Alteration of metabolite landscape in hypoxia replicates immune cell programs indicative of dysfunctional immunity in severe COVID-19

Abstract Our prior work has demonstrated that altered metabolic programs in T cells define dysregulated immunity in acute SARS-CoV-2 infection. Apoptotic T cells were defined by high expression of the mitochondrial membrane protein voltage-dependent anion channel 1 (VDAC1). These cells were markedly increased in elderly patients and correlated with lymphopenia. We devised in vitro systems in healthy T cells to investigate the mechanism driving this unique phenotype. While SARS-CoV-2 did not directly induce this T cell phenotype, factors that enhanced the development of VDAC1+ T cells, including hypoxia, advanced age of healthy T cell donor, and COVID-19 patient-derived plasma. Analysis of patient-derived plasma revealed robust differences in cytokine and metabolomic profiles between people who did or did not exhibit apoptotic T cells. Increased flux through the tryptophan:kynurenin pathway has been suggested as a biomarker of severe COVID-19 and was further enhanced in individuals with apoptotic T cells. Kynurenine directly induced VDAC1+ T cells in a dose dependent manner in vitro. Together, our work indicates metabolic alterations combined with cellular age and hypoxia may induce apoptosis of T cells following SARS-CoV-2 infection. This work highlights mechanisms leading to cellular alterations following infection and highlights key aspects of the host environment that could be targeted therapeutically. U54CA260492