1. Compartmental immunophenotyping in COVID-19 ARDS: A case series
- Author
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Sara Rørvig, Kristoffer Sølvsten Burgdorf, Ronan M. G. Berg, Jakob T. Bay, Hanne Vibeke Marquart, Anna K. Haugaard, Klaus Tjelle, Thomas Benfield, Henrik Ullum, Ronni R. Plovsing, Nicolai Bang Foss, Magnus Glindvad Ahlström, and Andreas Ronit
- Subjects
0301 basic medicine ,Male ,ARDS ,medicine.medical_treatment ,CD8-Positive T-Lymphocytes ,IP-10, IFN-γ–inducible protein-10 ,0302 clinical medicine ,Immunophenotyping ,MCP-1, Monocyte chemoattractant protein-1 ,Immunology and Allergy ,bronchoalveolar lavage ,030212 general & internal medicine ,PD1, Programmed cell death protein-1 ,Lung ,education.field_of_study ,Respiratory Distress Syndrome ,COVID-19, Coronavirus disease 2019 ,medicine.diagnostic_test ,Acute respiratory distress syndrome ,Middle Aged ,RTE, Recent thymic emigrant ,ICU, Intensive care unit ,medicine.anatomical_structure ,Cytokine ,CTLA-4, Cytotoxic T lymphocyte–associated protein ,Female ,Adult ,Immunology ,Population ,Article ,03 medical and health sciences ,Lymphopenia ,ARDS, Acute respiratory distress syndrome ,medicine ,BALF, Bronchoalveolar lavage fluid ,Humans ,education ,Aged ,SARS-CoV-2, Severe acute respiratory syndrome coronavirus 2 ,business.industry ,SARS-CoV-2 ,Monocyte ,flow cytometry ,COVID-19 ,medicine.disease ,Treg, Regulatory T ,cytokines ,030104 developmental biology ,Bronchoalveolar lavage ,Cross-Sectional Studies ,Th17 Cells ,business ,CD8 - 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., Graphical abstract
- Published
- 2020