Exhaustion and over-activation of immune cells in COVID-19: Challenges and therapeutic opportunities.

Exhaustion of immune cells in COVID-19 remains a serious concern for infection management and therapeutic interventions. As reported, immune cells such as T effector cells (Teff), T regulatory cells (Tregs), natural killer cells (NKs), and antigen-presenting cells (APCs) exhibit uncontrolled functions in COVID-19. Unfortunately, the mechanisms that orchestrate immune cell functionality and virus interaction are still unknown. Recent studies linked adaptive immune cell exhaustion to underlying epigenetic mechanisms that regulate the epigenetic transcription of inhibitory immune checkpoint receptors (ICs). Further to that, the over-activation of T cells accompanied by the dysfunctionality of DCs and Tregs may enhance uncontrollable alveoli inflammation and cytokine storm in COVID-19. This might explain the reasons behind the failure of DC-based vaccines in inducing sufficient anti-viral responses. This review explains the processes behind the over-activation and exhaustion of innate and adaptive immune cells in COVID-19, which may contribute to developing novel immune intervention strategies. • Overexpression of ICs and mitochondrial impairment in T cells contribute to increasing the severity of COVID-19. • T cell Exhaustion is caused primarily by ICs overexpression, even in low cytokine-producing T cells. • Over-activation of T cells in COVID-19 may elicit epithelial cell apoptosis and cytokine storm initiation. • SARS-CoV-2 promotes ICs upregulation by increasing epigenetic chromatin accessibility and ICs transcription. • Interaction between SARS-CoV-2 ORF8/ORF6 proteins and MHCI/II promotes the exhaustion of cytotoxic immune cells. [ABSTRACT FROM AUTHOR]