NK cells modulate in vivo control of SARS-CoV-2 replication and suppression of lung damage

Natural killer (NK) cells play a critical role in virus control. However, it has remained largely unclear whether NK cell mobilization in SARS-CoV-2 infections is beneficial or pathologic. To address this deficit, we employed a validated experimental NK cell depletion non-human primate (NHP) model with SARS-CoV-2 Delta variant B.1.617.2 challenge. Viral loads (VL), NK cell numbers, activation, proliferation, and functional measures were evaluated in blood and tissues. In non-depleted (control) animals, infection rapidly induced NK cell expansion, activation, and increased tissue trafficking associated with VL. Strikingly, we report that experimental NK cell depletion leads to higher VL, longer duration of viral shedding, significantly increased levels of pro-inflammatory cytokines in the lungs, and overt lung damage. Overall, we find the first significant and conclusive evidence for NK cell-mediated control of SARS-CoV-2 virus replication and disease pathology. These data indicate that adjunct therapies for infection could largely benefit from NK cell-targeted approaches. Natural killer (NK) cells play a critically understudied role in controlling SARS-CoV-2 viral replication, clearance, and disease sequelae. In this manuscript, we investigated the protective role of NK cells in acute infection using a well-established NK cell depletion strategy in cynomolgus macaques (CM) and a SARS-CoV-2 delta variant infection model. Circulating NK cells exhibited an increased proliferative and activated phenotype following infection, concomitant with peak NK cell expansion at 10 days post-infection (DPI). Importantly, following experimental NK cell depletion, CM exhibited increased viral shedding and delayed viral clearance compared to controls. NK cell-depleted animals also exhibited significantly increased lung pathology and Luminex cytokine analyses of broncho-alveolar lavage (BAL) fluid showed a 5-fold increase in interferon-alpha (IFN alpha) compared to controls during peak infection. Collectively, our findings suggest that NK cells play a crucial role in controlling SARS-CoV-2 replication and reducing lung damage. These results underscore the potential of NK cell-based vaccines and therapies for COVID-19 and other infectious diseases, warranting further investigation in this area.