Revisiting the monocrotaline-treated rat as a model of inflammatory lung disease: COVID-19 and future pandemic threats?

Luke P. Kris , Dani-Louise Dixon , Shailesh Bihari , Jillian M. Carr

Animal Models and Experimental Medicine ›› 2025, Vol. 8 ›› Issue (10) : 1785 -1793.

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Animal Models and Experimental Medicine ›› 2025, Vol. 8 ›› Issue (10) :1785 -1793. DOI: 10.1002/ame2.70099
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Revisiting the monocrotaline-treated rat as a model of inflammatory lung disease: COVID-19 and future pandemic threats?
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Abstract

The COVID-19 pandemic posed a challenge for clinical management of a new lung disease that was characterized by inflammation, endothelial cell dysfunction, and thrombosis, which occur after the replication phase of infection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). There are many laboratory models of active SARS-CoV-2 infection in mice, reflecting an acute lung injury in an otherwise healthy animal, but there is a lack of accurate animal models of the postviral inflammatory phase of the COVID-19 lung reflecting severe disease. The monocrotaline (MCT)–treated rat is a widely used laboratory model of pulmonary hypertension (PH). Not often discussed, however, are the observed changes in inflammation, edema, fibrosis, and microthrombosis in the lung prior to PH. At the cellular level, there is loss of pneumocytes and endotheliopathy, and at the molecular level the MCT rat lung is characterized by a pro-inflammatory cytokine profile, namely elevated interleukin 6, transforming growth factor β and tumor necrosis factor, M1 macrophage phenotype, and dysregulation of the angiotensin converting enzyme (ACE)/ACE2 balance. The systems-level pathophysiology of the MCT-treated rat includes progressive cardiopulmonary dysfunction. The MCT-treated rat clearly differs from the COVID-19 lung in terms of the triggers for pathology, but there are many parallels apparent in both the MCT-treated rat and the COVID-19 lung. The MCT-treated rat lung as a model of the COVID-19 lung may provide an in-depth understanding of the factors that drive the lung to more severe pathology, treatments that benefit lung recovery, or the factors that prove a useful research platform for future emerging respiratory threats of similar pathology.

Keywords

COVID-19 / inflammation / monocrotaline / rat model / respiratory

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Luke P. Kris, Dani-Louise Dixon, Shailesh Bihari, Jillian M. Carr. Revisiting the monocrotaline-treated rat as a model of inflammatory lung disease: COVID-19 and future pandemic threats?. Animal Models and Experimental Medicine, 2025, 8(10): 1785-1793 DOI:10.1002/ame2.70099

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References

[1]

Idell S, James KK, Gillies C, Fair DS, Thrall RS. Abnormalities of pathways of fibrin turnover in lung lavage of rats with oleic acid and bleomycin-induced lung injury support alveolar fibrin deposition. Am J Pathol. 1989;135:387-399.

[2]

Matute-Bello G, Frevert CW, Martin TR. Animal models of acute lung injury. Am J Physiol Lung Cell Mol Physiol. 2008;295:L379-L399.

[3]

Kadam AH, Schnitzer JE. Characterization of acute lung injury in the bleomycin rat model. Physiol Rep. 2023;11:e15618.

[4]

Aeffner F, Bolon B, Davis IC. Mouse models of acute respiratory distress syndrome: a review of analytical approaches, pathologic features, and common measurements. Toxicol Pathol. 2015;43:1074-1092.

[5]

Chu H, Chan JF, Yuen KY. Animal models in SARS-CoV-2 research. Nat Methods. 2022;19:392-394.

[6]

Munoz-Fontela C, Dowling WE, Funnell SGP, et al. Animal models for COVID-19. Nature. 2020;586:509-515.

[7]

Munoz-Fontela C, Widerspick L, Albrecht RA, et al. Advances and gaps in SARS-CoV-2 infection models. PLoS Pathog. 2022;18:e1010161.

[8]

Schafer A, Leist SR, Powers JM, Baric RS. Animal models of long covid: a hit-and-run disease. Sci Transl Med. 2024;16:eado2104.

[9]

Hrenak J, Simko F. Renin-angiotensin system: An important player in the pathogenesis of acute respiratory distress syndrome. Int J Mol Sci. 2020;21:8038.

[10]

Pagliaro P, Penna C. ACE/ACE2 ratio: a key also in 2019 coronavirus disease (Covid-19)? Front Med (Lausanne). 2020;7:335.

[11]

Samavati L, Uhal BD. ACE2, much more than just a receptor for SARS-COV-2. Front Cell Infect Microbiol. 2020;10:317.

[12]

Sarzani R, Giulietti F, Di Pentima C, Giordano P, Spannella F. Disequilibrium between the classic renin-angiotensin system and its opposing arm in SARS-CoV-2-related lung injury. Am J Physiol Lung Cell Mol Physiol. 2020;319:L325-L336.

[13]

Verdecchia P, Cavallini C, Spanevello A, Angeli F. The pivotal link between ACE2 deficiency and SARS-CoV-2 infection. Eur J Intern Med. 2020;76:14-20.

[14]

Dinnon KH III, Leist SR, Schafer A, et al. A mouse-adapted model of SARS-CoV-2 to test COVID-19 countermeasures. Nature. 2020;586:560-566.

[15]

Tsumita T, Takeda R, Maishi N, et al. Viral uptake and pathophysiology of the lung endothelial cells in age-associated severe SARS-CoV-2 infection models. Aging Cell. 2024;23:e14050.

[16]

Yu P, Qi F, Xu Y, et al. Age-related rhesus macaque models of COVID-19. Animal Model Exp Med. 2020;3:93-97.

[17]

Irvin CG, Bates JH. Measuring the lung function in the mouse: the challenge of size. Respir Res. 2003;4:4.

[18]

Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395:497-506.

[19]

World Health Organisation. COVID-19 Epidemiological Update. WHO; 2025.

[20]

Sahu T, Verma HK, Bhaskar L. Bacterial and fungal co-infection is a major barrier in COVID-19 patients: a specific management and therapeutic strategy is required. World J Virol. 2022;11:107-110.

[21]

Sreenath K, Batra P, Vinayaraj EV, et al. Coinfections with other respiratory pathogens among patients with COVID-19. Microbiol Spectr. 2021;9:e0016321.

[22]

Shi H, Han X, Jiang N, et al. Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: a descriptive study. Lancet Infect Dis. 2020;20:425-434.

[23]

Solomon JJ, Heyman B, Ko JP, Condos R, Lynch DA. CT of post-acute lung complications of COVID-19. Radiology. 2021;301:E383-E95.

[24]

Kwee TC, Kwee RM. Chest CT in COVID-19: what the radiologist needs to know. Radiographics. 2020;40:1848-1865.

[25]

Bosmuller H, Matter M, Fend F, Tzankov A. The pulmonary pathology of COVID-19. Virchows Arch. 2021;478:137-150.

[26]

Polak SB, Van Gool IC, Cohen D, von der Thusen JH, van Paassen J. A systematic review of pathological findings in COVID-19: a pathophysiological timeline and possible mechanisms of disease progression. Mod Pathol. 2020;33:2128-2138.

[27]

Aoki R, Iwasawa T, Hagiwara E, Komatsu S, Utsunomiya D, Ogura T. Pulmonary vascular enlargement and lesion extent on computed tomography are correlated with COVID-19 disease severity. Jpn J Radiol. 2021;39:451-458.

[28]

Eroume AEE, Shiwani HA, Nouthe B. From acute SARS-CoV-2 infection to pulmonary hypertension. Front Physiol. 2022;13:1023758.

[29]

Bonnemain J, Ltaief Z, Liaudet L. The right ventricle in COVID-19. J Clin Med. 2021;10:2535.

[30]

Lan Y, Liu W, Zhou Y. Right ventricular damage in COVID-19: association between myocardial injury and COVID-19. Front Cardiovasc Med. 2021;8:606318.

[31]

Krishna BA, Metaxaki M, Sithole N, Landin P, Martin P, Salinas-Botran A. Cardiovascular disease and covid-19: a systematic review. Int J Cardiol Heart Vasc. 2024;54:101482.

[32]

Zheng YY, Ma YT, Zhang JY, Xie X. COVID-19 and the cardiovascular system. Nat Rev Cardiol. 2020;17:259-260.

[33]

Aleksova A, Fluca AL, Gagno G, et al. Long-term effect of SARS-CoV-2 infection on cardiovascular outcomes and all-cause mortality. Life Sci. 2022;310:121018.

[34]

Xie Y, Xu E, Bowe B, Al-Aly Z. Long-term cardiovascular outcomes of COVID-19. Nat Med. 2022;28:583-590.

[35]

Knight R, Walker V, Ip S, et al. Association of COVID-19 with major arterial and venous thrombotic diseases: a population-wide cohort study of 48 million adults in England and Wales. Circulation. 2022;146:892-906.

[36]

Elsoukkary SS, Mostyka M, Dillard A, et al. Autopsy findings in 32 patients with COVID-19: a single-institution experience. Pathobiology. 2021;88:56-68.

[37]

Menter T, Haslbauer JD, Nienhold R, et al. Postmortem examination of COVID-19 patients reveals diffuse alveolar damage with severe capillary congestion and variegated findings in lungs and other organs suggesting vascular dysfunction. Histopathology. 2020;77:198-209.

[38]

Milross L, Majo J, Cooper N, et al. Post-mortem lung tissue: the fossil record of the pathophysiology and immunopathology of severe COVID-19. Lancet Respir Med. 2022;10:95-106.

[39]

Gattinoni L, Chiumello D, Caironi P, et al. COVID-19 pneumonia: different respiratory treatments for different phenotypes? Intensive Care Med. 2020;46:1099-1102.

[40]

Bos LDJ, Sjoding M, Sinha P, et al. Longitudinal respiratory subphenotypes in patients with COVID-19-related acute respiratory distress syndrome: results from three observational cohorts. Lancet Respir Med. 2021;9:1377-1386.

[41]

Bonaventura A, Mumoli N, Mazzone A, et al. Correlation of SpO(2)/FiO(2) and PaO(2)/FiO(2) in patients with symptomatic COVID-19: An observational, retrospective study. Intern Emerg Med. 2022;17:1769-1775.

[42]

Marini JJ, Gattinoni L. Management of COVID-19 respiratory distress. JAMA. 2020;323:2329-2330.

[43]

Dereli N, Babayigit M, Koc F, et al. Type-H, and type-L COVID-19: are they different subtypes or the same? Eur Rev Med Pharmacol Sci. 2022;26:3367-3373.

[44]

Lascarrou JB. COVID-19-related ARDS: one disease, two trajectories, and several unanswered questions. Lancet Respir Med. 2021;9:1345-1347.

[45]

Bridges JP, Vladar EK, Huang H, Mason RJ. Respiratory epithelial cell responses to SARS-CoV-2 in COVID-19. Thorax. 2022;77:203-209.

[46]

Delorey TM, Ziegler CGK, Heimberg G, Normand R, Yang Y, et al. COVID-19 tissue atlases reveal SARS-CoV-2 pathology and cellular targets. Nature. 2021;595:107-113.

[47]

Melms JC, Biermann J, Huang H, et al. A molecular single-cell lung atlas of lethal COVID-19. Nature. 2021;595:114-119.

[48]

Chen ST, Park MD, Del Valle DM, et al. A shift in lung macrophage composition is associated with COVID-19 severity and recovery. Sci Transl Med. 2022;14:eabn5168.

[49]

Wang C, Xie J, Zhao L, et al. Alveolar macrophage dysfunction and cytokine storm in the pathogenesis of two severe COVID-19 patients. EBioMedicine. 2020;57:102833.

[50]

Wendisch D, Dietrich O, Mari T, et al. SARS-CoV-2 infection triggers profibrotic macrophage responses and lung fibrosis. Cell. 2021;184:6243-6261.

[51]

Osburn WO, Smith K, Yanek L, et al. Markers of endothelial cell activation are associated with the severity of pulmonary disease in COVID-19. PLoS One. 2022;17:e0268296.

[52]

McGonagle D, Bridgewood C, Meaney JFM. A tricompartmental model of lung oxygenation disruption to explain pulmonary and systemic pathology in severe COVID-19. Lancet Respir Med. 2021;9:665-672.

[53]

Zheng M, Karki R, Williams EP, et al. TLR2 senses the SARS-CoV-2 envelope protein to produce inflammatory cytokines. Nat Immunol. 2021;22:829-838.

[54]

Diamond MS, Kanneganti TD. Innate immunity: the first line of defense against SARS-CoV-2. Nat Immunol. 2022;23:165-176.

[55]

Khanmohammadi S, Rezaei N. Role of toll-like receptors in the pathogenesis of COVID-19. J Med Virol. 2021;93:2735-2739.

[56]

Al-Qazazi R, Lima PDA, Prisco SZ, et al. Macrophage-NLRP3 activation promotes right ventricle failure in pulmonary arterial hypertension. Am J Respir Crit Care Med. 2022;206:608-624.

[57]

Tirelli C, De Amici M, Albrici C, et al. Exploring the role of immune system and inflammatory cytokines in SARS-CoV-2 induced lung disease: a narrative review. Biology (Basel). 2023;12:177.

[58]

Lee S, Channappanavar R, Kanneganti TD. Coronaviruses: innate immunity, inflammasome activation, inflammatory cell death, and cytokines. Trends Immunol. 2020;41:1083-1099.

[59]

Moore JB, June CH. Cytokine release syndrome in severe COVID-19. Science. 2020;368:473-474.

[60]

Stenmark KR, Frid MG, Gerasimovskaya E, et al. Mechanisms of SARS-CoV-2-induced lung vascular disease: potential role of complement. Pulm Circ. 2021;11:15799.

[61]

Arguinchona LM, Zagona-Prizio C, Joyce ME, Chan ED, Maloney JP. Microvascular significance of TGF-beta axis activation in COVID-19. Front Cardiovasc Med. 2022;9:1054690.

[62]

Stimler NP, Hugli TE, Bloor CM. Pulmonary injury induced by C3a and C5a anaphylatoxins. Am J Pathol. 1980;100:327-348.

[63]

Jafarzadeh A, Chauhan P, Saha B, Jafarzadeh S, Nemati M. Contribution of monocytes and macrophages to the local tissue inflammation and cytokine storm in COVID-19: lessons from SARS and MERS, and potential therapeutic interventions. Life Sci. 2020;257:118102.

[64]

Calvert BA, Quiroz EJ, Lorenzana Z, et al. Neutrophilic inflammation promotes SARS-CoV-2 infectivity and augments the inflammatory responses in airway epithelial cells. Front Immunol. 2023;14:1112870.

[65]

Banu N, Panikar SS, Leal LR, Leal AR. Protective role of ACE2 and its downregulation in SARS-CoV-2 infection leading to macrophage activation syndrome: therapeutic implications. Life Sci. 2020;256:117905.

[66]

Lu Y, Zhu Q, Fox DM, Gao C, Stanley SA, Luo K. SARS-CoV-2 down-regulates ACE2 through lysosomal degradation. Mol Biol Cell. 2022;33:ar147.

[67]

Gaddam RR, Chambers S, Bhatia M. ACE and ACE2 in inflammation: a tale of two enzymes. Inflamm Allergy Drug Targets. 2014;13:224-234.

[68]

Imai Y, Kuba K, Penninger JM. The renin-angiotensin system in acute respiratory distress syndrome. Drug Discov Today Dis Mech. 2006;3:225-229.

[69]

Marshall RP, Webb S, Bellingan GJ, et al. Angiotensin converting enzyme insertion/deletion polymorphism is associated with susceptibility and outcome in acute respiratory distress syndrome. Am J Respir Crit Care Med. 2002;166:646-650.

[70]

Iba T, Connors JM, Levy JH. The coagulopathy, endotheliopathy, and vasculitis of COVID-19. Inflamm Res. 2020;69:1181-1189.

[71]

Sakurai Y, Fujioka Y, Maishi N, et al. SARS-CoV-2 uptake and inflammatory response in senescent endothelial cells are regulated by the BSG/VEGFR2 pathway. Proc Natl Acad Sci U S A. 2025;122:e2502724122.

[72]

Topper MJ, Guarnieri JW, Haltom JA, et al. Lethal COVID-19 associates with RAAS-induced inflammation for multiple organ damage including mediastinal lymph nodes. Proc Natl Acad Sci U S A. 2024;121:e2401968121.

[73]

Hill NS, Gillespie MN, McMurtry IF. Fifty years of monocrotaline-induced pulmonary hypertension: what has it meant to the field? Chest. 2017;152:1106-1108.

[74]

Gomez-Arroyo JG, Farkas L, Alhussaini AA, et al. The monocrotaline model of pulmonary hypertension in perspective. Am J Physiol Lung Cell Mol Physiol. 2012;302:L363-L369.

[75]

Wilson DW, Segall HJ, Pan LC, Lame MW, Estep JE, Morin D. Mechanisms and pathology of monocrotaline pulmonary toxicity. Crit Rev Toxicol. 1992;22:307-325.

[76]

Akhavein F, St-Michel EJ, Seifert E, Rohlicek CV. Decreased left ventricular function, myocarditis, and coronary arteriolar medial thickening following monocrotaline administration in adult rats. J Appl Physiol. 2007;1985(103):287-295.

[77]

Holda MK, Szczepanek E, Bielawska J, et al. Changes in heart morphometric parameters over the course of a monocrotaline-induced pulmonary arterial hypertension rat model. J Transl Med. 2020;18:262.

[78]

Gillespie MN, Frederick WB, Altiere RJ, Olson JW, Kimmel EC. Pulmonary mechanical, ventilatory, and gas exchange abnormalities in rats with monocrotaline-induced pulmonary hypertension. Exp Lung Res. 1985;8:191-199.

[79]

Lai YL, Olson JW, Gillespie MN. Ventilatory dysfunction precedes pulmonary vascular changes in monocrotaline-treated rats. J Appl Physiol. 1991;70:561-566.

[80]

Rafikova O, Meadows ML, Kinchen JM, et al. Metabolic changes precede the development of pulmonary hypertension in the monocrotaline exposed rat lung. PLoS One. 2016;11:e0150480.

[81]

Tang C, Luo Y, Li S, Huang B, Xu S, Li L. Characteristics of inflammation process in monocrotaline-induced pulmonary arterial hypertension in rats. Biomed Pharmacother. 2021;133:111081.

[82]

Xiao G, Zhuang W, Wang T, et al. Transcriptomic analysis identifies toll-like and nod-like pathways and necroptosis in pulmonary arterial hypertension. J Cell Mol Med. 2020;24:11409-11421.

[83]

Schultze AE, Roth RA. Chronic pulmonary hypertension--the monocrotaline model and involvement of the hemostatic system. J Toxicol Environ Health B Crit Rev. 1998;1:271-346.

[84]

Schultze AE, Emeis JJ, Roth RA. Cellular fibronectin and von Willebrand factor concentrations in plasma of rats treated with monocrotaline pyrrole. Biochem Pharmacol. 1996;51:187-191.

[85]

White SM, Roth RA. Pulmonary platelet sequestration is increased following monocrotaline pyrrole treatment of rats. Toxicol Appl Pharmacol. 1988;96:465-475.

[86]

White RJ, Meoli DF, Swarthout RF, et al. Plexiform-like lesions and increased tissue factor expression in a rat model of severe pulmonary arterial hypertension. Am J Physiol Lung Cell Mol Physiol. 2007;293:L583-L590.

[87]

Luo A, Jia Y, Hao R, et al. Quantitative proteomic and Phosphoproteomic profiling of lung tissues from pulmonary arterial hypertension rat model. Int J Mol Sci. 2023;24:9629.

[88]

Morty RE, Nejman B, Kwapiszewska G, et al. Dysregulated bone morphogenetic protein signaling in monocrotaline-induced pulmonary arterial hypertension. Arterioscler Thromb Vasc Biol. 2007;27:1072-1078.

[89]

Guo X, Wang XF. Signaling cross-talk between TGF-beta/BMP and other pathways. Cell Res. 2009;19:71-88.

[90]

Yin X, Liang Z, Yun Y, Pei L. Intravenous transplantation of BMP2-transduced endothelial progenitor cells attenuates lipopolysaccharide-induced acute lung injury in rats. Cell Physiol Biochem. 2015;35:2149-2158.

[91]

Ferreira AJ, Shenoy V, Yamazato Y, et al. Evidence for angiotensin-converting enzyme 2 as a therapeutic target for the prevention of pulmonary hypertension. Am J Respir Crit Care Med. 2009;179:1048-1054.

[92]

Malikova E, Galkova K, Vavrinec P, et al. Local and systemic renin-angiotensin system participates in cardiopulmonary-renal interactions in monocrotaline-induced pulmonary hypertension in the rat. Mol Cell Biochem. 2016;418:147-157.

[93]

Wang R, Xu J, Wu J, Gao S, Wang Z. Angiotensin-converting enzyme 2 alleviates pulmonary artery hypertension through inhibition of focal adhesion kinase expression. Exp Ther Med. 2021;22:1165.

[94]

Xie SS, Deng Y, Guo SL, et al. Endothelial cell ferroptosis mediates monocrotaline-induced pulmonary hypertension in rats by modulating NLRP3 inflammasome activation. Sci Rep. 2022;12:3056.

[95]

Guo X, Chen Z, Xia Y, Lin W, Li H. Investigation of the genetic variation in ACE2 on the structural recognition by the novel coronavirus (SARS-CoV-2). J Transl Med. 2020;18:321.

[96]

Menezes MCS, Veiga ADM, Martins de Lima T, et al. Lower peripheral blood toll-like receptor 3 expression is associated with an unfavorable outcome in severe COVID-19 patients. Sci Rep. 2021;11:15223.

[97]

Bastard P, Orlova E, Sozaeva L, et al. Preexisting autoantibodies to type I IFNs underlie critical COVID-19 pneumonia in patients with APS-1. J Exp Med. 2021;218:45623.

[98]

Hofmann W, Koblinger L, Martonen TB. Structural differences between human and rat lungs: implications for Monte Carlo modeling of aerosol deposition. Health Phys. 1989;57(Suppl 1):41-46.

[99]

Stucki AO, Sauer UG, Allen DG, et al. Differences in the anatomy and physiology of the human and rat respiratory tracts and impact on toxicological assessments. Regul Toxicol Pharmacol. 2024;150:105648.

[100]

Cevik M, Kuppalli K, Kindrachuk J, Peiris M. Virology, transmission, and pathogenesis of SARS-CoV-2. BMJ. 2020;371:m3862.

[101]

Hu B, Guo H, Zhou P, Shi ZL. Characteristics of SARS-CoV-2 and COVID-19. Nat Rev Microbiol. 2021;19:141-154.

[102]

Lamers MM, Haagmans BL. SARS-CoV-2 pathogenesis. Nat Rev Microbiol. 2022;20:270-284.

[103]

OECD. Vaccinating the World. OECD. https://data.who.int/dashboards/covid19/vaccines, accessed 30/9/2025

[104]

Lewnard JA, McLaughlin JM, Malden D, et al. Effectiveness of nirmatrelvir-ritonavir in preventing hospital admissions and deaths in people with COVID-19: a cohort study in a large US health-care system. Lancet Infect Dis. 2023;23:806-815.

[105]

Wong CKH, Au ICH, Lau KTK, Lau EHY, Cowling BJ, Leung GM. Real-world effectiveness of early molnupiravir or nirmatrelvir-ritonavir in hospitalised patients with COVID-19 without supplemental oxygen requirement on admission during Hong Kong's omicron BA.2 wave: a retrospective cohort study. Lancet Infect Dis. 2022;22:1681-1693.

[106]

Carabelli AM, Peacock TP, Thorne LG, et al. SARS-CoV-2 variant biology: immune escape, transmission and fitness. Nat Rev Microbiol. 2023;21:162-177.

[107]

Fan H, Zhou L, Lv J, et al. Bacterial coinfections contribute to severe COVID-19 in winter. Cell Res. 2023;33:562-564.

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