Journal
CLINICAL IMMUNOLOGY
Volume 215, Issue -, Pages -Publisher
ACADEMIC PRESS INC ELSEVIER SCIENCE
DOI: 10.1016/j.clim.2020.108410
Keywords
SARS-CoV-2; Lupus; COVID-19; Epigenetics; ACE2; Methylation; Interferon
Categories
Funding
- Lupus Research Alliance [U19AI110502, R01AI097134]
- National Institute of Allergy and Infectious Diseases of the National Institutes of Health [U19AI110502, R01AI097134]
- National Natural Science Foundation of China [81830097]
- Innovation project of Chinese Academy of Medical Sciences [2019-I2M-5-033]
- Hunan Province for fighting against coronavirus disease-2019 epidemic [2020SK3005]
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Infection caused by SARS-CoV-2 can result in severe respiratory complications and death. Patients with a compromised immune system are expected to be more susceptible to a severe disease course. In this report we suggest that patients with systemic lupus erythematous might be especially prone to severe COVID-19 independent of their immunosuppressed state from lupus treatment. Specifically, we provide evidence in lupus to suggest hypomethylation and overexpression of ACE2, which is located on the X chromosome and encodes a functional receptor for the SARS-CoV-2 spike glycoprotein. Oxidative stress induced by viral infections exacerbates the DNA methylation defect in lupus, possibly resulting in further ACE2 hypomethylation and enhanced viremia. In addition, demethylation of interferon-regulated genes, NF.B, and key cytokine genes in lupus patients might exacerbate the immune response to SARS-CoV-2 and increase the likelihood of cytokine storm. These arguments suggest that inherent epigenetic dysregulation in lupus might facilitate viral entry, viremia, and an excessive immune response to SARS-CoV-2. Further, maintaining disease remission in lupus patients is critical to prevent a vicious cycle of demethylation and increased oxidative stress, which will exacerbate susceptibility to SARS-CoV-2 infection during the current pandemic. Epigenetic control of the ACE2 gene might be a target for prevention and therapy in COVID-19.
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