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Compartmental immunophenotyping in COVID-19 ARDS: a case series

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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 T H17 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.

Original languageEnglish
JournalThe Journal of allergy and clinical immunology
Volume147
Issue number1
Pages (from-to)81-91
Number of pages11
ISSN0091-6749
DOIs
Publication statusPublished - Jan 2021

Bibliographical note

Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.

    Research areas

  • Adult, Aged, CD8-Positive T-Lymphocytes/immunology, COVID-19/immunology, Cross-Sectional Studies, Cytokines/immunology, Female, Humans, Immunophenotyping, Lung/immunology, Lymphopenia/immunology, Male, Middle Aged, Respiratory Distress Syndrome/immunology, SARS-CoV-2/immunology, Th17 Cells/immunology

ID: 60934399