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Review 1: "Lipid droplets fuels SARS-CoV-2 replication and inflammatory response"

This study claims infection-mediated lipid droplet biogenesis contributes to SARS-CoV-2 replication while suppressing lipid droplet formation restricts infection. However, these are not fully substantiated by the data offered due to lack of proper controls.

Published onSep 21, 2020
Review 1: "Lipid droplets fuels SARS-CoV-2 replication and inflammatory response"
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key-enterThis Pub is a Review of
Lipid droplets fuel SARS-CoV-2 replication and production of inflammatory mediators
Lipid droplets fuel SARS-CoV-2 replication and production of inflammatory mediators

Viruses are obligate intracellular parasites that make use of the host metabolic machineries to meet their biosynthetic needs, identifying the host pathways essential for the virus replication may lead to potential targets for therapeutic intervention. The mechanisms and pathways explored by SARS-CoV-2 to support its replication within host cells are not fully known. Lipid droplets (LD) are organelles with major functions in lipid metabolism and energy homeostasis, and have multiple roles in infections and inflammation. Here we demonstrate that monocytes from COVID-19 patients have an increased LD accumulation compared to SARS-CoV-2 negative donors. In vitro, SARS-CoV-2 infection modulates pathways of lipid synthesis and uptake, as CD36, SREBP-1, PPARγ and DGAT-1 in human monocytes and triggered LD formation in different human cells. LDs were found in close apposition with SARS-CoV-2 proteins and double-stranded (ds)-RNA. The pharmacological modulation of LD formation by inhibition of DGAT-1 with A922500 significantly inhibited SARS-CoV-2 replication as well as reduced production of pro-inflammatory mediators. Taken together, we demonstrate the essential role of lipid metabolic reprograming and LD formation in SARS-CoV-2 replication and pathogenesis, opening new opportunities for therapeutic strategies to COVID-19.

RR:C19 Evidence Scale rating by reviewer:

  • Reliable. The main study claims are generally justified by its methods and data. The results and conclusions are likely to be similar to the hypothetical ideal study. There are some minor caveats or limitations, but they would/do not change the major claims of the study. The study provides sufficient strength of evidence on its own that its main claims should be considered actionable, with some room for future revision.



General Comments

In this manuscript evidence is presented that SARS-CoV-2 stimulates and interacts with lipid droplets (LDs) in infected human monocytes and different cell lines (A549, HMVEC-L, Vero E6). It is shown that in vitro infection of cells with SARS-CoV-2 reproduces the stimulation of LDs seen in ex vivo infected cells. Furthermore, chemical inhibition of a key enzyme of LD formation, diacylglycerol O-acyltransferase (DGAT-1), by compound A922500 inhibits the production of infectious progeny in SARS-CoV-2-infected cells. Modulation of pathways of lipogenesis in SARS-CoV-2-infected cells is observed. There is some co-localisation of viral proteins and the viral replicative dsRNA form with LDs. The pro-inflammatory innate immune response triggered by SARS-CoV-2 infection is reduced in A922500-pretreated, infected cells.

The data are of general interest, but deal with intracellular fatty acid biosynthesis and LD biogenesis in an incomplete way. The lack of uninfected, A922500-treated cells in Figs. 2 and 3 and their analyses is a major weakness. It may well be that the concentrations used of A922500 were non-toxic, but the evidence has to be presented in order to make the main data more convincing. The description of co-localisation data of viral proteins and viral replicative dsRNA with LDs should be rephrased 

Specific Comments


58        Consider citation of: Andersen KG, Rambaut A, Lipkin WI, Holmes EC, Garry RF. The proximal origin of SARS-CoV-2. Nat Med. 2020;26(4):450-452. doi:10.1038/s41591-020-0820-9

74        Consider citation of: Chatel-Chaix L, Bartenschlager R. Dengue virus- and hepatitis C virus-induced replication and assembly compartments: the enemy inside--caught in the web. J Virol. 2014;88(11):5907-5911.

78        Consider citation of: Cheung et al, 2010 (in ref list) and: Gaunt ER, Cheung W, Richards JE, Lever A, Desselberger U. Inhibition of rotavirus replication by downregulation of fatty acid synthesis. J Gen Virol. 2013a;94(Pt 6):1310-1317; Gaunt ER, Zhang Q, Cheung W, Wakelam MJO, Lever AML, Desselberger U. Lipidome analysis of rotavirus-infected cells confirms the close interaction of lipid droplets with viroplasms. J Gen Virol. 2013b;94(Pt 7):1576-1586.

85        Blockage of intracellular fatty acid (FA) biogenesis (and LD formation) by other compounds, such as TOFA, C75 and triacsin C, and its influence on viral replication  have been described [Crawford SE, Desselberger U. Lipid droplets form complexes with viroplasms and are crucial for rotavirus replication. Curr Opin Virol. 2016;19:11-15; Lever A, Desselberger U. Rotavirus replication and the role of cellular lipid droplets: New therapeutic targets?. J Formos Med Assoc. 2016;115(6):389-394 (Table 1); Gaunt et al, 2013a, cited above]

96        For HCV consider citation of Lee et al, 2019 (in ref. list).

97        A reference relevant for noroviruses could be added: Doerflinger SY, Cortese M, Romero-Brey I, et al. Membrane alterations induced by nonstructural proteins of human norovirus. PLoS Pathog. 2017;13(10):e1006705.

102      … in vitro infection of cells and cell lines…

104      Suppl. Fig. S1. In panel A, a photograph of the uninfected cell A549 is missing.

126      A reason should be given why cells were treated with A922500 for only 2 hours before viral infection. The highest non-toxic and lowest effective doses of the compound have to be determined in the experimental system used.

128f     and Fig. 2. In figure and text, relevant data on uninfected cells treated with A922500 are missing. The dose of 10 uM appears to be very high (with inhibitory doses 50% for different DGAT-1 enzymes being in the nanomolar range), and cells were pretreated with the compound for only 2 h. A dose response curve of treating uninfected cells with A922500 is missing. From experience with other inhibitors of the FA biosynthesis cascade it is known that inhibition of fatty acid biosynthesis and  LD formation can be cytotoxic and that the chemotherapeutic index of inhibitory compounds is often low.

138f     and Fig. 3. See comment on Fig. 2 above.

188      to line 199. Consider rephrasing, since SARS-CoV-2 antibody was used as a tool of detection of viral components. It is not clear which components were visualized, since a polyclonal convalescent serum was used. Figs. 4C and 4E show an incomplete merger of LDs and viral protein staining and viral dsRNA replicative form, respectively. Figs. 4C’ and 4E’ are not sharp and can be omitted.

233      … lipogenic phenotype… Please clarify and provide a reference.

251      Was it considered to infect cells with SARS-CoV-2 in the presence of oleic acid in the medium?

329      Fig. 1C uninfected is too dark.

333      Fig. 1E. The intracellular FA biosynthesis pathway is only partially shown. See Fig. 1 of Crawford and Desselberger, 2016 [cited above].

338      Fig. 1G. Consider phrasing: … Densitometric evaluation of data of panel 1F.

342      Fig. 2. Data on uninfected cells treated with compound A922500 are missing. See comment above.

354      Fig. 3. See comment to Fig. 2 (line 342).

386      Fig. S1. See comment above.

419      … endothelial cell line…

426f     and 433f should be merged.

469      and line 474. Indicate the pH of buffers.

494      Consider citation of: Schmittgen, TD, Livak KJ. Analyzing Real-Time PCR Data

by the Comparative CT Method. Nat Prot 2008; 3 (6): 1101–8.


[827 words]


Minor Comments


34        Consider reading: … biosynthetic needs. Thus, identifying…

38        … lipid metabolism, energy homeostasis and intracellular transport…

41        … were seen to modulate pathways of lipid synthesis and uptake as monitored by testing for CD36, SREBP-1, PPARgamma, and DGAT-1 expression … and triggered LD formation in different human cell lines…

46        … mediators of pro-inflammatory response…

64        … obligate intracellular parasites… [Not all viruses are pathogens.]

68        … Increasing evidence points at… [see also line 200]

76        … enzymes… reduce viral replication…

85        … blocking LD biogenesis with a pharmacological inhibitor of … blocks viral replication… [Spell out DGAT-1 at first mentioning.

87        … uncover details of viral manipulation…

109      … insights into the mechanisms…

116      Omit ‘and remodeling’.

129      … inhibited the LD formation triggered by… infection in a dose-dependent way…

141      … changes in the homeostasis of cellular compounds…

182      … a high replicative capacity for SARS-CoV-2.

185      … the supernatant was used to measure the infectivity of progeny virus….

203      … To explore whether LDs are associated…

219      … participate in SARS-CoV-2 infection at two levels…

241      … Based on these data we suggest that these two transcription factors are important…

249      … that … infection increases… suggesting that the increase…

261      … is critical for LD biogenesis and mediates…

262      and line 269. … pharmacological suppression of ..

264      … can contribute to…

268      … decreased the viral load…

279      … SARS-CoV-2 infection … recapitulates…

283      … mediators of inflammation…

284      … inhibition of LD accumulation and…

558      Ref. Codo et al, 2020 is incomplete.


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