- Wu, Chien-Ting;
- Lidsky, Peter V;
- Xiao, Yinghong;
- Lee, Ivan T;
- Cheng, Ran;
- Nakayama, Tsuguhisa;
- Jiang, Sizun;
- Demeter, Janos;
- Bevacqua, Romina J;
- Chang, Charles A;
- Whitener, Robert L;
- Stalder, Anna K;
- Zhu, Bokai;
- Chen, Han;
- Goltsev, Yury;
- Tzankov, Alexandar;
- Nayak, Jayakar V;
- Nolan, Garry P;
- Matter, Matthias S;
- Andino, Raul;
- Jackson, Peter K
Emerging evidence points toward an intricate relationship between the pandemic of coronavirus disease 2019 (COVID-19) and diabetes. While preexisting diabetes is associated with severe COVID-19, it is unclear whether COVID-19 severity is a cause or consequence of diabetes. To mechanistically link COVID-19 to diabetes, we tested whether insulin-producing pancreatic β cells can be infected by SARS-CoV-2 and cause β cell depletion. We found that the SARS-CoV-2 receptor, ACE2, and related entry factors (TMPRSS2, NRP1, and TRFC) are expressed in β cells, with selectively high expression of NRP1. We discovered that SARS-CoV-2 infects human pancreatic β cells in patients who succumbed to COVID-19 and selectively infects human islet β cells in vitro. We demonstrated that SARS-CoV-2 infection attenuates pancreatic insulin levels and secretion and induces β cell apoptosis, each rescued by NRP1 inhibition. Phosphoproteomic pathway analysis of infected islets indicates apoptotic β cell signaling, similar to that observed in type 1 diabetes (T1D). In summary, our study shows SARS-CoV-2 can directly induce β cell killing.