ACE2 is the critical in vivo receptor for SARS-CoV-2 in a novel COVID-19 mouse model with TNF- and IFNγ-driven immunopathology

• DOI: 10.7554/elife.74623
• Publication Date: 2022-01-13T13:00:31Z
• Authors: Riem Gawish; Philipp Starkl; Lisabeth Pimenov; Anastasiya Hladik; Karin Lakovits; Felicitas Oberndo...; Shane JF Cronin; Anna Ohradanova-R...; Gerald Wirnsberger; Benedikt Agerer; Lukas Endler; Tümay Capraz; Jan W Perthold; Domagoj Cikes; Rubina Koglgruber; Astrid Hagelkruys; Nuria Montserrat; Ali Mirazimi; Louis Boon; Hannes Stockinger; Andreas Bergthaler; Chris Oostenbrink; Josef M Penninger; Sylvia Knapp
• Keywords: 0301 basic medicine; QH301-705.5; Science; Immunology; Adaptive Immunity; Peptidyl-Dipeptidase A; Interferon-gamma; 03 medical and health sciences; Immunology and Inflammation; maVie16; Animals; Immunologia; Biology (General); recombinant soluble ace2; Mice, Inbred BALB C; mouse-adapted SARS-CoV-2; SARS-CoV-2; Q; R; COVID-19; COVID-19 mouse model; 3. Good health; Mice, Inbred C57BL; Disease Models, Animal; cytokine storm; Spike Glycoprotein, Coronavirus; Medicine; COVID-19 therapy; Angiotensin-Converting Enzyme 2

Despite tremendous progress in the understanding of COVID-19, mechanistic insight into immunological, disease-driving factors remains limited. We generated maVie16, a mouse-adapted SARS-CoV-2, by serial passaging of a human isolate. In silico modeling revealed how only three Spike mutations of maVie16 enhanced interaction with murine ACE2. maVie16 induced profound pathology in BALB/c and C57BL/6 mice, and the resulting mouse COVID-19 (mCOVID-19) replicated critical aspects of human disease, including early lymphopenia, pulmonary immune cell infiltration, pneumonia, and specific adaptive immunity. Inhibition of the proinflammatory cytokines IFNγ and TNF substantially reduced immunopathology. Importantly, genetic ACE2-deficiency completely prevented mCOVID-19 development. Finally, inhalation therapy with recombinant ACE2 fully protected mice from mCOVID-19, revealing a novel and efficient treatment. Thus, we here present maVie16 as a new tool to model COVID-19 for the discovery of new therapies and show that disease severity is determined by cytokine-driven immunopathology and critically dependent on ACE2 in vivo.