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Pro- and Anti-Inflammatory Responses in Severe COVID-19-Induced Acute Respiratory Distress Syndrome—An Observational Pilot Study
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Pro- and Anti-Inflammatory Responses in Severe COVID-19-Induced Acute Respiratory Distress Syndrome—An Observational Pilot Study
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Journal Article
Pro- and Anti-Inflammatory Responses in Severe COVID-19-Induced Acute Respiratory Distress Syndrome—An Observational Pilot Study
2020
Overview
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.
Publisher
Frontiers Media SA,Frontiers Media S.A
Subject
acute respiratory distress syndrome
/ Aged
/ Antibodies, Viral - immunology
/ Betacoronavirus - immunology
/ Coronavirus Infections - immunology
/ Coronavirus Infections - pathology
/ COVID-19
/ Cytokine Release Syndrome - immunology
/ Cytokine Release Syndrome - pathology
/ Female
/ growth differentiation factor 15
/ Growth Differentiation Factor 15 - blood
/ Humans
/ Immunoglobulin G - immunology
/ Male
/ Patients
/ Pneumonia, Viral - immunology
/ Pneumonia, Viral - pathology
/ Respiratory distress syndrome
/ Sepsis
/ Severe Acute Respiratory Syndrome - immunology
/ Severe Acute Respiratory Syndrome - pathology
/ Severe Acute Respiratory Syndrome Coronavirus 2
