Pro- and Anti-Inflammatory Responses in Severe COVID-19-Induced Acute Respiratory Distress Syndrome—An Observational Pilot Study

The severity of Coronavirus Disease 2019 (COVID-19) is largely determined by the immune response. First studies indicate altered lymphocyte counts and function. However, interactions of pro- and anti-inflammatory mechanisms remain elusive. In the current study we characterized the immune responses i...

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Veröffentlicht in:Frontiers in immunology Jg. 11; S. 581338
Hauptverfasser: Notz, Quirin, Schmalzing, Marc, Wedekink, Florian, Schlesinger, Tobias, Gernert, Michael, Herrmann, Johannes, Sorger, Lena, Weismann, Dirk, Schmid, Benedikt, Sitter, Magdalena, Schlegel, Nicolas, Kranke, Peter, Wischhusen, Jörg, Meybohm, Patrick, Lotz, Christopher
Format: Journal Article
Sprache:Englisch
Veröffentlicht: Switzerland Frontiers Media S.A 06.10.2020
Schlagworte:
acute respiratory distress syndrome
Aged
Antibodies, Viral - blood
Antibodies, Viral - immunology
Betacoronavirus - immunology
Coronavirus Disease 2019
Coronavirus Infections - immunology
Coronavirus Infections - pathology
COVID-19
Cytokine Release Syndrome - immunology
Cytokine Release Syndrome - pathology
cytokines
Female
growth differentiation factor 15
Growth Differentiation Factor 15 - blood
Humans
Immunoglobulin G - blood
Immunoglobulin G - immunology
Immunology
inflammation
Intensive Care Units
Interleukin-10 - blood
Interleukin-6 - blood
Longitudinal Studies
Lymphopenia
Male
Middle Aged
Pandemics
Pilot Projects
Pneumonia, Viral - immunology
Pneumonia, Viral - pathology
Retrospective Studies
SARS-CoV-2
Severe Acute Respiratory Syndrome - immunology
Severe Acute Respiratory Syndrome - pathology
Severe Acute Respiratory Syndrome Coronavirus 2
Spike Glycoprotein, Coronavirus - immunology
Coronavirus Disease 2019
immune response
inflammation
Severe Acute Respiratory Syndrome Coronavirus 2
acute respiratory distress syndrome
cytokines
growth differentiation factor 15
ISSN:1664-3224, 1664-3224
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Zusammenfassung:The severity of Coronavirus Disease 2019 (COVID-19) is largely determined by the immune response. First studies indicate altered lymphocyte counts and function. However, interactions of pro- and anti-inflammatory mechanisms remain elusive. In the current study we characterized the immune responses in patients suffering from severe COVID-19-induced acute respiratory distress syndrome (ARDS). This was a single-center retrospective study in patients admitted to the intensive care unit (ICU) with confirmed COVID-19 between March 14 and May 28 2020 (n = 39). Longitudinal data were collected within routine clinical care, including flow-cytometry of lymphocyte subsets, cytokine analysis and growth differentiation factor 15 (GDF-15). Antibody responses against the receptor binding domain (RBD) of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Spike protein were analyzed. All patients suffered from severe ARDS, 30.8% died. Interleukin (IL)-6 was massively elevated at every time-point. The anti-inflammatory cytokine IL-10 was concomitantly upregulated with IL-6. The cellular response was characterized by lymphocytopenia with low counts of CD8+ T cells, natural killer (NK) and naïve T helper cells. CD8+ T and NK cells recovered after 8 to 14 days. The B cell system was largely unimpeded. This coincided with a slight increase in anti-SARS-CoV-2-Spike-RBD immunoglobulin (Ig) G and a decrease in anti-SARS-CoV-2-Spike-RBD IgM. GDF-15 levels were elevated throughout ICU treatment. Massively elevated levels of IL-6 and a delayed cytotoxic immune defense characterized severe COVID-19-induced ARDS. The B cell response and antibody production were largely unimpeded. No obvious imbalance of pro- and anti-inflammatory mechanisms was observed, with elevated GDF-15 levels suggesting increased tissue resilience.
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This article was submitted to Inflammation, a section of the journal Frontiers in Immunology
Edited by: Rudolf Lucas, Augusta University, United States
Reviewed by: Juerg Hamacher, Lindenhofspital, Switzerland; Daniel Scott-Algara, Institut Pasteur, France
ISSN:1664-3224
1664-3224
DOI:10.3389/fimmu.2020.581338