Exploring Epigenetic Modulators as a Promising Therapeutic Avenue for Unresolved Pathogenic and Clinical Aspects of SARS-CoV-2 Infection


The emergence of SARS-CoV-2, the virus responsible for the COVID-19 pandemic, marked a significant moment in global health history. Initially identified in Wuhan, China, towards the end of 2019, this novel coronavirus rapidly evolved into a pandemic, leading to a substantial death toll worldwide.

The range of clinical manifestations of SARS-CoV-2 is broad, spanning from asymptomatic infections to severe conditions like pneumonia, acute respiratory distress syndrome (ARDS), and multiple organ failure. This wide spectrum of clinical presentations has necessitated the exploration of various therapeutic options.

A critical aspect of SARS-CoV-2 infection is its initial interaction with the host, primarily occurring in the epithelial cells of the upper respiratory tract and lungs. In the lungs, alveolar type I and type II cells, along with alveolar macrophages, play a pivotal role in both the infection process and the amplification of the inflammatory and immune responses. Furthermore, SARS-CoV-2 has the potential to spread to other organs, which might act as viral reservoirs, though the biological implications of this are still under investigation.

The entry of SARS-CoV-2 into host cells is facilitated primarily by the engagement of the angiotensin-converting enzyme 2 (ACE2) receptor. This receptor is not only expressed in the lungs but also in other critical organs like the heart and kidneys, potentially explaining the multi-organ impact of the virus. Additionally, the transmembrane protease serine 2 (TMPRSS2) is crucial for priming the virus’s spike protein, enabling it to fuse with the host cell membrane. Other receptors like ADAM17 and NRP1 have also been identified as facilitators of SARS-CoV-2 entry and infectivity.

Interestingly, research has shown that pleura mesothelial cells express both ACE2 and TMPRSS2 receptors. Infection of these cells by SARS-CoV-2 results in the production of a wide array of immune response elements, including interferons and cytokines. This response plays a significant role in the body’s defense against the virus and may also contribute to the remodeling of the extracellular matrix and immunomodulation.

Another aspect of the virus’s impact on the host is its influence on epigenetic regulation, specifically the acetylation and deacetylation of histone proteins. This process is crucial for regulating gene expression in eukaryotic cells. Histone acetyltransferases (HATs) and histone deacetylases (HDACs) are the primary enzymes involved in this regulation. The balance between these two enzyme families is crucial, and their inhibition has been a therapeutic approach in cancer and is being explored in the context of viral diseases, including COVID-19.

The study of class I and class IIb HDAC inhibitors in the context of SARS-CoV-2 infection, particularly their role in modulating ACE2 and TMPRSS2 expression, is an area of emerging interest. For instance, MS-275, a pharmacological inhibitor of HDAC1-3, has been found to significantly increase SARS-CoV-2 replication and productive infection by inducing the expression of ACE2 and TMPRSS2. These findings highlight the complexity of the virus-host interaction and underscore the potential for epigenetic modulation in managing COVID-19.

The ongoing research into SARS-CoV-2 and its interactions with the host at both the cellular and molecular levels continues to provide vital insights. These insights are not only crucial for understanding the pathophysiology of COVID-19 but also for developing effective therapeutic strategies to combat this and potentially future pandemics.

Building on the foundational understanding of SARS-CoV-2’s interactions with host cells, researchers have delved deeper into the virus’s mechanisms of infection and replication, as well as the host’s immune response. The focus on ACE2 and TMPRSS2 as key facilitators of viral entry has opened new avenues for potential therapeutic interventions. Moreover, the involvement of other receptors and the possibility of ACE2-independent pathways for infection, particularly in T lymphocytes, suggests a more complex virus-host interaction than initially understood.

The discovery of SARS-CoV-2’s ability to infect pleura mesothelial cells and its subsequent impact on cytokine production and extracellular matrix remodeling has significant implications. This interaction hints at a more systemic involvement of the virus, beyond the primary respiratory symptoms. The role of mesothelial cells in the immune response and ECM remodeling emphasizes the multi-faceted nature of SARS-CoV-2 infection and its widespread impact on various bodily systems.

The exploration of epigenetic mechanisms, particularly the role of histone acetylation and deacetylation, in the regulation of gene expression related to SARS-CoV-2 infection is a groundbreaking area of study. The potential of HDAC inhibitors, both pan-HDAC and isoform-specific, in modulating the viral life cycle offers a novel approach to therapy. The impact of these inhibitors on SARS-CoV-2 biology and their proposed repurposing for COVID-19 treatment is a testament to the innovative strategies being explored in response to the pandemic.

Furthermore, the study of HDAC inhibitors in the context of SARS-CoV-2 infection highlights the importance of understanding virus-host interactions at a molecular level. The finding that MS-275, an HDAC1-3 inhibitor, can influence SARS-CoV-2 replication by affecting ACE2 and TMPRSS2 expression underscores the potential of targeted epigenetic therapies. However, the precise mechanisms by which HDAC inhibition affects these processes and the broader implications for virus-host dynamics remain areas of active research.

As the global scientific community continues to unravel the complexities of SARS-CoV-2 and its impact on human health, the insights gained extend beyond the immediate context of the COVID-19 pandemic. The lessons learned about viral pathogenesis, host defense mechanisms, and therapeutic strategies will undoubtedly influence future research and response strategies for emerging infectious diseases. The ongoing investigation into the multifaceted nature of SARS-CoV-2 infection and the body’s response not only provides immediate benefits in managing the current crisis but also equips the medical and scientific communities with knowledge and tools to better tackle future challenges in global health.


The discussion section of this study delves into several important findings and implications regarding the role of HDAC1-3 inhibitors in the context of SARS-CoV-2 infection. Here, we will provide a detailed analysis of the key points discussed in the text:

  • Effect of HDAC1-3 Inhibition on SARS-CoV-2 Replication: The study uncovers a previously unrecognized effect of pharmacological inhibition of HDAC1-3, which appears to promote SARS-CoV-2 replication and virion production in macrophages (MCs). This effect is observed alongside increased ACE2 and TMPRSS2 gene expression and enhanced histone acetylation on their respective promoters.
  • Epigenetic Modulation of SARS-CoV-2 Pathogenesis: The discussion emphasizes the role of epigenetics in modulating various aspects of SARS-CoV-2 pathogenesis, including virus-cell interactions, cell spreading, and the development of inflammatory and immune responses. The study particularly focuses on the regulation of ACE2 and TMPRSS2 expression, given their significance in the viral entry process.
  • Significance of ACE2 Expression: ACE2 is identified as a crucial factor in SARS-CoV-2 infection, as it facilitates viral entry into respiratory airways. The study highlights the relationship between ACE2 expression and the severity of COVID-19, as well as the potential therapeutic value of human recombinant soluble ACE2 (hrsACE2) in blocking viral infection.
  • Effect of HDAC Inhibitors on ACE2 and TMPRSS2 Expression: Prior research on HDAC inhibitors and ACE2 expression is discussed, noting that different inhibitors have yielded variable effects. Notably, MS-275 and MGCD0103, selective HDAC1-3 inhibitors, appear to enhance ACE2 and TMPRSS2 expression. This effect is further validated by genetic silencing of HDAC1 and HDAC2, highlighting their role in this modulation.
  • HDAC3’s Additive Role: The study suggests that HDAC3 inhibition may play an additive role in increasing ACE2 and TMPRSS2 expression, as observed with the HDAC3-selective inhibitor MC4448.
  • Epigenetic Regulation at Promoters: The study delves into the epigenetic regulation of ACE2 and TMPRSS2 promoters. MS-275 treatment is found to significantly increase histone H3 and H4 acetylation at these promoters, which generally enhances transcriptional activity.
  • Differential Effects in Different Cell Lines: The research extends its findings to Calu-3 cells, a human lung epithelial cell line, which exhibits increased ACE2 and TMPRSS2 expression upon MS275 treatment. However, the effect is not as pronounced as in MeT5A cells, possibly due to differences in basal receptor expression levels.
  • Other Epigenetic Modulators: Besides HDACs, the study acknowledges the role of other epigenetic modulators in regulating ACE2 expression, including DNA methylation patterns and histone methylation.
  • Multiple Impact of HDAC Inhibitors: Beyond ACE2 regulation, HDAC inhibitors are recognized for their potential impact on SARS-CoV-2 infectivity and viral replication, involving mechanisms such as inhibition of endocytosis and modulation of inflammatory cytokine production.
  • Immunomodulatory Effects: Class I HDAC inhibitors like MS-275 have been associated with immunomodulatory effects, including the activation of CD8 T cells. These effects may have relevance in COVID-19 treatment and managing complications like lung fibrosis.
  • Clinical Implications: The study raises concerns about the use of selective HDAC1-3 inhibitors, particularly MS-275, in patients with SARS-CoV-2 infection. The increased expression of ACE2 and TMPRSS2, potentially facilitating viral spread, is discussed in the context of ongoing treatments and safety concerns for immunocompromised patients.
  • Limitations and Future Directions: The discussion could further address any limitations of the study, potential directions for future research, and the broader implications of these findings in the context of antiviral therapy and COVID-19 management.

In summary, this discussion section provides a comprehensive analysis of the study’s findings regarding HDAC1-3 inhibitors and their impact on SARS-CoV-2 replication and ACE2/TMPRSS2 expression, shedding light on the complex interplay between epigenetics and viral pathogenesis. It underscores the importance of considering the potential risks and benefits of using such inhibitors in the treatment of COVID-19.

reference link : https://www.frontiersin.org/articles/10.3389/fcimb.2023.1257683/full#h5


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