Mucus production stimulated by IFN-AhR signaling triggers hypoxia of COVID-19

Cell Res. 2020 Dec;30(12):1078-1087. doi: 10.1038/s41422-020-00435-z. Epub 2020 Nov 6.

Abstract

Silent hypoxia has emerged as a unique feature of coronavirus disease 2019 (COVID-19). In this study, we show that mucins are accumulated in the bronchoalveolar lavage fluid (BALF) of COVID-19 patients and are upregulated in the lungs of severe respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected mice and macaques. We find that induction of either interferon (IFN)-β or IFN-γ upon SARS-CoV-2 infection results in activation of aryl hydrocarbon receptor (AhR) signaling through an IDO-Kyn-dependent pathway, leading to transcriptional upregulation of the expression of mucins, both the secreted and membrane-bound, in alveolar epithelial cells. Consequently, accumulated alveolar mucus affects the blood-gas barrier, thus inducing hypoxia and diminishing lung capacity, which can be reversed by blocking AhR activity. These findings potentially explain the silent hypoxia formation in COVID-19 patients, and suggest a possible intervention strategy by targeting the AhR pathway.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Animals
  • COVID-19 / pathology
  • COVID-19 / virology
  • Cell Line
  • Epithelial Cells / cytology
  • Epithelial Cells / metabolism
  • Epithelial Cells / virology
  • Humans
  • Hypoxia
  • Interferon-beta / pharmacology
  • Interferon-gamma / pharmacology
  • Interferons / metabolism*
  • Lung / metabolism
  • Lung / pathology
  • Macaca
  • Mice
  • Mice, Inbred ICR
  • Mice, Transgenic
  • Mucins / metabolism
  • Mucus / metabolism*
  • Receptors, Aryl Hydrocarbon / metabolism*
  • SARS-CoV-2 / isolation & purification
  • SARS-CoV-2 / pathogenicity
  • Signal Transduction
  • Up-Regulation / drug effects

Substances

  • Mucins
  • Receptors, Aryl Hydrocarbon
  • Interferon-beta
  • Interferon-gamma
  • Interferons