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SARS-CoV-2 infection of human ACE2-transgenic mice causes severe lung inflammation and impaired function
Open accessAbstract
Although animal models have been evaluated for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, none have fully recapitulated the lung disease phenotypes seen in humans who have been hospitalized. Here, we evaluate transgenic mice expressing the human angiotensin I-converting enzyme 2 (ACE2) receptor driven by the cytokeratin-18 (K18) 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 lungs, with spread to other organs. A decline in pulmonary function occurs 4 days after peak viral titer and correlates with infiltration of monocytes, neutrophils and activated T cells. SARS-CoV-2-infected lung tissues show a massively upregulated innate immune response with signatures of nuclear factor-κB-dependent, type I and II interferon signaling, and leukocyte activation pathways. Thus, the K18-hACE2 model of SARS-CoV-2 infection shares many features of severe COVID-19 infection and can be used to define the basis of lung disease and test immune and antiviral-based countermeasures.
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“In a humanized transgenic mouse model, ACE2 was expressed in the heart and virus replication detected, but they did not observe cardiac inflammation. 181”
From COVID-19, Myocarditis and Pericarditis (2023) · cites this paper as [181]
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“These transgenic mice have a human ACE2 receptor which is the major cell entry receptor for SARS-CoV-216,17.”
From Efficacy of an unmodified bivalent mRNA vaccine against SARS-CoV-2 variants in female small animal models (2023) · cites this paper as [17]
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“However, only K18hACE2 mice could develop severe disease and cause high lethality [36, 37].”
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“Similar to previous studies with K18-hACE2 TG mice 7 and human patients, 10,35 the drastic reduction of the homeostatic alveolar macrophages (Mac.”
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BackgroundUraki, R., Imai, M., Ito, M., Yamayoshi, S., Kiso, M., Jounai, N., Miyaji, K., Iwatsuki‐Horimoto, K., Takeshita, F., & Kawaoka, Y. (2024) · npj Vaccines · doi:10.1038/s41541-023-00800-0 · Cited by 14
Zimmerman, O., Doss, A. M. A., Ying, B., Liang, C.-Y., Mackin, S., Davis-Adams, H. G., Adams, L. J., VanBlargan, L. A., Chen, R. E., Scheaffer, S. M., et al. (2024) · JCI Insight · doi:10.1172/jci.insight.176359 · Cited by 13
Self-citationKirk, N. M., Liang, Y., & Ly, H. (2024) · Virulence · doi:10.1080/21505594.2024.2316438 · Cited by 13
“Hematologic and coagulation abnormalities that occur in human disease have been documented in only a few of the animal models available thus far [122,169,196,202,244], although these readouts are generally not included in most studies.”
BackgroundMarcos-Villar, L., Perdiguero, B., Anthiya, S., Borrajo, M. L., Lou, G., Franceschini, L., Esteban, I., Sánchez‐Cordón, P. J., Zamora, C., Sorzano, C. Ó. S., et al. (2024) · npj Vaccines · doi:10.1038/s41541-024-00838-8 · Cited by 11
Hu, Z., López-Muñoz, A. D., Košík, I., Li, T., Callahan, V., Brooks, K., Yee, D. S., Hollý, J., Santos, J. J. D. S., Brant, A. C., et al. (2024) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.2310421121 · Cited by 11
“We next examined the pathogenicity of rOC43 - CoV2 S in established mouse models of SARS - CoV - 2 and hOC43, using, respectively, transgenic hACE2 mice and WT neonatal C57BL/6 mice (older mice do not support OC43 infection) (18–21).”
MethodSelf-citationSARS-CoV-2 infection in microglia and its sequelae: What do we know so far?
Luo, E. Y., Chang, R. C., & Gilbert‐Jaramillo, J. (2024) · Brain Behavior & Immunity - Health · doi:10.1016/j.bbih.2024.100888 · Cited by 14
Ohno, M., Sasaki, M., Orba, Y., Sekiya, T., Masum, M. A., Ichii, O., Sawamura, T., Kakino, A., Suzuki, Y., Kida, H., et al. (2021) · Viruses · doi:10.3390/v13112137 · Cited by 13
Cao, X., Tian, Y., Nguyen, V., Zhang, Y., Gao, C., Yin, R. L., Carver, W., Fan, D., Albrecht, H., Cui, T., et al. (2021) · The FASEB Journal · doi:10.1096/fasebj.2021.35.s1.00265 · Cited by 13
Tatham, L. M., Kipar, A., Sharp, J., Kijak, E., Herriott, J., Neary, M., Box, H., Toledo, E. G., Valentijn, A., Cox, H., et al. (2024) · Microbiology Spectrum · doi:10.1128/spectrum.03916-23 · Cited by 13
“4) as previously described (36–38).”
3D Bioprinted Neural‐Like Tissue as a Platform to Study Neurotropism of Mouse‐Adapted SARS‐CoV‐2
de Melo, B. A. G., Mundim, M. V., Lemes, R. M. R., Cruz, E. M., Ribeiro, T. N., Santiago, C. F., da Fonsêca, J. H. L., Benincasa, J. C., Stilhano, R. S., Mantovani, N., et al. (2022) · Advanced Biology · doi:10.1002/adbi.202200002 · Cited by 14
Host chitinase 3-like-1 is a universal therapeutic target for SARS-CoV-2 viral variants in COVID-19
Kamle, S., Ma, B., Lee, C. M., Schor, G., Zhou, Y., Lee, C. G., & Elias, J. A. (2022) · eLife · doi:10.7554/elife.78273 · Cited by 13
Intranasal soluble ACE2 improves survival and prevents brain SARS-CoV-2 infection
Hassler, L., Wysocki, J. A., Ahrendsen, J. T., Ye, M., Gelarden, I. A., Nicolaescu, V. I., Τοματσίδου, Α., Gula, H., Cianfarini, C. L., Khurram, N., et al. (2023) · Life Science Alliance · doi:10.26508/lsa.202301969 · Cited by 14
Can GPR4 Be a Potential Therapeutic Target for COVID-19?
Yang, L. V., Oppelt, K. A., Thomassen, M. J., Marie, M. A., Akhtar, S. N., & McCallen, J. (2021) · Frontiers in Medicine · doi:10.3389/fmed.2020.626796 · Cited by 15
Ketogenesis restrains aging-induced exacerbation of COVID in a mouse modelPreprint
Ryu, S., Shchukina, I., Youm, Y., Qing, H., Hilliard, B. K., Dlugos, T., Zhang, X., Yasumoto, Y., Booth, C. J., Fernandez-Hernando, C. F., et al. (2020) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.1101/2020.09.11.294363 · Cited by 13
“For example, epithelial cell specific induction of hACE2 (K18-hACE2) as a model of SARS-CoV-2 infection demonstrated that post intranasal inoculation, animals develop lung inflammation and pneumonia driven by infiltration of monocytes, neutrophils and T cells (Winkler et al., 2020).”
BackgroundSposito, B., Broggi, A., Pandolfi, L., Crotta, S., Ferrarese, R., Sisti, S., Clementi, N., Ambrosi, A., Liu, E., Frangipane, V., et al. (2021) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.1101/2021.03.30.437173 · Cited by 13
Lee, S.-H., Yoon, G. Y., Lee, S. J., Kwon, Y., Moon, H.-W., Kim, Y., Kim, H., Lee, W., Jeong, G. U., Kim, C., et al. (2022) · Microbiology Spectrum · doi:10.1128/spectrum.02371-22 · Cited by 12
Kwon, H., Košíková, M., Tang, W., Ortega‐Rodriguez, U., Radvák, P., Xiang, R., Mercer, K. E., Muskhelishvili, L., Davis, K., Ward, J. M., et al. (2022) · iScience · doi:10.1016/j.isci.2022.105507 · Cited by 11
Vieira-Alves, I., Alves, A. R. P., Souza, N. M. V., de Melo, T. L., Coimbra-Campos, L. M. C., Lacerda, L. D. S. B., Queiroz‐Junior, C. M., Andrade, A. C. D. S. P., Barcelos, L. S., Teixeira, M. M., et al. (2023) · Clinical Science · doi:10.1042/cs20220663 · Cited by 12
Multiantigen pan-sarbecovirus DNA vaccines generate protective T cell immune responses
van Bergen, J., Camps, M. G. M., Pardieck, I. N., Veerkamp, D. M. B., Leung, W. Y., Leijs, A. A., Myeni, S. K., Kikkert, M., Arens, R., Zondag, G. C. M., et al. (2023) · JCI Insight · doi:10.1172/jci.insight.172488 · Cited by 11
Coria, L. M., Rodriguez, J. M., Demaría, A., Bruno, L. A., Medrano, M. R., Castro, C. P., Castro, E. F., Priore, S. A. D., Hernando-Insúa, A., Kaufmann, I. G., et al. (2024) · Nature Communications · doi:10.1038/s41467-024-45180-8 · Cited by 11
Intranasal neomycin evokes broad-spectrum antiviral immunity in the upper respiratory tract
Mao, T., Kim, J., Peña-Hernández, M. A., Valle, G., Moriyama, M., Luyten, S., Ott, I. M., Gomez-Calvo, M. L., Gehlhausen, J. R., Baker, E., et al. (2024) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.2319566121 · Cited by 12
“In this model, the expression of human angiotensin - converting enzyme 2 (hACE2) is under the control of a keratin 18 (K18) gene promoter, enabling epithelial infection by SARS - CoV - 2 (14, 15).”
BackgroundSARS‐CoV‐2 infection induces thymic atrophy mediated by IFN‐γ in hACE2 transgenic mice
Rizvi, Z. A., Sadhu, S., Dandotiya, J., Sharma, P., Binayke, A., Singh, V., Das, V., Khatri, R., Kumar, R., Samal, S., et al. (2024) · European Journal of Immunology · doi:10.1002/eji.202350624 · Cited by 14
Verma, S. K., Ana‐Sosa‐Batiz, F., Timis, J., Shafee, N., Maule, E., Pinto, P. B. A., Conner, C., Valentine, K. M., Cowley, D. O., Miller, R., et al. (2024) · EBioMedicine · doi:10.1016/j.ebiom.2024.105361 · Cited by 15
Mendes, S., Guimarães, L. C., Costa, P. A. C., Fernandéz, C. C., Figueiredo, M. M., Teixeira, M. M., Santos, R. A. S., Guimarães, P. P. G., & Frézard, F. (2024) · Antimicrobial Agents and Chemotherapy · doi:10.1128/aac.00835-24 · Cited by 12
“K18-hACE2 mice infected with SARS-CoV-2 were used as a preclinical model of COVID-19, as described previously (29, 30).”
SIRT2 suppresses aging-associated cGAS activation and protects aged mice from severe COVID-19
Barthez, M., Xue, B., Zheng, J., Wang, Y., Song, Z., Mu, W., Wang, C.-L., Guo, J., Yang, F., Ma, Y., et al. (2025) · Cell Reports · doi:10.1016/j.celrep.2025.115562 · Cited by 14
Fc-Independent Protection from SARS-CoV-2 Infection by Recombinant Human Monoclonal Antibodies
Noy-Porat, T., Edri, A., Alcalay, R., Makdasi, E., Gur, D., Aftalion, M., Evgy, Y., Beth-Din, A., Levy, Y., Epstein, E., et al. (2021) · Antibodies · doi:10.3390/antib10040045 · Cited by 10
“It was previously shown that SARS-CoV-2 infection of K18-hACE2 mice manifests as progressive and widespread viral pneumonia with perivascular and pan-alveolar inflammation, immune cell infiltration, edema, lung consolidation and distinctive vascular system injury that were apparent even three weeks after infection (in…”
BackgroundCOVID-19 and cancer: start the resolution!
Barksdale, C., Kipper, F. C., Tripathy, S., Subbian, S., Serhan, C. N., & Panigrahy, D. (2022) · Cancer and Metastasis Reviews · doi:10.1007/s10555-021-10017-z · Cited by 14
Hingankar, N. K., Deshpande, S., Das, P., Rizvi, Z. A., Wibmer, C. K., Mashilo, P., Ansari, M. Y., Burns, A., Barman, S., Zhao, F., et al. (2022) · PLoS Pathogens · doi:10.1371/journal.ppat.1010465 · Cited by 14
Animal Models to Test SARS-CoV-2 Vaccines: Which Ones Are in Use and Future Expectations
Lima, G. G., Portilho, A. I., & Gaspari, E. D. (2022) · Pathogens · doi:10.3390/pathogens12010020 · Cited by 13
Tada, T., Dcosta, B. M., Zhou, H., & Landau, N. R. (2023) · iScience · doi:10.1016/j.isci.2023.106092 · Cited by 9
Rodriguez-Rodriguez, B. A., Ciabattoni, G. O., Duerr, R., Valero-Jimenez, A. M., Yeung, S. T., Crosse, K. M., Schinlever, A. R., Bernard, L., Galvan, J. R., McGrath, M. E., et al. (2023) · Nature Communications · doi:10.1038/s41467-023-38783-0 · Cited by 12
“Another limitation of our model is that the expression of the hACE2 transgene is driven by a non-native K18 promoter,allowingtheinfectionofmultipleorgans,andresultingintissue expression levels that are distinct from endogenously expressed murine Ace2 49,50 .”
Experimental Models for SARS-CoV-2 Infection
Kim, T., Lee, J. S., & Ju, Y. S. (2021) · Molecules and Cells · doi:10.14348/molcells.2021.0094 · Cited by 13
Qin, S., Li, R., Zheng, Z., Zeng, X., Wang, Y., & Wang, X. (2022) · Journal of Medical Virology · doi:10.1002/jmv.27718 · Cited by 11
Stebbings, R., Jones, C. R., Cotton, P., Armour, G., Maguire, S., Skellett, V., Tang, C.-M., Goodman, J., Brady, T. M., Takahashi, V., et al. (2022) · Frontiers in Immunology · doi:10.3389/fimmu.2022.836492 · Cited by 12
Meyer, M., Wang, Y., Edwards, D. K., Smith, G. R., Rubenstein, A. B., Ramanathan, P., Mire, C. E., Pietzsch, C. A., Chen, X., Ge, Y., et al. (2021) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.1101/2021.01.25.428136 · Cited by 12
Neuroinvasion and neurotropism by SARS-CoV-2 variants in the K18-hACE2 mousePreprint
Seehusen, F., Clark, J. J., Sharma, P., Bentley, E. G., Kirby, A., Subramaniam, K. S., Wunderlin, S., Hughes, G. L., Patterson, E. I., Michael, B. D., et al. (2021) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.1101/2021.04.16.440173 · Cited by 12
Evolutionary pathways to SARS-CoV-2 resistance are opened and closed by epistasis acting on ACE2
Castiglione, G. M., Zhou, L., Xu, Z., Neiman, Z. M., Hung, C., & Duh, E. J. (2021) · PLoS Biology · doi:10.1371/journal.pbio.3001510 · Cited by 9
SARS-CoV-2 bivalent mRNA vaccine with broad protection against variants of concern
Ma, Q., Li, M., Ma, L., Zhang, C., Zhang, H., Zhong, H., Wen, J., Wang, Y., Yan, Z., Xiong, W., et al. (2023) · Frontiers in Immunology · doi:10.3389/fimmu.2023.1195299 · Cited by 11
“To compare the protective effect of RBMRNA-405 with monovalent RBMRNA-404, groups of 6- to 9-week-old K18hACE2 transgenic mice (n = 5 per group) (41) were immunized with 5 or 20 mg of RBMRNA-405 or RBMRNA-404 via intramuscular inject ions and boosted with ident ica l immunizations 3 weeks later.”
MethodCsöbönyeiová, M., Smolinská, V., Harsányi, Š., Ivantysyn, M., & Klein, M. (2023) · Biomedicines · doi:10.3390/biomedicines11061736 · Cited by 11
“Exosomes can enhance drug stability, bioavailability, and targeted delivery, potentially improving their efficacy and reducing side effects [162,163].”
BackgroundChoi, C., Gadhave, K., Villano, J., Pekosz, A. S., Mao, X., & Jia, H. (2024) · Journal of Medical Virology · doi:10.1002/jmv.29349 · Cited by 14
“6,49 Consistent with these studies, our research observed significant infiltration of various immune cells, including B cells, T cells, dendritic cells, neutrophils, and macrophages, into the lungs at 3 dpi.”
Kwon, D.-I., Park, S., Jeong, Y. L., Kim, Y., Min, J., Lee, C., Choi, J.-A., Choi, Y. H., Kong, H.-J., Choi, Y., et al. (2024) · Cell Reports Medicine · doi:10.1016/j.xcrm.2023.101362 · Cited by 12
Next-generation nanovaccine induces durable immunity and protects against SARS-CoV-2
Ross, K. A., Kelly, S. M., Phadke, K. S., Peroutka‐Bigus, N., Fasina, O. O., Siddoway, A. C., Mallapragada, S. K., Wannemuehler, M. J., Bellaire, B. H., & Narasimhan, B. (2024) · Acta Biomaterialia · doi:10.1016/j.actbio.2024.05.048 · Cited by 11
Upregulation of inflammatory genes and pathways links obesity to severe COVID-19
Currey, J. M., Ellsworth, C. R., Khatun, M. S., Wang, C., Chen, Z., Liu, S., Midkiff, C. C., Xiao, M. T., Ren, M., Liu, F., et al. (2024) · Biochimica et Biophysica Acta (BBA) - Molecular Basis of Disease · doi:10.1016/j.bbadis.2024.167322 · Cited by 12
Metadata
- Authors
- Winkler, E. S., Bailey, A. L., Kafai, N. M., Nair, S., McCune, B. T., Yu, J., Fox, J. M., Chen, R. E., Earnest, J. T., Keeler, S. P., Ritter, J. H., Kang, L.-I., Dort, S., Robichaud, A., Head, R., Holtzman, M. J., & Diamond, M. S.
- Affiliations
- Washington University in St. Louis (US)
- Corresponding author
- Diamond, Michael S.
- ORCID
- Venue
- Nature Immunology
- Published
- 2020-08-24
- Volume
- 21
- Issue
- 11
- Pages
- 1327-1335
- ISSN
- 1529-2908 (ISSN-L)
- 1529-2916
- PMC
- PMC7578095
- OpenAlex
- W3080378920
- Cited by
- 901
- References
- 56
- Citations by year
- 2026: 55 · 2025: 72 · 2024: 124 · 2023: 131 · 2022: 234 · 2021: 252 · 2020: 32
- FWCI
- 21.20
- Type
- journal article
- Language
- en
- Update notices
- correction (2020-09-02)
- Open access
- bronze
- doi.org
- Locations
- Nature Immunology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- U.S. Department of Health & Human Services | NIH | National Institute of Allergy and Infectious Diseases (75N93019C00062, R01 AI127828, R01 AI130591, R35 HL145242, F32 AI138392)
- United States Department of Defense | Defense Advanced Research Projects Agency (HR001117S0019)
- Topics
- Health Sciences › Medicine › Infectious Diseases › SARS-CoV-2 and COVID-19 Research
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Life Sciences › Immunology and Microbiology › Immunology › interferon and immune responses
- Keywords
- SARS-CoV-2, COVID-19 pandemic, K18-hACE2 mice, animal model of COVID-19, lung inflammation, lung function decline, monocytes, neutrophils, T cell activation, innate immune response, interferon signaling, NF-κB signaling
- MeSH terms
- Betacoronavirus, Angiotensin-Converting Enzyme 2, COVID-19, SARS-CoV-2, Animals, Chlorocebus aethiops, Disease Models, Animal, Female, Humans, Immunity, Innate, Interferon Type I, Interferon-gamma, Peptidyl-Dipeptidase A, Leukocytes, Lymphocyte Activation, Male, Mice, Transgenic, Monocytes, Neutrophils, Pneumonia, Pneumonia, Viral, Promoter Regions, Genetic, T-Lymphocytes, Vero Cells, Virus Replication, NF-kappa B, Coronavirus Infections, Neutrophil Infiltration, Mice, Keratin-18, Pandemics
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