Erythrocytes increase endogenous sphingosine 1-phosphate (S1P) levels as an adaptive response to SARS-CoV-2 infection
Low plasma levels of the signaling lipid metabolite sphingosine 1-phosphate (S1P) are associated with disrupted endothelial cell barriers, lymphopenia and reduced responsivity to hypoxia. Total S1P levels were also reduced in 23 critically ill patients with coronavirus disease 2019 (COVID-19), and the two main S1P carrier serum albumin (SA) and high-density lipoprotein (HDL) were dramatically low. Surprisingly, we observed a carrier changing shift from SA to HDL, which probably prevented an even further drop of S1P levels. Furthermore, intracellular S1P levels in red blood cells (RBC) were significantly increased in COVID-19 patients compared to healthy controls due to upregulation of S1P producing sphingosine kinase 1 and downregulation of S1P degrading lyase expression. Cell culture experiments supported increased sphingosine kinase activity and unchanged S1P release from RBC stores of COVID-19 patients. These observations suggest adaptive mechanisms for maintenance of the vasculature and immunity as well as prevention of tissue hypoxia in COVID-19 patients.