Immune dysregulation and cytokine release syndrome have emerged as pathological hallmarks of severe Coronavirus Disease 2019 , leading to the evaluation of cytokine antagonists as therapeutic agents. A number of immune-directed therapies being considered for COVID-19 patients are already in clinical use in chronic inflammatory conditions like inflammatory bowel disease (IBD). These considerations led us to systematically examine the intersections between COVID-19 and the GI tract during health and intestinal inflammation. We have observed that IBD medications, both biologic and nonbiologic, do not significantly impact ACE2 and TMPRSS2 expression in the uninflamed intestines.Additionally, by comparing SARS CoV2-induced epithelial gene signatures with IBD-associated genes, we have identified a shared molecular subnetwork between COVID-19 and IBD. These data generate a novel appreciation of the confluence of COVID-19-and IBD-associated inflammation and provide mechanistic insights supporting further investigation of specific IBD drugs in the treatment of COVID-19. nearest neighbor. The most connected subnetworks were then extracted to generate model-specific SARS-CoV-2 infection-; IBD inflammation-; or drug-response associated subnetworks. Genes common between these networks were determined and tested for enrichment to various genesets using the Fisher's exact test and p-values were adjusted using Benjamini-Hochberg (BH) procedure.
Pathway and geneset enrichment analysis of subnetworks:Gene subnetworks were tested for functional enrichment using a Fisher's exact test with BH multiple test correction on a collection of gene sets. The collection of gene sets included i) Reactome pathways sourced from Enrichr 31 , i) genesets from Smillie et al 32 , ii) Huang et al 33 , iii) various macrophage perturbations (e.g. cytokines) 34 , iv) ACE2 co-expressed genes 35 and v) reported IBD GWAS genes (see supplementary methods).
Key driver gene analysis:7 Key driver analysis (KDA) identifies key or "master" driver genes for a given gene set in a given BGRN. We used a previously described KDA algorithm 36 which is summarized in supplementary methods.Genesets for KDA included those associated with NHBE-COVID-19 infection or IBD inflammation. Key driver genes (KDGs) were summarized by frequency across the networks/genesets tested.
Geneset variation analysis of SARS-CoV-2-infection gene expression signatures:We employed the epithelial model-COVID-19 response gene signatures (adjusted p value <0.05) in a gene set variation analysis (GSVA) using gene expression data from MSCCR and CERTIFI cohorts. For each gene set (up or down-regulated), GSVA was used to obtain a sample-wise enrichment score, that were then used for hypothesis testing with respect to phenotype information.