Compartmental immunophenotyping in COVID-19 ARDS: A case series - 09/01/21
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Abstract |
Background |
Severe immunopathology may drive the deleterious manifestations that are observed in the advanced stages of coronavirus disease 2019 (COVID-19) but are poorly understood.
Objective |
Our aim was to phenotype leukocyte subpopulations and the cytokine milieu in the lungs and blood of critically ill patients with COVID-19 acute respiratory distress syndrome (ARDS).
Methods |
We consecutively included patients less than 72 hours after intubation following informed consent from their next of kin. Bronchoalveolar lavage fluid was evaluated by microscopy; bronchoalveolar lavage fluid and blood were assessed by 10-color flow cytometry and a multiplex cytokine panel.
Results |
Four mechanically ventilated patients (aged 40-75 years) with moderate-to-severe COVID-19 ARDS were included. Immature neutrophils dominated in both blood and lungs, whereas CD4 and CD8 T-cell lymphopenia was observed in the 2 compartments. However, regulatory T cells and TH17 cells were found in higher fractions in the lung. Lung CD4 and CD8 T cells and macrophages expressed an even higher upregulation of activation markers than in blood. A wide range of cytokines were expressed at high levels both in the blood and in the lungs, most notably, IL-1RA, IL-6, IL-8, IP-10, and monocyte chemoattactant protein-1, consistent with hyperinflammation.
Conclusion |
COVID-19 ARDS exhibits a distinct immunologic profile in the lungs, with a depleted and exhausted CD4 and CD8 T-cell population that resides within a heavily hyperinflammatory milieu.
Il testo completo di questo articolo è disponibile in PDF.Graphical abstract |
Key words : Acute respiratory distress syndrome, bronchoalveolar lavage, COVID-19, cytokines, flow cytometry
Abbreviations used : ARDS, BALF, COVID-19, CTLA-4, ICU, IP-10, MCP-1, PD1, RTE, SARS-CoV-2, Treg
Mappa
This study was supported by the Lundbeck Foundation (grant R349-2020-540). |
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Disclosure of potential conflict of interest: T. Benfield reports personal fees and nonfinancial support from Bristol-Myers Squibb and Gilead. The rest of the authors declare that they have no relevant conflicts of interest. |
Vol 147 - N° 1
P. 81-91 - Gennaio 2021 Ritorno al numeroBenvenuto su EM|consulte, il riferimento dei professionisti della salute.