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Cell . 2021 Dec 22

SARS-CoV-2 infection triggers profibrotic macrophage responses and lung fibrosis

Daniel Wendisch, Oliver Dietrich, Tommaso Mari, Saskia von Stillfried, Ignacio L Ibarra, Mirja Mittermaier, Christin Mache, Robert Lorenz Chua, Rainer Knoll, Sara Timm, Sophia Brumhard, Tobias Krammer, Henrik Zauber, Anna Luisa Hiller, Anna Pascual-Reguant, Ronja Mothes, Roman David Bülow, Jessica Schulze, Alexander M Leipold, Sonja Djudjaj, Florian Erhard, Robert Geffers, Fabian Pott, Julia Kazmierski, Josefine Radke, Panagiotis Pergantis, Kevin Baßler, Claudia Conrad, Anna C Aschenbrenner, Birgit Sawitzki, Markus Landthaler, Emanuel Wyler, David Horst, Deutsche COVID-19 OMICS Initiative (DeCOI), Stefan Hippenstiel, Andreas Hocke, Frank L Heppner, Alexander Uhrig, Carmen Garcia, Felix Machleidt, Susanne Herold, Sefer Elezkurtaj, Charlotte Thibeault, Martin Witzenrath, Clément Cochain, Norbert Suttorp, Christian Drosten, Christine Goffinet, Florian Kurth, Joachim L Schultze, Helena Radbruch, Matthias Ochs, Roland Eils, Holger Müller-Redetzky, Anja E Hauser, Malte D Luecken, Fabian J Theis, Christian Conrad, Thorsten Wolff, Peter Boor, Matthias Selbach, Antoine-Emmanuel Saliba, Leif Erik Sander

COVID-19-induced "acute respiratory distress syndrome" (ARDS) is associated with prolonged respiratory failure and high mortality, but the mechanistic basis of lung injury remains incompletely understood. Here, we analyze pulmonary immune responses and lung pathology in two cohorts of patients with COVID-19 ARDS using functional single-cell genomics, immunohistology, and electron microscopy. We describe an accumulation of CD163-expressing monocyte-derived macrophages that acquired a profibrotic transcriptional phenotype during COVID-19 ARDS. Gene set enrichment and computational data integration revealed a significant similarity between COVID-19-associated macrophages and profibrotic macrophage populations identified in idiopathic pulmonary fibrosis. COVID-19 ARDS was associated with clinical, radiographic, histopathological, and ultrastructural hallmarks of pulmonary fibrosis. Exposure of human monocytes to SARS-CoV-2, but not influenza A virus or viral RNA analogs, was sufficient to induce a similar profibrotic phenotype in vitro. In conclusion, we demonstrate that SARS-CoV-2 triggers profibrotic macrophage responses and pronounced fibroproliferative ARDS.

PMID: 34914922