ORIGINAL ARTICLES
SU Xiaoyue, LI Jingxuan, LIN Ying, ZHANG Yongxiang, XIAO Zhiyong, ZHOU Wenxia
OBJECTIVE To establish a mouse model of diabetes mellitus (DM) combined with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection to investigate the important pathophysiological changes in the development of DM combined with SARS-CoV-2 infection. METHODS Wild-type (WT) mice and transgenic mice expressing the human angiotensin-converting enzyme 2 receptor driven by the cytokeratin-18 gene promoter (K18-hACE2) were randomly divided into the control group, DM group, SARS-CoV-2 spike protein (S) infection group and DM combined with S protein
infection group, with 10 to 12 mice in each group. All the mice were induced by 10 weeks of high-fat diet combined with 40 mg·kg-1 streptozotocin (STZ) for 3 days by ip, except those in the control group or S protein infection group. The control group was given the same volume of 0.1 mol·L-1 sodium citrate buffer. Mice in the S protein infection group and DM+S protein infection group were additionally given 50 μL mixture of 15 μg SARS-CoV-2 spike protein and 1 g·L-1 polyinosinic-polycytidylic acid (poly[I:C]) via intranasal drops, while the control group was given an equal volume of sterile water. The glucose tolerance level and pancreatic islet β cell function of mice were evaluated via oral glucose tolerance test at the 6th week of high-fat feeding and 1 week after the administration of STZ by ip. From the 6th week of high-fat feeding to 2 weeks after the administration of STZ, the random blood glucose and fasting blood glucose of mice were measured by a blood glucose meter. Blood samples were taken from submandibular veins of 3 mice in each group at 24, 48 and 120 h after S protein infection, and lung tissues were taken after euthanization. The pathological changes of lungs of DM mice before and after S protein infection were observed by HE staining. Except for the DM group, blood samples were collected before S protein infection and at 6, 24, 48, 72 and 120 h after infection. The levels of plasma interleukin 1β (IL-1β), IL-2, IL-6, IL-10, IL-17, interferon gamma-induced protein 10 (IP-10), interferon γ (IFN-γ), tumor necrosis factor α (TNF-α), monocyte chemotactic protein-1 (MCP-1) and granulocyte-colony stimulating factor (G-CSF) were detected by Luminex. The plasma levels of heparan sulfate (HS) were measured by enzyme-linked immunosorbent assay. The levels of cytokines and HS were correlated with the degree of pathological damage by Spearman correlation analysis. RESULTS STZ and high-fat diet could induce DM-like expression in mice, and the random blood glucose (P<0.01) and fasting blood glucose (P<0.05) after 1 week in the hACE2-DM group were significantly higher than in the WT-DM group, and the degree of islet function damage in hACE2-DM mice was significantly higher than that of WT-DM mice (P<0.05). Compared with the DM group, the DM+S group showed more severe pulmonary pathological changes after S protein infection, accompanied by a large number of inflammatory infiltrations and thickening of lung interstitial. Compared with the control group, the levels of pro-inflammatory cytokines G-CSF, IL-6 and IP-10 in the plasma of the WT-S group were significantly increased at 6 h after S protein infection (P<0.01), and those of pro-inflammatory cytokine IL-17 and anti-inflammatory cytokine IL-10 were significantly increased at 24 h after S protein infection (P<0.05). Compared with the control group, the plasma levels of pro-inflammatory cytokines IL-1β, IL-6, TNF-α, MCP-1, G-CSF and IP-10 in the hACE2-S group were significantly increased at 6 h after S protein infection (P<0.05, P<0.01). IL-17 was significantly increased at 24 h and 6 h after S protein infection in the WT-DM+S group and hACE2-DM+S group, respectively (P<0.01, P<0.05). In the hACE2-DM+S group, IFN-γ and IL-1β were significantly increased in delay to 48 h (P<0.05, P<0.01), and MCP-1 was significantly increased in delay to 72 h (P<0.05). Compared with the control group, the level of HS in the plasma of the WT-S group increased significantly (P<0.05, P<0.01) at 6 h and 24 h after S protein infection, but began to decrease at 48 h. At the same time, compared with the WT-S group, the HS level in the WT-DM+S group was slightly increased at 6 h after infection and decreased at 24 h. Compared with the control group, the HS level in the hACE2-S group was significantly increased at 24 h (P<0.01), as was the case with the WT-S group 24 h, 48 h and 120 h after S protein infection. At 6 h, 24 h and 48 h after S protein infection, the plasma HS level of the hACE2-DM+S group was significantly increased (P<0.01, P<0.05), and the duration of the increase was longer than in the hACE2-S group. Moreover, the levels of IL-1β, IL-10, MCP-1, IP-10, G-CSF and HS in plasma were positively correlated with the degree of lung damage in the DM+S group. CONCLUSION In this study, the mouse model of diabetes combined with SARS-CoV-2 spike protein infection has mimicked part of the pathophysiological features of clinical patients, mainly manifested as blunted immune response and elevated HS levels with longer duration to infection alone. IL-1β, IL-10, MCP-1, IP-10, G-CSF and HS may keep track of the course of disease in patients with diabetes combined with SARS-CoV-2 infection.