Seroconversion stages COVID19 into distinct pathophysiological states

COVID19 is a heterogeneous medical condition involving diverse underlying pathophysiological processes including hyperinflammation, endothelial damage, thrombotic microangiopathy, and end-organ damage. Limited knowledge about the molecular mechanisms driving these processes and lack of staging biomarkers hamper the ability to stratify patients for targeted therapeutics. We report here the results of a cross-sectional multi-omics analysis of hospitalized COVID19 patients revealing that seroconversion status associates with distinct underlying pathophysiological states. Low antibody titers associate with hyperactive T cells and NK cells, high levels of IFN alpha, gamma and lambda ligands, markers of systemic complement activation, and depletion of lymphocytes, neutrophils, and platelets. Upon seroconversion, all of these processes are attenuated, observing instead increases in B cell subsets, emergency hematopoiesis, increased D-dimer, and hypoalbuminemia. We propose that seroconversion status could potentially be used as a biosignature to stratify patients for therapeutic intervention and to inform analysis of clinical trial results in heterogenous patient populations.

Understanding Genetic and Immune Cellular-Signaling Defects in Common Variable Immunodeficiency with Granulomatous Lymphocytic Interstitial Lung Disease

Common Variable Immunodeficiency (CVID) is a heterogenous disorder characterized by hypogammaglobulinemia, failure to mount vaccine responses, recurrent sinopulmonary infections. Furthermore, a subset of CVID patients develop various autoimmune and lymphoproliferative complications, highlighting the dysregulated immune mechanisms underlying the disorder. One such autoimmune complication is granulomatous lymphocytic interstitial lung disease (GLILD) which is a major cause of mortality in CVID. The clinical heterogeneity of CVID indicate that it is a collection of disorders with monogenic and polygenic defects. Due to the genetic and phenotypic complexity of CVID, our understanding of the immunopathogenesis of CVID and the development of its complications is limited. Our goal is to elucidate relationships between genetic variants and their downstream phenotypic and signaling defects in CVID patients with GLILD. We hypothesize that specific genetic variants will result in unique immune cellular (and signaling) signatures in CVID with GLILD. To identify these cellular and molecular signatures, we integrate whole exome sequencing and mass cytometry data. We examined cellular subsets affected by perturbed T and B cell receptor signaling pathways via mass cytometry, and then correlate these signatures with specific genetic variants identified through whole exome sequencing. These results will reveal mechanisms of immune dysregulation in CVID with GLILD. In CVID patients with GLILD, we find expansion of CD57+ CD8+ T cells, which may represent a class of senescent cells. We also find enrichment of CD21-low B cells within CVID patients, regardless of GLILD status.

Prevalence of cervical intraepithelial neoplasia in sexually active teenagers and young adults. Results of data analysis of mass Papanicolaou screening of 796,337 women in the United States in 1981

One of the largest nationally reported cases of carcinoma in situ in the teenage population of the United States is based on 1 year's computerized data from Cancer Screening Services. In 1981, 796,337 women were screened with an average age of 25.9. Of these, 18,589 (2.33%) had abnormal cytology. In 194,069 (24.3%) of the 796,337 patients aged 15 to 19, 3,651 (1.9%) had abnormal cytology. In 17% of all patients with abnormal cytology biopsy of the cervix was performed. The prevalence rate of dysplasia and carcinoma in situ was 18.8/1,000 for ages 15 to 19 and 28.8/1,000 for ages 20 to 24. Biopsy-proved cases of all grades of cervical intraepithelial neoplasia in the teenage population indicates a prevalence of 13.3/1,000. Sixty cases of grade 3 cervical intraepithelial neoplasia (carcinoma in situ) were diagnosed by biopsy in the teenage population for a projected prevalence rate of 2.6/1,000. No invasive squamous cell carcinoma was found in this age group. This emphasizes the importance of cervical intraepithelial neoplasia as a developing medical and public health problem in this age group and indicates that teenagers of any "permissive society" should be considered as "high risk" and included in screening programs.