Mostafa M. Eltobgy, Ashley Zani, Adam D. Kenney, Shady Estfanous, Eunsoo Kim, Asmaa Badr, Cierra Carafice, Kylene Daily, Owen Whitham, Maciej Pietrzak, Amy Webb, Jeffrey Kawahara, Adrian C. Eddy, Parker Denz, Mijia Lu, Mahesh KC, Mark E. Peeples, Jianrong Li, Jian Zhu, Jianwen Que, Richard Robinson, Oscar Rosas Mejia, Rachael E. Rayner, Luanne Hall-Stoodley, Stephanie Seveau, Mikhail A. Gavrilin, Xiaoli Zhang, Jeronay Thomas, Jacob E. Kohlmeier, Mehul S. Suthar, Eugene Oltz, Andrea Tedeschi, Frank H. Robledo-Avila, Santiago Partida-Sanchez, Emily A. Hemann, Eman Abdelrazik, Adriana Forero, Shahid M. Nimjee, Prosper N. Boyaka, Estelle Cormet-Boyaka, Jacob S. Yount, and Amal O. Amer
Severe acute respiratory syndrome coronavirus 2 (SARS–CoV-2) is a worldwide health concern, and new treatment strategies are needed. Targeting inflammatory innate immunity pathways holds therapeutic promise, but effective molecular targets remain elusive. Here, we show that human caspase-4 (CASP4) and its mouse homolog, caspase-11 (CASP11), are up-regulated in SARS–CoV-2 infections and that CASP4 expression correlates with severity of SARS–CoV-2 infection in humans. SARS–CoV-2–infected Casp11−/− mice were protected from severe weight loss and lung pathology, including blood vessel damage, compared to wild-type (WT) mice and mice lacking the caspase downstream effector gasdermin-D (Gsdmd−/−). Notably, viral titers were similar regardless of CASP11 knockout. Global transcriptomics of SARS–CoV-2–infected WT, Casp11−/−, and Gsdmd−/− lungs identified restrained expression of inflammatory molecules and altered neutrophil gene signatures in Casp11−/− mice. We confirmed that protein levels of inflammatory mediators interleukin (IL)-1β, IL-6, and CXCL1, as well as neutrophil functions, were reduced in Casp11−/− lungs. Additionally, Casp11−/− lungs accumulated less von Willebrand factor, a marker for endothelial damage, but expressed more Kruppel-Like Factor 2, a transcription factor that maintains vascular integrity. Overall, our results demonstrate that CASP4/11 promotes detrimental SARS–CoV-2–induced inflammation and coagulopathy, largely independently of GSDMD, identifying CASP4/11 as a promising drug target for treatment and prevention of severe COVID-19.