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COVID-19 can present with lymphopenia and extraordinary complex multiorgan pathologies that can trigger long-term sequela. Given that inflammasome products, like caspase-1, play a role in the pathophysiology of a number of co-morbid conditions, we investigated caspases across the spectrum of COVID-19 disease. We assessed transcriptional states of multiple caspases and using flow cytometry, the expression of active caspase-1 in blood cells from COVID-19 patients in acute and convalescent stages of disease. Non-COVID-19 subject presenting with various comorbid conditions served as controls. Single-cell RNA-seq data of immune cells from COVID-19 patients showed a distinct caspase expression pattern in T cells, neutrophils, dendritic cells, and eosinophils compared with controls. Caspase-1 was upregulated in CD4+ T-cells from hospitalized COVID-19 patients compared with unexposed controls. Post-COVID-19 patients with lingering symptoms (long-haulers) also showed upregulated caspase-1activity in CD4+ T-cells that ex vivo was attenuated with a select pan-caspase inhibitor. We observed elevated caspase-3/7levels in red blood cells from COVID-19 patients compared with controls that was reduced following caspase inhibition. Our preliminary results suggest an exuberant caspase response in COVID-19 that may facilitate immune-related pathological processes leading to severe outcomes. Further clinical correlations of caspase expression in different stages of COVID-19 will be needed. Pan-caspase inhibition could emerge as a therapeutic strategy to ameliorate or prevent severe COVID-19. © 2021 European Academy of Allergy and Clinical Immunology and John Wiley & Sons Ltd.


Matthew Plassmeyer, Oral Alpan, Michael J Corley, Thomas A Premeaux, Kimberleigh Lillard, Paige Coatney, Tina Vaziri, Suzan Michalsky, Alina P S Pang, Zaheer Bukhari, Stephen T Yeung, Teresa H Evering, Gail Naughton, Martin Latterich, Philip Mudd, Alfred Spada, Nicole Rindone, Denise Loizou, Søren Ulrik Sønder, Lishomwa C Ndhlovu, Raavi Gupta. Caspases and therapeutic potential of caspase inhibitors in moderate-severe SARS-CoV-2 infection and long COVID. Allergy. 2022 Jan;77(1):118-129

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PMID: 33993490

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