Can GPR4 Be a Potential Therapeutic Target for COVID-19?

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Can GPR4 Be a Potential Therapeutic Target for COVID-19? HYPOTHESIS AND THEORY published: 21 January 2021 doi: 10.3389/fmed.2020.626796 Can GPR4 Be a Potential Therapeutic Target for COVID-19? Li V. Yang 1,2*, Karen A. Oppelt 3, Mary Jane Thomassen 1, Mona A. Marie 1, Shayan Nik Akhtar 2 and Justin D. McCallen 1 1 Department of Internal Medicine, Brody School of Medicine, East Carolina University, Greenville, NC, United States, 2 Department of Anatomy and Cell Biology, Brody School of Medicine, East Carolina University, Greenville, NC, United States, 3 Department of Comparative Medicine, Brody School of Medicine, East Carolina University, Greenville, NC, United States Coronavirus disease 19 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), first emerged in late 2019 and has since rapidly become a global pandemic. SARS-CoV-2 infection causes damages to the lung and other organs. The clinical manifestations of COVID-19 range widely from asymptomatic infection, mild respiratory illness to severe pneumonia with respiratory failure and death. Autopsy studies demonstrate that diffuse alveolar damage, inflammatory cell infiltration, edema, proteinaceous exudates, and vascular thromboembolism in the Edited by: Zisis Kozlakidis, lung as well as extrapulmonary injuries in other organs represent key pathological International Agency for Research on findings. Herein, we hypothesize that GPR4 plays an integral role in COVID-19 Cancer (IARC), France pathophysiology and is a potential therapeutic target for the treatment of COVID-19. Reviewed by: GPR4 is a pro-inflammatory G protein-coupled receptor (GPCR) highly expressed in Sujit Pujhari, University of South Carolina, vascular endothelial cells and serves as a “gatekeeper” to regulate endothelium-blood United States cell interaction and leukocyte infiltration. GPR4 also regulates vascular permeability Johnatas Dutra Silva, Queen’s University Belfast, and tissue edema under inflammatory conditions. Therefore, we hypothesize that United Kingdom GPR4 antagonism can potentially be exploited to mitigate the hyper-inflammatory *Correspondence: response, vessel hyper-permeability, pulmonary edema, exudate formation, vascular Li V. Yang thromboembolism and tissue injury associated with COVID-19. [email protected] Keywords: COVID-19, GPR4, inflammation, endothelial cell, vascular permeability, thromboembolism Specialty section: This article was submitted to Infectious Diseases - Surveillance, INTRODUCTION Prevention and Treatment, a section of the journal COVID-19 first emerged in Wuhan, China in December 2019 and has rapidly become a global Frontiers in Medicine pandemic with confirmed cases in more than 200 countries and regions. By November 5, 2020, Received: 06 November 2020 nearly 48 million confirmed cases and over 1.2 million deaths have been reported around the world Accepted: 30 December 2020 (1). The pandemic is continuing to spread and more confirmed cases and COVID-related deaths are Published: 21 January 2021 reported every day. In addition to the staggering number of human casualties and as a global effort Citation: to stop the pandemic, social distancing, stay-at-home orders, and closure of schools and businesses Yang LV, Oppelt KA, Thomassen MJ, have caused enormous societal burdens and economic losses. Development of effective vaccines and Marie MA, Nik Akhtar S and McCallen JD (2021) Can GPR4 Be a therapeutics is critical to curb the pandemic and save the lives of patients afflicted by COVID-19. Potential Therapeutic Target for For COVID-19 patients, disease severities span from asymptomatic infection, mild respiratory COVID-19? Front. Med. 7:626796. illness to severe pneumonia with respiratory failure and death(2–4). In a study of 44,415 cases in doi: 10.3389/fmed.2020.626796 China, 81% of patients had mild symptoms, 14% had severe symptoms and 5% had critical disease Frontiers in Medicine | www.frontiersin.org 1 January 2021 | Volume 7 | Article 626796 Yang et al. Role of GPR4 in COVID-19 manifestations (5). The worldwide mortality rate in inflamed tissues due to hypoxia and glycolytic cell metabolism is approximately 2.5% among the confirmed cases (27, 28). Importantly, genetic and pharmacological inhibition (1,221,781/47,930,397 as of November 5, 2020) (1), with of GPR4 alleviates inflammatory responses, reduces leukocyte a higher mortality rate in elderly patients and those with infiltration, and decreases tissue edema in several animal models underlying conditions such as hypertension, diabetes, and of inflammatory disorders including arthritis, inflammatory cardiovascular disease. bowel disease, chronic obstructive pulmonary disease (COPD), The pathophysiology of COVID-19 is not completely and ischemic diseases (14, 15, 17–20, 29). Many of the GPR4- understood. SARS-CoV-2 infects a wide range of cells, including regulated inflammatory processes described above share cardinal type II pneumocytes, vascular endothelial cells, pericytes, pathological features observed in COVID-19 patients (7–9). macrophages, T cells, cardiomyocytes, enterocytes, kidney Therefore, we hypothesize that GPR4 plays a role in COVID-19 epithelial cells and podocytes, all of which express the SARS- pathophysiology and GPR4 antagonism is a potential therapeutic CoV-2 receptor ACE2 (angiotensin converting enzyme 2) (4, approach to mitigate COVID-19 complications. 6). Airway epithelial cells infected by SARS-CoV-2 trigger an inflammatory response, with production of increased levels of cytokines and chemokines that stimulate the infiltration EVALUATION OF THE HYPOTHESIS of neutrophils, monocytes, and lymphocytes into the lung and other target organs (4, 6). Autopsy studies of patients Does GPR4 Play a Role in the succumbing to COVID-19 have revealed some key pathological Pathophysiology of COVID-19? findings, such as diffuse alveolar damage, inflammatory cell Pathophysiology of Inflammatory Responses in infiltration, pulmonary edema, proteinaceous exudates, and COVID-19 vascular thromboembolism in the lung, which potentially COVID-19 is caused by the infection of SARS-CoV-2, a novel contribute to disease severity, acute respiratory distress syndrome β-coronavirus sharing ∼88% and ∼80% sequence homology (ARDS) and respiratory failure in the patients (7–9). In addition with the bat derived SARS-like coronaviruses and SARS-CoV, to lung injuries, COVID-19 complications also include impaired respectively (30). Similar to SARS-CoV, the spike glycoprotein function of the liver, kidney, heart, brain, and coagulation system (S protein) of SARS-CoV-2 binds to cell surface ACE2 receptors (4, 6, 10). to gain entry into cells (4, 6). In the early stage of disease, SARS-CoV-2 targets the respiratory system, infecting nasal and bronchial epithelial cells and lung pneumocytes and stimulating HYPOTHESIS inflammatory responses in these cells. Consequently, the infected cells produce increased levels of cytokines and chemokines, such We propose that GPR4 is involved in COVID-19 as interleukin-6 (IL-6), IL-1, TNF-α, CXCL10 (IP-10), CCL2 pathophysiology and can be exploited as a potential therapeutic (MCP-1), and CCL3 (MIP-1α). The cytokines and chemokines, target for COVID-19. GPR4 is a pro-inflammatory GPCR in turn, induce massive infiltration of leukocytes into the lung. that regulates endothelial cell adhesion, leukocyte infiltration, The accumulation of neutrophils, monocytes, and macrophages blood vessel permeability, and angiogenesis (11–20). GPR4 in the lung further increases the production of cytokines is expressed in various tissues, with high expression in the and chemokines, generating a vicious cycle of inflammation. lung, heart, and kidney (21, 22). The cell types predominantly Excessive production of cytokines can lead to “cytokine storm,” expressing GPR4 are vascular endothelial cells and GPR4 gene acute respiratory distress syndrome (ARDS), tissue injury, multi- expression is also found in other cell types such as neurons, organ failure, and death in critically ill COVID-19 patients (4, 6). kidney epithelial cells, osteoblasts, and chondrocytes (12, 14, 23– Besides airway epithelial cells, SARS-CoV-2 also infects many 26). Biochemically, GPR4 can be activated by extracellular other types of cells expressing the ACE2 receptor, such as vascular protons (acidosis), with acidotic conditions commonly existing endothelial cells and pericytes (4, 6, 10). SARS-CoV-2 infection of lung microvascular endothelial cells aggravates the inflammatory Abbreviations: ACE2, angiotensin converting enzyme 2; ARDS, acute respiratory response. Endothelial cells function as a physiological interface distress syndrome; ATF3, activating transcription factor 3; CCL2 (MCP-1), to interact with leukocytes and platelets. Pulmonary endothelial C-C motif chemokine ligand 2 (monocyte chemoattractant protein-1); CCL3 (MIP-1α), C-C motif chemokine ligand 3 (macrophage inflammatory protein- and epithelial barriers are critical for the regulation of gas 1α); CHOP, C/EBP homologous protein; COPD, chronic obstructive pulmonary exchange and immune cell recruitment in the lung. SARS- disease; COVID-19, coronavirus disease 19; COX2, cyclooxygenase-2; CXCL10 CoV-2 infection of alveolar epithelial cells and pulmonary (IP-10), C-X-C motif chemokine ligand 10 (interferon gamma-induced protein endothelial cells can cause cell death and stimulate inflammatory 10); DSS, dextran sulfate sodium; ER, endoplasmic reticulum; FDA, Food and responses. Consequently, disruption of pulmonary endothelial Drug Administration; GPCR, G protein-coupled receptor; GPR4, G protein- coupled receptor 4; IBD, inflammatory bowel disease;
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