Braciale, Thomas J.

The relationship between diabetes and coronavirus disease 2019 (COVID-19) is bidirectional: Although individuals with diabetes and high blood glucose (hyperglycemia) are predisposed to severe COVID-19, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can also cause hyperglycemia and exacerbate underlying metabolic syndrome. Therefore, interventions capable of breaking the network of SARS-CoV-2 infection, hyperglycemia, and hyperinflammation, all factors that drive COVID-19 pathophysiology, are urgently needed. Here, we show that genetic ablation or pharmacological inhibition of mitochondrial pyruvate carrier (MPC) attenuates severe disease after influenza or SARS-CoV-2 pneumonia. MPC inhibition using a second-generation insulin sensitizer, MSDC-0602K (MSDC), dampened pulmonary inflammation and promoted lung recovery while concurrently reducing blood glucose levels and hyperlipidemia after viral pneumonia in obese mice. Mechanistically, MPC inhibition enhanced mitochondrial fitness and destabilized hypoxia-inducible factor–1α, leading to dampened virus-induced inflammatory responses in both murine and human lung macrophages. We further showed that MSDC enhanced responses to nirmatrelvir (the antiviral component of Paxlovid) to provide high levels of protection against severe host disease development after SARS-CoV-2 infection and suppressed cellular inflammation in human COVID-19 lung autopsies, demonstrating its translational potential for treating severe COVID-19. Collectively, we uncover a metabolic pathway that simultaneously modulates pulmonary inflammation, tissue recovery, and host metabolic health, presenting a synergistic therapeutic strategy to treat severe COVID-19, particularly in patients with underlying metabolic disease.

Abstract Alveolar Macrophages (AMs) are unique innate immune cells that reside in the alveolar space and accommodate the ever-changing need of the lungs against internal and external challenges. During homeostasis, AMs maintained themselves through self-renewal without the need for input from adult hematopoietic stem cells. Currently, little is known about how aging influences AM dynamics, heterogeneity and self-renewal. To this end, we have performed single-cell RNA sequencing (scRNA-seq) on murine lung AMs (CD11+ Siglec F+) isolated from young (~8w) and aged (~2y) mice. We discovered that despite similar transcriptome in the proliferating cells, AMs from aged mice had reduced proliferation and self-renew ability than those from the young mice. AMs from aged mice also displayed elevated senescence markers such as p16, p21 and p53. Consistently, AMs from aged mice had reduced DNA repair ability, which could contribute to their impaired capacity to pass through the cell cycle checkpoints. Interestingly, AMs from aged mice also possessed reduced pro-apoptotic gene profile. Thus, we hypothesize that the reduced proliferation- and apoptosis-associated gene profiles in aged AMs may lead to the enhanced senescence-like phenotype in those cells. Further validation of the senescence-like phenotype of aged AMs and investigation of how they contribute to lung “inflammaging” are warranted.

Abstract Alveolar Macrophages (AMs) are a unique population of innate immune cells that reside in the alveolar space and contribute to accommodate the ever-changing need of the lungs against the external environmental challenges. AMs derive from the fetal origins and are capable of maintaining themselves through self-renewal without the input of hematopoiesis during the adulthood. However, little is known about how aging is influencing the molecular characteristics and heterogeneity of the AMs during homeostasis. Using single-cell RNA sequencing (scRNA-seq) and Seurat clustering, we discovered AMs can be subdivided into different “subsets” with unique molecular characteristics during homeostasis. Interestingly, when we further investigate the AM population with the combined data from the young(~8w) and old(~2y) mice, the data suggested that the proliferating cell fall in the same cluster with reduced number in the old-mice group, while the poised inflammatory cells showed distinct molecular patterns between the group with different age. We hypothesize that the inflammatory and the self-renewal AM subpopulations may be maintained by distinct extracellular signals. With the progress of aging, the self-renewal ability of AMs would reduce because of the number of proliferating cells but not the change of molecular patterns. At the same time, the inflammatory population would change its characteristics with age, and potentially lead to functional change upon activation. Further validation of the AM subset identity as well as the developmental and functional interrelationship of these subsets are required. In addition, the extrinsic and intrinsic signals responsible for the maintenance of these AM subsets are to be explored.