogal Avila, Maria; Das, Ranjan; Kharlyngdoh, Joubert; Molina-Jijon, Eduardo; Donoro Blazquez, Hector; Gambut, Stephanie; Crowley, Michael; Crossman, David K; Gbadegesin, Rasheed A; Chugh, Sunveer S; Chugh, Sunjeet S; Avila-Casado, Carmen; Mace, Camille; Clement, Lionel C; Chugh, Sumant S
Journal JCI Insight Publication Year/Month 2023-May
PMID 37040185 PMCID -N/A-
Affiliation + expend 1.Glomerular Disease Therapeutics Laboratory, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA.

Viral illnesses like SARS-CoV-2 have pathologic effects on nonrespiratory organs in the absence of direct viral infection. We injected mice with cocktails of rodent equivalents of human cytokine storms resulting from SARS-CoV-2/COVID-19 or rhinovirus common cold infection. At low doses, COVID-19 cocktails induced glomerular injury and albuminuria in zinc fingers and homeoboxes 2 (Zhx2) hypomorph and Zhx2+/+ mice to mimic COVID-19-related proteinuria. Common Cold cocktail induced albuminuria selectively in Zhx2 hypomorph mice to model relapse of minimal change disease, which improved after depletion of TNF-alpha, soluble IL-4Ralpha, or IL-6. The Zhx2 hypomorph state increased cell membrane to nuclear migration of podocyte ZHX proteins in vivo (both cocktails) and lowered phosphorylated STAT6 activation (COVID-19 cocktail) in vitro. At higher doses, COVID-19 cocktails induced acute heart injury, myocarditis, pericarditis, acute liver injury, acute kidney injury, and high mortality in Zhx2+/+ mice, whereas Zhx2 hypomorph mice were relatively protected, due in part to early, asynchronous activation of STAT5 and STAT6 pathways in these organs. Dual depletion of cytokine combinations of TNF-alpha with IL-2, IL-13, or IL-4 in Zhx2+/+ mice reduced multiorgan injury and eliminated mortality. Using genome sequencing and CRISPR/Cas9, an insertion upstream of ZHX2 was identified as a cause of the human ZHX2 hypomorph state.

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