Here, we demonstrate a novel role for macrophage-activation signaling in orchestrating the recruitment process in response to S protein. Although much effort has been made to understand the basis of molecular activation of macrophages, the mechanisms of SARS-CoV-2 S protein fragments by which macrophages mediate signaling are poorly documented in COVID-19. We identified peptides of SARS-CoV-2 Spike, with special role of PSPD2003, as key components to control the host immunity by macrophage recruitment and activation and inflammatory modulation in vitro and in vivo. Within the decrease in inflammatory macrophages, at later in the inflammatory process, we observed less Mpeg1+/TNFα+ cells, decreased SOD activity and consequently less hydrogen peroxide produced. Such data is further supported by an increase in catalase activity after PSPD2003 injection. Several studies report that ROS modulation and SOD and CAT substrates, superoxide ion and hydrogen peroxide, respectively, participate in cellular signaling in favor of proper inflammatory resolution 30; 31; 32
Among the imminent challenges in combating the pandemic is the intense search to develop adequate and reliable animal models that can reproduce the pathophysiology of the disease. The ideal model should be permissive to infection, allowing the study of the virus-host interaction and mimicking the clinical pathology of the disease 33. Our study brought a new alternative to study the inflammatory process triggered in a patient with COVID-19 by using synthetic peptides in a zebrafish model. The peptides PSPD2002 and PSPD2003, synthesized from the S protein of SARS-CoV-2 were also validated by in silico. They showed binding stability over time and interaction with both human and zebrafish immune system receptors and ACE2. This interaction is extremely important, because unlike the application of peptides based on their antiviral activity aimed at developing new drugs 34, our proposal is to use these particles to challenge and mimic the organism's response to the virus. But the restricted handling of the SARS-CoV-2 virus in a biosafety level 3 (BSL-3) laboratory has still been a major problem for its research. To circumvent this, at least some virus-like particles without virulence that can be handled in BSL-2 have been developed 35; 36 However, the use of peptides is even more advantageous for our purpose, since besides dispensing with the use of BSL-3, they present lower synthesis costs.
Besides the innovation in the use of peptides, we bring the use of an emerging animal model in zebrafish for the study of human diseases. This allows us to study the immune response to stimulation with viral particles, as well histopathological changes. Zebrafish have already been used to study infections with several viruses that trigger disease in humans such as dengue virus 37, chikungunya virus 38; 39, zika 40, herpes (HSV-1) 41; 42, cytomegalovirus 43, influenza A 44; 45; hepatitis B 46, and hepatitis C 47. The hyperinflammation seen in patients with severe COVID-19 is markedly caused by an exacerbated response of the body to infection, which can lead to multiple organ failure and death. The leukocyte infiltrate in the lungs of these patients is mostly composed of macrophages 48. In viral infection, the inflammatory cascade initiated by macrophages, such as the release of cytokines like IL-6 and IL-1β that act in the recruitment of neutrophils and cytotoxic T cells, contributes to both viral control and tissue damage 49.
Understanding the role of the innate immune system during viral infections is particularly promising in the zebrafish model system, since the animal exclusively displays innate immunity in the first weeks of life 50. Humanized adult zebrafish infected with SARS-CoV-2 protein S in the swim bladder showed accumulation of macrophages and granulocytes 9. Animals infected with the recombinant spike protein also showed a toxic inflammatory response with macrophage infiltrate 51. We found a similar response. The peptides were able to increase the recruitment of these cells to the inoculation site and modulate their phenotype. In animals immunized with PSPD2002, although there was no increase in the total number of these cells within days, a higher number of pro-inflammatory cells was observed. When administered the highest concentration 10µg/ml of PSPD2002, this increase quickly occurred already at 1-dpi, while the peak of these cells in the group exposed to 1µg/ml was later, being observed only at 6-dpi. Thus, the higher the peptide concentration, the faster the inflammatory process was established and resolved, while lower concentrations of the peptide triggered the slower response, progressively until day 6.
Animals immunized with PSPD2003 showed an increase in the total number of macrophages and a markedly pro-inflammatory phenotype. At 1 and 2-dpi, animals immunized with 10µg/ml PSPD2003 showed a higher number of inflammatory macrophages when compared to the control group. While the 1µg/ml administration only had its expressive increase in the total number of these cells at 6-dpi, but now with an antiinflammatory profile, characterizing the beginning of the resolution of the process. This time-response relationship and severity of the inflammatory process is observed in SARS-CoV-2 infected patients. Patients with higher viral titers had a shorter duration of illness, averaging 7 days, while patients with a lower viral load maintained the condition for 19 days 52. In a study where SARS-CoV-2 spike protein was injected into the swim bladder of larvae, a high infiltration of inflammatory macrophages was observed at 4dpi, resulting in an inflammatory process. In 7dpi analysis no cells with an inflammatory profile were observed, but cellular debris was, which confirms the reduction of the inflammatory process 9.
Studies indicates that pathogenicity of SARS-CoV-2 is associated with oxidative stress 53. Oxidative stress is the result of an imbalance between oxidant production and antioxidant mechanisms and triggers the events that may contribute to the severity of COVID-19 in patients 54; 55. The complex responsible for the respiratory burst, important in the recruitment of additional phagocytes and ROS production, is conserved between humans and zebrafish 50. In our study an increase in malondialdehyde (MDA) synthesis was observed by injection of both peptides. MDA is an indicative parameter of oxidative stress, which makes it possible to correlate this marker with viral infections of the respiratory tract, especially RNA viruses 56. Nitrite synthesis was reduced after administration of the peptide PSPD2002. Plasma levels of nitrite are involved with regional endothelial NO synthase (eNOS) enzyme activity 57. Viral infection triggers damage to the endothelium of the respiratory tract, leading to reduced eNOS and therefore resulting in reduced nitrite 58. The respiratory burst performed by macrophages when exposed to virus infection leads to ROS production 59. Patients infected with SARS-CoV-2, show high serum levels of antioxidant enzymes 60. The enzymes SOD and CAT act in the neutralization of oxidant molecules, such as ROS 61. It was observed that SOD levels decreased after administration of both peptides, and CAT levels increased after administration of the peptide PSPD2003. SARS-CoV-2 infection leads to excessive ROS production, which triggers a weakened antioxidant response 62. This reduction in SOD activity has also been observed during infections with other viruses 63; 64.
We further evaluated the activation of neutrophils challenged with the peptides. In homeostasis, neutrophils show high expression of CD62L, but during inflammatory processes the expression of this selectin is reduced. Post-ICU patients on COVID-19 exhibited a pronounced increase in circulating CD62Llow neutrophils showing fragility and hypersecretion 65. The elevated numbers of neutrophils in patients with severe COVID-19 accompanied by increased levels of neutrophil extracellular traps (NETs) were related to an increased risk of death and the development of lung injury and microthrombi 66. In our study, the peptides were unable to activate neutrophils, marked by reduced expression of CD62L on their surface.
In conclusion, our study shows new alternatives for studying the characteristic inflammatory process observed in COVID-19 patients. Non-virulent peptides synthesized from SARS-CoV-2 protein S were able to immunize zebrafish larvae and trigger the inflammatory process, marked by macrophage infiltration and changes in oxidative stress biomarkers. The change in macrophage polarization in a dose-dependent manner triggered by the fragments can be extrapolated to the clinical context, where viral load is associated with patient clinical outcome. Our results are important in helping to elucidate the pathophysiology of the disease and characterize an animal model that allows broad drug screening, enabling the development of new therapies.