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Quincho-Lopez A, Poma N, José Montenegro-Idrogo J. COVID-19 associated with cryptococcosis: a scoping review. Ther Adv Infect Dis 2024; 11:20499361241232851. [PMID: 38361915 PMCID: PMC10868154 DOI: 10.1177/20499361241232851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 01/30/2024] [Indexed: 02/17/2024] Open
Abstract
Background There is growing evidence of fungal infections associated with COVID-19. The development of cryptococcosis in these patients has been infrequently reported. However, it can be life-threatening. Objective To identify cases of COVID-19 patients who developed cryptococcosis and to compare baseline characteristics and management between those who survived and those who died. Methods We conducted a scoping review using PubMed, Scopus, Web of Science, and Embase to identify studies that reported patients with COVID-19 and cryptococcosis. No language restriction was applied. Single case reports, case series, and original articles were included. It is important to note that 'n' refers to the total number of individuals with the specified variable. Results A total of 58 studies were included. Among these studies, 51 included individual patient data, detailing information on a total of 65 patients, whereas eight studies reported the proportion of cryptococcosis in COVID-19 patients. One study provided both individual and aggregate case information. From individual patient data, the majority were male (73.9%; n = 48) with a median age of 60 years (range: 53-70). Severe COVID-19 and multiple comorbidities, led by arterial hypertension and diabetes mellitus, were frequently reported, but few had classic immunosuppression factors. On the other hand, HIV status, either negative or positive, was reported in just over half of the patients (61.5%; n = 40). Most were admitted to the intensive care unit (ICU) (58.5%; n = 31), received mechanical ventilation (MV) (50.0%; n = 26), and developed disseminated cryptococcosis (55.4%; n = 36). Secondary infection, mainly bacterial, was reported in 19 patients (29.2%). Mortality was 47.7% (n = 31). Of the studies that reported the proportion of cryptococcosis in COVID-19 cases, the majority were descriptive studies published as conference abstracts. Conclusion Cryptococcosis in COVID-19 patients has been reported more frequently. However, it is still not as common as other fungal infections associated with COVID-19. Few patients have some classic immunosuppression factors. The factors associated with mortality were male sex, age, ICU admission, MV, secondary infections, and lymphopenia.
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Affiliation(s)
- Alvaro Quincho-Lopez
- Unidad de Investigación en Bibliometría, Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima, Peru
| | - Nuvith Poma
- Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Juan José Montenegro-Idrogo
- Clinical Epidemiology and Biostatistics, Universidad Científica del Sur, Lima, Peru
- Infectious Diseases and Tropical Medicine Service, Hospital Nacional Dos de Mayo, Lima, Peru
- Centro de Investigaciones Tecnológicas, Biomédicas y Medioambientales, Universidad Nacional Mayor de San Marcos, Lima, Peru
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Pathakumari B, Marty PK, Shah M, Van Keulen VP, Erskine CL, Block MS, Arias-Sanchez P, Escalante P, Peikert T. Convalescent Adaptive Immunity Is Highly Heterogenous after SARS-CoV-2 Infection. J Clin Med 2023; 12:7136. [PMID: 38002748 PMCID: PMC10672050 DOI: 10.3390/jcm12227136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 11/03/2023] [Accepted: 11/14/2023] [Indexed: 11/26/2023] Open
Abstract
The optimal detection strategies for effective convalescent immunity after SARS-CoV-2 infection and vaccination remain unclear. The objective of this study was to characterize convalescent immunity targeting the SARS-CoV-2 spike protein using a multiparametric approach. At the beginning of the pandemic, we recruited 30 unvaccinated convalescent donors who had previously been infected with COVID-19 and 7 unexposed asymptomatic controls. Peripheral blood mononuclear cells (PBMCs) were obtained from leukapheresis cones. The humoral immune response was assessed by measuring serum anti-SARS-CoV-2 spike S1 subunit IgG via semiquantitative ELISA, and T-cell immunity against S1 and S2 subunits were studied via IFN-γ enzyme-linked immunosorbent spot (ELISpot) and flow cytometric (FC) activation-induced marker (AIM) assays and the assessment of cytotoxic CD8+ T-cell function (in the subset of HLA-A2-positive patients). No single immunoassay was sufficient in identifying anti-spike convalescent immunity among all patients. There was no consistent correlation between adaptive humoral and cellular anti-spike responses. Our data indicate that the magnitude of anti-spike convalescent humoral and cellular immunity is highly heterogeneous and highlights the need for using multiple assays to comprehensively measure SARS-CoV-2 convalescent immunity. These observations might have implications for COVID-19 surveillance, and the determination of optimal vaccination strategies for emerging variants. Further studies are needed to determine the optimal assessment of adaptive humoral and cellular immunity following SARS-CoV-2 infection, especially in the context of emerging variants and unclear vaccination schedules.
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Affiliation(s)
- Balaji Pathakumari
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA; (B.P.); (P.K.M.); (M.S.); (V.P.V.K.); (P.A.-S.); (P.E.)
| | - Paige K. Marty
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA; (B.P.); (P.K.M.); (M.S.); (V.P.V.K.); (P.A.-S.); (P.E.)
| | - Maleeha Shah
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA; (B.P.); (P.K.M.); (M.S.); (V.P.V.K.); (P.A.-S.); (P.E.)
| | - Virginia P. Van Keulen
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA; (B.P.); (P.K.M.); (M.S.); (V.P.V.K.); (P.A.-S.); (P.E.)
- Department of Immunology, Mayo Clinic, Rochester, MN 55905, USA; (C.L.E.); (M.S.B.)
| | - Courtney L. Erskine
- Department of Immunology, Mayo Clinic, Rochester, MN 55905, USA; (C.L.E.); (M.S.B.)
| | - Matthew S. Block
- Department of Immunology, Mayo Clinic, Rochester, MN 55905, USA; (C.L.E.); (M.S.B.)
- Department of Oncology, Mayo Clinic, Rochester, MN 55905, USA
| | - Pedro Arias-Sanchez
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA; (B.P.); (P.K.M.); (M.S.); (V.P.V.K.); (P.A.-S.); (P.E.)
| | - Patricio Escalante
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA; (B.P.); (P.K.M.); (M.S.); (V.P.V.K.); (P.A.-S.); (P.E.)
| | - Tobias Peikert
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA; (B.P.); (P.K.M.); (M.S.); (V.P.V.K.); (P.A.-S.); (P.E.)
- Department of Immunology, Mayo Clinic, Rochester, MN 55905, USA; (C.L.E.); (M.S.B.)
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Ruytinx P, Vandormael P, Fraussen J, Pieters Z, Thonissen S, Hellings N, Stinissen P, Callebaut I, Penders J, Vanhove K, Kieffer D, Rummens JL, Valkenborgh T, Messiaen P, Stessel B, Mesotten D, Somers V. Comprehensive antibody and cytokine profiling in hospitalized COVID-19 patients in relation to clinical outcomes in a large Belgian cohort. Sci Rep 2023; 13:19322. [PMID: 37935729 PMCID: PMC10630327 DOI: 10.1038/s41598-023-46421-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 10/31/2023] [Indexed: 11/09/2023] Open
Abstract
The immune response in patients with Coronavirus Disease 2019 (COVID-19) is highly variable and is linked to disease severity and mortality. However, antibody and cytokine responses in the early disease stage and their association with disease course and outcome are still not completely understood. In this large, multi-centre cohort study, blood samples of 434 Belgian COVID-19 hospitalized patients with different disease severities (ranging from asymptomatic/mild to critically ill) from the first wave of the COVID-19 pandemic were obtained. Baseline antibody and cytokine responses were characterized and associations with several clinical outcome parameters were determined. Anti-spike immunoglobulin (Ig)G and IgM levels were elevated in patients with a more severe disease course. This increased baseline antibody response however was associated with decreased odds for hospital mortality. Levels of the pro-inflammatory cytokines IL-6, IP-10 and IL-8, the anti-inflammatory cytokine IL-10 and the antiviral cytokines IFN-α, IFN-β and IFN-λ1 were increased with disease severity. Remarkably, we found significantly lower levels of IFN-λ2,3 in critically ill patients compared to patients of the moderate and severe disease category. Finally, levels of IL-8, IL-6, IP-10, IL-10, IFN-α, IFN-β, IFN-γ and IFN-λ1 at baseline were positively associated with mortality, whereas higher IFN-λ2,3 levels were negatively associated with mortality.
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Affiliation(s)
- Pieter Ruytinx
- Department of Immunology and Infection, UHasselt, Biomedical Research Institute, Martelarenlaan 42, 3500, Hasselt, Belgium
| | - Patrick Vandormael
- Department of Immunology and Infection, UHasselt, Biomedical Research Institute, Martelarenlaan 42, 3500, Hasselt, Belgium
| | - Judith Fraussen
- Department of Immunology and Infection, UHasselt, Biomedical Research Institute, Martelarenlaan 42, 3500, Hasselt, Belgium
| | - Zoë Pieters
- Data Science Institute, UHasselt, I-BioStat, Martelarenlaan 42, 3500, Hasselt, Belgium
| | - Stef Thonissen
- Faculty of Medicine and Life Sciences, UHasselt, Martelarenlaan 42, 3500, Hasselt, Belgium
| | - Niels Hellings
- Department of Immunology and Infection, UHasselt, Biomedical Research Institute, Martelarenlaan 42, 3500, Hasselt, Belgium
| | - Piet Stinissen
- Department of Immunology and Infection, UHasselt, Biomedical Research Institute, Martelarenlaan 42, 3500, Hasselt, Belgium
- Faculty of Medicine and Life Sciences, UHasselt, LCRC, Martelarenlaan 42, 3500, Hasselt, Belgium
| | - Ina Callebaut
- Faculty of Medicine and Life Sciences, UHasselt, LCRC, Martelarenlaan 42, 3500, Hasselt, Belgium
- Department of Intensive Care and Anesthesiology, Jessa Hospital, Hasselt, Belgium
| | - Joris Penders
- Faculty of Medicine and Life Sciences, UHasselt, LCRC, Martelarenlaan 42, 3500, Hasselt, Belgium
- Department of Laboratory Medicine, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Karolien Vanhove
- Faculty of Medicine and Life Sciences, UHasselt, LCRC, Martelarenlaan 42, 3500, Hasselt, Belgium
- Department of Respiratory Medicine, AZ Vesalius Hospital, Hazelereik 51, 3700, Tongeren, Belgium
| | - Davy Kieffer
- Department of Clinical Biology, Sint-Trudo Hospital, Diestersteenweg 100, 3800, Sint-Truiden, Belgium
| | - Jean-Luc Rummens
- Faculty of Medicine and Life Sciences, UHasselt, Martelarenlaan 42, 3500, Hasselt, Belgium
- Faculty of Medicine and Life Sciences, UHasselt, LCRC, Martelarenlaan 42, 3500, Hasselt, Belgium
- Department of Laboratory Medicine, Jessa Hospital, 3500, Hasselt, Belgium
- UHasselt, University Biobank Limburg (UBiLim), Jessa Hospital, 3500, Hasselt, Belgium
| | - Tom Valkenborgh
- Department of Anesthesiology and Intensive Care, Noorderhart Pelt, Belgium
| | - Peter Messiaen
- Faculty of Medicine and Life Sciences, UHasselt, LCRC, Martelarenlaan 42, 3500, Hasselt, Belgium
- Department of Infectious Diseases and Immunity, Jessa Hospital, 3500, Hasselt, Belgium
| | - Björn Stessel
- Faculty of Medicine and Life Sciences, UHasselt, LCRC, Martelarenlaan 42, 3500, Hasselt, Belgium
- Department of Intensive Care and Anesthesiology, Jessa Hospital, Hasselt, Belgium
| | - Dieter Mesotten
- Faculty of Medicine and Life Sciences, UHasselt, LCRC, Martelarenlaan 42, 3500, Hasselt, Belgium
- Department of Anesthesiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Veerle Somers
- Department of Immunology and Infection, UHasselt, Biomedical Research Institute, Martelarenlaan 42, 3500, Hasselt, Belgium.
- Faculty of Medicine and Life Sciences, UHasselt, Martelarenlaan 42, 3500, Hasselt, Belgium.
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4
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Jegorović B, Nikolić A, Milinković N, Ignjatović S, Šipetić-Grujičić S. The utility of serum amyloid A and other acute-phase reactants determination in ambulatory care COVID-19 patients. J Med Biochem 2023; 42:492-504. [PMID: 37790210 PMCID: PMC10542288 DOI: 10.5937/jomb0-42799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 03/13/2023] [Indexed: 10/05/2023] Open
Abstract
Background The unpredictable course of Coronavirus Disease 19 (COVID-19) is making good severity assessment tools crucial. This study aimed to assess the usefulness of serum amyloid A (SAA) and other acute-phase reactants (APRs) in ambulatory care COVID-19 patients and identified relationships between these markers and disease outcomes. Methods From August to November 2020, patients seen in the outpatient department of the Clinic for Infectious and Tropical Diseases (Belgrade, Serbia) with confirmed COVID-19 were included. Patients were classified into mild, moderate, and severe disease groups based on World Health Organization criteria. SAA, C-reactive protein (CRP), interleukin-6 (IL-6), procalcitonin (PCT), ferritin, fibrinogen, D-dimer, albumin, and transferrin were measured. The median values of all APRs were compared between COVID-19 severity groups, hospitalized and non-hospitalized patients, and survivors and non-survivors. The Receiver operator characteristic (ROC) curve analysis was used for the classification characteristics assessment of individual APRs for the severity of illness, hospitalization, and survival.
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Affiliation(s)
- Boris Jegorović
- University Clinical Center of Serbia, Clinic for Infectious and Tropical Diseases "Prof. Dr. Kosta Todorović", Belgrade
| | - Aleksandra Nikolić
- University of Belgrade, Faculty of Medicine, Institute for Epidemiology, Belgrade
| | - Neda Milinković
- University of Belgrade, Faculty of Pharmacy, Department of Medical Biochemistry, Belgrade
| | - Svetlana Ignjatović
- University of Belgrade, Faculty of Pharmacy, Department of Medical Biochemistry, Belgrade
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5
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Marty PK, Pathakumari B, Shah M, Keulen VP, Erskine CL, Block MS, Arias-Sanchez P, Escalante P, Peikert T. Convalescent Adaptive Immunity is Highly Heterogenous after SARS-CoV-2 Infection. RESEARCH SQUARE 2023:rs.3.rs-3222112. [PMID: 37674707 PMCID: PMC10479471 DOI: 10.21203/rs.3.rs-3222112/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
Optimal detection strategies for effective convalescent immunity after SARS-CoV-2 infection and vaccination remain unclear. The objective of this study was to characterize convalescent immunity targeting the SARS-CoV-2 spike protein using a multiparametric approach. At the beginning of the pandemic, between April 23, 2020, to May 11, 2020, we recruited 30 COVID-19 unvaccinated convalescent donors and 7 unexposed asymptomatic donors. Peripheral blood mononuclear cells (PBMCs) were obtained from leukapheresis cones. The humoral immune response was assessed by measuring serum anti-SARS-CoV-2 spike S1 subunit IgG semiquantitative ELISA and T cell immunity against S1 and S2 subunits were studied by IFN-γ Enzyme-Linked Immune absorbent Spot (ELISpot), flow cytometric (FC) activation-induced marker (AIM) assays and the assessment of cytotoxic CD8+ T-cell function (in the subset of HLA-A2 positive patients). No single immunoassay was sufficient in identifying anti-spike convalescent immunity among all patients. There was no consistent correlation between adaptive humoral and cellular anti-spike responses. Our data indicate that the magnitude of anti-spike convalescent humoral and cellular immunity is highly heterogeneous and highlights the need for using multiple assays to comprehensively measure SARS-CoV-2 convalescent immunity. These observations might have implications for COVID-19 surveillance, and optimal vaccination strategies for emerging variants. Further studies are needed to determine the optimal assessment of adaptive humoral and cellular immunity following SARSCoV-2 infection, especially in the context of emerging variants and unclear vaccination schedules.
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6
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Ulakcsai Z, Szabo L, Szabo Z, Karaszi E, Szabo T, Fazekas L, Vereb A, Kovacs NF, Nemeth D, Kovacs E, Nemeth E, Nagy G, Vago H, Merkely B. T cell immune response predicts survival in severely ill COVID-19 patients requiring venovenous extracorporeal membrane oxygenation support. Front Immunol 2023; 14:1179620. [PMID: 37600824 PMCID: PMC10433181 DOI: 10.3389/fimmu.2023.1179620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 07/04/2023] [Indexed: 08/22/2023] Open
Abstract
Introduction There is a critical gap in understanding which SARS-CoV-2 patients would benefit most from venovenous extracorporeal membrane oxygenation (VV-ECMO) support. The potential role of a dysregulated immune response is still unclear in this patient population. Objectives To assess the potential predictive value of SARS-CoV-2 specific cellular and humoral immune responses for survival in critically ill COVID-19 patients requiring VV-ECMO. Methods We conducted a prospective single-center observational study of unvaccinated patients requiring VV-ECMO support treated at the intensive care unit of Semmelweis University Heart and Vascular Center between March and December 2021. Peripheral blood samples were collected to measure the humoral and cellular immune statuses of the patients at the VV-ECMO cannulation. Patients were followed until hospital discharge. Results Overall, 35 COVID-19 patients (63% men, median age 37 years) on VV-ECMO support were included in our study. The time from COVID-19 verification to ECMO support was a median (IQR) of 10 (7-14) days. Of the patients, 9 (26%) were discharged alive and 26 (74%) died during their hospital stay. Immune tests confirmed ongoing SARS-CoV-2 infection in all the patients, showing an increased humoral immune response. SARS-CoV-2-specific cellular immune response was significantly higher among survivors compared to the deceased patients. A higher probability of survival was observed in patients with markers indicating a higher T cell response detected by both QuantiFeron (QF) and flow cytometry (Flow) assays. (Flow S1 CD8+ ≥ 0.15%, Flow S1 CD4+ ≥ 0.02%, QF CD4 ≥ 0.07, QF whole genome ≥ 0.59). In univariate Cox proportional hazard regression analysis BMI, right ventricular (RV) failure, QF whole genome T cell level, and Flow S1 CD8+ T cell level were associated with mortality, and we found that an increased T cell response showed a significant negative association with mortality, independent of BMI and RV failure. Conclusion Evaluation of SARS-CoV-2 specific T cell response before the cannulation can aid the risk stratification and evaluation of seriously ill COVID-19 patients undergoing VV-ECMO support by predicting survival, potentially changing our clinical practice in the future.
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Affiliation(s)
| | - Liliana Szabo
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Zsofia Szabo
- Department of Laboratory Medicine, Semmelweis University, Budapest, Hungary
| | - Eva Karaszi
- Pediatric Healthcare Center, Council of Budafok-Tétény, Budapest, Hungary
| | - Tamas Szabo
- Department of Laboratory Medicine, Semmelweis University, Budapest, Hungary
| | - Levente Fazekas
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Alexandra Vereb
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | | | - Dora Nemeth
- Department of Rheumatology and Clinical Immunology, Semmelweis University, Budapest, Hungary
- Department of Genetics, Cell- and Immunobiology, Semmelweis University, Budapest, Hungary
| | - Eniko Kovacs
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Endre Nemeth
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Gyorgy Nagy
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- Department of Rheumatology and Clinical Immunology, Semmelweis University, Budapest, Hungary
- Hospital of the Hospitaller Order of Saint John of God, Budapest, Hungary
| | - Hajnalka Vago
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- Department of Sports Medicine, Semmelweis University, Budapest, Hungary
| | - Bela Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- Department of Sports Medicine, Semmelweis University, Budapest, Hungary
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Lee YJ, Seok SH, Lee NY, Choi HJ, Lee YW, Chang HJ, Hwang JY, On DI, Noh HA, Lee SB, Kwon HK, Yun JW, Shin JS, Seo JY, Nam KT, Lee H, Lee HY, Park JW, Seong JK. Murine Coronavirus Disease 2019 Lethality Is Characterized by Lymphoid Depletion Associated with Suppressed Antigen-Presenting Cell Functionality. THE AMERICAN JOURNAL OF PATHOLOGY 2023; 193:866-882. [PMID: 37024046 PMCID: PMC10073095 DOI: 10.1016/j.ajpath.2023.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 02/28/2023] [Accepted: 03/16/2023] [Indexed: 04/08/2023]
Abstract
The disease severity of coronavirus disease 2019 (COVID-19) varies considerably from asymptomatic to serious, with fatal complications associated with dysregulation of innate and adaptive immunity. Lymphoid depletion in lymphoid tissues and lymphocytopenia have both been associated with poor disease outcomes in patients with COVID-19, but the mechanisms involved remain elusive. In this study, human angiotensin-converting enzyme 2 (hACE2) transgenic mouse models susceptible to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection were used to investigate the characteristics and determinants of lethality associated with the lymphoid depletion observed in SARS-CoV-2 infection. The lethality of Wuhan SARS-CoV-2 infection in K18-hACE2 mice was characterized by severe lymphoid depletion and apoptosis in lymphoid tissues related to fatal neuroinvasion. The lymphoid depletion was associated with a decreased number of antigen-presenting cells (APCs) and their suppressed functionality below basal levels. Lymphoid depletion with reduced APC function was a specific feature observed in SARS-CoV-2 infection but not in influenza A infection and had the greatest prognostic value for disease severity in murine COVID-19. Comparison of transgenic mouse models resistant and susceptible to SARS-CoV-2 infection revealed that suppressed APC function could be determined by the hACE2 expression pattern and interferon-related signaling. Thus, we demonstrated that lymphoid depletion associated with suppressed APC function characterizes the lethality of COVID-19 mouse models. Our data also suggest a potential therapeutic approach to prevent the severe progression of COVID-19 by enhancing APC functionality.
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Affiliation(s)
- Yu Jin Lee
- Division of Biomedical Convergence, College of Biomedical Science, Kangwon National University, ChunCheon, Republic of Korea
| | - Sang Hyeok Seok
- Division of Biomedical Convergence, College of Biomedical Science, Kangwon National University, ChunCheon, Republic of Korea
| | - Na Yun Lee
- Division of Biomedical Convergence, College of Biomedical Science, Kangwon National University, ChunCheon, Republic of Korea
| | - Hee Jin Choi
- Division of Biomedical Convergence, College of Biomedical Science, Kangwon National University, ChunCheon, Republic of Korea
| | - Yoon Woo Lee
- Department of Nuclear Medicine, Seoul National University Bundang Hospital, Seoul, Republic of Korea
| | - Hee Jung Chang
- Department of Nuclear Medicine, Seoul National University Bundang Hospital, Seoul, Republic of Korea
| | - Ji-Yeon Hwang
- Preclinical Research Center, Seoul National University Bundang Hospital, Seoul, Republic of Korea
| | - Da In On
- Korea Mouse Phenotyping Center, Seoul National University, Seoul, Republic of Korea
| | - Hyun Ah Noh
- Korea Mouse Phenotyping Center, Seoul National University, Seoul, Republic of Korea
| | - Su-Bin Lee
- Department of Microbiology and Immunology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ho-Keun Kwon
- Department of Microbiology and Immunology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jun-Won Yun
- College of Veterinary Medicine, Seoul National University, Seoul, Republic of Korea
| | - Jeon-Soo Shin
- Department of Microbiology and Immunology, Yonsei University College of Medicine, Seoul, Republic of Korea; Severance Biomedical Science Institute, and the Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jun-Young Seo
- Severance Biomedical Science Institute, and the Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ki Taek Nam
- Severance Biomedical Science Institute, and the Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ho Lee
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea
| | - Ho Young Lee
- Department of Nuclear Medicine, Seoul National University Bundang Hospital, Seoul, Republic of Korea
| | - Jun Won Park
- Division of Biomedical Convergence, College of Biomedical Science, Kangwon National University, ChunCheon, Republic of Korea.
| | - Je Kyung Seong
- Korea Mouse Phenotyping Center, Seoul National University, Seoul, Republic of Korea; Laboratory of Developmental Biology and Genomics, Research Institute for Veterinary Science, and BK 21 PLUS Program for Creative Veterinary Science Research, College of Veterinary Medicine, Seoul National University, Seoul, Republic of Korea.
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8
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Marshall GD. The pathophysiology of postacute sequelae of COVID-19 (PASC): Possible role for persistent inflammation. Asia Pac Allergy 2023; 13:77-84. [PMID: 37388814 PMCID: PMC10287107 DOI: 10.5415/apallergy.0000000000000106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 05/26/2023] [Indexed: 07/01/2023] Open
Abstract
As the SARS-CoV-2-induced pandemic wanes, a substantial number of patients with acute Corona Virus-induced disease (COVID-19 continue to have symptoms for a prolonged time after initial infection. These patients are said to have postacute sequelae of COVID (PASC) or "long COVID". The underlying pathophysiology of this syndrome is poorly understood and likely quite heterogeneous. The role of persistent, possibly deviant inflammation as a major factor in comorbidity is suspected. Objective To review data that address the relative importance of inflammation in the pathophysiology spectrum of PASC and to address how this would impact diagnosis and approach to therapy in patients identified as having such inflammatory abnormalities. Methods A review of public databases, including PubMed, MeSH, NLM catalog, and clinical trial databases such as clinicaltrials.gov. Results The literature supports a prominent role for various forms and types of inflammation in the pathophysiologic spectrum of PASC. Such inflammation can be persistent ant CoV-2-specific responses, new onset autoimmune responses, or a loss of normal immunoregulation resulting in widespread, sustained inflammatory pathologies that can affect both broad constitutional symptoms (such as fatigue, neurocognitive dysfunction, and anxiety/depression) and organ-specific dysfunction and/or failure. Conclusions PASC is a significant clinical entity with similarities to and differences from other postviral syndromes. Significant research efforts are ongoing to better understand specific aberrant inflammatory pathways present in individual patients for the purpose of developing and implementing effective therapies and ultimately prophylaxis strategies to prevent the progression of COVID-19 as well as likely future viral illnesses and pandemics.
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Affiliation(s)
- Gailen D. Marshall
- Department of Medicine, The University of Mississippi Medical Center, Jackson, MS, USA
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9
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Lesteberg KE, Araya P, Waugh KA, Chauhan L, Espinosa JM, Beckham JD. Severely ill and high-risk COVID-19 patients exhibit increased peripheral circulation of CD62L+ and perforin+ T cells. Front Immunol 2023; 14:1113932. [PMID: 36817450 PMCID: PMC9932815 DOI: 10.3389/fimmu.2023.1113932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 01/20/2023] [Indexed: 02/05/2023] Open
Abstract
Introduction The emergence of SARS-CoV-2, which causes COVID-19, has led to over 400 million reported cases worldwide. COVID-19 disease ranges from asymptomatic infection to severe disease and may be impacted by individual immune differences. Methods We used multiparameter flow cytometry to compare CD4+ and CD8+ T cell responses in severe (ICU admitted) and non-severe (admitted to observational unit) hospitalized COVID-19 patients. Results We found that patients with severe COVID- 19 had greater frequencies of CD4+ T cells expressing CD62L compared to non-severe patients and greater frequencies of perforin+ CD8+ T cells compared to recovered patients. Furthermore, greater frequencies of CD62L+ CD4+ and CD8+ T cells were seen in severely ill diabetic patients compared to non-severe and non-diabetic patients, and increased CD62L+ CD4+ T cells were also seen in severely ill patients with hypertension. Discussion This is the first report to show that CD62L+ T cells and perforin+ T cells are associated with severe COVID-19 illness and are significantly increased in patients with high-risk pre-existing conditions including older age and diabetes. These data provide a potential biological marker for severe COVID-19.
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Affiliation(s)
- Kelsey E. Lesteberg
- Department of Medicine, Division of Infectious Diseases, University of Colorado School of Medicine, Aurora, CO, United States
- Department of Immunology and Microbiology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Paula Araya
- Linda Crnic Institute for Down Syndrome, University of Colorado School of Medicine, Aurora, CO, United States
| | - Katherine A. Waugh
- Linda Crnic Institute for Down Syndrome, University of Colorado School of Medicine, Aurora, CO, United States
- Department of Pharmacology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Lakshmi Chauhan
- Department of Medicine, Division of Infectious Diseases, University of Colorado School of Medicine, Aurora, CO, United States
| | - Joaquin M. Espinosa
- Linda Crnic Institute for Down Syndrome, University of Colorado School of Medicine, Aurora, CO, United States
- Department of Pharmacology, University of Colorado School of Medicine, Aurora, CO, United States
| | - J. David Beckham
- Department of Medicine, Division of Infectious Diseases, University of Colorado School of Medicine, Aurora, CO, United States
- Department of Immunology and Microbiology, University of Colorado School of Medicine, Aurora, CO, United States
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, United States
- Department of Medicine, Rocky Mountain VA Medical Center, Aurora, CO, United States
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10
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Wigerblad G, Warner SA, Ramos-Benitez MJ, Kardava L, Tian X, Miao R, Reger R, Chakraborty M, Wong S, Kanthi Y, Suffredini AF, Dell’Orso S, Brooks S, King C, Shlobin O, Nathan SD, Cohen J, Moir S, Childs RW, Kaplan MJ, Chertow DS, Strich JR. Spleen tyrosine kinase inhibition restores myeloid homeostasis in COVID-19. SCIENCE ADVANCES 2023; 9:eade8272. [PMID: 36598976 PMCID: PMC9812373 DOI: 10.1126/sciadv.ade8272] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 11/23/2022] [Indexed: 06/17/2023]
Abstract
Spleen tyrosine kinase (SYK) is a previously unidentified therapeutic target that inhibits neutrophil and macrophage activation in coronavirus disease 2019 (COVID-19). Fostamatinib, a SYK inhibitor, was studied in a phase 2 placebo-controlled randomized clinical trial and was associated with improvements in many secondary end points related to efficacy. Here, we used a multiomic approach to evaluate cellular and soluble immune mediator responses of patients enrolled in this trial. We demonstrated that SYK inhibition was associated with reduced neutrophil activation, increased circulation of mature neutrophils (CD10+CD33-), and decreased circulation of low-density granulocytes and polymorphonuclear myeloid-derived suppressor cells (HLA-DR-CD33+CD11b-). SYK inhibition was also associated with normalization of transcriptional activity in circulating monocytes relative to healthy controls, an increase in frequency of circulating nonclassical and HLA-DRhi classical monocyte populations, and restoration of interferon responses. Together, these data suggest that SYK inhibition may mitigate proinflammatory myeloid cellular and soluble mediator responses thought to contribute to immunopathogenesis of severe COVID-19.
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Affiliation(s)
- Gustaf Wigerblad
- Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Disease, Bethesda, MD, USA
| | - Seth A. Warner
- Critical Care Medicine Department, National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Marcos J. Ramos-Benitez
- Critical Care Medicine Department, National Institutes of Health Clinical Center, Bethesda, MD, USA
- Postdoctoral Research Associate Training Program, National Institute of General Medical Sciences, Bethesda, MD, USA
- Ponce Health Science University and Ponce Research Institute, Department of Basic Sciences, School of Medicine, Ponce, Puerto Rico, USA
| | - Lela Kardava
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health (NIH), Bethesda, MD, USA
| | - Xin Tian
- Office of Biostatistics Research, National Heart, Lung, and Blood Institute, NIH, Bethesda, MD, USA
| | - Rui Miao
- Office of Biostatistics Research, National Heart, Lung, and Blood Institute, NIH, Bethesda, MD, USA
| | - Robert Reger
- Laboratory of Transplantation Immunotherapy, National Heart, Lung, and Blood Institute, NIH, Bethesda, MD, USA
| | - Mala Chakraborty
- Laboratory of Transplantation Immunotherapy, National Heart, Lung, and Blood Institute, NIH, Bethesda, MD, USA
| | - Susan Wong
- Laboratory of Transplantation Immunotherapy, National Heart, Lung, and Blood Institute, NIH, Bethesda, MD, USA
| | - Yogendra Kanthi
- Laboratory of Vascular Thrombosis and Inflammation, National Heart, Lung, and Blood Institute, NIH, Bethesda, MD, USA
| | - Anthony F. Suffredini
- Critical Care Medicine Department, National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Stefania Dell’Orso
- Genomic Technology Section, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Stephen Brooks
- Biodata Mining and Discovery Section, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Christopher King
- Advanced Lung Disease and Lung Transplant Program, Inova Fairfax Hospital, Falls Church, VA, USA
| | - Oksana Shlobin
- Advanced Lung Disease and Lung Transplant Program, Inova Fairfax Hospital, Falls Church, VA, USA
| | - Steven D. Nathan
- Advanced Lung Disease and Lung Transplant Program, Inova Fairfax Hospital, Falls Church, VA, USA
| | - Jonathan Cohen
- Adventist Healthcare Shady Grove Medical Center, Rockville, MD, USA
| | - Susan Moir
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health (NIH), Bethesda, MD, USA
| | - Richard W. Childs
- Laboratory of Transplantation Immunotherapy, National Heart, Lung, and Blood Institute, NIH, Bethesda, MD, USA
- United States Public Health Service Commissioned Corps, Rockville, MD, USA
| | - Mariana J. Kaplan
- Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Disease, Bethesda, MD, USA
| | - Daniel S. Chertow
- Critical Care Medicine Department, National Institutes of Health Clinical Center, Bethesda, MD, USA
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health (NIH), Bethesda, MD, USA
- United States Public Health Service Commissioned Corps, Rockville, MD, USA
| | - Jeffrey R. Strich
- Critical Care Medicine Department, National Institutes of Health Clinical Center, Bethesda, MD, USA
- United States Public Health Service Commissioned Corps, Rockville, MD, USA
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11
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Wiech M, Chroscicki P, Swatler J, Stepnik D, De Biasi S, Hampel M, Brewinska-Olchowik M, Maliszewska A, Sklinda K, Durlik M, Wierzba W, Cossarizza A, Piwocka K. Remodeling of T Cell Dynamics During Long COVID Is Dependent on Severity of SARS-CoV-2 Infection. Front Immunol 2022; 13:886431. [PMID: 35757700 PMCID: PMC9226563 DOI: 10.3389/fimmu.2022.886431] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 04/22/2022] [Indexed: 12/14/2022] Open
Abstract
Several COVID-19 convalescents suffer from the post-acute COVID-syndrome (PACS)/long COVID, with symptoms that include fatigue, dyspnea, pulmonary fibrosis, cognitive dysfunctions or even stroke. Given the scale of the worldwide infections, the long-term recovery and the integrative health-care in the nearest future, it is critical to understand the cellular and molecular mechanisms as well as possible predictors of the longitudinal post-COVID-19 responses in convalescent individuals. The immune system and T cell alterations are proposed as drivers of post-acute COVID syndrome. However, despite the number of studies on COVID-19, many of them addressed only the severe convalescents or the short-term responses. Here, we performed longitudinal studies of mild, moderate and severe COVID-19-convalescent patients, at two time points (3 and 6 months from the infection), to assess the dynamics of T cells immune landscape, integrated with patients-reported symptoms. We show that alterations among T cell subsets exhibit different, severity- and time-dependent dynamics, that in severe convalescents result in a polarization towards an exhausted/senescent state of CD4+ and CD8+ T cells and perturbances in CD4+ Tregs. In particular, CD8+ T cells exhibit a high proportion of CD57+ terminal effector cells, together with significant decrease of naïve cell population, augmented granzyme B and IFN-γ production and unresolved inflammation 6 months after infection. Mild convalescents showed increased naïve, and decreased central memory and effector memory CD4+ Treg subsets. Patients from all severity groups can be predisposed to the long COVID symptoms, and fatigue and cognitive dysfunctions are not necessarily related to exhausted/senescent state and T cell dysfunctions, as well as unresolved inflammation that was found only in severe convalescents. In conclusion, the post-COVID-19 functional remodeling of T cells could be seen as a two-step process, leading to distinct convalescent immune states at 6 months after infection. Our data imply that attenuation of the functional polarization together with blocking granzyme B and IFN-γ in CD8+ cells might influence post-COVID alterations in severe convalescents. However, either the search for long COVID predictors or any treatment to prevent PACS and further complications is mandatory in all patients with SARS-CoV-2 infection, and not only in those suffering from severe COVID-19.
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Affiliation(s)
- Milena Wiech
- Laboratory of Cytometry, Nencki Institute of Experimental Biology, Polish Academy of Sciences, Warsaw, Poland
| | - Piotr Chroscicki
- Laboratory of Cytometry, Nencki Institute of Experimental Biology, Polish Academy of Sciences, Warsaw, Poland
| | - Julian Swatler
- Laboratory of Cytometry, Nencki Institute of Experimental Biology, Polish Academy of Sciences, Warsaw, Poland
| | - Dawid Stepnik
- Laboratory of Cytometry, Nencki Institute of Experimental Biology, Polish Academy of Sciences, Warsaw, Poland
| | - Sara De Biasi
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia School of Medicine, Modena, Italy
| | - Michal Hampel
- Department of Gastroenterological Surgery and Transplantology, Central Clinical Hospital of the Ministry of Interior, Warsaw, Poland
| | - Marta Brewinska-Olchowik
- Laboratory of Cytometry, Nencki Institute of Experimental Biology, Polish Academy of Sciences, Warsaw, Poland
| | - Anna Maliszewska
- Department of Gastroenterological Surgery and Transplantology, Central Clinical Hospital of the Ministry of Interior, Warsaw, Poland
| | - Katarzyna Sklinda
- Department of Radiology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Marek Durlik
- Department of Gastroenterological Surgery and Transplantology, Central Clinical Hospital of the Ministry of Interior, Warsaw, Poland.,Departament of Gastroenterological Surgery and Transplantology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Waldemar Wierzba
- Central Clinical Hospital of the Ministry of Interior, Warsaw, Poland.,University of Humanities and Economics, Lodz, Poland
| | - Andrea Cossarizza
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia School of Medicine, Modena, Italy.,National Institute for Cardiovascular Research, Bologna, Italy
| | - Katarzyna Piwocka
- Laboratory of Cytometry, Nencki Institute of Experimental Biology, Polish Academy of Sciences, Warsaw, Poland
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12
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Vargas L, Valdivieso N, Tempio F, Simon V, Sauma D, Valenzuela L, Beltrán C, Castillo-Delgado L, Contreras-Benavides X, Acevedo ML, Acevedo J, Gonzalez RI, Valiente-Echeverría F, Soto-Rifo R, Rosemblatt M, Lopez M, Osorio F, Bono MR. Serological study of CoronaVac vaccine and booster doses in Chile: immunogenicity and persistence of anti-SARS-CoV-2 spike antibodies. BMC Med 2022; 20:216. [PMID: 35676738 PMCID: PMC9177225 DOI: 10.1186/s12916-022-02406-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 05/16/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Chile was severely affected by COVID19 outbreaks but was also one of the first countries to start a nationwide program to vaccinate against the disease. Furthermore, Chile became one of the fastest countries to inoculate a high percentage of the target population and implemented homologous and heterologous booster schemes in late 2021 to prevent potential immunological waning. The aim of this study is to compare the immunogenicity and time course of the humoral response elicited by the CoronaVac vaccine in combination with homologous versus heterologous boosters. METHODS We compared the immunogenicity of two doses of CoronaVac and BNT162b2 vaccines and one homologous or heterologous booster through an ELISA assay directed against the ancestral spike protein of SARS-CoV-2. Sera were collected from individuals during the vaccination schedule and throughout the implementation of homologous and heterologous booster programs in Chile. RESULTS Our findings demonstrate that a two-dose vaccination scheme with CoronaVac induces lower levels of anti-SARS-CoV-2 spike antibodies than BNT162b2 in a broad age range (median age 42 years; interquartile range (IQR) 27-61). Furthermore, antibody production declines with time in individuals vaccinated with CoronaVac and less noticeably, with BNT162b2. Analysis of booster schemes revealed that individuals vaccinated with two doses of CoronaVac generate immunological memory against the SARS-CoV-2 ancestral strain, which can be re-activated with homologous or heterologous (BNT162b2 and ChAdOx1) boosters. Nevertheless, the magnitude of the antibody response with the heterologous booster regime was considerably higher (induction fold BNT162b2: 11.2x; ChAdoX1; 12.4x; CoronaVac: 6.0x) than the responses induced by the homologous scheme. Both homologous and heterologous boosters induced persistent humoral responses (median 122 days, IQR (108-133)), although heterologous boosters remained superior in activating a humoral response after 100 days. CONCLUSIONS Two doses of CoronaVac induces antibody titers against the SARS-CoV-2 ancestral strain which are lower in magnitude than those induced by the BNT162b2 vaccine. However, the response induced by CoronaVac can be greatly potentiated with a heterologous booster scheme with BNT162b2 or ChAdOx1 vaccines. Furthermore, the heterologous and homologous booster regimes induce a durable antibody response which does not show signs of decay 3 months after the booster dose.
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Affiliation(s)
- Leonardo Vargas
- Laboratory of Immunology, Biology Department, Faculty of Sciences, Universidad de Chile, Las Palmeras 3425, 7800003, Santiago, Chile.,Centro Ciencia & Vida, Av. Zañartu 1482, Santiago, Chile
| | - Nicolás Valdivieso
- Laboratory of Immunology, Biology Department, Faculty of Sciences, Universidad de Chile, Las Palmeras 3425, 7800003, Santiago, Chile
| | - Fabián Tempio
- Laboratory of Cancer Immunoediting, Immunology Program, Institute of Biomedical Sciences, Faculty of Medicine, Universidad de Chile, Av. Independencia 1027, 8380453, Santiago, Chile
| | - Valeska Simon
- Laboratory of Immunology, Biology Department, Faculty of Sciences, Universidad de Chile, Las Palmeras 3425, 7800003, Santiago, Chile
| | - Daniela Sauma
- Laboratory of Immunology, Biology Department, Faculty of Sciences, Universidad de Chile, Las Palmeras 3425, 7800003, Santiago, Chile
| | - Lucía Valenzuela
- Immunogastroenterology Lab., Gastroenterology Unit, Hospital Clínico Universidad de Chile, Facullty of Medicine, Universidad de Chile, Santiago, Chile
| | - Caroll Beltrán
- Immunogastroenterology Lab., Gastroenterology Unit, Hospital Clínico Universidad de Chile, Facullty of Medicine, Universidad de Chile, Santiago, Chile
| | - Loriana Castillo-Delgado
- Hospital Clínico Metropolitano La Florida "Dra. Eloisa Diaz I.", Santiago, Región Metropolitana, Chile
| | | | - Mónica L Acevedo
- Laboratory of Molecular and Cellular Virology, Virology Program, Institute of Biomedical Sciences, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Johanna Acevedo
- Faculty of Medicine, Universidad del Desarrollo, Santiago, Chile
| | - Rafael I Gonzalez
- Centro de Nanotecnología Aplicada, Universidad Mayor, Santiago, Chile.,Center for the Development of Nanoscience and Nanotechnology, CEDENNA, Santiago, Chile
| | - Fernando Valiente-Echeverría
- Laboratory of Molecular and Cellular Virology, Virology Program, Institute of Biomedical Sciences, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Ricardo Soto-Rifo
- Laboratory of Molecular and Cellular Virology, Virology Program, Institute of Biomedical Sciences, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Mario Rosemblatt
- Laboratory of Immunology, Biology Department, Faculty of Sciences, Universidad de Chile, Las Palmeras 3425, 7800003, Santiago, Chile.,Centro Ciencia & Vida, Av. Zañartu 1482, Santiago, Chile.,Faculty of Medicine and Sciences, Universidad San Sebastian, Santiago, Chile
| | - Mercedes Lopez
- Centro Ciencia & Vida, Av. Zañartu 1482, Santiago, Chile. .,Laboratory of Cancer Immunoediting, Immunology Program, Institute of Biomedical Sciences, Faculty of Medicine, Universidad de Chile, Av. Independencia 1027, 8380453, Santiago, Chile.
| | - Fabiola Osorio
- Faculty of Medicine, Universidad del Desarrollo, Santiago, Chile. .,Laboratory of Immunology and Cellular Stress, Immunology Program, Institute of Biomedical Sciences, Faculty of Medicine, University of Chile, Av. Independencia 1027, 8380453, Santiago, Chile.
| | - María Rosa Bono
- Laboratory of Immunology, Biology Department, Faculty of Sciences, Universidad de Chile, Las Palmeras 3425, 7800003, Santiago, Chile. .,Centro Ciencia & Vida, Av. Zañartu 1482, Santiago, Chile.
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13
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Cocoş R, Mahler B, Turcu-Stiolica A, Stoichiță A, Ghinet A, Shelby ES, Bohîlțea LC. Risk of Death in Comorbidity Subgroups of Hospitalized COVID-19 Patients Inferred by Routine Laboratory Markers of Systemic Inflammation on Admission: A Retrospective Study. Viruses 2022; 14:v14061201. [PMID: 35746672 PMCID: PMC9228480 DOI: 10.3390/v14061201] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 05/27/2022] [Accepted: 05/28/2022] [Indexed: 12/21/2022] Open
Abstract
Our study objective was to construct models using 20 routine laboratory parameters on admission to predict disease severity and mortality risk in a group of 254 hospitalized COVID-19 patients. Considering the influence of confounding factors in this single-center study, we also retrospectively assessed the correlations between the risk of death and the routine laboratory parameters within individual comorbidity subgroups. In multivariate regression models and by ROC curve analysis, a model of three routine laboratory parameters (AUC 0.85; 95% CI: 0.79–0.91) and a model of six laboratory factors (AUC 0.86; 95% CI: 0.81–0.91) were able to predict severity and mortality of COVID-19, respectively, compared with any other individual parameter. Hierarchical cluster analysis showed that inflammatory laboratory markers grouped together in three distinct clusters including positive correlations: WBC with NEU, NEU with neutrophil-to-lymphocyte ratio (NLR), NEU with systemic immune-inflammation index (SII), NLR with SII and platelet-to-lymphocyte ratio (PLR) with SII. When analyzing the routine laboratory parameters in the subgroups of comorbidities, the risk of death was associated with a common set of laboratory markers of systemic inflammation. Our results have shown that a panel of several routine laboratory parameters recorded on admission could be helpful for early evaluation of the risk of disease severity and mortality in COVID-19 patients. Inflammatory markers for mortality risk were similar in the subgroups of comorbidities, suggesting the limited effect of confounding factors in predicting COVID-19 mortality at admission.
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Affiliation(s)
- Relu Cocoş
- Institute of Pneumophtisiology “Marius Nasta”, 050159 Bucharest, Romania; (B.M.); (A.S.); (A.G.)
- Department of Medical Genetics, University of Medicine and Pharmacy “Carol Davila”, 020032 Bucharest, Romania;
- Correspondence: (R.C.); (A.T.-S.)
| | - Beatrice Mahler
- Institute of Pneumophtisiology “Marius Nasta”, 050159 Bucharest, Romania; (B.M.); (A.S.); (A.G.)
- Pneumology Department (II), University of Medicine and Pharmacy “Carol Davila”, 020021 Bucharest, Romania
| | - Adina Turcu-Stiolica
- Department of Pharmacoeconomics, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
- Correspondence: (R.C.); (A.T.-S.)
| | - Alexandru Stoichiță
- Institute of Pneumophtisiology “Marius Nasta”, 050159 Bucharest, Romania; (B.M.); (A.S.); (A.G.)
- Department of Cardiology, University of Medicine and Pharmacy “Carol Davila”, 020021 Bucharest, Romania
| | - Andreea Ghinet
- Institute of Pneumophtisiology “Marius Nasta”, 050159 Bucharest, Romania; (B.M.); (A.S.); (A.G.)
| | - Elena-Silvia Shelby
- Scientific Research Nucleus, Dr. Nicolae Robanescu National Clinical Centre for Children’s Neurorecovery, 041408 Bucharest, Romania;
| | - Laurențiu Camil Bohîlțea
- Department of Medical Genetics, University of Medicine and Pharmacy “Carol Davila”, 020032 Bucharest, Romania;
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