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Compartmental immunophenotyping in COVID-19 ARDS: a case series

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@article{b8a72013a7f547dabede0ab53a08f627,
title = "Compartmental immunophenotyping in COVID-19 ARDS: a case series",
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 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.",
keywords = "Acute respiratory distress syndrome, bronchoalveolar lavage, COVID-19, cytokines, flow cytometry",
author = "Andreas Ronit and Berg, {Ronan M G} and Bay, {Jakob T} and Haugaard, {Anna K} and Ahlstr{\"o}m, {Magnus G} and Burgdorf, {Kristoffer S} and Henrik Ullum and R{\o}rvig, {Sara B} and Klaus Tjelle and Foss, {Nicolai B} and Thomas Benfield and Marquart, {Hanne Vibeke} and Plovsing, {Ronni R}",
note = "Copyright {\circledC} 2020 The Authors. Published by Elsevier Inc. All rights reserved.",
year = "2020",
month = "9",
day = "23",
doi = "10.1016/j.jaci.2020.09.009",
language = "English",
journal = "Allergie et Immunologie",
issn = "0091-6749",
publisher = "Mosby, Inc",

}

RIS

TY - JOUR

T1 - Compartmental immunophenotyping in COVID-19 ARDS

T2 - a case series

AU - Ronit, Andreas

AU - Berg, Ronan M G

AU - Bay, Jakob T

AU - Haugaard, Anna K

AU - Ahlström, Magnus G

AU - Burgdorf, Kristoffer S

AU - Ullum, Henrik

AU - Rørvig, Sara B

AU - Tjelle, Klaus

AU - Foss, Nicolai B

AU - Benfield, Thomas

AU - Marquart, Hanne Vibeke

AU - Plovsing, Ronni R

N1 - Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.

PY - 2020/9/23

Y1 - 2020/9/23

N2 - 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.

AB - 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.

KW - Acute respiratory distress syndrome

KW - bronchoalveolar lavage

KW - COVID-19

KW - cytokines

KW - flow cytometry

U2 - 10.1016/j.jaci.2020.09.009

DO - 10.1016/j.jaci.2020.09.009

M3 - Journal article

JO - Allergie et Immunologie

JF - Allergie et Immunologie

SN - 0091-6749

ER -

ID: 60934399