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Compartmental immunophenotyping in COVID-19 ARDS: A case series
Andreas Ronit1, Ronan M G Berg2, Jakob T Bay3
1Department of Infectious Diseases, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark.
The Journal of Allergy and Clinical Immunology
|September 26, 2020
Summary
Critically ill COVID-19 patients with acute respiratory distress syndrome (ARDS) show distinct lung immune cell profiles, including depleted T-cells and high inflammation. Understanding this immunopathology is key to treating severe coronavirus disease 2019 (COVID-19).
Area of Science:
- Immunology
- Pulmonology
- Critical Care Medicine
Background:
- Severe immunopathology is implicated in advanced coronavirus disease 2019 (COVID-19) manifestations.
- The precise immune mechanisms in severe COVID-19 acute respiratory distress syndrome (ARDS) remain poorly understood.
Purpose of the Study:
- To phenotype leukocyte subpopulations and cytokine profiles in the lungs and blood of critically ill COVID-19 ARDS patients.
Main Methods:
- Consecutive inclusion of mechanically ventilated patients within 72 hours of intubation.
- Analysis of bronchoalveolar lavage fluid and blood via microscopy, 10-color flow cytometry, and multiplex cytokine panels.
Main Results:
- Dominance of immature neutrophils and lymphopenia of CD4 and CD8 T-cells in blood and lungs.
- Increased fractions of regulatory T cells and TH17 cells in the lung.
- Upregulated activation markers on lung CD4/CD8 T-cells and macrophages, with high systemic and local cytokine levels (e.g., IL-6, IL-8), indicating hyperinflammation.
Conclusions:
- COVID-19 ARDS presents a unique lung immunologic profile.
- Characterized by depleted and exhausted CD4 and CD8 T-cell populations.
- Occurs within a significantly hyperinflammatory environment.
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