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Galati D, Mallardo D, Nicastro C, Zanotta S, Capitelli L, Lombardi C, Baino B, Cavalcanti E, Sale S, Labonia F, Boenzi R, Atripaldi L, Ascierto PA, Bocchino M. The Dysregulation of the Monocyte-Dendritic Cell Interplay Is Associated with In-Hospital Mortality in COVID-19 Pneumonia. J Clin Med 2024; 13:2481. [PMID: 38731010 PMCID: PMC11084469 DOI: 10.3390/jcm13092481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 04/19/2024] [Accepted: 04/21/2024] [Indexed: 05/13/2024] Open
Abstract
Background: The monocyte-phagocyte system (MPS), including monocytes/macrophages and dendritic cells (DCs), plays a key role in anti-viral immunity. We aimed to analyze the prognostic value of the MPS components on in-hospital mortality in a cohort of 58 patients (M/F; mean age ± SD years) with COVID-19 pneumonia and 22 age- and sex-matched healthy controls. Methods: We measured frequencies and absolute numbers of peripheral blood CD169+ monocytes, conventional CD1c+ and CD141+ (namely cDC2 and cDC1), and plasmacytoid CD303+ DCs by means of multi-parametric flow cytometry. A gene profile analysis of 770 immune-inflammatory-related human genes and 20 SARS-CoV-2 genes was also performed. Results: Median frequencies and absolute counts of CD169-expressing monocytes were significantly higher in COVID-19 patients than in controls (p 0.04 and p 0.01, respectively). Conversely, percentages and absolute numbers of all DC subsets were markedly depleted in patients (p < 0.0001). COVID-19 cases with absolute counts of CD169+ monocytes above the median value of 114.68/μL had significantly higher in-hospital mortality (HR 4.96; 95% CI: 1.42-17.27; p = 0.02). Interleukin (IL)-6 concentrations were significantly increased in COVID-19 patients (p < 0.0001 vs. controls), and negatively correlated with the absolute counts of circulating CD1c+ cDC2 (r = -0.29, p = 0.034) and CD303+ pDC (r = -0.29, p = 0.036) subsets. Viral genes were upregulated in patients with worse outcomes along with inflammatory mediators such as interleukin (IL)-1 beta, tumor necrosis-α (TNF-α) and the anticoagulant protein (PROS1). Conversely, surviving patients had upregulated genes related to inflammatory and anti-viral-related pathways along with the T cell membrane molecule CD4. Conclusions: Our results suggest that the dysregulated interplay between the different components of the MPS along with the imbalance between viral gene expression and host anti-viral immunity negatively impacts COVID-19 outcomes. Although the clinical scenario of COVID-19 has changed over time, a deepening of its pathogenesis remains a priority in clinical and experimental research.
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Affiliation(s)
- Domenico Galati
- Hematology-Oncology and Stem Cell Transplantation Unit, Department of Hematology and Innovative Diagnostics, Istituto Nazionale Tumori–IRCCS-Fondazione G. Pascale, 80131 Naples, Italy; (D.G.); (S.Z.)
| | - Domenico Mallardo
- Unit of Melanoma and Innovative Therapy, Department of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori–IRCCS-Fondazione G. Pascale, 80131 Naples, Italy; (D.M.); (P.A.A.)
| | - Carmine Nicastro
- Clinical Biochemistry Unit, AORN dei Colli, Ospedale Monaldi, 80131 Naples, Italy; (C.N.); (S.S.); (R.B.); (L.A.)
| | - Serena Zanotta
- Hematology-Oncology and Stem Cell Transplantation Unit, Department of Hematology and Innovative Diagnostics, Istituto Nazionale Tumori–IRCCS-Fondazione G. Pascale, 80131 Naples, Italy; (D.G.); (S.Z.)
| | - Ludovica Capitelli
- Respiratory Medicine Division, Department of Clinical Medicine and Surgery, Federico II University, Monaldi Hospital, 80131 Naples, Italy; (L.C.); (C.L.); (B.B.)
| | - Carmen Lombardi
- Respiratory Medicine Division, Department of Clinical Medicine and Surgery, Federico II University, Monaldi Hospital, 80131 Naples, Italy; (L.C.); (C.L.); (B.B.)
| | - Bianca Baino
- Respiratory Medicine Division, Department of Clinical Medicine and Surgery, Federico II University, Monaldi Hospital, 80131 Naples, Italy; (L.C.); (C.L.); (B.B.)
| | - Ernesta Cavalcanti
- Laboratory Medicine Unit, Istituto Nazionale Tumori–IRCCS-Fondazione G. Pascale, 80131 Naples, Italy; (E.C.)
| | - Silvia Sale
- Clinical Biochemistry Unit, AORN dei Colli, Ospedale Monaldi, 80131 Naples, Italy; (C.N.); (S.S.); (R.B.); (L.A.)
| | - Francesco Labonia
- Laboratory Medicine Unit, Istituto Nazionale Tumori–IRCCS-Fondazione G. Pascale, 80131 Naples, Italy; (E.C.)
| | - Rita Boenzi
- Clinical Biochemistry Unit, AORN dei Colli, Ospedale Monaldi, 80131 Naples, Italy; (C.N.); (S.S.); (R.B.); (L.A.)
| | - Luigi Atripaldi
- Clinical Biochemistry Unit, AORN dei Colli, Ospedale Monaldi, 80131 Naples, Italy; (C.N.); (S.S.); (R.B.); (L.A.)
| | - Paolo Antonio Ascierto
- Unit of Melanoma and Innovative Therapy, Department of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori–IRCCS-Fondazione G. Pascale, 80131 Naples, Italy; (D.M.); (P.A.A.)
| | - Marialuisa Bocchino
- Respiratory Medicine Division, Department of Clinical Medicine and Surgery, Federico II University, Monaldi Hospital, 80131 Naples, Italy; (L.C.); (C.L.); (B.B.)
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