Pulmonary infection by SARS-CoV-2 induces senescence accompanied by an inflammatory phenotype in severe COVID-19: possible implications for viral mutagenesis
Open accessAbstract
Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection of the respiratory system can progress to a multisystemic disease with aberrant inflammatory response. Cellular senescence promotes chronic inflammation, named senescence-associated secretory phenotype (SASP). We investigated whether coronavirus disease 2019 (COVID-19) is associated with cellular senescence and SASP. Methods: Autopsy lung tissue samples from 11 COVID-19 patients and 43 age-matched non-COVID-19 controls with similar comorbidities were analysed by immunohistochemistry for SARS-CoV-2, markers of senescence and key SASP cytokines. Virally induced senescence was functionally recapitulated in vitro , by infecting epithelial Vero-E6 cells and a three-dimensional alveosphere system of alveolar type 2 (AT2) cells with SARS-CoV-2 strains isolated from COVID-19 patients. Results: SARS-CoV-2 was detected by immunocytochemistry and electron microscopy predominantly in AT2 cells. Infected AT2 cells expressed angiotensin-converting enzyme 2 and exhibited increased senescence (p16 INK4A and SenTraGor positivity) and interleukin (IL)-1β and IL-6 expression. In vitro , infection of Vero-E6 cells with SARS-CoV-2 induced senescence (SenTraGor), DNA damage (γ-H2AX) and increased cytokine (IL-1β, IL-6, CXCL8) and apolipoprotein B mRNA-editing (APOBEC) enzyme expression. Next-generation sequencing analysis of progenies obtained from infected/senescent Vero-E6 cells demonstrated APOBEC-mediated SARS-CoV-2 mutations. Dissemination of the SARS-CoV-2-infection and senescence was confirmed in extrapulmonary sites (kidney and liver) of a COVID-19 patient. Conclusions: We demonstrate that in severe COVID-19, AT2 cells infected by SARS-CoV-2 exhibit senescence and a proinflammatory phenotype. In vitro , SARS-CoV-2 infection induces senescence and inflammation. Importantly, infected senescent cells may act as a source of SARS-CoV-2 mutagenesis mediated by APOBEC enzymes. Therefore, SARS-CoV-2-induced senescence may be an important molecular mechanism of severe COVID-19, disease persistence and mutagenesis.
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SARS-CoV-2 directly induces senescence in vitro in Vero kidney cells, shown by increased lipofuscin, SASP factors, γH2A.X, and loss of Ki67.
“The direct induction of senescence through infection with SARS-CoV-2 was demonstrated in vitro with a SARS-CoV-2-susceptible kidney cell line (Vero) as detected by an increase in lipofuscin (Box 1), the secretion of SASP factors, including IL-1β, IL-6 and IL-8, and the DNA damage mark γH2A.X, as well as a loss of Ki67 expression44”
From COVID-19 and cellular senescence (2023) · cites this paper as [44]
Lung specimens from COVID-19 patients show much stronger signs of senescence than SARS-CoV-2 negative controls.
“Similar analyses of lung specimens from patients with COVID-19, consistent with multiple independent patient datasets29,44,52, also showed much stronger signs of senescence compared to SARS-CoV-2 negative controls28.”
From COVID-19 and cellular senescence (2023) · cites this paper as [44]
A panel of senescence markers distinguishes nasopharyngeal mucosa from COVID-19 patients versus pre-pandemic controls, with higher reactivity in COVID-19 samples.
“when comparing samples of nasopharyngeal mucosa from patients with COVID-19 to pre-pandemic biopsy samples from individuals without a manifest respiratory tract infection, a panel of senescence markers was shown to robustly discriminate these two groups, with significantly higher reactivity in samples from patients with COVID-19 (refs.28,29,44,52).”
From COVID-19 and cellular senescence (2023) · cites this paper as [44]
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Self-citationCOVID-19 lung disease shares driver AT2 cytopathic features with Idiopathic pulmonary fibrosis
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Treatment with the senolytics dasatinib/quercetin reduces SARS‐CoV ‐2‐related mortality in mice
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A GATA2-CDC6 axis modulates androgen receptor blockade-induced senescence in prostate cancer
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Immunological and regenerative properties of lung stem cells
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Self-citationCellular and molecular features of COVID-19 associated ARDS: therapeutic relevance
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Self-citationDecoding T cell senescence in cancer: Is revisiting required?
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Senotherapy for chronic lung disease
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Self-citationSenotherapeutics: An emerging approach to the treatment of viral infectious diseases in the elderly
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Blockade of endothelin receptors mitigates SARS-CoV-2-induced osteoarthritis
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Persistent alveolar type 2 dysfunction and lung structural derangement in post-acute COVID-19Preprint
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Virus‐Induced Cellular Senescence Causes Pulmonary Sequelae Post‐Influenza Infection
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Self-citationShould We Expect an Increase in the Number of Cancer Cases in People with Long COVID?
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Self-citationBulk and Single-Cell RNA Sequencing Elucidate the Etiology of Severe COVID-19
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Imaging Techniques: Essential Tools for the Study of SARS-CoV-2 Infection
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Alveolar epithelial cells of lung fibrosis patients are susceptible to severe virus-induced injury
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Loss of CFTR Reverses Senescence Hallmarks in SARS-CoV-2 Infected Bronchial Epithelial Cells
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Self-citationLinks between COVID-19, long COVID, and neurodegeneration: The role of glycosphingolipids
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Self-citationSenescence Signatures Predict Hospitalization Risk and Severity in COVID-19 Patients
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Self-citationMechanism and significance of cell senescence induced by viral infection
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Love in the Time of COVID: Psychiatric Outcomes Related to Oxytocin and the “Endocrine Organ”
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Madruga, M. P., Grün, L. K., Santos, L. S. M. D., Friedrich, F. O., Antunes, D. B., Rocha, M. E. F., Silva, P. L., Dorneles, G. P., Teixeira, P. C., Oliveira, T. F., et al. (2024) · Figshare · doi:10.6084/m9.figshare.25367524
de Gonzalo-Calvo, D., Molinero, M., Benitez, I. D., Perez‐Pons, M., García‐Mateo, N., Ortega, A., Postigo, T., García‐Hidalgo, M. C., Belmonte, T., Rodríguez‐Muñoz, C., et al. (2023) · Figshare · doi:10.6084/m9.figshare.23536167
de Gonzalo-Calvo, D., Molinero, M., Benitez, I. D., Perez‐Pons, M., García‐Mateo, N., Ortega, A., Postigo, T., García‐Hidalgo, M. C., Belmonte, T., Rodríguez‐Muñoz, C., et al. (2023) · Figshare · doi:10.6084/m9.figshare.23536164
Madruga, M. P., Grün, L. K., Santos, L. S. M. D., Friedrich, F. O., Antunes, D. B., Rocha, M. E. F., Silva, P. L., Dorneles, G. P., Teixeira, P. C., Oliveira, T. F., et al. (2024) · Figshare · doi:10.6084/m9.figshare.25367332
Madruga, M. P., Grün, L. K., Santos, L. S. M. D., Friedrich, F. O., Antunes, D. B., Rocha, M. E. F., Silva, P. L., Dorneles, G. P., Teixeira, P. C., Oliveira, T. F., et al. (2024) · Figshare · doi:10.6084/m9.figshare.26690674
Cellular sensor DAP5 decodes Betacoronaviral NSP5 to drive virus-induced senescence
Lu, Y. P., Xiao, J., Wang, J., Meng, Z. S., Fan, G., Zheng, J. H., Yu, Z., Wang, X., & Li, L. (2026) · Frontiers in Immunology · doi:10.3389/fimmu.2026.1768183
Kyryk, V. M., Ustymenko, A., Tsupykov, O., Skarzhevskyi, O. A., & Parkhomenko, A. N. (2026) · BioMed Research International · doi:10.1155/bmri/5553698
- Authors
- Evangelou, K., Veroutis, D., Paschalaki, K., Foukas, P. G., Lagopati, N., Dimitriou, M., Papaspyropoulos, A., Konda, B., Hazapis, O., Polyzou, A., Havaki, S., Kotsinas, A., Kittas, C., Tzioufas, A. G., de Leval, L., Vassilakos, D., Tsiodras, S., Stripp, B. R., Papantonis, A., Blandino, G., Karakasiliotis, I., Barnes, P. J., & Gorgoulis, V. G.
- Affiliations
- National and Kapodistrian University of Athens (GR)
- Imperial College London (GB)
- Democritus University of Thrace (GR)
- Cedars-Sinai Medical Center (US)
- University of Cologne (DE)
- Instituto Nazionale Tumori Regina Elena (IT)
- Corresponding author
- Gorgoulis, Vassilis G.
- ORCID
- Evangelou, Konstantinos
- Veroutis, Dimitris
- Paschalaki, Koralia
- Foukas, Periklis G.
- Dimitriou, Marios
- Papaspyropoulos, Angelos
- Konda, Bindu
- Havaki, Sophia
- Kotsinas, Athanassios
- Kittas, Christos
- Tzioufas, Athanasios G.
- Tsiodras, Sotirios
- Stripp, Barry R.
- Papantonis, Argyris
- Blandino, Giovanni
- Barnes, Peter J.
- Gorgoulis, Vassilis G.
- Venue
- European Respiratory Journal
- Publisher
- European Respiratory Society (ERS)
- Published
- 2022-01-27
- Volume
- 60
- Issue
- 2
- Pages
- 2102951
- ISSN
- 0903-1936 (ISSN-L)
- 1399-3003
- PMC
- PMC8796696
- OpenAlex
- W4210558603
- Cited by
- 98
- References
- 66
- Citations by year
- 2026: 9 · 2025: 17 · 2024: 21 · 2023: 31 · 2022: 20
- FWCI
- 11.23
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- European Respiratory Journal (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Kölner Universitäts PublikationsServer (Universität zu Köln) (publishedVersion)
- SERVAL (Université de Lausanne) (publishedVersion, cc-by)
- IRIS (submittedVersion, cc-by)
- Funders
- National Public Investment Program of the Ministry of Development and Investment / General Secretariat for Research and Technology, in the framework of the Flagship Initiative to address SARS-CoV-2 (2020ΣΕ01300001)
- H2020 Marie Skłodowska-Curie Actions (722729 (SYNTRAIN))
- Welfare Foundation for Social & Cultural Sciences, Athens, Greece
- Hellenic Foundation for Research and Innovation (3782, 70/3/8916, 775, NKUA-SARG grant)
- H. Pappas
- Topics
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Health Sciences › Medicine › Physiology › Telomeres, Telomerase, and Senescence
- Health Sciences › Medicine › Infectious Diseases › SARS-CoV-2 and COVID-19 Research
- Keywords
- SARS-CoV-2, COVID-19 pandemic, cellular senescence, senescence-associated secretory phenotype, alveolar type II cells, APOBEC mutagenesis, viral mutagenesis, APOBEC3G, APOBEC3F, interleukin-6, IL-1β, interleukin-8, p16INK4a, ACE2, lung tissue, extrapulmonary dissemination, chronic inflammation
- MeSH terms
- COVID-19, SARS-CoV-2, Humans, Inflammation, Lung, Phenotype, Interleukin-6, Cytokines, Mutagenesis, Cellular Senescence
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