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SARS-CoV-2 infection in the lungs of human ACE2 transgenic mice causes severe inflammation, immune cell infiltration, and compromised respiratory function

By Emma S Winkler, Adam L Bailey, Natasha M. Kafai, Sharmila Nair, Broc T. McCune, Jinsheng Yu, Julie M Fox, Rita E. Chen, James T Earnest, Shamus P Keeler, Jon H Ritter, Liang-I Kang, Sarah Dort, Annette Robichaud, Richard Head, Michael J. Holtzman, Michael S. Diamond

Posted 10 Jul 2020
bioRxiv DOI: 10.1101/2020.07.09.196188

Severe Acute Respiratory Syndrome Coronavirus -2 (SARS-CoV-2) emerged in late 2019 and has spread worldwide resulting in the Coronavirus Disease 2019 (COVID-19) pandemic. Although animal models have been evaluated for SARS-CoV-2 infection, none have recapitulated the severe lung disease phenotypes seen in hospitalized human cases. Here, we evaluate heterozygous transgenic mice expressing the human ACE2 receptor driven by the epithelial cell cytokeratin-18 gene promoter (K18-hACE2) as a model of SARS-CoV-2 infection. Intranasal inoculation of SARS-CoV-2 in K18-hACE2 mice results in high levels of viral infection in lung tissues with additional spread to other organs. Remarkably, a decline in pulmonary function, as measured by static and dynamic tests of respiratory capacity, occurs 4 days after peak viral titer and correlates with an inflammatory response marked by infiltration into the lung of monocytes, neutrophils, and activated T cells resulting in pneumonia. Cytokine profiling and RNA sequencing analysis of SARS-CoV-2-infected lung tissues show a massively upregulated innate immune response with prominent signatures of NF-kB-dependent, type I and II interferon signaling, and leukocyte activation pathways. Thus, the K18-hACE2 model of SARS-CoV-2 infection recapitulates many features of severe COVID-19 infection in humans and can be used to define the mechanistic basis of lung disease and test immune and antiviral-based countermeasures. ### Competing Interest Statement M. S. Diamond is a consultant for Inbios, Eli Lilly, Vir Biotechnology, NGM Biopharmaceuticals, and on the Scientific Advisory Board of Moderna. The Diamond laboratory has received funding under sponsored research agreements from Moderna, Vir Biotechnology, and Emergent BioSolutions. S. Dort and A.Robichaud are employed by SCIREQ Inc., a commercial entity having commercial interest in a subject area related to the content of this article. SCIREQ Inc. is an emka TECHNOLOGIES company. M. Holtzman is a member of the DSMB for AstroZeneca and founder of NuPeak Therapeutics.

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