Efferocytosis of SARS-CoV-2-infected dying cells impairs macrophage anti-inflammatory functions and clearance of apoptotic cells
Ana Carolina Guerta Salina, Douglas dos-Santos, Tamara Silva Rodrigues, Marlon Fortes-Rocha, Edismauro Garcia Freitas Filho, Daniel L Alzamora-Terrel, Ícaro Maia Santos de Castro, Thais FC Fraga da Silva, Mikhael HF de Lima, Daniele C. Nascimento, Camila M. Silva, Juliana E. Toller-Kawahisa, Amanda Becerra, Samuel Oliveira, Diego B. Caetité, Letícia de Almeida, Adriene Y. Ishimoto, Thais M. Lima, Ronaldo B. Martins, Flávio Veras, Natália B. do Amaral, Marcela C Giannini, Letícia Pastorelli Bonjorno, Maria IF Lopes, Maíra Nilson Benatti, Sabrina Setembre Batah, Rodrigo de Carvalho Santana, Fernando Crivelenti Vilar, Maria Auxiliadora‐Martins, Rodrigo Luppino Assad, Sergio CL de Almeida, Fabíola Reis de Oliveira, Eurico Arruda Neto, Thiago M. Cunha, José C. Alves‐Filho, Vânia Luiza Deperon Bonato, Fernando Q. Cunha, Alexandre Todorovic Fabro, Helder I. Nakaya, Dario S. Zamboni, Paulo Louzada‐Júnior, Rene DR Oliveira, Larissa D. Cunha
Abstract
COVID-19 is a disease of dysfunctional immune responses, but the mechanisms triggering immunopathogenesis are not established. The functional plasticity of macrophages allows this cell type to promote pathogen elimination and inflammation or suppress inflammation and promote tissue remodeling and injury repair. During an infection, the clearance of dead and dying cells, a process named efferocytosis, can modulate the interplay between these contrasting functions. Here, we show that engulfment of SARS-CoV-2-infected apoptotic cells exacerbates inflammatory cytokine production, inhibits the expression of efferocytic receptors, and impairs continual efferocytosis by macrophages. We also provide evidence supporting that lung monocytes and macrophages from severe COVID-19 patients have compromised efferocytic capacity. Our findings reveal that dysfunctional efferocytosis of SARS-CoV-2-infected cell corpses suppresses macrophage anti-inflammation and efficient tissue repair programs and provides mechanistic insights for the excessive production of pro-inflammatory cytokines and accumulation of tissue damage associated with COVID-19 immunopathogenesis.