- Xian, Hongxu;
- Liu, Yuan;
- Rundberg Nilsson, Alexandra;
- Gatchalian, Raphaella;
- Crother, Timothy R;
- Tourtellotte, Warren G;
- Zhang, Yi;
- Aleman-Muench, German R;
- Lewis, Gavin;
- Chen, Weixuan;
- Kang, Sarah;
- Luevanos, Melissa;
- Trudler, Dorit;
- Lipton, Stuart A;
- Soroosh, Pejman;
- Teijaro, John;
- de la Torre, Juan Carlos;
- Arditi, Moshe;
- Karin, Michael;
- Sanchez-Lopez, Elsa
Acute respiratory distress syndrome (ARDS), an inflammatory condition with high mortality rates, is common in severe COVID-19, whose risk is reduced by metformin rather than other anti-diabetic medications. Detecting of inflammasome assembly in post-mortem COVID-19 lungs, we asked whether and how metformin inhibits inflammasome activation while exerting its anti-inflammatory effect. We show that metformin inhibited NLRP3 inflammasome activation and interleukin (IL)-1β production in cultured and alveolar macrophages along with inflammasome-independent IL-6 secretion, thus attenuating lipopolysaccharide (LPS)- and SARS-CoV-2-induced ARDS. By targeting electron transport chain complex 1 and independently of AMP-activated protein kinase (AMPK) or NF-κB, metformin blocked LPS-induced and ATP-dependent mitochondrial (mt) DNA synthesis and generation of oxidized mtDNA, an NLRP3 ligand. Myeloid-specific ablation of LPS-induced cytidine monophosphate kinase 2 (CMPK2), which is rate limiting for mtDNA synthesis, reduced ARDS severity without a direct effect on IL-6. Thus, inhibition of ATP and mtDNA synthesis is sufficient for ARDS amelioration.