Journal Article

Group IIA secreted phospholipase A2 is associated with the pathobiology leading to COVID-19 mortality

Wang, Qiuming, Bime, Christian, Seeds, Michael C., Chilton, Floyd H., Luberto, Chiara, Lutrick, Karen, Kew, Richard R., Carr, Tara F., Hallmark, Brian, Sergeant, Susan, Parthasarathy, Sairam, McCall, Charles E., Guerra, Stefano, Snider, Ashley J., Snider, Justin M., Zec, Manja M., Hannun, Yusuf A., Johnstone, Laurel, Zhang, Hao Helen, Yao, Guang, Del Poeta, Maurizio, Wang, Xia, Sprissler, Ryan, You, Jeehyun Karen

2021

Overview

There is an urgent need to identify the cellular and molecular mechanisms responsible for severe COVID-19 that results in death. We initially performed both untargeted and targeted lipidomics as well as focused biochemical analyses of 127 plasma samples and found elevated metabolites associated with secreted phospholipase A2 (sPLA2) activity and mitochondrial dysfunction in patients with severe COVID-19. Deceased COVID-19 patients had higher levels of circulating, catalytically active sPLA2 group IIA (sPLA2-IIA), with a median value that was 9.6-fold higher than that for patients with mild disease and 5.0-fold higher than the median value for survivors of severe COVID-19. Elevated sPLA2-IIA levels paralleled several indices of COVID-19 disease severity (e.g., kidney dysfunction, hypoxia, multiple organ dysfunction). A decision tree generated by machine learning identified sPLA2-IIA levels as a central node in the stratification of patients who died from COVID-19. Random forest analysis and least absolute shrinkage and selection operator-based (LASSO-based) regression analysis additionally identified sPLA2-IIA and blood urea nitrogen (BUN) as the key variables among 80 clinical indices in predicting COVID-19 mortality. The combined PLA-BUN index performed significantly better than did either one alone. An independent cohort (n = 154) confirmed higher plasma sPLA2-IIA levels in deceased patients compared with levels in plasma from patients with severe or mild COVID-19, with the PLA-BUN index-based decision tree satisfactorily stratifying patients with mild, severe, or fatal COVID-19. With clinically tested inhibitors available, this study identifies sPLA2-IIA as a therapeutic target to reduce COVID-19 mortality.

• Publisher: American Society for Clinical Investigation
• Subject: Adolescent / Adult / Aged / Aged, 80 and over / Atrophy / Bacterial infections / Biomarkers / Biomedical research / Child / Coronaviruses / COVID-19 / COVID-19 - blood / COVID-19 - mortality / Cytochrome / Decision trees / Disease / Disease-Free Survival / Female / Group II Phospholipases A2 - blood / Health aspects / Humans / Hypoxia / Kidney diseases / Kidneys / Learning algorithms / Male / Metabolism / Metabolites / Middle Aged / Mitochondria / Mitochondrial DNA / Molecular modelling / Mortality / Multiple organ dysfunction syndrome / Patients / Phospholipase A2 / Phospholipases / Physiological aspects / Plasma / Pneumonia / SARS-CoV-2 - metabolism / Sepsis / Severe acute respiratory syndrome coronavirus 2 / Severity of Illness Index / Survival Rate / Therapeutic targets / Urea