• Camila Meirelles S Silva, Carlos Wagner S Wanderley, Flavio Protasio Veras, Augusto Velozo Gonçalves, Mikhael Haruo Fernandes Lima, Juliana Escher Toller-Kawahisa, Giovanni Freitas Gomes, Daniele Carvalho Nascimento, Valter V Silva Monteiro, Isadora Marques Paiva, Cícero José Luíz Ramos Almeida, Diego Brito Caetité, Juliana Costa Silva, Maria Isabel Fernandes Lopes, Letícia Pastorelli Bonjorno, Marcela Cavichioli Giannini, Natalia Brasil Amaral, Maíra Nilson Benatti, Rodrigo Carvalho Santana, Luis Eduardo Alves Damasceno, Bruna Manuella Souza Silva, Ayda Henriques Schneider, Icaro Maia Santos Castro, Juan Carlo Santos Silva, Amanda Pereira Vasconcelos, Tiago Tomazini Gonçalves, Sabrina Setembre Batah, Tamara Silva Rodrigues, Victor Ferreira Costa, Marjorie Cornejo Pontelli, Ronaldo B Martins, Timna Varela Martins, EspósitoDanillo Lucas AlvesDLADepartment of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil., Guilherme Cesar Martelossi Cebinelli, da FonsecaBenedito Antônio LopesBALDepartment of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil., Luiz Osório Silveira Leiria, Larissa Dias Cunha, Eurico Arruda, Helder I Nakaia, Alexandre Todorovic Fabro, Rene D R Oliveira, Dario S Zamboni, Paulo Louzada-Junior, Thiago Mattar Cunha, José Carlos Farias Alves-Filho, and Fernando Queiroz Cunha.
• Center for Research in Inflammatory Diseases (CRID), Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes 3900, Monte Alegre, Ribeirão Preto, São Paulo, 14049-900, Brazil.
• Crit Care. 2022 Jul 7; 26 (1): 206.

BackgroundThe release of neutrophil extracellular traps (NETs) is associated with inflammation, coagulopathy, and organ damage found in severe cases of COVID-19. However, the molecular mechanisms underlying the release of NETs in COVID-19 remain unclear.ObjectivesWe aim to investigate the role of the Gasdermin-D (GSDMD) pathway on NETs release and the development of organ damage during COVID-19.MethodsWe performed a single-cell transcriptome analysis in public data of bronchoalveolar lavage. Then, we enrolled 63 hospitalized patients with moderate and severe COVID-19. We analyze in blood and lung tissue samples the expression of GSDMD, presence of NETs, and signaling pathways upstreaming. Furthermore, we analyzed the treatment with disulfiram in a mouse model of SARS-CoV-2 infection.ResultsWe found that the SARS-CoV-2 virus directly activates the pore-forming protein GSDMD that triggers NET production and organ damage in COVID-19. Single-cell transcriptome analysis revealed that the expression of GSDMD and inflammasome-related genes were increased in COVID-19 patients. High expression of active GSDMD associated with NETs structures was found in the lung tissue of COVID-19 patients. Furthermore, we showed that activation of GSDMD in neutrophils requires active caspase1/4 and live SARS-CoV-2, which infects neutrophils. In a mouse model of SARS-CoV-2 infection, the treatment with disulfiram inhibited NETs release and reduced organ damage.ConclusionThese results demonstrated that GSDMD-dependent NETosis plays a critical role in COVID-19 immunopathology and suggests GSDMD as a novel potential target for improving the COVID-19 therapeutic strategy.© 2022. The Author(s).

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