SARS-CoV-2 infection induces EMT-like molecular changes, including ZEB1-mediated repression of the viral receptor ACE2, in lung cancer models

Stewart, C. Allison; Gay, Carl M.; Ramkumar, Kavya; Cargill, Kasey R.; Cardnell, Robert J.; Nilsson, Monique B.; Heeke, Simon; Park, Elizabeth M.; Kundu, Samrat T.; Diao, Lixia; Wang, Qi; Shen, Li; Xi, Yuanxin; Maria Della Corte, Carminia; Fan, Youhong; Kundu, Kiran; Pickering, Curtis R.; Johnson, Faye M.; Zhang, Jianjun; Kadara, Humam; Minna, John D.; Gibbons, Don L.; Wang, Jing; Heymach, John V.; Byers, Lauren Averett

COVID-19 is an infectious disease caused by SARS-CoV-2, which enters host cells via the cell surface proteins ACE2 and TMPRSS2. Using normal and malignant models and tissues from the aerodigestive and respiratory tracts, we investigated the expression and regulation of ACE2 and TMPRSS2. We find that ACE2 expression is restricted to a select population of highly epithelial cells and is repressed by ZEB1, in concert with ZEB1’s established role in promoting epithelial to mesenchymal transition (EMT). Notably, infection of lung cancer cells with SARS-CoV-2 induces metabolic and transcriptional changes consistent with EMT, including upregulation of ZEB1 and AXL, thereby downregulating ACE2 post-infection. This suggests a novel model of SARS-CoV-2 pathogenesis in which infected cells shift toward an increasingly mesenchymal state and lose ACE2 expression, along with its acute respiratory distress syndrome-protective effect, in a ZEB1-dependent manner. AXL-inhibition and ZEB1-reduction, as with bemcentinib, offers a potential strategy to reverse this effect.