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SARS-CoV-2 Infects Human Engineered Heart Tissues and Models COVID-19 Myocarditis
Open accessPublished version of a preprint
Abstract
Epidemiological studies of the COVID-19 pandemic have revealed evidence of cardiac involvement and documented that myocardial injury and myocarditis are predictors of poor outcomes. Nonetheless, little is understood regarding SARS-CoV-2 tropism within the heart and whether cardiac complications result directly from myocardial infection. Here, we develop a human engineered heart tissue model and demonstrate that SARS-CoV-2 selectively infects cardiomyocytes. Viral infection is dependent on expression of angiotensin-I converting enzyme 2 (ACE2) and endosomal cysteine proteases, suggesting an endosomal mechanism of cell entry. After infection with SARS-CoV-2, engineered tissues display typical features of myocarditis, including cardiomyocyte cell death, impaired cardiac contractility, and innate immune cell activation. Consistent with these findings, autopsy tissue obtained from individuals with COVID-19 myocarditis demonstrated cardiomyocyte infection, cell death, and macrophage-predominate immune cell infiltrate. These findings establish human cardiomyocyte tropism for SARS-CoV-2 and provide an experimental platform for interrogating and mitigating cardiac complications of COVID-19.
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Metadata
- Authors
- Bailey, A. L., Dmytrenko, O., Greenberg, L., Bredemeyer, A. L., Ma, P., Liu, J., Penna, V., Winkler, E. S., Sviben, S., Brooks, E., Nair, A. P., Heck, K. A., Rali, A. S., Simpson, L., Saririan, M., Hobohm, D., Stump, W. T., Fitzpatrick, J. A., Xie, X., Zhang, X., Shi, P.-Y., Hinson, J. T., Gi, W.-T., Schmidt, C., Leuschner, F., Lin, C.-Y., Diamond, M. S., Greenberg, M. J., & Lavine, K. J.
- Affiliations
- Washington University in St. Louis (US)
- University of Wisconsin–Madison (US)
- Baylor College of Medicine (US)
- Vanderbilt University (US)
- Creighton University (US)
- The University of Texas Medical Branch at Galveston (US)
- The Jackson Laboratory for Genomic Medicine (US)
- Heidelberg University (DE)
- Corresponding author
- Lavine, Kory J.
- ORCID
- Bailey, Adam L.
- Dmytrenko, Oleksandr
- Greenberg, Lina
- Bredemeyer, Andrea L.
- Ma, Pan
- Liu, Jing
- Penna, Vinay
- Winkler, Emma S.
- Sviben, Sanja
- Brooks, Erin
- Nair, Ajith P.
- Rali, Aniket S.
- Simpson, Leo
- Saririan, Mehrdad
- Fitzpatrick, James A.
- Xie, Xuping
- Zhang, Xianwen
- Shi, Pei-Yong
- Hinson, J. Travis
- Gi, Weng-Tein
- Schmidt, Constanze
- Leuschner, Florian
- Lin, Chieh-Yu
- Diamond, Michael S.
- Greenberg, Michael J.
- Lavine, Kory J.
- Venue
- JACC: Basic to Translational Science
- Publisher
- Elsevier BV
- Published
- 2021-04
- Volume
- 6
- Issue
- 4
- Pages
- 331-345
- ISSN
- 2452-302X (ISSN-L)
- PMC
- PMC7909907
- OpenAlex
- W3134776434
- Cited by
- 193
- References
- 80
- Citations by year
- 2026: 8 · 2025: 13 · 2024: 37 · 2023: 50 · 2022: 42 · 2021: 43
- FWCI
- 29.50
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- JACC Basic to Translational Science (publishedVersion, cc-by-nc-nd)
- bioRxiv (Cold Spring Harbor Laboratory) (acceptedVersion)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Digital Commons@Becker (Washington University School of Medicine) (submittedVersion, cc-by-nc-nd)
- PubMed Central (submittedVersion)
- Digital Commons-TMC (Texas Medical Center) (submittedVersion)
- The Mouseion at the JAXlibrary (Jackson Laboratory) (submittedVersion)
- Funders
- Foundation for Barnes-Jewish Hospital
- Center for Cellular Imaging, Washington University
- National Institutes of Health (75N93019C00062, R01 AI127828, R01 HL138466, R01 HL139714, R01 HL141086)
- St. Louis Children's Hospital (CDI-CORE-2015-505, CDI-CORE-2019-813)
- Defense Advanced Research Projects Agency (HR001117S0019)
- Burroughs Wellcome Fund (1014782)
- March of Dimes Foundation (FY18-BOC-430198)
- Topics
- Health Sciences › Medicine › Infectious Diseases › Viral Infections and Immunology Research
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Health Sciences › Medicine › Infectious Diseases › SARS-CoV-2 and COVID-19 Research
- Keywords
- SARS-CoV-2, COVID-19 myocarditis, engineered heart tissue, cardiac complications of COVID-19, sarcomere disassembly, cytokine production, cardiomyocyte contractile dysfunction, cell death, viral pathogenesis, myocardial pathology
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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