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The Capital Region of Denmark - a part of Copenhagen University Hospital
E-pub ahead of print

Compartmental immunophenotyping in COVID-19 ARDS: a case series

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BACKGROUND: Severe immunopathology may drive the deleterious manifestations observed in the advanced stages of coronavirus disease 2019 (COVID-19) but are poorly understood.

OBJECTIVE: 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 <72 hours after intubation following informed consent from next of kin. Bronchoalveolar lavage fluid (BALF) was evaluated by microscopy and BALF and blood was assessed by 10-colored flow cytometry and a multiplex cytokine panel.

RESULTS: Four mechanically ventilated patients (40-75 yr.) with moderate to severe COVID-19 ARDS were included. Immature neutrophils dominated in both blood and lungs, while CD4 and CD8 T cell lymphopenia were observed in the two compartments. However, T regulatory 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 blood and in the lungs, most notably IL-1RA, IL-6, IL-8, IP-10, and MCP-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.

TRIAL REGISTRATION: clinicaltrials.gov/ct2/show/NCT04354584.

Original languageEnglish
JournalThe Journal of allergy and clinical immunology
ISSN0091-6749
DOIs
Publication statusE-pub ahead of print - 23 Sep 2020

    Research areas

  • Acute respiratory distress syndrome, bronchoalveolar lavage, COVID-19, cytokines, flow cytometry

ID: 60934399