AOP ID and Title:

Short Title: SARS-CoV2 to thrombosis and DIC

Authors

Shihori Tanabe¹, Youngjun Kim², Sally Mayasich³, Maria João Amorim⁴, Nikolaos Parissis⁵, Penny Nymark⁶, Marvin Martens⁷, Dan Jacobson⁸, Felicity N. E. Gavins⁹, Luigi Margiotta-Casaluci¹⁰, Sabina Halappanavar¹¹, Natàlia Garcia-Reyero¹², Julija Filipovska¹³, Stephen W. Edwards¹⁴‚ Rebecca Ram¹⁵, Adrienne Layton¹⁶, Brigitte Landesmann⁵, Hasmik Yepiskoposyan¹⁷, Jukka Sund¹⁸, Clemens Wittwehr⁵, Laure-Alix Clerbaux¹⁹

 

¹Division of Risk Assessment, Center for Biological Safety and Research, National Institute of Health Sciences, Kawasaki, Japan

²KIST Europe Forschungsgesellschaft mbH, Saarbrücken, Germany

³University of Wisconsin-Madison at U.S. Environmental Protection Agency, Duluth, Minnesota, United States

⁴Instituto Gulbenkian de Ciência – Fundação Calouste Gulbenkian, Oeiras, Portugal

⁵European Commission, Joint Research Centre (JRC), Ispra, Italy

⁶Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden

⁷Maastricht University, Maastricht, Netherlands

⁸Oak Ridge National Laboratory, Oak Ridge, United States

⁹Brunel University London, London, United Kingdom

¹⁰King’s College London, London, United Kingdom

¹¹Environmental Health Science and Research Bureau, Health Canada, Ottawa, Canada

¹²U.S. Army Engineer Research and Development Center (ERDC), Vicksburg, United States

¹³Independent Scientist & Consultant, North Macedonia

¹⁴GenOmics, Bioinformatics, and Translational Research Center, RTI International, Washington DC, United States

¹⁵Safer Medicines Trust, Kingsbridge, United Kingdom

¹⁶U.S. Consumer Product Safety Commission, Bethesda, United States

¹⁷Philip Morris International, Neuchatel, Switzerland

¹⁸Finnish Safety and Chemicals Agency, Finland

¹⁹Institute of Clinical and Experimental Research (IREC), UCLouvain, Brussels, Belgium

Status

Abstract

Coronavirus disease-19 (COVID-19) is circulating all over the world. To understand and find a way of the COVID-19 treatment, the signaling pathway and therapeutic mechanism of COVID-19 should be investigated. The pathogenesis of COVID-19 includes molecular networks such as the binding of the membrane proteins, signaling pathways, and RNA replication. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which is a new type of coronavirus causing COVID-19, infects the cells via the binding of the membrane proteins of human cells and is internalized by the cells. The viral genome is replicated by RNA-dependent RNA polymerase (RdRp), followed by the packaging and releasing of the viral particles. These steps can be the main targets for the therapeutics of COVID-19. The AOP379 "Binding to ACE2 leading to thrombosis and disseminated intravascular coagulation" consists of the molecular initiating event (MIE) as “Binding to ACE2” (KE1739), key events (KEs) as “SARS-CoV-2 cell entry” (KE1738), “Interferon-I antiviral response, antagonized by SARS-CoV-2” (KE1901), "Increased SARS-CoV-2 production" (KE1847), “Diminished protective oxidative stress response" (KE1869) and "Coagulation" (KE1845), and adverse outcome (AO) as "Thrombosis and Disseminated Intravascular Coagulation" (KE1846).

Summary of the AOP

Events

Molecular Initiating Events (MIE), Key Events (KE), Adverse Outcomes (AO)

Key Event Relationships

Stressors

Overall Assessment of the AOP

Domain of Applicability

Life Stage Applicability Taxonomic Applicability Sex Applicability

This AOP is applicable to all sexes in Homo sapiens.

Essentiality of the Key Events

Essentiality of the KEs
Event	ID and Title	Direct Evidence	Indirect Evidence	No experimental evidence
KE1	KE1738: SARS-CoV-2 cell entry	**	***	***
KE2	KE1901: Interferon-I antiviral response, antagonized by SARS-CoV-2		***	***
KE3	KE1847: Increased SARS-CoV-2 production	**	***	***
KE4	KE1869: Diminished protective oxidative stress response		***	***
KE5	KE1845: Coagulation		***	***

Weight of Evidence Summary

[Evidence Assessment]
1. Support for Biological Plausibility of KERs
MIE => KE1: KER2056: Binding to ACE2 leads to SARS-CoV-2 cell entry	Biological Plausibility of the MIE => KE1 is high. Rationale: Binding of SARS-CoV-2 to ACE2 cell-surface receptor initiates infection of SARS-CoV-2 where SARS-CoV-2 cell entry is essential (Zhou P et al., 2020, Benton DJ et al., 2020).
KE1 => KE2: KER2496: SARS-CoV-2 cell entry leads to IFN-I response, antagonized	Biological Plausibility of the KE1 => KE2 is moderate. Rationale: The expression of type I interferons (IFN-I) is antagonized by SARS-CoV-2 (Benton DJ et al., 2020). Individual viral proteins interact with and block host proteins in the IFN-I pathway or IFN-I stimulated genes.
KE2 => KE3: KER2497: IFN-I response, antagonized leads to SARS-CoV-2 production	Biological Plausibility of the KE2 => KE3 is moderate. Rationale: Inhibition of IFN-I response induces SARS-CoV-2 production.
KE3 => KE4: KER2358: SARS-CoV-2 production leads to Diminished Protective Response to ROS	Biological Plausibility of the KE3 => KE4 is moderate. Rationale: The fixation of SARS-CoV-2 in ACE2 receptor results in excessive production of pro-inflammatory and pro-oxidant agents (Ramdani and Bachari, 2020).
KE4 => KE5: KER2359: Diminished Protective Response to ROS leads to Coagulation	Biological Plausibility of the KE4 => KE5 is moderate. Rationale: The ROS results in lung injury and coagulopathy (Barrett CD et al., 2018).
KE5 => KE4: KER2360: Coagulation leads to Diminished Protective Response to ROS	Biological Plausibility of the KE5 => KE4 is moderate. Rationale: Coagulation imbalance induces oxidative stress (Robea MA et al., 2023).
KE5 => AO:  KER2290: Coagulation leads to Thrombosis and DIC	Biological Plausibility of the KE5 => AO is high. Rationale: Extreme aggravation of blood coagulation induces multiple thrombi in the microvasculature, which leads to consumption coagulopathy followed by disseminated intravascular disease.
2. Support for Essentiality of KEs
AOP379	Rationale for Essentiality of KEs in the AOP is Moderate.
3. Empirical Support for KERs
MIE => KE1: KER2056: Binding to ACE2 leads to SARS-CoV-2 cell entry	Empirical Support of the MIE => KE1 is moderate. Rationale: The SARS-CoV-2 binding to ACE2 induce fusion of the virus and cell membranes to release the virus genome into the cell. (Zhou P et al., 2020, Benton DJ et al., 2020).
KE1 => KE2: KER2496: SARS-CoV-2 cell entry leads to IFN-I response, antagonized	Empirical Support of the KE1 => KE2 is moderate. Rationale: SARS-CoV-2-infection induces IFN-I pathway reduction (Sui C et al., 2022, Blanco-Melo, 2020).
KE2 => KE3: KER2497: IFN-I response, antagonized leads to SARS-CoV-2 production	Empirical Support of the KE2 => KE3 is moderate. Rationale: Reduced IFN-I response induces SARS-CoV-2 production.
KE3 => KE4: KER2358: SARS-CoV-2 production leads to Diminished Protective Response to ROS	Empirical Support of the KE3 => KE4 is moderate. Rationale: As SARS-CoV-2 is attached to ACE2, ACE2 is not available within the renin-angiotensin system to convert Ang II to angiotensin-(1,7) resulting in Ang II to accumulate. Ang II stimulates membrane-bound NADPH oxidase, which in turn generate ROS and oxidative stress (Janardhan et al., 2020).
KE4 => KE5: KER2359: Diminished Protective Response to ROS leads to Coagulation	Empirical Support of the KE4 => KE5 is moderate. Rationale: The presence of ROS assists in the transformation of a circulating, non-oxidized, circular-shaped beta2-glycoprotein 1 into an oxidized J-shape, which binds to antiphospholipid antibodies such as anticardiolipin, lupus anticoagulant, and anti-beta2-GP1 antibodies (Janardhan et al., 2020). Domain V of beta2gP1 binds with the phospholipid layer of platelets or endothelial cells via Annexin (Janardhan et al., 2020).
KE5 => KE4: KER2360: Coagulation leads to Diminished Protective Response to ROS	Empirical Support of the KE5 => KE4 is moderate. Rationale: Excessive coagulation induces oxidative stress.
KE5 => AO:  KER2290: Coagulation leads to Thrombosis and DIC	Empirical Support of the KE5 => AO is high. Rationale: Extreme aggravation of blood coagulation induces multiple thrombi in the microvasculature, which leads to consumption coagulopathy followed by disseminated intravascular disease.

Considerations for Potential Applications of the AOP (optional)

The AOP379 focuses on the coronavirus-induced thrombosis and disseminated intravascular coagulation, which may contribute to the development of therapeutics of COVID-19 and long COVID syndrome. The understanding of the mechanism of the coronavirus-induced vascular adverse outcome may predict adverse responses of COVID-19 vaccines.

References

Banerjee AK, Blanco MR, Bruce EA, Honson DD, Chen LM, Chow A, et al. SARS-CoV-2 Disrupts Splicing, Translation, and Protein Trafficking to Suppress Host Defenses. Cell. 2020;183(5):1325-39.e21.

Barrett CD, Hsu AT, Ellson CD, B YM, Kong YW, Greenwood JD, et al. Blood clotting and traumatic injury with shock mediates complement-dependent neutrophil priming for extracellular ROS, ROS-dependent organ injury and coagulopathy. Clin Exp Immunol. 2018;194(1):103-17.

Benton DJ, Wrobel AG, Xu P, Roustan C, Martin SR, Rosenthal PB, et al. Receptor binding and priming of the spike protein of SARS-CoV-2 for membrane fusion. Nature. 2020;588(7837):327-30.

Blanco Melo D, Nilsson-Payant BE, Liu WC, Uhl S, Hoagland D, Møller R, et al. Imbalanced Host Response to
SARS-CoV-2 Drives Development of COVID-19. Cell. 181;(5):1036-1045.

Chen B, Tian EK, He B, Tian L, Han R, Wang S, et al. Overview of lethal human Coronaviruses. Signal
Transduction and Targeted Therapy, 2020;5(1):89.

Clerbaux, L.-A., Amigó, N., Amorim, M. J., Bal-Price, A., Batista Leite, S., Beronius, A., Bezemer, G. F. G., Bostroem, A.-C., Carusi, A., Coecke, S., Concha, R., Daskalopoulos, E. P., De Bernardi, F., Edrosa, E., Edwards, S. W., Filipovska, J., Garcia-Reyero, N., Gavins, F. N. E., Halappanavar, S., Hargreaves, A. J., Hogberg, H. T., Huynh, M. T., Jacobson, D., Josephs-Spaulding, J., Kim, Y. J., Kong, H. J., Krebs, C. E., Lam, A., Landesmann, B., Layton, A., Lee, Y. O., Macmillan, D. S., Mantovani, A., Margiotta-Casaluci, L., Martens, M., Masereeuw, R., Mayasich, S. A., Mei, L. M., Mortensen, H., Munoz Pineiro, A., Nymark, P., Ohayon, E., Ojasi, J., Paini, A., Parissis, N., Parvatam, S., Pistollato, F., Sachana, M., Sørli, J. B., Sullivan, K. M., Sund, J., Tanabe, S., Tsaioun, K., Vinken, M., Viviani, L., Waspe, J., Willett, C. and Wittwehr, C. (2022) “COVID-19 through adverse outcome pathways: Building networks to better understand the disease – 3rd CIAO AOP Design Workshop”, ALTEX - Alternatives to animal experimentation, 39(2), pp. 322–335. doi: 10.14573/altex.2112161.

Cui J, Li F, Shi ZL. Origin and evolution of pathogenic Coronaviruses. Nature Reviews Microbiology.
2019;17(3):181-192.

Florindo HF, Kleiner R, Vaskovich-Koubi D, Acúrcio RC, Carreira B, Yeini,E, et al. Immune-mediated
approaches against COVID-19. Nature Nanotechnology. 2020:15(8):630-45.

Janardhan V, Janardhan V, Kalousek V. COVID-19 as a Blood Clotting Disorder Masquerading as a Respiratory Illness: A Cerebrovascular Perspective and Therapeutic Implications for Stroke Thrombectomy. Journal of Neuroimaging. 2020;30(5):555-61.

Kowalewski J, Ray A. Predicting novel drugs for SARS-CoV-2 using machine learning from a & g 10 million
chemical space. Heliyon. 2020;6(8).

Nymark P, Clerbaux L-A, Amorim M-J, Andronis C, de Bernardi F, Bezemer GFG, Coecke S, Gavins FNE, Jacobson D, Lekka E, Margiotta-Casaluci L, Martens M, Mayasich SA, Mortensen HM, Kim YJ, Sachana M, Tanabe S, Virvilis V, Edwards SW and Halappanavar S (2024) Building an Adverse Outcome Pathway network for COVID-19. Front. Syst. Biol. 4:1384481. doi: 10.3389/fsysb.2024.1384481

Pizzorno A, Padey B, Julien T, Trouillet-Assant S, Traversier A, Errazuriz-Cerda E, et al. Characterization and
Treatment of SARS-CoV-2 in Nasal and Bronchial Human Airway Epithelia. Cell Reports Medicine. 2020:1(4). 

Ramdani LH and Bachari K. Potential therapeutic effects of resveratrol against SARS-CoV-2. Acta virologica 2020;64, 276-280

Riva L, Yuan S, Yin X, Martin-Sancho L, Matsunaga N, Pache L, et al. Discovery of SARS-CoV-2 antiviral drugs
through large-scale compound repurposing. Nature. 2020.

Robea MA, Balmus I-M, Girleanu I, Huiban L, Muzica C, Ciobica A, et al. Coagulation Dysfunctions in Non-Alcoholic Fatty Liver Disease—Oxidative Stress and Inflammation Relevance. Medicina. 2023;59(9):1614.

Sui C, Xiao T, Zhang S, Zeng H, Zheng Y, Liu B, et al. SARS-CoV-2 NSP13 Inhibits Type I IFN Production by Degradation of TBK1 via p62-Dependent Selective Autophagy. The Journal of Immunology. 2022;208(3):753-61.

Tanabe S (2020a). Cellular Internalization and RNA Regulation of RNA virus. Adv Clin Med Res. 2020;1(1):1-3. https://www.genesispub.org/cellular-internalization-and-rna-regulation-of-rna-virus

Tanabe S (2020b). The Therapeutic Mechanism of COVID-19. J Clin Med Res. 2020;2(5):1-3. DOI: https://doi.org/10.37191/Mapsci-2582-4333-2(5)-048

Tanabe, S., Beaton, D., Chauhan, V., Choi, I., Danielsen, P. H., Delrue, N., Esterhuizen, M., Filipovska, J., FitzGerald, R., Fritsche, E., Gant, T., Garcia-Reyero, N., Helm, J., Huliganga, E., Jacobsen, N., Kay, J. E., Kim, Y.-J., Klose, J., La Rocca, C., Luettich, K., Mally, A., O’Brien, J., Poulsen, S. S., Rudel, R. A., Sovadinova, I., Tollefsen, K. E., Vogel, U., Yepiskoposyan, H. and Yauk, C. (2022) “Report of the 1st and 2nd Mystery of Reactive Oxygen Species Conferences”, ALTEX - Alternatives to animal experimentation, 39(2), pp. 336–338. doi: 10.14573/altex.2203011.

Zhou P, Yang X-L, Wang X-G, Hu B, Zhang L, Zhang W, et al. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature. 2020;579(7798):270-3.

Appendix 1

List of MIEs in this AOP

Event: 1739: Binding to ACE2

Short Name: Binding to ACE2

Key Event Component

AOPs Including This Key Event

Stressors

Biological Context

Cell term

Organ term

Domain of Applicability

Taxonomic Applicability Life Stage Applicability Sex Applicability

The KE is applicable to broad species/life stage/sex. The binding of ACE2 occure in the cells which express ACE2. 

Key Event Description

Angiotensin-converting enzyme 2 (ACE2) is an enzyme that can be found either attached to the membrane of the cells (mACE2) in many tissues and in a soluble form form (sACE2).

A table on ACE2 expression levels according to tissues (Kim et al.)

	Sample size	ACE2 mean expression	Standard deviation of expression
Intestine	51	9.50	1.183
Kidney	129	9.20	2.410
Stomach	35	8.25	3.715
Bile duct	9	7.23	1.163
Liver	50	6.86	1.351
Oral cavity	32	6.23	1.271
Lung	110	5.83	0.710
Thyroid	59	5.65	0.646
Esophagus	11	5.31	1.552
Bladder	19	5.10	1.809
Breast	113	4.61	0.961
Uterus	25	4.37	1.125
Protaste	52	4.35	1.905

ACE2 receptors in the brain (endothelial, neuronal and glial cells):

The highest ACE2 expression level in the brain was found in the pons and medulla oblongata in the human brainstem, containing the medullary respiratory centers (Lukiw et al., 2020). High ACE2 receptor expression was also found in the amygdala, cerebral cortex and in the regions involved in cardiovascular function and central regulation of blood pressure including the sub-fornical organ, nucleus of the tractus solitarius, paraventricular nucleus, and rostral ventrolateral medulla (Gowrisankar and Clark 2016; Xia and Lazartigues 2010). The neurons and glial cells, like astrocytes and microglia also express ACE-2.

In the brain, ACE2 is expressed in endothelium and vascular smooth muscle cells (Hamming et al., 2004), as well as in neurons and glia (Gallagher et al., 2006; Matsushita et al., 2010; Gowrisankar and Clark, 2016; Xu et al., 2017; de Morais et al., 2018) (from Murta et al., 2020). Astrocytes are the main source of angiotensinogen and express ATR1 and MasR; neurons express ATR1, ACE2, and MasR, and microglia respond to ATR1 activation (Shi et al., 2014; de Morais et al., 2018).

ACE2 receptors in the intestines

The highest levels of ACE2 are found at the luminal surface of the enterocytes, the differentiated epithelial cells in the small intestine, lower levels in the crypt cells and in the colon (Liang et al, 2020; Hashimoto et al., 2012, Fairweather et al. 2012; Kowalczuk et al. 2008).

 

 

How it is Measured or Detected

In vitro methods supporting interaction between ACE2 and SARS-CoV-2 spike protein

Several reports using surface plasmon resonance (SPR) or biolayer interferometry binding (BLI) approaches. to study the interaction between recombinant ACE2 and S proteins have determined a dissociation constant (Kd) for SARS-CoV S and SARS-CoV-2 S as follow,

Reference	ACE2 protein	SARS-CoV S	SARS-CoV2 S	Method	Measured Kd
doi:10.1126/science.abb2507	1–615 aa	306–577 aa		SPR	325.8 nM
			1–1208 aa		14.7 nM
doi:10.1001/jama.2020.3786	19–615 aa	306–527 aa		SPR	408.7 nM
			319–541 aa		133.3 nM
Lan et al., 2020	19–615 aa	306–527 aa		SPR	31.6 nM
			319–541 aa		4.7 nM
doi:10.1016/j.cell.2020.02.058	1–614 aa	306–575 aa		BLI	1.2 nM
			328–533 aa		5 nM
doi:10.1126/science.abb2507	1–615 aa	306–577 aa		BLI	13.7 nM
			319–591 aa		34.6 nM

Pseudo typed vesicular stomatitis virus expressing SARS-CoV-2 S (VSV-SARS-S2) expression system can be used efficiently infects cell lines, with Calu-3 human lung adenocarcinoma epithelial cell line, CaCo-2 human colorectal adenocarcinoma colon epithelial cell line and Vero African grey monkey kidney epithelial cell line being the most permissive (Hoffmann et al., 2020; Ou et al., 2020).  It can be measured using a wide variety of assays targeting different biological phases of infection and altered cell membrane permeability and cell organelle signaling pathway. Other assay measured alteration in the levels of permissive cell lines all express ACE2 or hACE2-expressing 293T cell (e.g. pNUO1-hACE2, pFUSE-hIgG1-Fc2), as previously demonstrated by indirect immunofluorescence (IF) or by immunoblotting are associated with ELISA(W Tai et al., nature 2020). To prioritize the identified potential KEs for selection and to select a KE to serve as a case study, further in-silico data that ACE2 binds to SARS-CoV-2 S is necessary for virus entry. The above analysis outlined can be used evidence-based assessment of molecular evidence as a MIE.

References

de Morais SDB, et al. Integrative Physiological Aspects of Brain RAS in Hypertension. Curr Hypertens Rep. 2018 Feb 26; 20(2):10.

Gallagher PE, et al. Distinct roles for ANG II and ANG-(1-7) in the regulation of angiotensin-converting enzyme 2 in rat astrocytes. Am J Physiol Cell Physiol. 2006 Feb; 290(2):C420-6.

Gowrisankar YV, Clark MA. Angiotensin II regulation of angiotensin-converting enzymes in spontaneously hypertensive rat primary astrocyte cultures. J Neurochem. 2016 Jul; 138(1):74-85.

Hamming I et al. Tissue distribution of ACE2 protein, the functional receptor for SARS coronavirus. A first step in understanding SARS pathogenesis. J Pathol. 2004 Jun;203(2):631-7.

Jakhmola S, et al. SARS-CoV-2, an Underestimated Pathogen of the Nervous System. SN Compr Clin Med. 2020.

Lukiw WJ et al. SARS-CoV-2 Infectivity and Neurological Targets in the Brain. Cell Mol Neurobiol. 2020 Aug 25;1-8.

Matsushita T, et al. CSF angiotensin II and angiotensin-converting enzyme levels in anti-aquaporin-4 autoimmunity. J Neurol Sci. 2010 Aug 15; 295(1-2):41-5.

Murta et al. Severe Acute Respiratory Syndrome Coronavirus 2 Impact on the Central Nervous System: Are Astrocytes and Microglia Main Players or Merely Bystanders? ASN Neuro. 2020. PMID: 32878468

Shi A, et al. Isolation, purification and molecular mechanism of a peanut protein-derived ACE-inhibitory peptide. PLoS One. 2014; 9(10):e111188.

Xia, H. and Lazartigues, E.  Angiotensin-Converting Enzyme 2: Central Regulator for Cardiovascular Function. Curr. Hypertens. 2010  Rep. 12 (3), 170– 175

List of Key Events in the AOP

Event: 1738: SARS-CoV-2 cell entry

Short Name: SARS-CoV-2 cell entry

Key Event Component

AOPs Including This Key Event

Stressors

Biological Context

Cell term

Organ term

Domain of Applicability

Taxonomic Applicability Life Stage Applicability Sex Applicability

TMPRSS2 vertebrates (Lam et al., 2020)

NRP1 in human & rodents (but also present in monkey and other vertebrates (Lu and Meng, 2015)

The ability for SARS-CoV-2 to use multiple host pathways for viral entry, means that it is critical to map which viral entry pathway is prevalent in specific cell types. This is key for understanding coronavirus biology, but also use informed decisions to select cells for cell-based genetic and small-molecule screens and to interpret data. In fact, a combination of protease inhibitors that block both TRMPSS2 and cathepsin L is the most efficient combination to block coronavirus infection (Yamamoto et al., 2020, Shang et al., 2020, Shirato et al., 2018). In accordance, SARS-CoV-2 entry processes are highly dependent on endocytosis and endocytic maturation in cells that do not express TMPRSS2, such as VeroE6 or 293T cells (Murgolo et al., 2021, Kang et al., 2020, Mirabelli et al., 2020, Riva et al., 2020). However, even in these cells, heterologous expression of TMPRSS2 abrogates the pharmacological blockade of cathepsin inhibitors (Kawase et al., 2012, Hoffmann et al., 2020a). Treatment of SARS-CoV-2 with trypsin enables viral cell surface entry, even when TMPRSS2 is absent. Moreover, TMPRSS2 is more efficient to promote viral entry than cathepsins (Lamers et al., 2020), as when both factors are present,d cathepsin inhibitors are less effective than TMPRSS2 inhibitors (Hoffmann et al., 2020b). Therefore it is critical to map which cells contain the different types of proteases.

In summary, TMPRSS2 appears to be expressed in a wide range of healthy adult organs, but in restricted cell types, including:

• AT2 and clara cells of lungs
• sinusoidal endothelium, and hepatocyte of the liver,
• endocrine cells of the prostate,
• goblet cells , and enterocytes of the small intestine,
• intercalated cells, and the proximal tubular of the kidney.
• Ciliated, secretory and suprabasal of nasal
• spermatogonial stem cells of testes
• cyto tropoblast and peri vascular cells of placenta
• The nasal epithelium expresses various combinations of factors that, in principle, could facilitate SARS-CoV-2 infection, but it also expresses robust basal levels of RFs, which may act as a strong protective barrier in this tissue.

There is a shift in TMPRSS2 regulation during nasal epithelium differentiation in young individuals that is not occurring in old individuals (Lin et al., 1999, Lucas et al., 2008, Singh et al., 2020).

Only a small minority of human respiratory and intestinal cells have genes that express both ACE2 and TMPRSS2. Amongst the ones that do, three main cell types were identified: A) lung cells called type II pneumocytes (which help maintain air sacs, known as alveoli); B) intestinal cells called enterocytes, which help the body absorb nutrients; and C) goblet cells in the nasal passage, which secrete mucus (Ziegler et al., 2020).

The clinical manifestations of COVID‐19 include not only complications from acute myocardial injury, elevated liver enzymes, and acute kidney injury in patients presenting to hospitals, but also gastrointestinal symptoms in community patients experiencing milder forms of the disease (Madjid et al., 2020, Pan et al., 2020).

 

NRP-1:

All life stages

The expression of isoforms 1 (NRP1) and 2 (NRP2) does not seem to overlap. Isoform 1 is expressed by the blood vessels of different tissues. In the developing embryo it is found predominantly in the nervous system. In adult tissues, it is highly expressed in heart and placenta; moderately in lung, liver, skeletal muscle, kidney and pancreas; and low in adult brain. Isoform 2 is found in liver hepatocytes, kidney distal and proximal tubules. Expressed in colon and 234 other tissues with Low tissue specificity (UniProtKB).

The expression of NRP1 protein in gastric cancer was not related to gender or age (Cao et al., 2020).

 

Sex Applicability:

TMPRSS2:

Androgen receptors (ARs) play a key role in the transcription of TMPRSS2 (Fig. 1). This may explain the predominance of males to COVID-19 infection, fatality, and severity because males tend to have a higher expression and activation of ARs than females, which is due to the presence of dihydrotestosterone (DHT).

Regulation of COVID-19 severity and fatality by sex hormones. Females have aromatase, the enzyme that converts androgen substrates into estrogen. On the other hand, males have steroid 5α reductase, the enzyme that is responsible for the conversion of testosterone into dihydrotestosterone (DHT). In case of males, DHT activates androgen receptor (AR) that binds to the androgen response element (ARE) present in the promoter of TMPRSS2 gene, leading to its transcription. This ultimately results into enhanced processing of viral spike protein for greater entry and spread of SARS-CoV-2 into host cells. On the other hand,in females, estrogen activates estrogen receptor (ER), which binds to the estrogen response element (ERE) present in the promoter of eNOS gene to drive its transcription and catalyze the formation of nitric oxide (NO) from L-arginine. This NO is involved in vasodilation as well as inhibition of viral replication.

NRP-1:

For more information difference of NRP1 expression between male and female see https://www.proteinatlas.org/ENSG00000099250-NRP1/tissue.

The expression of NRP1 protein in gastric cancer was not related to gender, age. The expression of NRP1 protein in gastric cancer is closely correlated to clinical stage, tumor size, TNM stage, differentiation, and lymph node metastasis (Cao et al., 2020).

SARS-CoV-2 Spike protein co-opts VEGF-A/Neuropilin-1 receptor signalling to induce analgesia had same results on both male and female rodents (Moutal et al., 2020).

Key Event Description

Coronavirus is recognized by the binding of S protein on the viral surface and angiotensin-converting enzyme 2 (ACE2) receptor on the cellular membrane, followed by viral entry via processing of S protein by transmembrane serine protease 2 (TMPRSS2) (Hoffmann et al., 2020b). ACE2 is expressed on epithelial cells of the lung and intestine, and also can be found in the heart, kidney, adipose, and male and female reproductive tissues (Lukassen et al., 2020, Lamers et al., 2020, Chen et al., 2020, Jing et al., 2020, Subramanian et al., 2020).

SARS-CoV-2 is an enveloped virus characterized by displaying spike proteins at the viral surface (Juraszek et al., 2021). Spike is critical for viral entry (Hoffmann et al., 2020b) and is the primary target of vaccines and therapeutic strategies, as this protein is the immunodominant target for antibodies (Yuan et al., 2020, Ju et al., 2020, Robbiani et al., 2020, Premkumar et al., 2020, Liu et al., 2020). Spike is composed of S1 and S2 subdomains. S1 contains the N-terminal (NTD) and receptor-binding (RBD) domains, and the S2 contains the fusion peptide (FP), heptad repeat 1 (HR1) and HR2, the transmembrane (TM) and cytoplasmic domains (CD) (Lan et al., 2020). S1 leads to the recognition of the angiotensin-converting enzyme 2 (ACE2) receptor and S2 is involved in membrane fusion (Hoffmann et al., 2020b, Letko et al., 2020, Shang et al., 2020).

Upon binding to ACE2, the spike protein needs to be activated (or primed) through proteolytic cleavage (by a host protease) to allow membrane fusion. Fusion is a key step in viral entry as it is the way to release SARS-CoV-2 genetic material inside the cell. Cleavage happens between its spike’s S1 and S2 domains, liberating S2 that inserts its N-terminal domain into a host cell membrane and mediates membrane fusion (Millet and Whittaker, 2018). Many proteases were identified to activate coronaviruses including furin, cathepsin L, trypsin-like serine proteases TMPRSS2, TMPRSS4, TMPRSS11, and human airway trypsin-like protease (HATs). These may operate at four different stages of the virus infection cycle: (a) pro-protein convertases (e.g., furin) during virus packaging in virus-producing cells, (b) extracellular proteases (e.g., elastase) after virus release into extracellular space, (c) cell surface proteases [e.g., type II transmembrane serine protease (TMPRSS2)] after virus attachment to virus-targeting cells, and (d ) lysosomal proteases (e.g., cathepsin L) after virus endocytosis in virus-targeting cells (Li, 2016). SARS-CoV-2 lipidic envelope may fuse with two distinct membrane types, depending on the host protease(s) responsible for cleaving the spike protein: (i) cell surface following activation by serine proteases such as TMPRSS2 and furin (Hoffmann et al., 2020b); or (ii) endocytic pathway within the endosomal–lysosomal compartments including processing by lysosomal cathepsin L (Yang and Shen, 2020). These flexibility for host cell factors mediating viral entry, highlights that the availability of factors existing in a cell type dictates the mechanism of viral entry (Kawase et al., 2012). When TMPRSS2 (or other serine proteases such as TMPRSS4 (Zang et al., 2020) or human airway trypsin-like protease [HAT] (Bestle et al., 2020a)) is expressed, fusion of the virus with the cell surface membrane is preferred (Shirato et al., 2018), while in their absence, the virus can penetrate the cell by endocytosis (Kawase et al., 2012). A third factor has also been shown to facilitate SARS-CoV-2 entry in cells that have ACE2 and even promote, although to very low levels, SARS-CoV-2 entry in cells that lack ACE2 and TMPRSS2 which is the neuropilin-1 (NRP-1) (Cantuti-Castelvetri et al., 2020). This key event deals with SARS-CoV-2 entry in host cells and is divided in three categories: TMPRSS2, capthesin L and NRP-1.

TMPRSS2 Spike cleavage:

TMPRSS2 (transmembrane serine protease 2, (https://www.ncbi.nlm.nih.gov/gene/7113) is a cell-surface protease (Hartenian et al., 2020) that facilitates entry of viruses into host cells by proteolytically cleaving and activating viral envelope glycoproteins. Viruses found to use this protein for cell entry include Influenza virus and the human coronaviruses HCoV-229E, MERS-CoV, SARS-CoV and SARS-CoV-2 (COVID-19 virus).

TMPRSS2 is a membrane bound serine protease also known as epitheliasin. TMPRSS2 belongs to the S1A class of serine proteases alongside proteins such as factor Xa and trypsin. Whilst there is evidence that TMPRSS2 autoclaves to generate a secreted protease, its physiological function has not been clearly identified. However, it is known to play a crucial role in facilitating entry of coronavirus particles into cells by cleaving the spike protein (Huggins, 2020).

After ACE2 receptor binding, SARS-CoV-2 S proteins can be subsequently cleaved and activated by host cell-surface protease at the S1/S2 and S2’ sites, generating the subunits S1 and S2 that remain non-covalently linked. Cleavage leads to activation of the S2 domain that drives fusion of the viral and host membranes (Hartenian et al., 2020, Walls et al., 2016). For other coronaviruses, processing of spike was proposed to be sequential with S1/S2 cleavage preceding that of S2. Cleavage at S1/S2 may be crucial for inducing conformational changes required for receptor binding or exposure of the S2 site to host proteases.

The S1/S2 site of SARS-CoV-2 S protein contains an insertion of four amino acids providing a minimal furin cleavage site (RRAR685↓) (that is absent in SARS-CoV). Interestingly, the furin cleavage site has been implicated in increased viral pathogensis (Bestle et al., 2020b, Huggins, 2020). Processing of the spike protein by furin at the S1/S2 cleavage site is thought to occur following viral replication in the endoplasmic reticulum Golgi intermediate compartment (ERGIC) (Hasan et al., 2020). The spike S2’ cleavage site of SARS-CoV-2 possesses a paired dibasic motif with a single KR segment (KR815↓) (as SARS-CoV) that is recognized by trypsin-like serine proteases such as TMPRSS2. The current data support a model for SARS-CoV-2 entry in which furin-mediated cleavage at the S1/S2 site pre-primes spike during biogenesis, facilitating the activation for membrane fusion by a second cleavage event at S2’ by TMPRSS2 following ACE2 binding (Bestle et al., 2020b, Johnson et al., 2020).

Virus	S1/S2 site	S2’ site
SARS-CoV-2	TNSPRRAR|SVA	PSKPSKR|SFIEDL
SARS-CoV	S----LLR|STS	PLKPTKR|SFIEDL

Camostat mesylate, an inhibitor of TMPRSS2, blocks SARS-CoV-2 infection of lung cells like Calu-3 cells but not Huh7.5 and Vero E6 cells. Cell entry was assessed using a viral isolate and viral pseudotypes (artificial viruses) expressing the COVID-19 spike (S) protein. The ability of the viral pseudotypes (expressing S protein from SARS-CoV and SARS-CoV-2) to enter human and animal cell lines was demonstrated, showing that SARS-CoV-2 can enter similar cell lines as SARS-CoV. Amino acid analysis and cell culture experiments showed that, like SARS-CoV, SARS-CoV-2 spike protein binds to human and bat angiotensin-converting enzyme 2 (ACE2) and uses a cellular protease TMPRSS2 for priming. Priming activates the spike protein to facilitate viral fusion and entry into cells. Cell culture experiments were performed using immortalized cell lines and primary human lung cells (Hoffmann et al., 2020b, Rahman et al., 2020).

 

Spike binding to neuropilin-1:

Neuropilin-1 (NRP1) is a transmembrane glycoprotein that serves as a cell surface receptor for semaphorins and various ligands involved in angiogenesis in vertebrates. NRP1 is expressed in neurons, blood vessels (endothelial cells), immune cells and many other cell types in the mammalian body (maternal fetal interface) and binds a range of structurally and functionally diverse extracellular ligands to modulate organ development and function (Raimondi et al., 2016).  NRP1 is well described as a co-receptor for members of the class 3 semaphorins (SEMA3) or vascular endothelial growth factors (VEGFs) (Gelfand et al., 2014). Structurally, NRP1 comprises seven sub-domains, of which the first five are extracellular; two CUB domains (a1 and a2), two coagulation factor V/VIII domains (FV/VIII; b1 and b2) and a meprin, A5 μ-phosphatase domain (MAM; c). NRP1 contains only a short cytosolic tail with a PDZ-binding domain lacking internal signaling activity. The different ligand families bind to different sites of NRP1; SEMA3A binding requires the first three sub-domains of NRP1 (a1, a2, and b1), whereas binding of VEGF-A requires the b1 and b2 domains (Muhl et al., 2017). Additional studies conducted by means of in silico computational technology to identify and validate inhibitors of the interaction between NRP1 and SARS-CoV-2 Spike protein are reported in (Perez-Miller et al., 2020).  Represents a schematic picture of VEGF-A triggered phosphorylation of VEGF-R2. Screening of NRP-1/VEGF-A165 inhibitors by in-cell Western (Perez-Miller et al., 2020).v NRP1 acts as a co-receptor for SARS-CoV-2.

NRP1 is a receptor for furin-cleaved SARS-CoV-2 spike peptide (Cantuti-Castelvetri et al., 2020, Daly et al., 2020, Johnson et al., 2020). Blockade of NRP1 reduces infectivity and entry, and alteration of the furin site leads to loss of NRP1 dependence, reduced replication in Calu3, augmented replication in Vero E6, and attenuated disease in a hamster pathogenesis disease model (Johnson et al., 2020). In fact, a small sequence of amino acids was found that appeared to mimic a protein sequence found in human proteins that interact with NRP1. The spike protein of SARS-CoV-2 binding with NRP1 aids viral infection of human cells. This was confirmed by applying a range of structural and biochemical approaches to establish that the spike protein of SARS-CoV-2 does indeed bind to NRP1. The host protease furin cleaves the full-length precursor S glycoprotein into two associated polypeptides: S1 and S2. Cleavage of S generates a polybasic RRAR C-terminal sequence on S1, which conforms to a C-end rule (CendR) motif that binds to cell surface neuropilin-1 (NRP1) and neuropilin-2 (NRP2) receptors. It was reported that the S1 CendR motif directly bound NRP1 by X-ray crystallography and biochemical approaches. Blocking this interaction using RNAi or selective inhibitors reduced SARS-CoV-2 entry and infectivity in cell culture (Daly et al., 2020).

NRP1, known to bind furin-cleaved substrates, significantly potentiates SARS-CoV-2 infectivity, which was revealed by a monoclonal blocking antibody against NRP1. It was found that a SARS-CoV-2 mutant with an altered furin cleavage site did not depend on NRP1 for infectivity. Pathological analysis of olfactory epithelium obtained from human COVID-19 autopsies revealed that SARS-CoV-2 infected NRP1-positive cells faced the nasal cavity (Cantuti-Castelvetri et al., 2020). Furthermore, it has been found that NRP1 is a new potential SARS‑CoV‑2 infection mediator implicated in the neurologic features and central nervous system involvement of COVID‑19.  Preclinical studies have suggested that NRP1, a transmembrane receptor that lacks a cytosolic protein kinase domain and exhibits high expression in the respiratory and olfactory epithelium, may also be implicated in COVID‑19 by enhancing the entry of SARS‑CoV‑2 into the brain through the olfactory epithelium. NRP1 is also expressed in the CNS, including olfactory‑related regions such as the olfactory tubercles and paraolfactory gyri. Supporting the potential role of NRP1 as an additional SARS‑CoV‑2 infection mediator implicated in the neurologic manifestations of COVID‑19. Accordingly, the neurotropism of SARS‑CoV‑2 via NRP1‑expressing cells in the CNS merits further investigation (Davies et al., 2020).

 

Up-regulation of NRP1 protein in diabetic kidney cells hints at its importance in a population at risk of severe COVID-19. Involvement of NRP-1 in immune function is compelling, given the role of an exaggerated immune response in disease severity and deaths due to COVID-19. NRP-1 has been suggested to be an immune checkpoint of T cell memory. It is unknown whether involvement and up-regulation of NRP-1 in COVID-19 may translate into disease outcome and long-term consequences, including possible immune dysfunction (Mayi et al., 2021).

The main feature of NRP1 co-receptor is to form complexes with multiple other receptors. Hence, there is a competition between receptors to complex with NRP-1, which may determine their abilities both quantitatively and qualitatively to transduce signals. It is tempting to hypothesize that the occupancy of NRP-1 with one receptor may thus decrease its availability for virus entry. Recent proteomics work has shown that NRP-1 can form a complex with the α7 nicotinic receptor in mice. Both receptors are expressed in the human nasal and pulmonary epithelium (Mayi et al., 2021).

NRP1, is highly expressed in the respiratory and olfactory epithelium; it is also expressed in the CNS, including olfactory related regions such as the olfactory tubercles and paraolfactory gyri (Davies et al., 2020).

More information on tissue distribution and protein expression of NRP1 can be found in https://www.proteinatlas.org/ENSG000000992 50-NRP1

Spike entry via lysosomal cathepsins and endocytosis:

Evidence shows the role of TMPRSS2 and other serine proteases in activating the coronavirus spike protein for plasma membrane fusion. However, studies using various cell culture systems showed that SARS-CoV2 could enter cells via an alternative endosomal–lysosomal pathway. Evidence came from studies demonstrating that lysosomotropic agents reduced SARS-CoV replication in cells lacking TMPRSS2 and other studies, using highly potent and specific small-molecule cathepsin inhibitors, to understand the role of cathepsins in processing and activating the spike for membrane fusion, mainly of cathepsin L (one of the 11 cathepsins) (Rossi et al., 2004, Simmons et al., 2005). SARS-CoV-2 and other coronaviruses can establish infection through endosomal entry in commonly used in vitro cell culture systems. Of relevance, inhibitors of the endosomal pathway, as the cathepsin inhibitor Z-FA-FMK and PIKfyve inhibitor apilimod, blocked viral entry in Huh7.5 and Vero E6 cells but not Calu-3 cells.

Viral entry leads to delivery of virion proteins and translation of viral proteins immediately:

Coronavirus is a class of viruses that have single-stranded positive-sense RNA genomes in their envelopes [Kim D, et al., 2020]. The virus contains a 29.7 kB positive-sense RNA genome flanked by 5' and 3' untranslated regions of 265 and 342 nucleotides, respectively that contain cis-acting secondary RNA structures essential for RNA synthesis [Huston N. C. et al., 2021]. The genome just prior to the 5′ end contains the transcriptional regulatory sequence leader (TRS-L) [Budzilowicx C.J., et al., 1985]. The SARS-CoV genome is polycistronic and contains 14 open reading frames (ORFs) that are expressed by poorly understood mechanisms [Snijder E. J., et al., 2003]. Preceding each ORF there are other TRSs called the body TRS (TRS B). The 5′ two-thirds of the genome contains two large, overlapping, nonstructural ORFs and the 3′ third contains the remainder ORFs [Di H., et al., 2018]. Genome expression starts with the translation of two large ORFs of the 5’ two-thirds: ORF1a of 4382 amino acids and ORF1ab of 7073 amino acid that occurs via a programmed (- 1) ribosomal frameshifting [Snijder E. J., et al., 2003], yielding pp1a and pp1ab. These two polyproteins are cleaved into 16 subunits by two viral proteinases encoded by ORF1a, nsp3, and nsp5 that contain a papain-like protease domain and a 3C-like protease domain [Sacco M. D. et al., 2020]. The processing products are a group of replicative enzymes, named nsp1-nsp16, that assemble into a viral replication and transcription complex (RTC) associated with membranes of endoplasmic reticulum (ER) with the help of various membrane-associated viral proteins [Klein S., et al., 2021, Snijder E. J., et al., 2020, V'Kovski P. , et al., 2021]. This association leads to replication factories or organelles, that are originate new membranous structures that are observed by electron mciroscopy . They are a feature of all coronaviridae and the site of viral replication and transcription hidden from innate immune molecules.

How it is Measured or Detected

SARS-CoV2 entry can be determined by many different ways:

1) quantitative RT-PCR specific to the subgenomic mRNA of the N transcript, in cells manipulated with host factors that express of not TMPRSS2, cathepsinL, neuropilin-1, hACE2 [Glowacka I, et al. (2011)], or exogenous addition of HAT or furin.

2) using spike-pseudotyped viral particles expressing GFP/luciferase/bgalactosidase and comparing with vesicular stomatitis virus G seudotyped particles expressing the same reporter analysed in manipulated cultured with cell lines, followed by determining fluorescence, biolumincescence, luciferase activity in cell lysates  [Hoffmann M, et al. (2020)].

TMPRSS2:

TMPRSS2 gene expression can be measured by RNAseq and microarray (Baughn et al., 2020).

Expression levels of TMPRSS2 can be measured by RNA in situ hybridization (RNA-ISH) (Qiao et al., 2020)

NRP-1:

Several methods have been identified in the literature for measuring and detecting NRP1 receptor binding. Briefly described:

1. X-ray crystallography  and biochemical approaches help to show that the S1 CendR motif directly bound NRP1 (1).  Binding of the S1 fragment to NRP1 was assessed and ability of SARS-CoV-2 to use NRP1 to infect cells was measured in angiotensin-converting enzyme-2 (ACE-2)-expressing cell lines by knocking out NRP1 expression, blocking NRP1 with 3 different anti-NRP1 monoclonal antibodies, or using NRP1 small molecule antagonists (Centers for Disease Control and Prevention, 2020, Daly et al., 2020).

Key findings (Centers for Disease Control and Prevention, 2020, Daly et al., 2020):

• The S1 fragment of the cleaved SARS-CoV-2 spike protein binds to the cell surface receptor neuropilin-1 (NRP1).

• SARS-CoV-2 utilizes NRP1 for cell entry as evidenced by decreased infectivity of cells in the presence of: NRP1 deletion (p <0.01). Three different anti-NRP1 monoclonal antibodies (p <0.001). Selective NRP1 antagonist, EG00229 (p <0.01).

2. Cell lines were modified to express ACE2 and TMPRSS2, the two known SARS-CoV-2 host factors, and NRP1 to assess the contribution of NRP1 to infection. Autopsy specimens from multiple airway sites were stained with antibodies against SARS-CoV-2 proteins, ACE2, and NRP1, to visualize co-localization of proteins (6, 15).

Key findings (Cantuti-Castelvetri et al., 2020, Centers for Disease Control and Prevention, 2020):

• Infectivity of cells expressing angiotensin converting enzyme-2 (ACE2, receptor for SARS-CoV-2), transmembrane protease serine-2 (TSS2, primes the Spike [S] protein), and neuropilin-1 (NRP1) with pseudovirus expressing the SARS-CoV-2 S1 protein was approximately 3-fold higher than in cells expressing either ACE2 or TSS2 alone (p<0.05).

• Analysis of autopsy tissue from COVID-19 patients showed co-localization of the SARS-CoV-2 spike (S) protein and NRP1 in olfactory and respiratory epithelium.

Virtual screen of nearly 0.5 million compounds against the NRP-1 CendR site, resulting in nearly 1,000 hits. A pharmacophore model was derived from the identified ligands, considering both steric and electronic requirements. Preparation of receptor protein and grid for virtual screening, docking of known NRP-1 targeting compounds, ELISA based NRP1-VEGF-A165 protein binding assay; more details on methodology in the referenced paper (Perez-Miller et al., 2020)

References

BAUGHN, L. B., SHARMA, N., ELHAIK, E., SEKULIC, A., BRYCE, A. H. & FONSECA, R. 2020. Targeting TMPRSS2 in SARS-CoV-2 Infection. Mayo Clin Proc, 95, 1989-1999.

BESTLE, D., HEINDL, M. R., LIMBURG, H., VAN LAM VAN, T., PILGRAM, O., MOULTON, H., STEIN, D. A., HARDES, K., EICKMANN, M., DOLNIK, O., ROHDE, C., KLENK, H.-D., GARTEN, W., STEINMETZER, T. & BÖTTCHER-FRIEBERTSHÄUSER, E. 2020a. TMPRSS2 and furin are both essential for proteolytic activation of SARS-CoV-2 in human airway cells. Life Science Alliance, 3.

BESTLE, D., HEINDL, M. R., LIMBURG, H., VAN LAM VAN, T., PILGRAM, O., MOULTON, H., STEIN, D. A., HARDES, K., EICKMANN, M., DOLNIK, O., ROHDE, C., KLENK, H. D., GARTEN, W., STEINMETZER, T. & BOTTCHER-FRIEBERTSHAUSER, E. 2020b. TMPRSS2 and furin are both essential for proteolytic activation of SARS-CoV-2 in human airway cells. Life Sci Alliance, 3.

BUDZILOWICZ, C.J., WILCZYNSKI, S.P., AND WEISS, S.R. (1985). Three intergenic regions of coronavirus mouse hepatitis virus strain A59 genome RNA contain a common nucleotide sequence that is homologous to the 3' end of the viral mRNA leader sequence. J Virol 53, 834-840.

CANTUTI-CASTELVETRI, L., OJHA, R., PEDRO, L. D., DJANNATIAN, M., FRANZ, J., KUIVANEN, S., VAN DER MEER, F., KALLIO, K., KAYA, T., ANASTASINA, M., SMURA, T., LEVANOV, L., SZIROVICZA, L., TOBI, A., KALLIO-KOKKO, H., OSTERLUND, P., JOENSUU, M., MEUNIER, F. A., BUTCHER, S. J., WINKLER, M. S., MOLLENHAUER, B., HELENIUS, A., GOKCE, O., TEESALU, T., HEPOJOKI, J., VAPALAHTI, O., STADELMANN, C., BALISTRERI, G. & SIMONS, M. 2020. Neuropilin-1 facilitates SARS-CoV-2 cell entry and infectivity. Science, 370, 856-860.

CAO, H., LI, Y., HUANG, L., BAI, B. & XU, Z. 2020. Clinicopathological Significance of Neuropilin 1 Expression in Gastric Cancer: A Meta-Analysis. Dis Markers, 2020, 4763492.

CENTERS FOR DISEASE CONTROL AND PREVENTION, U. S. D. O. H. A. H. S. 2020. Covid-19 Science Update 2020.

CHEN, L., LI, X., CHEN, M., FENG, Y. & XIONG, C. 2020. The ACE2 expression in human heart indicates new potential mechanism of heart injury among patients infected with SARS-CoV-2. Cardiovasc Res, 116, 1097-1100.

DALY, J. L., SIMONETTI, B., KLEIN, K., CHEN, K. E., WILLIAMSON, M. K., ANTON-PLAGARO, C., SHOEMARK, D. K., SIMON-GRACIA, L., BAUER, M., HOLLANDI, R., GREBER, U. F., HORVATH, P., SESSIONS, R. B., HELENIUS, A., HISCOX, J. A., TEESALU, T., MATTHEWS, D. A., DAVIDSON, A. D., COLLINS, B. M., CULLEN, P. J. & YAMAUCHI, Y. 2020. Neuropilin-1 is a host factor for SARS-CoV-2 infection. Science, 370, 861-865.

DAVIES, J., RANDEVA, H. S., CHATHA, K., HALL, M., SPANDIDOS, D. A., KARTERIS, E. & KYROU, I. 2020. Neuropilin1 as a new potential SARSCoV2 infection mediator implicated in the neurologic features and central nervous system involvement of COVID19. Mol Med Rep, 22, 4221-4226.

DI, H., MCINTYRE, A.A., AND BRINTON, M.A. (2018). New insights about the regulation of Nidovirus subgenomic mRNA synthesis. Virology 517, 38-43.

GELFAND, M. V., HAGAN, N., TATA, A., OH, W. J., LACOSTE, B., KANG, K. T., KOPYCINSKA, J., BISCHOFF, J., WANG, J. H. & GU, C. 2014. Neuropilin-1 functions as a VEGFR2 co-receptor to guide developmental angiogenesis independent of ligand binding. Elife, 3, e03720.

HARTENIAN, E., NANDAKUMAR, D., LARI, A., LY, M., TUCKER, J. M. & GLAUNSINGER, B. A. 2020. The molecular virology of coronaviruses. J Biol Chem, 295, 12910-12934.

HASAN, A., PARAY, B. A., HUSSAIN, A., QADIR, F. A., ATTAR, F., AZIZ, F. M., SHARIFI, M., DERAKHSHANKHAH, H., RASTI, B., MEHRABI, M., SHAHPASAND, K., SABOURY, A. A. & FALAHATI, M. 2020. A review on the cleavage priming of the spike protein on coronavirus by angiotensin-converting enzyme-2 and furin. J Biomol Struct Dyn, 1-9.

HOFFMANN, M., KLEINE-WEBER, H. & POHLMANN, S. 2020a. A Multibasic Cleavage Site in the Spike Protein of SARS-CoV-2 Is Essential for Infection of Human Lung Cells. Mol Cell, 78, 779-784 e5.

HOFFMANN, M., KLEINE-WEBER, H., SCHROEDER, S., KRUGER, N., HERRLER, T., ERICHSEN, S., SCHIERGENS, T. S., HERRLER, G., WU, N. H., NITSCHE, A., MULLER, M. A., DROSTEN, C. & POHLMANN, S. 2020b. SARS-CoV-2 Cell Entry Depends on ACE2 and TMPRSS2 and Is Blocked by a Clinically Proven Protease Inhibitor. Cell, 181, 271-280 e8.

HUGGINS, D. J. 2020. Structural analysis of experimental drugs binding to the SARS-CoV-2 target TMPRSS2. J Mol Graph Model, 100, 107710.

HUSTON, N.C., WAN, H., STRINE, M.S., DE CESARIS ARAUJO TAVARES, R., WILEN, C.B., AND PYLE, A.M. (2021). Comprehensive in vivo secondary structure of the SARS-CoV-2 genome reveals novel regulatory motifs and mechanisms. Mol Cell 81, 584-598 e585.

JING, Y., RUN-QIAN, L., HAO-RAN, W., HAO-RAN, C., YA-BIN, L., YANG, G. & FEI, C. 2020. Potential influence of COVID-19/ACE2 on the female reproductive system. Mol Hum Reprod, 26, 367-373.

JOHNSON, B. A., XIE, X., KALVERAM, B., LOKUGAMAGE, K. G., MURUATO, A., ZOU, J., ZHANG, X., JUELICH, T., SMITH, J. K., ZHANG, L., BOPP, N., SCHINDEWOLF, C., VU, M., VANDERHEIDEN, A., SWETNAM, D., PLANTE, J. A., AGUILAR, P., PLANTE, K. S., LEE, B., WEAVER, S. C., SUTHAR, M. S., ROUTH, A. L., REN, P., KU, Z., AN, Z., DEBBINK, K., SHI, P. Y., FREIBERG, A. N. & MENACHERY, V. D. 2020. Furin Cleavage Site Is Key to SARS-CoV-2 Pathogenesis. bioRxiv.

JU, B., ZHANG, Q., GE, J., WANG, R., SUN, J., GE, X., YU, J., SHAN, S., ZHOU, B., SONG, S., TANG, X., YU, J., LAN, J., YUAN, J., WANG, H., ZHAO, J., ZHANG, S., WANG, Y., SHI, X., LIU, L., ZHAO, J., WANG, X., ZHANG, Z. & ZHANG, L. 2020. Human neutralizing antibodies elicited by SARS-CoV-2 infection. Nature, 584, 115-119.

JURASZEK, J., RUTTEN, L., BLOKLAND, S., BOUCHIER, P., VOORZAAT, R., RITSCHEL, T., BAKKERS, M. J. G., RENAULT, L. L. R. & LANGEDIJK, J. P. M. 2021. Stabilizing the closed SARS-CoV-2 spike trimer. Nat Commun, 12, 244.

KANG, Y.-L., CHOU, Y.-Y., ROTHLAUF, P. W., LIU, Z., SOH, T. K., CURETON, D., CASE, J. B., CHEN, R. E., DIAMOND, M. S., WHELAN, S. P. J. & KIRCHHAUSEN, T. 2020. Inhibition of PIKfyve kinase prevents infection by Zaire ebolavirus and SARS-CoV-2. bioRxiv, 2020.04.21.053058.

KAWASE, M., SHIRATO, K., VAN DER HOEK, L., TAGUCHI, F. & MATSUYAMA, S. 2012. Simultaneous treatment of human bronchial epithelial cells with serine and cysteine protease inhibitors prevents severe acute respiratory syndrome coronavirus entry. J Virol, 86, 6537-45.

KIM, D., LEE, J.Y., YANG, J.S., KIM, J.W., KIM, V.N., AND CHANG, H. (2020). The Architecture of SARS-CoV-2 Transcriptome. Cell 181, 914-921 e910.

KLEIN, S., CORTESE, M., WINTER, S.L., WACHSMUTH-MELM, M., NEUFELDT, C.J., CERIKAN, B., STANIFER, M.L., BOULANT, S., BARTENSCHLAGER, R., AND CHLANDA, P. (2020). SARS-CoV-2 structure and replication characterized by in situ cryo-electron tomography. Nat Commun 11, 5885.

LAM, S. D., BORDIN, N., WAMAN, V. P., SCHOLES, H. M., ASHFORD, P., SEN, N., VAN DORP, L., RAUER, C., DAWSON, N. L., PANG, C. S. M., ABBASIAN, M., SILLITOE, I., EDWARDS, S. J. L., FRATERNALI, F., LEES, J. G., SANTINI, J. M. & ORENGO, C. A. 2020. SARS-CoV-2 spike protein predicted to form complexes with host receptor protein orthologues from a broad range of mammals. Sci Rep, 10, 16471.

LAMERS, M. M., BEUMER, J., VAN DER VAART, J., KNOOPS, K., PUSCHHOF, J., BREUGEM, T. I., RAVELLI, R. B. G., PAUL VAN SCHAYCK, J., MYKYTYN, A. Z., DUIMEL, H. Q., VAN DONSELAAR, E., RIESEBOSCH, S., KUIJPERS, H. J. H., SCHIPPER, D., VAN DE WETERING, W. J., DE GRAAF, M., KOOPMANS, M., CUPPEN, E., PETERS, P. J., HAAGMANS, B. L. & CLEVERS, H. 2020. SARS-CoV-2 productively infects human gut enterocytes. Science, 369, 50-54.

LAN, J., GE, J., YU, J., SHAN, S., ZHOU, H., FAN, S., ZHANG, Q., SHI, X., WANG, Q., ZHANG, L. & WANG, X. 2020. Structure of the SARS-CoV-2 spike receptor-binding domain bound to the ACE2 receptor. Nature, 581, 215-220.

LETKO, M., MARZI, A. & MUNSTER, V. 2020. Functional assessment of cell entry and receptor usage for SARS-CoV-2 and other lineage B betacoronaviruses. Nat Microbiol, 5, 562-569.

LI, F. 2016. Structure, Function, and Evolution of Coronavirus Spike Proteins. Annu Rev Virol, 3, 237-261.

LIN, B., FERGUSON, C., WHITE, J. T., WANG, S., VESSELLA, R., TRUE, L. D., HOOD, L. & NELSON, P. S. 1999. Prostate-localized and androgen-regulated expression of the membrane-bound serine protease TMPRSS2. Cancer Res, 59, 4180-4.

LIU, L., WANG, P., NAIR, M. S., YU, J., RAPP, M., WANG, Q., LUO, Y., CHAN, J. F., SAHI, V., FIGUEROA, A., GUO, X. V., CERUTTI, G., BIMELA, J., GORMAN, J., ZHOU, T., CHEN, Z., YUEN, K. Y., KWONG, P. D., SODROSKI, J. G., YIN, M. T., SHENG, Z., HUANG, Y., SHAPIRO, L. & HO, D. D. 2020. Potent neutralizing antibodies against multiple epitopes on SARS-CoV-2 spike. Nature, 584, 450-456.

LU, Y. & MENG, Y. G. 2015. Quantitation of Circulating Neuropilin-1 in Human, Monkey, Mouse, and Rat Sera by ELISA. Methods Mol Biol, 1332, 39-48.

LUCAS, J. M., TRUE, L., HAWLEY, S., MATSUMURA, M., MORRISSEY, C., VESSELLA, R. & NELSON, P. S. 2008. The androgen-regulated type II serine protease TMPRSS2 is differentially expressed and mislocalized in prostate adenocarcinoma. J Pathol, 215, 118-25.

LUKASSEN, S., CHUA, R. L., TREFZER, T., KAHN, N. C., SCHNEIDER, M. A., MULEY, T., WINTER, H., MEISTER, M., VEITH, C., BOOTS, A. W., HENNIG, B. P., KREUTER, M., CONRAD, C. & EILS, R. 2020. SARS-CoV-2 receptor ACE2 and TMPRSS2 are primarily expressed in bronchial transient secretory cells. EMBO J, 39, e105114.

MADJID, M., SAFAVI-NAEINI, P., SOLOMON, S. D. & VARDENY, O. 2020. Potential Effects of Coronaviruses on the Cardiovascular System: A Review. JAMA Cardiol, 5, 831-840.

MAYI, B. S., LEIBOWITZ, J. A., WOODS, A. T., AMMON, K. A., LIU, A. E. & RAJA, A. 2021. The role of Neuropilin-1 in COVID-19. PLoS Pathog, 17, e1009153.

MILLET, J. K. & WHITTAKER, G. R. 2018. Physiological and molecular triggers for SARS-CoV membrane fusion and entry into host cells. Virology, 517, 3-8.

MIRABELLI, C., WOTRING, J. W., ZHANG, C. J., MCCARTY, S. M., FURSMIDT, R., FRUM, T., KADAMBI, N. S., AMIN, A. T., O’MEARA, T. R., PRETTO, C. D., SPENCE, J. R., HUANG, J., ALYSANDRATOS, K. D., KOTTON, D. N., HANDELMAN, S. K., WOBUS, C. E., WEATHERWAX, K. J., MASHOUR, G. A., O’MEARA, M. J. & SEXTON, J. Z. 2020. Morphological Cell Profiling of SARS-CoV-2 Infection Identifies Drug Repurposing Candidates for COVID-19. bioRxiv, 2020.05.27.117184.

MOUTAL, A., MARTIN, L. F., BOINON, L., GOMEZ, K., RAN, D., ZHOU, Y., STRATTON, H. J., CAI, S., LUO, S., GONZALEZ, K. B., PEREZ-MILLER, S., PATWARDHAN, A., IBRAHIM, M. M. & KHANNA, R. 2020. SARS-CoV-2 Spike protein co-opts VEGF-A/Neuropilin-1 receptor signaling to induce analgesia. bioRxiv.

MUHL, L., FOLESTAD, E. B., GLADH, H., WANG, Y., MOESSINGER, C., JAKOBSSON, L. & ERIKSSON, U. 2017. Neuropilin 1 binds PDGF-D and is a co-receptor in PDGF-D-PDGFRbeta signaling. J Cell Sci, 130, 1365-1378.

MUKHERJEE, S. & PAHAN, K. 2021. Is COVID-19 Gender-sensitive? J Neuroimmune Pharmacol, 16, 38-47.

MURGOLO, N., THERIEN, A. G., HOWELL, B., KLEIN, D., KOEPLINGER, K., LIEBERMAN, L. A., ADAM, G. C., FLYNN, J., MCKENNA, P., SWAMINATHAN, G., HAZUDA, D. J. & OLSEN, D. B. 2021. SARS-CoV-2 tropism, entry, replication, and propagation: Considerations for drug discovery and development. PLoS Pathog, 17, e1009225.

PAN, X. W., XU, D., ZHANG, H., ZHOU, W., WANG, L. H. & CUI, X. G. 2020. Identification of a potential mechanism of acute kidney injury during the COVID-19 outbreak: a study based on single-cell transcriptome analysis. Intensive Care Med, 46, 1114-1116.

PEREZ-MILLER, S., PATEK, M., MOUTAL, A., CABEL, C. R., THORNE, C. A., CAMPOS, S. K. & KHANNA, R. 2020. In silico identification and validation of inhibitors of the interaction between neuropilin receptor 1 and SARS-CoV-2 Spike protein. bioRxiv.

PREMKUMAR, L., SEGOVIA-CHUMBEZ, B., JADI, R., MARTINEZ, D. R., RAUT, R., MARKMANN, A., CORNABY, C., BARTELT, L., WEISS, S., PARK, Y., EDWARDS, C. E., WEIMER, E., SCHERER, E. M., ROUPHAEL, N., EDUPUGANTI, S., WEISKOPF, D., TSE, L. V., HOU, Y. J., MARGOLIS, D., SETTE, A., COLLINS, M. H., SCHMITZ, J., BARIC, R. S. & DE SILVA, A. M. 2020. The receptor binding domain of the viral spike protein is an immunodominant and highly specific target of antibodies in SARS-CoV-2 patients. Sci Immunol, 5.

QIAO, Y., WANG, X. M., MANNAN, R., PITCHIAYA, S., ZHANG, Y., WOTRING, J. W., XIAO, L., ROBINSON, D. R., WU, Y. M., TIEN, J. C., CAO, X., SIMKO, S. A., APEL, I. J., BAWA, P., KREGEL, S., NARAYANAN, S. P., RASKIND, G., ELLISON, S. J., PAROLIA, A., ZELENKA-WANG, S., MCMURRY, L., SU, F., WANG, R., CHENG, Y., DELEKTA, A. D., MEI, Z., PRETTO, C. D., WANG, S., MEHRA, R., SEXTON, J. Z. & CHINNAIYAN, A. M. 2020. Targeting transcriptional regulation of SARS-CoV-2 entry factors ACE2 and TMPRSS2. Proc Natl Acad Sci U S A.

RAHMAN, N., BASHARAT, Z., YOUSUF, M., CASTALDO, G., RASTRELLI, L. & KHAN, H. 2020. Virtual Screening of Natural Products against Type II Transmembrane Serine Protease (TMPRSS2), the Priming Agent of Coronavirus 2 (SARS-CoV-2). Molecules, 25.

RAIMONDI, C., BRASH, J. T., FANTIN, A. & RUHRBERG, C. 2016. NRP1 function and targeting in neurovascular development and eye disease. Prog Retin Eye Res, 52, 64-83.

RIVA, L., YUAN, S., YIN, X., MARTIN-SANCHO, L., MATSUNAGA, N., BURGSTALLER-MUEHLBACHER, S., PACHE, L., DE JESUS, P. P., HULL, M. V., CHANG, M., CHAN, J. F.-W., CAO, J., POON, V. K.-M., HERBERT, K., NGUYEN, T.-T., PU, Y., NGUYEN, C., RUBANOV, A., MARTINEZ-SOBRIDO, L., LIU, W.-C., MIORIN, L., WHITE, K. M., JOHNSON, J. R., BENNER, C., SUN, R., SCHULTZ, P. G., SU, A., GARCIA-SASTRE, A., CHATTERJEE, A. K., YUEN, K.-Y. & CHANDA, S. K. 2020. A Large-scale Drug Repositioning Survey for SARS-CoV-2 Antivirals. bioRxiv, 2020.04.16.044016.

ROBBIANI, D. F., GAEBLER, C., MUECKSCH, F., LORENZI, J. C. C., WANG, Z., CHO, A., AGUDELO, M., BARNES, C. O., GAZUMYAN, A., FINKIN, S., HAGGLOF, T., OLIVEIRA, T. Y., VIANT, C., HURLEY, A., HOFFMANN, H. H., MILLARD, K. G., KOST, R. G., CIPOLLA, M., GORDON, K., BIANCHINI, F., CHEN, S. T., RAMOS, V., PATEL, R., DIZON, J., SHIMELIOVICH, I., MENDOZA, P., HARTWEGER, H., NOGUEIRA, L., PACK, M., HOROWITZ, J., SCHMIDT, F., WEISBLUM, Y., MICHAILIDIS, E., ASHBROOK, A. W., WALTARI, E., PAK, J. E., HUEY-TUBMAN, K. E., KORANDA, N., HOFFMAN, P. R., WEST, A. P., JR., RICE, C. M., HATZIIOANNOU, T., BJORKMAN, P. J., BIENIASZ, P. D., CASKEY, M. & NUSSENZWEIG, M. C. 2020. Convergent antibody responses to SARS-CoV-2 in convalescent individuals. Nature, 584, 437-442.

ROSSI, A., DEVERAUX, Q., TURK, B. & SALI, A. 2004. Comprehensive search for cysteine cathepsins in the human genome. Biol Chem, 385, 363-72.

SACCO, M.D., MA, C., LAGARIAS, P., GAO, A., TOWNSEND, J.A., MENG, X., DUBE, P., ZHANG, X., HU, Y., KITAMURA, N., et al. (2020). Structure and inhibition of the SARS-CoV-2 main protease reveal strategy for developing dual inhibitors against M(pro) and cathepsin L. Sci Adv 6(50):eabe0751.

SHANG, J., WAN, Y., LUO, C., YE, G., GENG, Q., AUERBACH, A. & LI, F. 2020. Cell entry mechanisms of SARS-CoV-2. Proc Natl Acad Sci U S A, 117, 11727-11734.

SHIRATO, K., KAWASE, M. & MATSUYAMA, S. 2018. Wild-type human coronaviruses prefer cell-surface TMPRSS2 to endosomal cathepsins for cell entry. Virology, 517, 9-15.

SIMMONS, G., GOSALIA, D. N., RENNEKAMP, A. J., REEVES, J. D., DIAMOND, S. L. & BATES, P. 2005. Inhibitors of cathepsin L prevent severe acute respiratory syndrome coronavirus entry. Proc Natl Acad Sci U S A, 102, 11876-81.

SINGH, M., BANSAL, V. & FESCHOTTE, C. 2020. A single-cell RNA expression map of human coronavirus entry factors. bioRxiv.

SNIJDER, E.J., BREDENBEEK, P.J., DOBBE, J.C., THIEL, V., ZIEBUHR, J., POON, L.L.M., GUAN, Y., ROZANOV, M., SPAAN, W.J.M., AND GORBALENYA, A.E. (2003). Unique and Conserved Features of Genome and Proteome of SARS-coronavirus, an Early Split-off From the Coronavirus Group 2 Lineage. Journal of Molecular Biology 331, 991-1004.

SNIJDER, E.J., LIMPENS, R., DE WILDE, A.H., DE JONG, A.W.M., ZEVENHOVEN-DOBBE, J.C., MAIER, H.J., FAAS, F., KOSTER, A.J., AND BARCENA, M. (2020). A unifying structural and functional model of the coronavirus replication organelle: Tracking down RNA synthesis. PLoS Biol 18, e3000715.

SUBRAMANIAN, A., VERNON, K. A., SLYPER, M., WALDMAN, J., LUECKEN, M. D., GOSIK, K., DUBINSKY, D., CUOCO, M. S., KELLER, K., PURNELL, J., NGUYEN, L., DIONNE, D., ROZENBLATT-ROSEN, O., WEINS, A., REGEV, A. & GREKA, A. 2020. RAAS blockade, kidney disease, and expression of ACE2, the entry receptor for SARS-CoV-2, in kidney epithelial and endothelial cells.

UNIPROTKB - O14786 (NRP1_HUMAN)

V'KOVSKI, P., KRATZEL, A., STEINER, S., STALDER, H., AND THIEL, V. (2021). Coronavirus biology and replication: implications for SARS-CoV-2. Nat Rev Microbiol. 19, 155–170.

WALLS, A. C., TORTORICI, M. A., BOSCH, B. J., FRENZ, B., ROTTIER, P. J. M., DIMAIO, F., REY, F. A. & VEESLER, D. 2016. Cryo-electron microscopy structure of a coronavirus spike glycoprotein trimer. Nature, 531, 114-117.

WANG, Y., LIU, M. & GAO, J. 2020. Enhanced receptor binding of SARS-CoV-2 through networks of hydrogen-bonding and hydrophobic interactions. Proc Natl Acad Sci U S A, 117, 13967-13974.

YAMAMOTO, M., KISO, M., SAKAI-TAGAWA, Y., IWATSUKI-HORIMOTO, K., IMAI, M., TAKEDA, M., KINOSHITA, N., OHMAGARI, N., GOHDA, J., SEMBA, K., MATSUDA, Z., KAWAGUCHI, Y., KAWAOKA, Y. & INOUE, J. I. 2020. The Anticoagulant Nafamostat Potently Inhibits SARS-CoV-2 S Protein-Mediated Fusion in a Cell Fusion Assay System and Viral Infection In Vitro in a Cell-Type-Dependent Manner. Viruses, 12.

YANG, N. & SHEN, H.-M. 2020. Targeting the Endocytic Pathway and Autophagy Process as a Novel Therapeutic Strategy in COVID-19. International Journal of Biological Sciences, 16, 1724-1731.

YUAN, M., WU, N. C., ZHU, X., LEE, C. D., SO, R. T. Y., LV, H., MOK, C. K. P. & WILSON, I. A. 2020. A highly conserved cryptic epitope in the receptor binding domains of SARS-CoV-2 and SARS-CoV. Science, 368, 630-633.

ZANG, R., GOMEZ CASTRO, M. F., MCCUNE, B. T., ZENG, Q., ROTHLAUF, P. W., SONNEK, N. M., LIU, Z., BRULOIS, K. F., WANG, X., GREENBERG, H. B., DIAMOND, M. S., CIORBA, M. A., WHELAN, S. P. J. & DING, S. 2020. TMPRSS2 and TMPRSS4 promote SARS-CoV-2 infection of human small intestinal enterocytes. Sci Immunol, 5.

ZIEGLER, C. G. K., ALLON, S. J., NYQUIST, S. K., MBANO, I. M., MIAO, V. N., TZOUANAS, C. N., CAO, Y., YOUSIF, A. S., BALS, J., HAUSER, B. M., FELDMAN, J., MUUS, C., WADSWORTH, M. H., 2ND, KAZER, S. W., HUGHES, T. K., DORAN, B., GATTER, G. J., VUKOVIC, M., TALIAFERRO, F., MEAD, B. E., GUO, Z., WANG, J. P., GRAS, D., PLAISANT, M., ANSARI, M., ANGELIDIS, I., ADLER, H., SUCRE, J. M. S., TAYLOR, C. J., LIN, B., WAGHRAY, A., MITSIALIS, V., DWYER, D. F., BUCHHEIT, K. M., BOYCE, J. A., BARRETT, N. A., LAIDLAW, T. M., CARROLL, S. L., COLONNA, L., TKACHEV, V., PETERSON, C. W., YU, A., ZHENG, H. B., GIDEON, H. P., WINCHELL, C. G., LIN, P. L., BINGLE, C. D., SNAPPER, S. B., KROPSKI, J. A., THEIS, F. J., SCHILLER, H. B., ZARAGOSI, L. E., BARBRY, P., LESLIE, A., KIEM, H. P., FLYNN, J. L., FORTUNE, S. M., BERGER, B., FINBERG, R. W., KEAN, L. S., GARBER, M., SCHMIDT, A. G., LINGWOOD, D., SHALEK, A. K., ORDOVAS-MONTANES, J., LUNG-NETWORK@HUMANCELLATLAS.ORG, H. C. A. L. B. N. E. A. & NETWORK, H. C. A. L. B. 2020. SARS-CoV-2 Receptor ACE2 Is an Interferon-Stimulated Gene in Human Airway Epithelial Cells and Is Detected in Specific Cell Subsets across Tissues. Cell, 181, 1016-1035 e19.

Event: 1901: Interferon-I antiviral response, antagonized by SARS-CoV-2

Short Name: IFN-I response, antagonized

Key Event Component

AOPs Including This Key Event

Stressors

Biological Context

Cell term

Organ term

Domain of Applicability

Taxonomic Applicability Life Stage Applicability Sex Applicability

Broad mammalian host range based on spike protein tropism for and binding to ACE2 (Conceicao et al. 2020; Wu et al. 2020) and cross-species ACE2 structural analysis (Damas et al. 2020). Some literature found on non-human hosts indicates that NSPs and accessory proteins can interact in a similar manner with bird (chicken) and other mammal proteins in the IFN-I pathway (Moustaqil et al. 2021; Rui et al. 2021).

Key Event Description

SARS-CoV-2 is an enveloped virus with a single-stranded RNA genome of ~30 kb, sequence orientation in a 5’ to 3’ direction typical of positive sense and reflective of the resulting mRNA (doi:https://doi.org/10.1016/j.cell.2020.04.01). The SARS-CoV-2 genome contains a 5’-untranslated region (UTR; 265 bp), ORF1ab (21,289 bp) holding two overlapping open reading frames (13,217 bp and 21,289 bp, respectively) that encode two polyproteins (Kim et al. 2020; O’Leary et al. 2020). Viral transcription and replication is explained in depth in KE1847. Briefly, the first event upon cell entry is the primary translation of the ORF1a and ORF1b genomic RNA to produce non-structural proteins (NSPs). The ORF1a produces polypeptide 1a (pp1a, 440–500 kDa) that is cleaved into NSP-1 through NSP-11. A -1-ribosome frameshift occurs immediately upstream of the ORF1a stop codon, to allow translation through ORF1b, yielding 740–810 kDa polypeptide pp1ab, which is cleaved into 15 NSPs (duplications of NSP1-11 and five additional proteins, NSP12-16). Viral proteases NSP3 and NSP5 cleave the polypeptides through domains functioning as a papain-like protease and a 3C-like protease, respectively (doi:https://doi.org/10.1016/j.cell.2020.04.01). The NSPs, structural proteins, and accessory proteins are encoded by 10 ORFs in the SARS-CoV-2 RNA genome. They may have multiple functions during viral replication as well as in evasion of the host innate immune response, thus augmenting viral replication and spread (Amor et al. 2020). Extensive protein-protein interaction (Gordon et al. 2020) and viral protein-host RNA interaction networks have been demonstrated between the viral NSPs and accessory proteins and host molecules. 

This key event is focused on the specific viral:host protein interactions within the infected cell that are involved in the IFN-I antiviral response pathways. IFN-I is the main component of the innate immune system that is suppressed by the SARS-CoV-2 coronavirus early in infection. The primary form of host intracellular virus surveillance detects viral components to induce an immediate systemic type I interferon (IFN) response. Cellular RNA sensors called pattern recognition receptors (PRRs) such as RIG-I, MDA5 and LGP2 detect the presence of viral RNAs and promote nuclear translocation of the transcription factor IRF3, leading to transcription, translation, and secretion of IFN-α and IFN-β. This in turn leads to interaction with the IFN receptor (IFNAR), phosphorylation of STAT1 and 2, and transcription and translation of hundreds of antiviral genes (Quarleri and Delpino, 2021).

Interactions between SARS-CoV-2 proteins and human RNAs thwart the IFN response upon infection: NSP1 binds to 40S ribosomal RNA in the mRNA entry channel of the ribosome to inhibit host mRNA translation; NSP8 and NSP9 displace signal recognition particle proteins (SRP54, 27 and 19) to bind to the 7SL RNA and block protein trafficking to the cell membrane (Banerjee et al. 2020; Gordon et al. 2020). Xia et al. (2020) found that NSP6 and NSP13 antagonize IFN-I production via distinct mechanisms: NSP6 binds TANK binding kinase 1 (TBK1) to suppress interferon regulatory factor 3 (IRF3) phosphorylation, and NSP13 binds and blocks TBK1 phosphorylation. NSP14 induces lysosomal degradation of type 1 IFNAR to prevent STAT activation (Hayn et al. 2021). ORF6 hijacks KPNA2 to block IRF3, and Nup98/RAE1 to block STAT nuclear import, to silence IFN-I gene expression (Xia and Shi, 2020). ORF7a suppresses STAT2 phosphorylation and ORF7b suppresses STAT1 and STAT2 phosphorylation to block ISGF3 complex formation with IRF9 (Xia and Shi, 2020). ORF8 interacts and downregulates MHC-I (Zhang et al 2020), and has been reported to block INFβ expression, but the mechanism has not been identified (Rashid et al. 2021; Li et al. 2020). ORF9b antagonizes Type I Interferons by targeting multiple components of RIG-I/MDA-5-MAVS, TOMM70, NEMO and cGAS-STING signalling (Han et al. 2020; Jiang et al. 2020; Wu et al. 2021; Gordon et al 2020).

Following is a table of the current state of knowledge of SARS-CoV-2 protein putative functions in relation to IFN-I antiviral response antagonism.

 

Gene	Protein	Function	Role in early innate immune evasion
ORF1a	NSP1	NSP1 antagonizes interferon induction to suppress host antiviral response.	DNA Polymerase Alpha Complex: Regulates the activation of IFN-I through cytosolic RNA-DNA synthesis (POLA1/2-PRIM1/2) and primes DNA replication in the nucleus (Gordon et al. 2020; Chaudhuri et al. 2020). Can also inhibit host gene expression by binding to ribosomes and modifying host mRNAs (Shi et al. 2020; Schubert et al. 2020; Thoms et al. 2020).
	NSP2	While not essential for viral replication, deletion of NSP2 diminishes viral growth and RNA synthesis	Translation repression through binding GIGYF2and EIF4E2 (4EHP) (Gupta et al. 2021)
	NSP3	Papain-like protease (Plpro); Cleaves the ORF1a and 1ab polypeptides	Suppresses IFN-I: Cleaves IRF3 (Moustaqil et al. 2021); binds/cleaves ISG15 (Rui et al. 2021; Shin et al. 2020; Liu et al. 2021; Klemm et al. 2020)
	NSP5	3C-like protease (3CLpro); Cleaves the ORF1a and 1ab polypeptides	Binds STING (Rui et al. 2021)
	NSP6	Limits autophagosome expansion	Suppresses IFN-I expression: Binds TBK-1 to supress IRF3 phosphorylation (Xia et al. 2020; Quarleri and Delpino, 2021)
	NSP7	In complex with NSP8 forms primase as part of multimeric RNA-dependent RNA replicase (RdRp)
	NSP8	Replication complex with NSP7, NSP9 and NSP12	Binds SRP72/54/19 (Gordon et al. 2020) and 7SL RNA to block IFN membrane transport (Banerjee et al. 2020)
	NSP9	Replication complex with NSP7, NSP8 and NSP12	Binds SRP and 7SL RNA with NSP8 to block IFN membrane transport (Banerjee et al. 2020)
ORF1b	NSP13	Helicase and triphosphatase that initiates the first step in viral mRNA capping.	Binds TBK1 (Xia et al. 2020)
	NSP14		Induces lysosomal degradation of IFNAR1 (Hayn et al. 2021)
ORF2	Spike (S)	ACE2 interaction, cell entry
ORF3a	ORF3a	Interacts with M, S, E and 7a; form viroporins; immune evasion	Binds STING (Rui et al 2021)
ORF4	Envelope (E)	Viral assembly and budding
ORF5	Membrane (M)	Viral assembly	Interacts with RIG-I and MAVS sensors of viral RNA (Fu et al 2020)
ORF6	ORF6	Viral pathogenesis and virulence; interacts with ORF8; promotes RNA polymerase activity	Hijacks the nuclear importin Karyopherin a 2 (KPNA2) to block IRF3 (Xia and Shi, 2020) and Nup98/RAE1 to block STAT nuclear import (Miorin et al. 2020; Kato et al. 2020), leading to the silence of downstream ISGs
ORF7a	ORF7a	Interacts with S, ORF3a; immune evasion	Suppresses STAT2 phosphorylation to block IFN-I response (Xia and Shi, 2020).
ORF7b	ORF7b	Structural component of virion	Suppresses STAT1 and STAT2 phosphorylation to block IFN-I response (Xia and Shi, 2020)
ORF8	ORF8	Immune evasion	Interacts and downregulates MHC-I (Zhang et al. 2020).  May inhibit type I interferon (IFN-β) and interferon-stimulated response element (ISRE) (Rashid et al. 2020; Li et al. 2020)
ORF9	Nucleocapsid (N)	Stabilizes viral RNA	Attenuates stress granule formation: G3BP1/2 (Chen et al. 2020; Cascarina et al. 2020); G3BP1 also interacts with RIG-I (Kim et al. 2019) and STAT1/2 (Mu et al. 2020)
ORF9b	ORF9b	Immune evasion	Membrane protein antagonizes Type I Interferons by targeting multiple components of RIG-I/MDA-5-MAVS, TOMM70, NEMO, and cGAS-STING signaling pathways (Fu et al. 2020; Chen et al. 2020; Han et al. 2020; Jiang et al. 2020; Wu et al. 2021; Gordon et al 2020)

How it is Measured or Detected

Detection of IFN-I suppression involves measuring gene promoter/transcription activation (luciferase assays), gene up/down regulation (quantitative PCR), protein-protein interaction (immunoprecipitation, immunoblotting) or in-situ co-location of viral and host proteins (immunofluorescent or confocal microscopy) in cell culture. Examples of methods used include the following:

Interferon I decrease (Xia et al. 2020):

• IFN-I production and signaling luciferase reporter assays
• Co-immunoprecipitation and western blot
• Indirect immunofluorescence assays
• DNA assembly and RNA transcription of a luciferase replicon for SARS-CoV-2
• Replicon RNA electroporation and luciferase reporter assay

SARS-CoV-2 ORF9b inhibits RIG-I-MAVS antiviral signaling (Wu et al. 2021)

• Viral- and host-protein-specific antibodies
• Immunoprecipitation
• Immunofluorescent microscopy
• Dual-luciferase reporter assays
• Fluorescence quantification immunoblotting

SARS-CoV-2-Human Protein-Protein Interaction Map (Gordon et al. 2020)

• Cloning and expression of viral proteins via plasmid transfection into HEK293T cell line
• Protein affinity purification using MagStrep beads with detection by anti-strep western blot of cell lysate
• Global analysis of SARS-CoV-2 host interacting proteins using affinity purification-mass spectrometry

 

References

Amor et al. 2020. Innate immunity during SARS-CoV-2: evasion strategies and activation trigger hypoxia and vascular damage. Clinical and Experimental Immunology, 202: 193–209. doi: 10.1111/cei.13523

Andres et al. 2020. SARS-CoV-2 ORF9c Is a Membrane-Associated Protein that Suppresses Antiviral Responses in Cells. bioRxiv preprint doi: https://doi.org/10.1101/2020.08.18.256776

Banerjee et al. 2020. SARS-CoV-2 disrupts splicing, translation, and protein trafficking to supress host defenses. Cell 183, 1325–1339. https://doi.org/10.1016/j.cell.2020.10.004

Cascarina and Ross, 2020. A proposed role for the SARS-CoV-2 nucleocapsid protein in the formation and regulation of biomolecular condensates. The FASEB Journal, 34:9832–9842. DOI: 10.1096/fj.202001351

Chaudhuri, A. 2021. Comparative analysis of non-structural protein 1 of SARS-CoV2 with SARS-CoV1 and MERS-CoV: An in-silico study. Journal of Molecular Structure, Volume 1243, 130854, https://doi.org/10.1016/j.molstruc.2021.130854.

Chen et al. 2021. SARS-CoV-2 Nucleocapsid Protein Interacts with RIG-I and Represses RIG-Mediated IFN-β Production. Viruses. 13(1):47. https://doi.org/10.3390/v13010047

Conceicao et al. 2020. The SARS-CoV-2 Spike protein has a broad tropism for mammalian ACE2 proteins. PLoS Biol 18(12): e3001016. https://doi.org/10.1371/journal.pbio.3001016

Damas et al. 2020. Broad host range of SARS-CoV-2 predicted by comparative and structural analysis of ACE2 in vertebrates. PNAS vol. 117 no. 36:22311–22322 www.pnas.org/cgi/doi/10.1073/pnas.2010146117 

Fu et al. 2021. SARS-CoV-2 membrane glycoprotein M antagonizes the MAVS-mediated innate antiviral response. Cell Mol Immunol 18: 613–620. https://doi.org/10.1038/s41423-020-00571-x

Gordon et al. 2020. A SARS-CoV-2 protein interaction map reveals targets for drug repurposing. Nature 483:459-473. https://doi.org/10.1038/s41586-020-2286-9

Gupta et al. 2021. CryoEM and AI reveal a structure of SARS-CoV-2 Nsp2, a multifunctional protein involved in key host processes. bioRxiv 2021.05.10.443524; doi: https://doi.org/10.1101/2021.05.10.443524

Han et al. 2020. SARS-CoV-2 ORF9b Antagonizes Type I and III Interferons by Targeting Multiple Components of RIG-I/MDA-5-MAVS, TLR3-TRIF, and cGAS-STING Signaling Pathways. bioRX https://doi.org/10.1101/2020.08.16.252973

Hayn et al. 2021. Systematic functional analysis of SARS-CoV-2 proteins uncovers viral innate immune antagonists and remaining vulnerabilities. Cell Reports 35, 109126. https://doi.org/10.1016/j.celrep.2021.109126

Jiang et al. 2020. SARS-CoV-2 Orf9b suppresses type I interferon responses by targeting TOM70. Cellular & Molecular Immunology 17:998–1000; https://doi.org/10.1038/s41423-020-0514-8

Kato et al. 2021. Overexpression of SARS-CoV-2 protein ORF6 dislocates RAE1 and NUP98 from the nuclear pore complex. Biochemical and Biophysical Research Communications 536:59-66 https://doi.org/10.1016/j.bbrc.2020.11.115

Kim et al. 2019. The stress granule protein G3BP1 binds viral dsRNA and RIG-I to enhance interferon-β response. J. Biol. Chem. 294(16): 6430–6438. DOI 10.1074/jbc.RA118.005868

Kim et al. 2020. The Architecture of SARS-CoV-2 Transcriptome. Cell 181, 914–921. https://doi.org/10.1016/j.cell.2020.04.011

Li et al. 2020. The ORF6, ORF8 and nucleocapsid proteins of SARS-CoV-2 inhibit type I interferon signaling pathway. Virus Research vol. 286. https://doi.org/10.1016/j.virusres.2020.198074

Liu et al. 2021. ISG15-dependent activation of the sensor MDA5 is antagonized by the SARS-CoV-2 papain-like protease to evade host innate immunity. Nature Microbiol 6: 467–478. https://doi.org/10.1038/s41564-021-00884-1

Moustaqil et al. 2021. SARS-CoV-2 proteases PLpro and 3CLpro cleave IRF3 and critical modulators of inflammatory pathways (NLRP12 and TAB1): implications for disease presentation across species, Emerging Microbes & Infections, 10:1, 178-195. https://doi.org/10.1080/22221751.2020.1870414

Mu et al. 2020. SARS-CoV-2 N protein antagonizes type I interferon signaling by suppressing phosphorylation and nuclear translocation of STAT1 and STAT2. Cell Discov 6, 65. https://doi.org/10.1038/s41421-020-00208-3

O’Leary et al. 2020 Unpacking Pandora from Its Box: Deciphering the Molecular Basis of the SARS-CoV-2 Coronavirus. Int. J. Mol. Sci. 2021, 22, 386. https://doi.org/10.3390/ijms22010386

Quarleri and Delpino, 2020. Type I and III IFN-mediated antiviral actions counteracted by SARS-CoV-2 proteins and host inherited factors. Cytokine & Growth Factor Reviews, 58: 55-65. https://doi.org/10.1016/j.cytogfr.2021.01.003

Rashid et al. The ORF8 protein of SARS-CoV-2 induced endoplasmic reticulum stress and mediated immune evasion by antagonizing production of interferon beta. Virus Research 296, 198350. https://doi.org/10.1016/j.virusres.2021.198350

Ren et al. 2020. The ORF3a protein of SARS-CoV-2 induces apoptosis in cells. Cellular & Molecular Immunology 17:881–883; https://doi.org/10.1038/s41423-020-0485-9

Rui et al. 2021. Unique and complementary suppression of cGAS-STING and RNA sensing-triggered innate immune responses by SARS-CoV-2 proteins. Sig Transduct Target Ther 6, 123. https://doi.org/10.1038/s41392-021-00515-5

Schubert et al. 2020. SARS-CoV-2 Nsp1 binds the ribosomal mRNA channel to inhibit translation. Nature Structural & Molecular Bio. 27:959-966. https://doi.org/10.1038/s41594-020-0511-8

Shin et al. 2020. Papain-like protease regulates SARS-CoV-2 viral spread and innate immunity. Nature 587: 657–662. https://doi.org/10.1038/s41586-020-2601-5

Thoms et al. 2020. Structural basis for translational shutdown and immune evasion by the Nsp1 protein of SARS-CoV-2. Science 369(6508): 1249-1255. DOI: 10.1126/science.abc8665

Wu et al. 2021. SARS-CoV-2 ORF9b inhibits RIG-I-MAVS antiviral signaling by interrupting K63-linked ubiquitination of NEMO. Cell Reports 34, 108761. https://doi.org/10.1016/j.celrep.2021.108761

Wu et al. 2020. Broad host range of SARS-CoV-2 and the molecular basis for SARS-CoV-2 binding to cat ACE2. Cell Discovery 6:68. https://doi.org/10.1038/s41421-020-00210-9

Xia et al. 2020. Evasion of Type I Interferon by SARS-CoV-2. Cell Reports 33, 108234. https://doi.org/10.1016/j.celrep.2020.108234

Xia and Shi, 2020. Antagonism of Type I Interferon by Severe Acute Respiratory Syndrome Coronavirus 2. Journal of Interferon & Cytokine Research v.40, no. 12 DOI:10.1089/jir.2020.0214

Zhang et al. 2020. The ORF8 Protein of SARS-CoV-2 Mediates Immune Evasion through Potently Downregulating MHC-I. bioRxiv preprint doi: https://doi.org/10.1101/2020.05.24.111823

Event: 1847: Increased SARS-CoV-2 production

Short Name: SARS-CoV-2 production

Key Event Component

AOPs Including This Key Event

Stressors

Biological Context

Cell term

Organ term

Domain of Applicability

Taxonomic Applicability Life Stage Applicability Sex Applicability

Broad mammalian host range has been demonstrated based on spike protein tropism for and binding to ACE2 [Conceicao et al. 2020; Wu et al. 2020] and cross-species ACE2 structural analysis [Damas et al. 2020]. No literature has been found on primary translation and molecular interactions of nsps in non-human host cells, but it is assumed to occur if the virus replicates in other species.

Very broad mammalian tropism: human, bat, cat, dog, civet, ferret, horse, pig, sheep, goat, water buffalo, cattle, rabbit, hamster, mouse

Key Event Description

This KE1847 "Increase coronavirus production" deals with how the genome of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is translated, replicated, and transcribed in detail, and how the genomic RNA (gRNA) is packaged, and the virions are assembled and released from the cell. 

Coronavirus is a class of viruses that have single-stranded positive-sense RNA genomes in their envelopes [D. Kim et al.]. The virus contains a 29.7 kB positive-sense RNA genome flanked by 5' and 3' untranslated regions of 265 and 342 nucleotides, respectively [E. J. Snijder et al.] that contain cis-acting secondary RNA structures essential for RNA synthesis [N. C. Huston et al.]. The genome just prior to the 5′ end contains the transcriptional regulatory sequence leader (TRS-L) [C.J. Budzilowicx et al.]. The SARS-CoV genome is polycistronic and contains 14 open reading frames (ORFs) that are expressed by poorly understood mechanisms [E. J. Snijder et al.]. Preceding each ORF there are other TRSs called the body TRS (TRS B). The 5′ two-thirds of the genome contains two large, overlapping, nonstructural ORFs and the 3′ third contains the remainder ORFs [H. Di et al.]. Genome expression starts with the translation of two large ORFs of the 5’ two-thirds: ORF1a of 4382 amino acids and ORF1ab of 7073 amino acid that occurs via a programmed (- 1) ribosomal frameshifting [E. J. Snider et al.], yielding pp1a and pp1ab. These two polyproteins are cleaved into 16 subunits by two viral proteinases encoded by ORF1a, nsp3, and nsp5 that contain a papain-like protease domain and a 3C-like protease domain [M. D. Sacco et al.]. The processing products are a group of replicative enzymes, named nsp1-nsp16, that assemble into a viral replication and transcription complex (RTC) associated with membranes of endoplasmic reticulum (ER) with the help of various membrane-associated viral proteins [S. Klein et al., E. J. Snijder et al., P. V'Kovski, et al.]. Besides replication, which yields the positive-sense gRNA, the replicase also mediates transcription leading to the synthesis of a nested set of subgenomic (sg) mRNAs to express all ORFs downstream of ORF1b that encode structural and accessory viral proteins. These localize to the 3′ one-third of the genome, as stated above, and result in a 3′ coterminal nested set of 7–9 mRNAs that share ~70–90 nucleotide (nt) in the 5′ leader and that is identical to the 5′ end of the genome [P. Liu, and J. Leibowitz]. sgRNAs encode conserved structural proteins (spike protein [S], envelope protein [E], membrane protein [M], and nucleocapsid protein [N]), and several accessory proteins. SARS-CoV-2 is known to have at least six accessory proteins (3a, 6, 7a, 7b, 8, and 10). Overall the virus is predicted to express 29 proteins [D. Kim et al.]. The gRNA is packaged by the structural proteins to assemble progeny virions.

Viral translation:

SARS-CoV-2 is an enveloped virus with a single-stranded RNA genome of ~30 kb, sequence orientation in a 5’ to 3’ direction typical of positive sense and reflective of the resulting mRNA [D. Kim et al.]. The SARS-CoV-2 genome contains a 5’-untranslated region (UTR; 265 bp), ORF1ab (21,289 bp) holding two overlapping open reading frames (13,217 bp and 21,289 bp, respectively) that encode two polyproteins [D. Kim et al.]. Other elements of the genome include are shown below [V. B. O'Leary et al.]. The first event upon cell entry is the primary translation of the ORF1a and ORF1b gRNA to produce non-structural proteins (nsps).

This is completely dependent on the translation machinery of the host cell. Due to fewer rare “slow-codons”, SARS-CoV-2 may have a higher protein translational rate, and therefore higher infectivity compared to other coronavirus groups [V. B. O'Leary et al.]. The ORF1a produces polypeptide 1a (pp1a, 440–500 kDa) that is cleaved into nsp-1 through nsp-11. A -1 ribosome frameshift occurs immediately upstream of the ORF1a stop codon, to allow translation through ORF1b, yielding 740–810 kDa polypeptide pp1ab, which is cleaved into 15 nsps [D. Kim et al.]. Two overlapping ORFs, ORF1a and ORF1b, generate continuous polypeptides, which are cleaved into a total of 16 so-called nsps [Y Finkel et al.]. Functionally, there are five proteins from pp1ab (nsp-12 through nsp-16) as nsp-1-11 are duplications of the proteins in pp1a due to the ORF overlap. The pp1a is approximately 1.4–2.2 times more expressed than pp1ab. After translation, the polyproteins are cleaved by viral proteases nsp3 and nsp5. Nsp5 protease can be referred to as 3C-like protease (3CL^pro) or as main protease (M^pro), as it cleaves the majority of the polyprotein cleavage sites. [H.A. Hussein et al.] Nsp1 cleavage is quick and nsp1 associates with host cell ribosomes and results in host cellular shutdown, suppressing host gene expression [M. Thoms et al.]. Fifteen proteins, nsp2–16 constitute the viral RTC. They are targeted to defined subcellular locations and establish a network with host cell factors. Nsp2–11 remodel host membrane architecture, mediate host immune evasion and provide cofactors for replication, whilst nsp12–16 contain the core enzymatic functions involved in RNA synthesis, modification and proofreading [P. V'Kovski et al.].  nsp-7 and nsp-8 form a complex priming the RNA-dependent RNA polymerase (RdRp or RTC) - nsp-12. nsp14 provides a 3′–5′ exonuclease activity providing RNA proofreading function. Nsp-10 composes the RNA capping machinery nsp-9. nsp13 provides the RNA 5′-triphosphatase activity. Nsp-14 is a N7-methyltransferase and nsp-16 the 2′-O-methyltransferase. Many of the nsps have multiple functions and many viral proteins are involved in innate immunity inhibition. Nsp-3 is involved in vesicle formation along with nsp-4 and nsp-6 where viral replication occurs. Interactions between SARS-CoV-2 proteins and human RNAs thwart the IFN response upon infection: nsp-16 binds to U1 and U2 splicing RNAs to suppress global mRNA splicing; nsp-1 binds to 40S ribosomal RNA in the mRNA entry channel of the ribosome to inhibit host mRNA translation; nsp-8 and nsp-9 bind to the 7SL RNA to block protein trafficking to the cell membrane [A. K. Banerjee et al.]. Xia et al. [H. Xia et al.] found that nsp-6 and nsp-13 antagonize IFN-I production via distinct mechanisms: nsp-6 binds TANK binding kinase 1 (TBK1) to suppress interferon regulatory factor 3 (IRF3) phosphorylation, and nsp-13 binds and blocks TBK1 phosphorylation.

 

Viral transcription and replication:

Viral transcription and replication occur at the viral replication organelle (RO) [E. J. Snijder et al.]. The RO is specifically formed during infection by reshaping ER and other membranes, giving rise to small spherular invaginations, and large vesiculotubular clusters, consisting of single- and/or double-membrane vesicles (DMV), convoluted membranes (CM) and double-membrane spherules invaginating from the ER  [S. Klein et al., E. J. Snijder et al.]. There is some evidence that DMV accommodate viral replication which is based on radiolabelling viral RNA with nucleoside precursor ([5-³[H]uridine) and detection by EM autoradiography [E. J. Snijder et al.].

Viral replicative proteins and specific host factors are recruited to ROs [E. J. Snijder et al.]. RNA viral genome is transcribed into messenger RNA by the viral RTC [P. Ahlquist et al.]. Viral RTC act in combination with other viral and host factors involved in selecting template RNAs, elongating RNA synthesis, differentiating genomic RNA replication from mRNA transcription, modifying product RNAs with 5’ caps or 3’ polyadenylate [P. Ahlquist et al.]. Positive-sense (messenger-sense) RNA viruses replicate their genomes through negative-strand RNA intermediates [M. Schwartz et al.]. The intermediates comprise full-length negative-sense complementary copies of the genome, which functions as templates for the generation of new positive-sense gRNA, and a nested set of sg mRNAs that lead to the expression of proteins encoded in all ORFs downstream of ORF1b. The transcription of coronaviruses is a discontinuous process that produces nested 3′ and 5′ co-terminal sgRNAs. Of note, the synthesis of sg mRNAs is not exclusive to the order Nidovirales but a discontinuous minus-strand synthesis strategy to produce a nested set of 3′ co-terminal sg mRNAs with a common 5′ leader in infected cells are unique features of the coronaviruses and arteriviruses [W. A. Miller and G. Koev.]. Of note, the produced genomic RNA represents a small fraction of the total vRNA [N. S. Ogando et al.].

The discontinuous minus-strand synthesis of a set of nested sg mRNAs happens during the synthesis of the negative-strand RNA, by an interruption mechanism of the RTC as it reads the TRS-B preceding each gene in the 3′ one-third of the viral genome [I. Sola, F. Almazan et al., I. Sola, J. L. Moreno, et al.]. The synthesis of the negative-strand RNA stops and is re-initiated at the TRS-L of the genome sequence close from the 5′ end of the genome [H. Di et al.]. Therefore, the mechanism by which the leader sequence is added to the 5' end requires that the RTC switches template by a jumping mechanism. This interruption process involves the interaction between complementary TRSs of the nascent negative-strand RNA TRS-B and the positive-strand gRNA at the positive-sense TRS-L. The TRS-B site has a 7-8 bp conserved core sequence (CS) that facilitates RTC template switching as it hybridizes with a near complementary CS in the TRS-L [I. Sola, F. Almazan et al. I. Sola, J. L. Moreno, et al.]. Upon re-initiation of RNA synthesis at the TRS-L region, a negative-strand copy of the leader sequence is added to the nascent RNA to complete the synthesis of negative-strand sgRNAs. This means that all sg mRNAs as well as the genomic RNA share a common 5' sequence, named leader sequence [X. Zhang et al.]. This programmed template switching leads to the generation of sg mRNAs with identical 5' and 3' sequences, but alternative central regions corresponding to the beginning of each structural ORF [I. Sola et al. 2015, S. G. Sawicki et al., Y. Yang et al.]. Of note, the existence of TRSs also raises the possibility that these sites are at the highest risk of recombining through TRS-B mediated template switching [Y. Yang]. The set of sg mRNAs is then translated to yield 29 identified different proteins [F. Wu et al.], although many papers have identified additional ORFs [D. Kim et al.. Y. Finkel et al., A. Vandelli et al.]. The translation of the linear single-stranded RNA conducts to the generation of the following proteome: 4 are structural proteins, S, N, M, and E; 16 proteins nsp: the first 11 are encoded in ORF1a whereas the last 5 are encoded in ORF1ab. In addition, 9 accessory proteins named ORF3a, ORF3b, ORF6, ORF7a, ORF7b, ORF8, ORF9b, ORF9c, and ORF10 have been identified [F. Wu et al.]. At the beginning of infection, there is the predominant expression of the nsp that result from ORF1a and ORF1ab, however, at 5 hpi, the proteins encoded by the 5′ last third are found in higher amounts, and the nucleoprotein is the protein found in higher levels [Y. Finkel et al.].

 

Viral assembly:

The final step of viral production requires virion assembly and this process is not well explored for SARS-CoV-2. For example, the role of the structural proteins of SARS-CoV-2 in virus assembly and budding in not known. In general, all beta-coronavirus structural proteins assemble at the endoplasmic reticulum (ER)-to-Golgi compartment [J. R. Cohen et al., A. Perrier et al.] and viral assembly requires two steps: Genome packaging which is a process in which the SARS-CoV-2 gRNA must be coated by the viral protein nucleoprotein (N) protein, forming viral ribonucleoprotein (vRNPs) complexes, before being selectively packaged into progeny virions [P. V'Kovski et al.], a step in which vRNPs bud into the lumen of the ER and the ER-Golgi intermediate compartment (ERGIC) [N. S. Ogando et al.]. This results in viral particles enveloped with host membranes containing viral M, E, and S transmembrane structural proteins that need to be released from the cell.

SARS-CoV-2 gRNA packaging involves the N protein. The N protein of human coronaviruses is highly expressed in infected cells. It is considered a multifunctional protein, promoting efficient sub-genomic viral RNA transcription, viral replication, virion assembly, and interacting with multiple host proteins [P. V'Kovski et al., D. E. Gordon et al., R. McBride, and M. van Zyl, B. C.]. In relation to transcription and replication, the N protein could provide a cooperative mechanism to increase protein and RNA concentrations at specific localizations S. Alberti, and S. Carra, S. F. Banani et al.], and this way organize viral transcription. Five studies have shown that N protein undergoes liquid-liquid phase separation (LLPS) in vitro [A. Savastano et al., H. Chen et al., C. Iserman et al., T. M. Perdikari et al., J. Cubuk et al.], dependent on its C-terminal domain (CTD) [H. Chen et al.]. It has been hypothesised that N could be involved in replication close to the ER and in packaging of gRNA into vRNPs near the ERGIC where genome assembly is thought to take place [A. Savastano et al.], but so far this is still speculative. Phosphorylation of N could adjust the physical properties of condensates differentially in ways that could accommodate the two different functions of N: transcription and progeny genome assembly [A. Savastano et al., C. Iserman et al., C. R. Carlson et al.].

The ERGIC constitutes the main assembly site of coronaviruses [S. Klein et al., E. J. Snijder et al., L. Mendonca et al.] and budding events have been seen by EM studies. For SARS-CoV-2, virus-budding was mainly clustered in regions with a high vesicle density and close to ER- and Golgi-like membrane arrangements [S. Klein et al., E. J. Snijder et al., L. Mendonca et al.]. The ectodomain of S trimers were found facing the ERGIC lumen and not induce membrane curvature on its own, therefore proposing that vRNPs and spike trimers [S. Klein et al.].

Finally, it has been shown that SARS-CoV-2 virions de novo formed traffic to lysosomes for unconventional egress by Arl8b-dependent lysosomal exocytosis [S. Ghosh et al.]. This process results in lysosome deacidification, inactivation of lysosomal degradation enzymes, and disruption of antigen presentation [S. Ghosh et al.].

How it is Measured or Detected

Viral translation:

SARS-CoV-2 Nsp1 binds the ribosomal mRNA channel to inhibit translation [Schubert et al. 2020]

• Sucrose pelleting binding assay to verify Nsp1–40S complex formation
• In vivo translation assay
• Transient expression of FLAG-Nsp1 in HeLa cells and puromycin incorporation assay

SARS-CoV-2 disrupts splicing, translation, and protein trafficking [Banerjee et al. 2020]

• SARS-CoV-2 viral protein binding to RNA
• Interferon stimulation experiments
• Splicing assessment experiments
• IRF7-GFP splicing reporter, 5EU RNA labeling, capture of biotinylated 5EU labeled RNA

Membrane SUnSET assay for transport of plasma membrane proteins to the cell surface

Viral transcription:

The mRNA transcripts are detected by the real-time reverse transcription-PCR (RT-PCR) assay. Several methods targeting the mRNA transcripts have been developed, which includes the RT-PCR assays targeting RdRp/helicase (Hel), spike (S), and nucleocapsid (N) genes of SARS-CoV-2 [Chan et al.]. RT-PCR assays detecting SARS-CoV-2 RNA in saliva include quantitative RT-PCR (RT-qPCR), direct RT-qPCR, reverse transcription-loop-mediated isothermal amplification (RT-LAMP) [Nagura-Ikeda M, et al.]. The viral mRNAs are reverse-transcribed with RT, followed by the amplification by PCR.

Viral replication:

viral replication is measured by RT-qPCR in infected cells, formation of liquid organelles is assessed in vitro reconstitution systems and in infected cells. Labelling by radioactive nucleosides.

Viral production:

Plaque assays, infectivity assays, RT-qPCR to detect viral RNA in released virions, sequencing to detect mutations in the genome, electron microscopy.

References

1.         D. Kim et al., The Architecture of SARS-CoV-2 Transcriptome. Cell 181, 914-921 e910 (2020).

2.         E. J. Snijder et al., Unique and Conserved Features of Genome and Proteome of SARS-coronavirus, an Early Split-off From the Coronavirus Group 2 Lineage. Journal of Molecular Biology 331, 991-1004 (2003).

3.         N. C. Huston et al., Comprehensive in vivo secondary structure of the SARS-CoV-2 genome reveals novel regulatory motifs and mechanisms. Mol Cell 81, 584-598 e585 (2021).

4.         C. J. Budzilowicz, S. P. Wilczynski, S. R. Weiss, Three intergenic regions of coronavirus mouse hepatitis virus strain A59 genome RNA contain a common nucleotide sequence that is homologous to the 3' end of the viral mRNA leader sequence. J Virol 53, 834-840 (1985).

5.         H. Di, A. A. McIntyre, M. A. Brinton, New insights about the regulation of Nidovirus subgenomic mRNA synthesis. Virology 517, 38-43 (2018).

6.         M. D. Sacco et al., Structure and inhibition of the SARS-CoV-2 main protease reveal strategy for developing dual inhibitors against M(pro) and cathepsin L. Sci Adv 6,  (2020).

7.         S. Klein et al., SARS-CoV-2 structure and replication characterized by in situ cryo-electron tomography. BioRxiv,  (2020).

8.         E. J. Snijder et al., A unifying structural and functional model of the coronavirus replication organelle: Tracking down RNA synthesis. PLoS Biol 18, e3000715 (2020).

9.         P. V'Kovski, A. Kratzel, S. Steiner, H. Stalder, V. Thiel, Coronavirus biology and replication: implications for SARS-CoV-2. Nat Rev Microbiol,  (2020).

10.       P. Liu, J. Leibowitz, in Molecular Biology of the SARS-Coronavirus. (2010),  chap. Chapter 4, pp. 47-61.

11.       V. B. O'Leary, O. J. Dolly, C. Hoschl, M. Cerna, S. V. Ovsepian, Unpacking Pandora From Its Box: Deciphering the Molecular Basis of the SARS-CoV-2 Coronavirus. Int J Mol Sci 22,  (2020).

12.       Y. Finkel et al., The coding capacity of SARS-CoV-2. Nature 589, 125-130 (2021).

13.       H. A. Hussein, R. Y. A. Hassan, M. Chino, F. Febbraio, Point-of-Care Diagnostics of COVID-19: From Current Work to Future Perspectives. Sensors (Basel) 20,  (2020).

14.       M. Thoms et al., Structural basis for translational shutdown and immune evasion by the Nsp1 protein of SARS-CoV-2. Science 369, 1249-1255 (2020).

15.       A. K. Banerjee et al., SARS-CoV-2 Disrupts Splicing, Translation, and Protein Trafficking to Suppress Host Defenses. Cell 183, 1325-1339 e1321 (2020).

16.       H. Xia et al., Evasion of Type I Interferon by SARS-CoV-2. Cell Rep 33, 108234 (2020).

17.       P. Ahlquist, RNA-dependent RNA polymerases, viruses, and RNA silencing. Science 296, 1270-1273 (2002).

18.       M. Schwartz et al., A Positive-Strand RNA Virus Replication Complex Parallels Form and Function of Retrovirus Capsids. Molecular Cell 9, 505-514 (2002).

19.       W. A. Miller, G. Koev, Synthesis of subgenomic RNAs by positive-strand RNA viruses. Virology 273, 1-8 (2000).

20.       N. S. Ogando et al., SARS-coronavirus-2 replication in Vero E6 cells: replication kinetics, rapid adaptation and cytopathology. J Gen Virol 101, 925-940 (2020).

21.       I. Sola, F. Almazan, S. Zuniga, L. Enjuanes, Continuous and Discontinuous RNA Synthesis in Coronaviruses. Annu Rev Virol 2, 265-288 (2015).

22.       I. Sola, J. L. Moreno, S. Zuniga, S. Alonso, L. Enjuanes, Role of nucleotides immediately flanking the transcription-regulating sequence core in coronavirus subgenomic mRNA synthesis. J Virol 79, 2506-2516 (2005).

23.       X. Zhang, C. L. Liao, M. M. Lai, Coronavirus leader RNA regulates and initiates subgenomic mRNA transcription both in trans and in cis. J Virol 68, 4738-4746 (1994).

24.       S. G. Sawicki, D. L. Sawicki, S. G. Siddell, A contemporary view of coronavirus transcription. J Virol 81, 20-29 (2007).

25.       Y. Yang, W. Yan, B. Hall, X. Jiang, Characterizing transcriptional regulatory sequences in coronaviruses and their role in recombination. bioRxiv,  (2020).

26.       F. Wu et al., A new coronavirus associated with human respiratory disease in China. Nature 579, 265-269 (2020).

27.       A. Vandelli et al., Structural analysis of SARS-CoV-2 genome and predictions of the human interactome. Nucleic Acids Res 48, 11270-11283 (2020).

28.       J. R. Cohen, L. D. Lin, C. E. Machamer, Identification of a Golgi complex-targeting signal in the cytoplasmic tail of the severe acute respiratory syndrome coronavirus envelope protein. J Virol 85, 5794-5803 (2011).

29.       A. Perrier et al., The C-terminal domain of the MERS coronavirus M protein contains a trans-Golgi network localization signal. J Biol Chem 294, 14406-14421 (2019).

30.       D. E. Gordon et al., A SARS-CoV-2 protein interaction map reveals targets for drug repurposing. Nature 583, 459-468 (2020).

31.       R. McBride, M. van Zyl, B. C. Fielding, The coronavirus nucleocapsid is a multifunctional protein. Viruses 6, 2991-3018 (2014).

32.       S. Alberti, S. Carra, Quality Control of Membraneless Organelles. Journal of Molecular Biology 430, 4711-4729 (2018).

33.       S. F. Banani, H. O. Lee, A. A. Hyman, M. K. Rosen, Biomolecular condensates: organizers of cellular biochemistry. Nature Reviews Molecular Cell Biology 18, 285-298 (2017).

34.       A. Savastano, A. I. de Opakua, M. Rankovic, M. Zweckstetter, Nucleocapsid protein of SARS-CoV-2 phase separates into RNA-rich polymerase-containing condensates.  (2020).

35.       H. Chen et al., Liquid-liquid phase separation by SARS-CoV-2 nucleocapsid protein and RNA. Cell Res,  (2020).

36.       C. Iserman et al., Specific viral RNA drives the SARS CoV-2 nucleocapsid to phase separate. bioRxiv,  (2020).

37.       T. M. Perdikari et al., SARS-CoV-2 nucleocapsid protein undergoes liquid-liquid phase separation stimulated by RNA and partitions into phases of human ribonucleoproteins. bioRxiv,  (2020).

38.       J. Cubuk et al., The SARS-CoV-2 nucleocapsid protein is dynamic, disordered, and phase separates with RNA. bioRxiv,  (2020).

39.       C. Iserman et al. (Cold Spring Harbor Laboratory, 2020).

40.       C. R. Carlson et al., Phosphoregulation of phase separation by the SARS-CoV-2 N protein suggests abiophysical basis for its dual functions. Molecular Cell,  (2020).

41.       L. Mendonca et al., SARS-CoV-2 Assembly and Egress Pathway Revealed by Correlative Multi-modal Multi-scale Cryo-imaging. bioRxiv,  (2020).

42.       S. Ghosh et al., beta-Coronaviruses Use Lysosomes for Egress Instead of the Biosynthetic Secretory Pathway. Cell 183, 1520-1535 e1514 (2020).

43.       Schubert, K., Karousis, E.D., Jomaa, A. et al. SARS-CoV-2 Nsp1 binds the ribosomal mRNA channel to inhibit translation. Nat Struct Mol Biol 27, 959–966 (2020). 

44.       Chan, Jasper Fuk-Woo et al. Improved Molecular Diagnosis of COVID-19 by the Novel, Highly Sensitive and Specific COVID-19-RdRp/Hel Real-Time Reverse Transcription-PCR Assay Validated In Vitro and with Clinical Specimens. J Clin Microbiol. 2020:58(5)e00310-20. doi:10.1128/JCM.00310-20

45.       Nagura-Ikeda M, Imai K, Tabata S, et al. Clinical Evaluation of Self-Collected Saliva by Quantitative Reverse Transcription-PCR (RT-qPCR), Direct RT-qPCR, Reverse Transcription-Loop-Mediated Isothermal Amplification, and a Rapid Antigen Test To Diagnose COVID-19. J Clin Microbiol. 2020;58(9):e01438-20. doi:10.1128/JCM.01438-20

46.       Conceicao C, Thakur N, Human S, Kelly JT, Logan L, Bialy D, et al. (2020) The SARS-CoV-2 Spike protein has a broad tropism for mammalian ACE2 proteins. PLoS Biol 18(12): e3001016. https://doi.org/10.1371/journal.pbio.3001016

47.       Damas J, Hughes GM, Keough KC, Painter CA, Persky NS, Corbo M, Hiller M, Koepfli KP, Pfenning AR, Zhao H, Genereux DP, Swofford R, Pollard KS, Ryder OA, Nweeia MT, Lindblad-Toh K, Teeling EC, Karlsson EK, Lewin HA. Broad host range of SARS-CoV-2 predicted by comparative and structural analysis of ACE2 in vertebrates. Proc Natl Acad Sci U S A. 2020 Sep 8;117(36):22311-22322. doi: 10.1073/pnas.2010146117. Epub 2020 Aug 21. PMID: 32826334; PMCID: PMC7486773.

Event: 1869: Diminished protective oxidative stress response

Short Name: Diminished Protective Response to ROS

Key Event Component

AOPs Including This Key Event

Stressors

Biological Context

Cell term

Organ term

Domain of Applicability

Taxonomic Applicability Life Stage Applicability Sex Applicability

Response to ROS occurs in many cell types and tissues in all life stages and the broad range of mammals.

Key Event Description

The "Diminished Protective Oxidative Stress Response" is a critical key event in the Adverse Outcome Pathway (AOP) framework that plays a central role in understanding how exposure to various stressors can lead to adverse outcomes.

Oxidative stress is caused by an imbalance between the production of reactive oxygen and the detoxification of reactive intermediates. Reactive intermediates such as peroxides and free radicals can be very damaging to many parts of cells such as proteins, lipids, and DNA. Severe oxidative stress can trigger apoptosis and necrosis. (Ref. IPA, NRF2-mediated Oxidative Stress Response, version60467501, release date: 2020-11-19)

One essential component of this key event is the activity of Nuclear factor erythroid 2-related factor 2 (Nrf2), a transcription factor that plays a pivotal role in the regulation of the oxidative stress response. Detecting Nrf2 activity is crucial for assessing the status of the oxidative stress response.

The cellular defence/defense response to oxidative stress includes induction of detoxifying enzymes and antioxidant enzymes. Nuclear factor-erythroid 2-related factor 2 (Nrf2) binds to the antioxidant response elements (ARE) within the promoter of these enzymes and activates their transcription. Inactive Nrf2 is retained in the cytoplasm by association with an actin-binding protein Keap1. Upon exposure of cells to oxidative stress, Nrf2 is phosphorylated in response to the protein kinase C, phosphatidylinositol 3-kinase and MAP kinase pathways. After phosphorylation, Nrf2 translocates to the nucleus, binds AREs, and transactivates detoxifying enzymes and antioxidant enzymes, such as glutathione S-transferase, cytochrome P450, NAD(P)H quinone oxidoreductase, heme oxygenase, and superoxide dismutase. (Ref. IPA, NRF2-mediated Oxidative Stress Response, version60467501, release date: 2020-11-19)

Nrf2, a master regulator of oxidative stress through enhanced expression of anti-oxidant genes of glutathione and thioredoxin-antioxidant systems, has anti-inflammatory, anti-apoptotic, and antioxidant effects. Dimethyl fumarate (DMF), an activator of Nrf2, can decrease inflammation and reactive oxygen species (ROS) through the inhibition of NF-kappaB by inducing anti-oxidant enzymes (Jackson et al, 2014; Hassan et al, 2020; Timpani et al, 2021).

Inactivation of Nrf2 causes diminished protective responses to ROS.

How it is Measured or Detected

Oxidative stress can be measured as follows:

1. Direct detection of reactive oxygen species (ROS)

ROS can be detected by intracellular ROS assay, in vitro ROS/RNS assay. Nitric oxide can be detected in intracellular nitric oxide assay (Ashoka et al, 2020).

Hydroxyl, peroxyl, or other ROS can be measured using a fluorescence probe, 2', 7'-Dichlorodihydrofluorescin diacetate (DCFH-DA), at fluorescence detection at 480 nm/530 nm.

Hydrogen peroxide (H2O2) can be detected with a colorimetric probe, which reacts with H2O2 in a 1:1 stoichiometry to produce a bright pink colored product, followed by the detection with a standard colorimetric microplate reader with a filter in the 540-570 nm range.

ROS can be detected by PEGylated bilirubin-coated iron oxide nanoparticles in whole blood (Lee et al, 2020).

2. Measurement of anti-oxidants

The level of catalase, glutathione, or superoxide dismutase can be measured as anti-oxidants. Catalase is an anti-oxidative enzyme that catalyses the resolution of hydrogen peroxide (H2O2) into H2O and O2. The chemiluminescence or fluorescence of HRP catalytic reaction can be detected with residual H2O2 and probes (DHBS+AAP, or ADHP (10-Acetyl-3, 7-dihydroxyphenoxazine)).

Anti-oxidant capacity is also one of the oxidative stress markers. Oxygen radical antioxidant capacity (ORAC), hydroxyl radical antioxidant capacity (HORAC), total antioxidant capacity (TAC), the cell-based exogenous antioxidant assay can be used for measuring the antioxidant capacity.

3. Detection of damages in protein, lipid, DNA or RNA

Oxidation of protein can be measured by the detection of protein carbonyl content (PCC), 3-nitrotyrosine, advanced oxidation protein products, or BPDE protein adduct. 

DNA oxidation can be detected with 8-oxo-dG / 8-hydroxy-2'-deoxyguanosine (8-OHdG) by ELISA or HPLC (Chepelev et al, 2015; Valavanidis et al, 2009).

Lipid peroxides decompose to form malondialdehyde (MDA) and 4, hydroxynonenal (4-HNE), natural bi-products of lipid peroxidation. Lipid peroxidation can be monitored by thiobarbituric acid (TBA) reactive substances in biological samples. MDA and TBA form MDA-TBA adduct in a 1:2 stoichiometry and detected by colorimetric or fluorometric measurement.

4. Detection of Nrf2 activity

Measuring Nrf2 activity involves assessing its transcriptional activity or protein abundance.

Several methods can be employed to detect Nrf2 activity, and these include:

a. Luciferase Reporter Assay:

   - This widely used method involves creating a reporter plasmid containing Nrf2-responsive antioxidant response element (ARE) sequences and a luciferase gene.

   - Cells of interest are transfected with the Nrf2-ARE luciferase reporter construct.

   - After exposure to the stressor of interest, cells are lysed, and luciferase activity is measured.

   - Increased luciferase activity indicates Nrf2 activation, while decreased activity suggests diminished Nrf2 activity.

b. Quantitative PCR (qPCR):

   - Assessing Nrf2 activity at the transcriptional level can be achieved through qPCR.

   - Specific Nrf2 target genes (e.g., NQO1, HO-1) are selected and their mRNA levels are quantified.

   - Increased expression of these genes is indicative of Nrf2 activation, while reduced expression suggests diminished Nrf2 activity.

c. Western Blotting:

   - This method allows the detection of Nrf2 protein levels in cell or tissue samples.

   - After exposure to a stressor, proteins are extracted, separated by electrophoresis, and transferred to a membrane.

   - Specific antibodies against Nrf2 are used to detect its abundance.

   - Increased Nrf2 protein levels suggest Nrf2 activation, while reduced levels indicate diminished activity.

d. Immunofluorescence:

   - Immunofluorescence can be used to assess the cellular localization of Nrf2.

   - Cells are fixed and probed with antibodies specific to Nrf2, followed by fluorescently labeled secondary antibodies.

   - Nrf2 localization within the cell (e.g., cytoplasm or nucleus) can indicate its activation status.

e. Electrophoretic Mobility Shift Assay (EMSA):

   - EMSA is a technique that measures the binding of Nrf2 to ARE sequences.

   - Radioactively labeled ARE sequences are incubated with nuclear extracts, and the formation of DNA-protein complexes is visualized on a gel.

   - The intensity of the complex can indicate Nrf2 binding activity.
 

References

Ashoka, A.H. et al. (2020), “Recent Advances in Fluorescent Probes for Detection of HOCl and HNO”, ACS omega, 5(4), 1730-1742. https://doi.org/10.1021/acsomega.9b03420.

Chepelev, N.L. et al. (2015), “HPLC Measurement of the DNA Oxidation Biomarker, 8-oxo-7,8-dihydro-2'-deoxyguanosine, in Cultured Cells and Animal Tissues”, J Vis Exp, e52697-e52697, https://doi.org/10.3791/52697.

Hassan, S.M. et al. (2020), “The Nrf2 Activator (DMF) and Covid-19: Is there a Possible Role?”, Med Arch, 74(2), 134-138. https://doi.org/10.5455/medarh.2020.74.134-138.

Jackson, A.F. et al. (2014), “Case study on the utility of hepatic global gene expression profiling in the risk assessment of the carcinogen furan”, Toxicol Appl Pharmacol, 274, 63-77, https://doi.org/10.1016/j.taap.2013.10.019.

Lee, D.Y. et al. (2020), “PEGylated Bilirubin-coated Iron Oxide Nanoparticles as a Biosensor for Magnetic Relaxation Switching-based ROS Detection in Whole Blood”, Theranostics, 10(5), 1997-2007. https://doi.org/10.7150/thno.39662.

Timpani, C.A, E. Rybalka. (2021), “Calming the (Cytokine) Storm: Dimethyl Fumarate as a Therapeutic Candidate for COVID-19.”, Pharmaceuticals, 14(1), 15. https://doi.org/10.3390/ph14010015.

Valavanidis, A. et al. (2009), “8-hydroxy-2' -deoxyguanosine (8-OHdG): A critical biomarker of oxidative stress and carcinogenesis”, J Environ Sci Health C Environ Carcinog Ecotoxicol Rev. 27, 120-39. https://doi.org/10.1080/10590500902885684

Event: 1845: Coagulation

Short Name: Coagulation

Key Event Component

AOPs Including This Key Event

Stressors

Biological Context

Organ term

Domain of Applicability

Taxonomic Applicability Life Stage Applicability Sex Applicability

The KE is applicable to broad species/life stage/sex. 

Key Event Description

Coagulation is a process that responds to injury by the rapid formation of a clot. Activation of coagulation factor proteins are involved in coagulation.  In the extrinsic pathway, platelets, upon the contact with collagen in the injured blood vessel wall, release thromboxane A2 (TXA2) and adenosine 2 phosphates (ADP), leading to the clot formation. Extravascular tissue factor (TF) binds to plasma factor VIIa (FVIIa) and promotes the activation of FXa. Activated FXa assembles with cofactors FVa and FVIIIa on the surface of aggregated platelets, which lead to generation of thrombin (FIIa). Thrombin catalyzes the production of fibrin (FG) which creates a clot.
The binding of prekallikrein and high-molecular weight kininogen activate FXIIa in the intrinsic pathway.
Many regulators are involved in coagulation system. Plasmin is one of the modulators required for dissolution of the fibrin clot. Plasmin is activated by tissue plasminogen activator (tPA) and urokinase plasminogen activation (uPA). SERPINs inhibit thrombin, plasmin and tPA. For example, SERPINE1 or plasminogen activator inhibitor-1 (PAI-1) inhibits tPA/uPA and results in hypofibrinolysis [Bernard I,et al. Viruses. 2021; 13(1):29.]. In addition, SERPING1 inhibits FXII, and thus down-regulation of SERPING1 lifts suppression of FXII of the intrinsic coagulation cascade [Garvin et al. eLife 2020;9:e59177]. Protein C, protein S and thrombomodulin degrade FVa and FVIIIa. [Ref. IPA, Coagulation System, version60467501, release date: 2020-11-19]

How it is Measured or Detected

Coagulation and inflammatory parameters are measured in COVID-19 patients [Di Nisio et al. 2021]. Coagulation parameters include platelet count, prothrombin time, activated partial thromboplastin time, D-dimer, fibrinogen, antithrombin III [Di Nisio et al. 2021]. These parameters are measured in the blood.

In vitro systems

Whole human blood model for testing the activation of coagulation and complement system, as well as clot formation [Ekstrand-Hammarström, B. et al. Biomaterials 2015, 51, 58-68, Ekdahl, K.N., et al. Nanomedicine: Nanotechnology, Biology and Medicine 2018, 14, 735-744, Ekdahl, K.N., et al. Science and Technology of Advanced Materials, 20:1, 688-698,]

References

1. Bernard I, Limonta D, Mahal LK, Hobman TC. Endothelium Infection and Dysregulation by SARS-CoV-2: Evidence and Caveats in COVID-19. Viruses. 2021; 13(1):29. DOI: https://doi.org/10.3390/v13010029
2. Garvin et al. A mechanistic model and therapeutic interventions for COVID-19 involving a RAS-mediated bradykinin storm. eLife 2020;9:e59177. DOI: https://doi.org/10.7554/eLife.59177
3. Di Nisio, Marcello et al. Interleukin-6 receptor blockade with subcutaneous tocilizumab improves coagulation activity in patients with COVID-19 European Journal of Internal Medicine, Volume 83, 34 - 38 DOI: https://doi.org/10.1016/j.ejim.2020.10.020
4. Ekstrand-Hammarström, B.; Hong, J.; Davoodpour, P.; Sandholm, K.; Ekdahl, K.N.; Bucht, A., Nilsson, B. TiO2 nanoparticles tested in a novel screening whole human blood model of toxicity trigger adverse activation of the kallikrein system at low concentrations. Biomaterials 2015, 51, 58-68 DOI:https://doi.org/10.1016/j.biomaterials.2015.01.031
5. Ekdahl, K.N.; Davoodpour, P.; Ekstrand-Hammarström, B.; Fromell, K.; Hamad, O.A.; Hong, J.; Bucht, A.; Mohlin, C.; Seisenbaeva, G.A.; Kessler, V.G., Nilsson, B. Contact (kallikrein/kinin) system activation in whole human blood induced by low concentrations of α-Fe2O3 nanoparticles. Nanomedicine: Nanotechnology, Biology and Medicine 2018, 14, 735-744 [DOI: https://doi.org/10.1016/j.nano.2017.12.008]
6. Kristina N Ekdahl, Karin Fromell, Camilla Mohlin, Yuji Teramura & Bo Nilsson (2019) A human whole-blood model to study the activation of innate immunity system triggered by nanoparticles as a demonstrator for toxicity, Science and Technology of Advanced Materials, 20:1, 688-698, DOI: 10.1080/14686996.2019.1625721

List of Adverse Outcomes in this AOP

Event: 1846: Thrombosis and Disseminated Intravascular Coagulation

Short Name: Thrombosis and DIC

Key Event Component

AOPs Including This Key Event

Stressors

Biological Context

Organ term

Domain of Applicability

Taxonomic Applicability Life Stage Applicability Sex Applicability

Homo sapiens

Key Event Description

Thrombosis is defined as the formation or presence of a thrombus. Clotting within a blood vessel may cause infarction of tissues supplied by the vessel. Extreme aggravation of blood coagulation induces multiple thrombi in the microvasculature, which leads to consumption coagulopathy followed by disseminated intravascular coagulation (DIC).

DIC is a pathological syndrome resulting from the formation of thrombin, subsequent activation and consumption of coagulation proteins, and the production of fibrin thrombi. The initial pathologic events are thrombotic in nature resulting in thrombotic vascular occlusions.  The initial clinical events are usually hemorrhagic resulting in oozing from mucosa and massive gastrointestinal blood loss. The occlusive events occur as a result of fibrin microthrombi or platelet microthrombi that obstruct the microcirculation of organs. This obstruction can result in organ hypoperfusion and ischemia, infarction, and necrosis. All organs are potentially vulnerable to the effects of thrombotic occlusions.

The renal effects of DIC are multifactorial and may be associated with hypovolemia or hypotension. If the hypotension is not corrected it may lead to renal failure due to acute tubular necrosis. Fibrin thrombi may also block glomerular capillaries causing ischemic, renal cortical necrosis (Colman, 1984).

The cerebral effects of DIC often result in nonspecific changes such as altered state of consciousness, convulsions, and coma. Major vascular occlusions, subarachnoid hemorrhage, multiple cortical and brain stem hemorrhages may occur following microvascular occlusions (Schwartzman RJ, 1982).

The pulmonary effects of DIC may be caused by interstitial hemorrhage resulting in a clinical effect resembling acute respiratory distress syndrome (Schwartzman RJ,1973; Shahl RL, 1984).

How it is Measured or Detected

Clinical laboratory tests are used to diagnose DIC.

Prothrombin time (PT) is a blood test that measures how long it takes blood to clot. PT measures the time required for fibrin clot formation after the addition of tissue thromboplastin and calcium. The average time range for blood to clot is about 10 to 13 seconds.

Activated partial prothrombin time (APTT). Platelet poor plasma [PPP] is incubated at 37°C then phospholipid (cephalin) and a contact activator (e.g. Kaolin, micronized silica, or ellagic acid) are added.  This leads to the conversion of Factor XI [FXI] to FXIa. The remainder of the pathway is not activated as no calcium is present.  The addition of calcium (pre-warmed to 37°C) initiates clotting. The APTT is the time taken from the addition of calcium to the formation of a fibrin clot. The clotting time for the APTT lies between 27-35 seconds.

 

Decreased fibrinogen concentrations

Diluted plasma is clotted with a high concentration of Thrombin. The tested plasma is diluted (usually 1:10 but this may vary if the Fibrinogen concentration is very low or very high) to minimize the effect of 'inhibitory substances' within the plasma e.g. heparin, elevated levels of FDPs. The use of a high concentration of Thrombin (typically 100 U/ml) ensures that the clotting times are independent of Thrombin concentration over a wide range of Fibrinogen levels. The test requires a reference plasma with a known Fibrinogen concentration and that has been calibrated against a known international reference standard. A calibration curve is constructed using this reference plasma by preparing a series of dilutions (1:5 –1:40) in the buffer to give a range of Fibrinogen concentrations. The clotting time of each of these dilutions is established (using duplicate samples) and the results (clotting time(s)/Fibrinogen concentration (g/L) are plotted on Log-Log graph paper. The 1:10 concentration is considered to be 100% i.e. normal. There should be a linear correlation between clotting times in the region of 10-50 sec. The test platelet-poor diluted plasma (diluted 1:10 in buffer) is incubated at 37°C, Thrombin [~100 U/mL] added (all pre-warmed to 37°C). The time taken for the clot to form is compared to the calibration curve and the Fibrinogen concentration deduced. Test samples whose clotting times fall out with the linear part of the calibration curve should be re-tested using different dilutions. Most laboratories use an automated method in which clot formation is deemed to have occurred when the optical density of the mixture has exceeded a certain threshold.   Platelet Measurements- A platelet count is the number of platelets a person has per microliter. The ideal platelet range is 150,000 – 400,000 per microliter in most healthy people. Fibrinolysis measurements-         d-dimer concentration ALERE TRIAGE® D-DIMER TEST D-Dimer can be measured by a fluorescence immunoassay. To determine cross-linked fibrin degradation products containing D-dimer in EDTA anticoagulated whole blood and plasma specimens. The test is used as an aid in the assessment and evaluation of patients suspected of having disseminated intravascular coagulation or thromboembolic events including pulmonary embolism Procedure:  Commercially available kits are available to measure d-dimer in whole blood or plasma. The kits contain all the reagents necessary for the quantification of cross-linked fibrin degradation products containing D-dimer in EDTA anticoagulated whole blood or plasma specimens.

Regulatory Significance of the AO

Thrombosis is one of the world’s main concerns in terms of severe symptoms or adverse responses of the vaccine for COVID-19 which is caused by SARS-CoV-2. Excess thrombosis leads to DIC, which might be mortal. For safely developing the therapeutics and vaccines of COVID-19, it is regulatory significant to understand the cellular and molecular mechanisms in the pathogenesis of coronaviral infection, which may include thrombosis and DIC, AO1846.

References

Hemostasis and Thrombosis Basic Principles and Clinical Practices Robert W Colman, Jack Hirsh, Victor J. Marder, Edwin W. Salzman (ed) Philadelphia, 1994.

Schwartzman RJ, Hill JB: Neurologic complications of DIC. Neurology 32:791, 1982

Robboy SJ, Minna JD, Colman RW et.al. Pulmonary hemorrhage syndrome as a manifestation of DIC: Analysis of 10 cases. Chest 63:718, 1973.

Stahl RL, Javid JP, Lackner H: Unrecognized pulmonary embolism presenting as DIC. SM J Med 76:772, 1984.

Appendix 2

List of Key Event Relationships in the AOP