Epigenetic and microRNA-mediated regulation of pulmonary fibrosis and immune dysregulation in fatal COVID-19

Severe cases of COVID-19 can result in acute respiratory distress syndrome, extensive lung damage, and long-term structural changes, particularly extracellular matrix (ECM) remodeling. ECM remodeling is characterized by excessive collagen deposition and imbalanced activity of enzymes, such as matrix metalloproteinases. Although immune and inflammatory pathways in patients with COVID-19 are well understood, the epigenetic and post-transcriptional regulation is not well understood. In this exploratory study, we examined DNA methylation and miRNA-mediated regulation in lung tissues from fatal cases of COVID-19. Methods included gene and protein expression analyses, DNA methylation assays, evaluation of DNMT activity, MSP‒dPCR, miRNA profiling and pathway enrichment analysis. We observed altered expression of ECM regulators, such as MMP2, MMP9 and ADAM33, as well as molecules related to SARS-CoV-2 infection, including ADAM17 and ACE2. Evidence of methylation-mediated regulation was observed for ADAM33 and ACE2. Two miRNAs were significantly downregulated (miR-16-5p and miR-30d-5p), whereas miR-19a-3p/19b-3p and miR-21-5p were upregulated. Pathway analysis revealed activation of p53, apoptosis, and growth factor related pathways, as well as the suppression of vascular, interferon and T-cell activation signaling pathways. Overall, these findings suggest that, in this cohort of fatal COVID-19 cases, lung tissue exhibits features consistent with ECM remodeling, epithelial fibrosis, and immune dysregulation. Additionally, the results raise the possibility that epigenetic alterations and miRNA-mediated regulatory mechanisms may be associated with disease progression in severe cases.