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Notch4 signaling limits regulatory T-cell-mediated tissue repair and promotes severe lung inflammation in viral infections #MMPMID33915108
Harb H; Benamar M; Lai PS; Contini P; Griffith JW; Crestani E; Schmitz-Abe K; Chen Q; Fong J; Marri L; Filaci G; Del Zotto G; Pishesha N; Kolifrath S; Broggi A; Ghosh S; Gelmez MY; Oktelik FB; Cetin EA; Kiykim A; Kose M; Wang Z; Cui Y; Yu XG; Li JZ; Berra L; Stephen-Victor E; Charbonnier LM; Zanoni I; Ploegh H; Deniz G; De Palma R; Chatila TA
Immunity 2021[Jun]; 54 (6): 1186-1199.e7 PMID33915108show ga
A cardinal feature of COVID-19 is lung inflammation and respiratory failure. In a prospective multi-country cohort of COVID-19 patients, we found that increased Notch4 expression on circulating regulatory T (Treg) cells was associated with disease severity, predicted mortality, and declined upon recovery. Deletion of Notch4 in Treg cells or therapy with anti-Notch4 antibodies in conventional and humanized mice normalized the dysregulated innate immunity and rescued disease morbidity and mortality induced by a synthetic analog of viral RNA or by influenza H1N1 virus. Mechanistically, Notch4 suppressed the induction by interleukin-18 of amphiregulin, a cytokine necessary for tissue repair. Protection by Notch4 inhibition was recapitulated by therapy with Amphiregulin and, reciprocally, abrogated by its antagonism. Amphiregulin declined in COVID-19 subjects as a function of disease severity and Notch4 expression. Thus, Notch4 expression on Treg cells dynamically restrains amphiregulin-dependent tissue repair to promote severe lung inflammation, with therapeutic implications for COVID-19 and related infections.