Introduction
In September 2012, a novel human coronavirus, HCoV-EMC, was reported to health authorities from two cases of acute respiratory syndrome with renal failure (
1–4). The most recent update by the WHO identified a total of 17 confirmed cases of human infection, including 11 deaths, suggesting a mortality rate of ~65% (
5). All of these individuals had a history of recent travel to the Middle East. Identification of clusters of coronavirus cases indicates that HCoV-EMC can be transmitted from human to human (
6) and raises concern about a possible outbreak of this virus, similar to the one caused by a related virus, the severe acute respiratory syndrome-related coronavirus (SARS-CoV), in 2002–2003. SARS-CoV, originating in China, spread throughout Asia and to other continents and affected more than 8,000 people (
7,
8). The overall mortality during the outbreak was estimated at 9.6% (7). While the mortality rate of HCoV-EMC cannot be assessed with certainly, it could be more pathogenic than SARS-CoV.
HCoV-EMC belongs to the genus betacoronavirus, as does SARS-CoV. However, HCoV-EMC is more closely related to the bat coronaviruses HKU4 and HKU5 (lineage 2C) than it is to SARS-CoV (lineage 2B) (
2,
9). Less than 50% amino acid sequence identity is conserved in the replicase domains between SARS-CoV and HCoV-EMC. Another important difference between the two viruses is that they do not use the same host cell receptor for infection (
10). Indeed, it was clearly shown that human angiotensin-converting receptor 2 (hACE2), used by SARS-CoV, is not the HCoV-EMC receptor (
10). Dipeptidyl peptidase 4 was recently identified as the HCoV-EMC receptor (
11). This receptor is conserved among different species such as bats and humans, partially explaining the large host range of HCoV-EMC. This was somewhat surprising, as coronaviruses generally show strict host specificity.
While recent identification of the crystal structure of HCoV-EMC protease suggests that a wide-spectrum CoV protease inhibitor could block the catalytic site (
12), there is currently no proven antiviral treatment for HCoV-EMC. Viruses rely on host factors to replicate and often hijack cellular processes initiated in response to infection to ensure efficient replication (
13). Targeting cellular responses has been shown to inhibit viral replication (
13,
14). Furthermore, immunomodulatory drugs that reduce the excessive host inflammatory response to respiratory viruses, as seen with influenza virus infections, have therapeutic benefit (reviewed in reference 15). Several genome-based drug repurposing strategies successfully identified known drugs that could be reused to treat lung cancer, inflammatory bowel disease (
16), and influenza virus infection (
14). Such an approach has the advantage of accelerating treatment availability, which could be crucial in case of an outbreak of an emerging pathogen.
Overall, differences in viral sequences, host cell receptor, and host range indicate that HCoV-EMC and SARS-CoV may have distinct strategies for interacting with their hosts. This fact could impact treatment strategies. To begin to assess this question, we compared the host response of human cells to HCoV-EMC and SARS-CoV infection using global transcriptomic profiling. Our goal was to gain a rapid and comprehensive assessment of the host response to HCoV-EMC infection that could guide research on this emerging virus. Importantly, we used this information to computationally predict antiviral treatment and identified a broad down-regulation of the antigen presentation pathway that may be important in vivo for the development of an adaptive immune response.
DISCUSSION
HCoV-EMC was isolated from a patient who died from an acute respiratory disease similar to that caused by SARS-CoV. However, there are several indicators that the host responses to these two viruses may be significantly different. Several cases of HCoV-EMC infection have resulted in renal failure, which has rarely been observed in SARS-CoV infection. In addition, SARS-CoV and HCoV-EMC do not use the same cell receptor, and there are important differences in their genomic sequences. This study adds strength to the assertion that “HCoV-EMC is not the same as SARS-CoV” (
23). Indeed, even though we identified specific characteristics of the SARS-CoV response in the HCoV-EMC signatures, HCoV-EMC induced robust and specific transcriptional responses that were distinct from those induced by SARS-CoV, including the broad down-regulation of MHC molecules.
This study is the first global transcriptomic analysis of the cellular response to HCoV-EMC infection. Kindler et al. performed RNA-Seq on human airway epithelium (HAE) cells infected with HCoV-EMC (
24). However, their analysis was focused on viral sequences and did not include a genome-wide analysis of the host response. They did, however, use RT-qPCR (quantitative PCR) to compare expression levels of a set of 15 genes, including IFN, RNA sensor molecules, and IFN-stimulated genes (ISGs), following infection with HCoV-EMC, SARS-CoV, or HCoV-229E (MOI 0.1). In our study, we confirm that SARS-CoV and HCoV-EMC induce a similar up-regulation of RNA sensor molecules, such as
RIGI,
MDA5, and two of three genes of ISGF3 (
IRF9 and
STAT1) (genes in cluster I [
Fig. 3]). Of note, HCoV-EMC titers were up to 10
2-fold higher than those of SARS-CoV in HAE cells (
24), whereas we observed similar viral replication of the two CoVs in Calu-3 cells. Lower replication of SARS-CoV in HAE cells might be explained by the mixed cell population in these primary cultures, with likely nonuniform expression of SARS-CoV receptor (
ACE2). In contrast, Calu-3 2B4 cells used in our study are a clonal population of Calu-3 cells sorted for ACE2 expression which support high replication of SARS-CoV. In addition, while Kindler et al. noted the absence of induction of
IFN-
β at 3, 6, and 12 hpi (24), we found a specific up-regulation of
IFN-
α5 and
IFN-
β1 by HCoV-EMC at 18 and 24 hpi (genes in cluster III) and an up-regulation of
IFN-
α21 by both SARS-CoV and HCoV-EMC at 24 hpi (cluster I) (expression values for all DE genes are available at
http://www.systemsvirology.org). These data illustrate that HCoV-EMC and SARS-CoV both trigger the activation of pattern recognition receptors but may subsequently induce different levels of IFN. Moreover, there were stark differences in global downstream ISG expression following infection with SARS-CoV or HCoV-EMC; this analysis is discussed in detail elsewhere (V. D. Menachery et al., submitted for publication).
Activation of similar innate viral-sensing pathways by HCoV-EMC and SARS-CoV is not surprising given the conservation of this mechanism to detect foreign RNA and familial relationships of the viruses. We also found that both viruses induced proinflammatory cytokines related to IL-17 pathways. It has previously been shown that IL-17A-related gene expression exacerbates severe respiratory syncytial virus (RSV) or influenza virus infection (
25,
26). IL-17A was predicted to be activated throughout infection with HCoV-EMC and may induce immune-mediated pathology that possibly contributes to a high mortality rate. IL-17A is known to be produced by T-helper cells, but its expression in Calu3 cells was increased up to 2-fold at 24 hpi after HCoV-EMC infection. Interestingly, IL-17C and IL-17F, which can be produced by epithelial cells under certain inflammatory conditions and which activate pathways similar to IL-17A-mediated responses (
27), were increased earlier and to a greater extent following HCoV-EMC infection (up to 3-fold at 18 hpi for IL-17C and 4-fold at 7 hpi for IL-17F). Therefore, further study of the IL-17 response may provide interesting targets to limit lung injury (
26).
A main difference between responses to HCoV-EMC and SARS-CoV was the specific down-regulation of the antigen presentation pathway after HCoV-EMC infection. In contrast, these genes were found to be up-regulated after SARS-CoV infection. Several viruses have evolved mechanisms to inhibit both the MHC class I (reviewed in references 28 and 29) and class II (reviewed in reference 30) pathways. While expression of MHC class II is usually limited to professional antigen-presenting cells, human lung epithelial cells constitutively express this complex (
31). Our data demonstrated down-regulation of the MHC class II transactivator (
CIITA) after HCoV-EMC infection, a finding that possibly explains decreases in MHC class II molecule expression; this is a common viral strategy used to block that pathway (
30). MHC class II inhibition can prevent class II-mediated presentation of endogenous viral antigens produced within infected cells and impair the adaptive immune response. Similarly, MHC class I genes were also down-regulated after HCoV-EMC infection; decreasing expression of MHC class I can attenuate CD8 T-cell-mediated recognition of infected cells and could allow immune evasion by HCoV-EMC. Finally,
PSMB8 and
PSMB9, parts of the immunoproteasome, were also down-regulated by HCoV-EMC; these components replace portions of the standard proteasome and enhance production of MHC class I binding peptides (
32). In their absence, proteins targeted for degradation may not generate peptides that robustly bind MHC class I, thus limiting their presentation. Down-regulation of
PSMB8 and
PSMB9 could counteract the host response to viral infection, including up-regulation of ubiquitins and ubiquitin ligases observed during HCoV-EMC infection (
Fig. 3B) that may ineffectively target viral protein for degradation. Together, the inhibition of MHC class I and II as well as immunoproteasome construction may have an important impact on the
in vivo adaptive immune response against HCoV-EMC.
While there is no proven effective antiviral therapy against SARS-CoV (
33), several molecules have
in vitro antiviral activity, including ribavirin, lopinavir, and type I IFN, but their benefits for patients are unclear (
33). IFN-α pretreatment of cells has been shown to inhibit HCoV-EMC replication (
24), but no direct antiviral therapies have been reported. Targeting host factors important for the virus, instead of the virus itself, has been investigated for HIV (
34) and influenza virus (
13). For example, inhibiting upstream regulators (such as NF-κB) that control the host response to influenza virus infection has been shown to reduce virus replication
in vitro and in mice (
35). Inhibition of immunophilins that interact with the viral nonstructural protein 1 (Nsp1) resulted in potent inhibition of SARS-CoV replication (
36,
37). In this study, we characterized upstream regulators predicted to be activated (e.g., NF-κB and IL-17, which could be targeted with specific inhibitors) and upstream regulators predicted to be inhibited.
The top five inhibited regulators included one glucocorticoid and four kinase inhibitors; these drugs may be able to directly block part of the host response and impact viral replication/pathogenesis. Among them, LY294002, a potent inhibitor of phosphatidylinositol 3 kinase (PI3K), has known antiviral activity, inhibiting the replication of influenza virus (
38), vaccinia virus (
39), and HCMV (
40). SB203580, an inhibitor of p38 MAPK, is also an effective antiviral against the encephalomyocarditis virus (
41), RSV (
42), and HIV (
43). LY294002 and SB203580 were also identified in Connectivity Map, a database of drug-associated gene expression profiles (
22), as molecules reversing components of the HCoV-EMC gene expression signature. Finally, SB203580 showed promising antiviral results against both HCoV-EMC and SARS-CoV in our
in vitro assay (
Fig. 4C). Further extensive studies, including dose-response tests and tests of other kinases inhibitors, are ongoing. Nonetheless, these results validate our genome-based drug prediction, which allows rapid identification of effective antivirals. Despite central roles of PI3K and MAPK pathways in regulating multiple cellular processes, many kinase inhibitors targeting these pathways have been shown to be safe and well tolerated
in vivo (reviewed in references 44 and 45). It has been hypothesized that mitogenic MAPK and survival PI3K/Akt pathways may be of major importance only during early development of an organism and may be dispensable in adult tissues (
13). Several drugs targeting JNK, PI3K, and MEK have shown promising therapeutic potential in humans against a variety of diseases, including cancer and inflammatory disorder (
44,
45). p38 MAPK inhibitors have also been evaluated in humans, but the first generation of molecules, including SB203580, has a high
in vivo toxicity (liver and/or central nervous system). However, development of novel nontoxic inhibitors (e.g., ML3403) (
46), more selective molecules (e.g., AS1940477) (
47), and administration via inhalation (
48) are promising strategies for use of this class of inhibitor for treatment of pulmonary disease. Overall, these results indicate that kinase inhibitors could be used as broad anti-CoV agents which might be combined with other host-targeting molecules, like peroxisome proliferator-activated receptor α (PPARα) agonists, to better inhibit HCoV-EMC replication.
In conclusion, using global gene expression profiling, we have shown that HCoV-EMC induces a dramatic host transcriptional response, most of which does not overlap the response induced by SARS-CoV. This study highlights the advantages of high-throughput “-omics” to globally and efficiently characterize emerging pathogens. The robust host gene expression analysis of HCoV-EMC infection provides a plethora of data to mine for further hypotheses and understanding. Host response profiles can also be used to quickly identify possible treatment strategies, and we anticipate that host transcriptional profiling will become a general strategy for the rapid characterization of future emerging viruses.