Immune Alterations in a Patient with SARS-CoV-2-Related Acute Respiratory Distress Syndrome

Overview

Journal J Clin Immunol

Publisher Springer

Specialty Allergy & Immunology

Date 2020 Aug 24

PMID 32829467

Citations 37

Authors

Lila Bouadma

Aurelie Wiedemann

Juliette Patrier

Mathieu Surenaud

Paul-Henri Wicky

Emile Foucat

Jean-Luc Diehl

Boris P Hejblum

Fabrice Sinnah

Etienne de Montmollin

Christine Lacabaratz

Rodolphe Thiebaut

J F Timsit

Yves Levy

Affiliations

Soon will be listed here.

Abstract

We report a longitudinal analysis of the immune response associated with a fatal case of COVID-19 in Europe. This patient exhibited a rapid evolution towards multiorgan failure. SARS-CoV-2 was detected in multiple nasopharyngeal, blood, and pleural samples, despite antiviral and immunomodulator treatment. Clinical evolution in the blood was marked by an increase (2-3-fold) in differentiated effector T cells expressing exhaustion (PD-1) and senescence (CD57) markers, an expansion of antibody-secreting cells, a 15-fold increase in γδ T cell and proliferating NK-cell populations, and the total disappearance of monocytes, suggesting lung trafficking. In the serum, waves of a pro-inflammatory cytokine storm, Th1 and Th2 activation, and markers of T cell exhaustion, apoptosis, cell cytotoxicity, and endothelial activation were observed until the fatal outcome. This case underscores the need for well-designed studies to investigate complementary approaches to control viral replication, the source of the hyperinflammatory status, and immunomodulation to target the pathophysiological response. The investigation was conducted as part of an overall French clinical cohort assessing patients with COVID-19 and registered in clinicaltrials.gov under the following number: NCT04262921.

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