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Severe immunosuppression and not a cytokine storm characterizes COVID-19 infections #MMPMID32687484
Remy KE; Mazer M; Striker DA; Ellebedy AH; Walton AH; Unsinger J; Blood TM; Mudd PA; Yi DJ; Mannion DA; Osborne DF; Martin RS; Anand NJ; Bosanquet JP; Blood J; Drewry AM; Caldwell CC; Turnbull IR; Brakenridge SC; Moldwawer LL; Hotchkiss RS
JCI Insight 2020[Sep]; 5 (17): ä PMID32687484show ga
COVID-19-associated morbidity and mortality have been attributed to a pathologic host response. Two divergent hypotheses have been proposed: hyperinflammatory cytokine storm; and failure of host protective immunity that results in unrestrained viral dissemination and organ injury. A key explanation for the inability to address this controversy has been the lack of diagnostic tools to evaluate immune function in COVID-19 infections. ELISpot, a highly sensitive, functional immunoassay, was employed in 27 patients with COVID-19, 51 patients with sepsis, 18 critically ill nonseptic (CINS) patients, and 27 healthy control volunteers to evaluate adaptive and innate immune status by quantitating T cell IFN-? and monocyte TFN-alpha production. Circulating T cell subsets were profoundly reduced in COVID-19 patients. Additionally, stimulated blood mononuclear cells produced less than 40%-50% of the IFN-? and TNF-alpha observed in septic and CINS patients, consistent with markedly impaired immune effector cell function. Approximately 25% of COVID-19 patients had increased IL-6 levels that were not associated with elevations in other canonical proinflammatory cytokines. Collectively, these findings support the hypothesis that COVID-19 suppresses host functional adaptive and innate immunity. Importantly, IL-7 administered ex vivo restored T cell IFN-? production in COVID-19 patients. Thus, ELISpot may functionally characterize host immunity in COVID-19 and inform prospective therapies.