Compartmental immunophenotyping in COVID-19 ARDS: A case series.

Department of Infectious Diseases, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark.Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Clinical Physiology, Nuclear Medicine and PET and Centre for Physical Activity Research, University of Copenhagen, Copenhagen, Denmark; Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, United Kingdom.Department of Clinical Immunology, University of Copenhagen, Copenhagen, Denmark.Department of Clinical Immunology, University of Copenhagen, Copenhagen, Denmark.Department of Clinical Microbiology, University of Copenhagen, Copenhagen, Denmark.Department of Clinical Immunology, University of Copenhagen, Copenhagen, Denmark.Department of Clinical Immunology, University of Copenhagen, Copenhagen, Denmark.Department of Pathology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.Department of Anesthesiology and Intensive Care, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark.Department of Anesthesiology and Intensive Care, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark.Department of Infectious Diseases, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark.Department of Clinical Immunology, University of Copenhagen, Copenhagen, Denmark.Department of Anesthesiology and Intensive Care, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark. Electronic address: ronni.thermann.reitz.plovsing.01@regionh.dk.

The Journal of allergy and clinical immunology. 2021;(1):81-91

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.

Methodological quality

Publication Type : Clinical Trial

Metadata

MeSH terms : SARS-CoV-2