519. Immune responses and COVID-19 severity

Background

The coronavirus-19-disease (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread to >200 countries and surpassed 7 million cases. There is a broad range of COVID-19 illness, ranging from milder disease to a rapidly progressive respiratory disease and ARDS. The causes of this different clinical course and the drivers for severe disease are currently unknown. A fulminant increase of pro-inflammatory cytokines is thought to play a role in causing a rapid disease evolution, however the immune correlates of severe COVID-19 remain unclear.

Methods

To gain insight into relationship between immune responses and disease severity we built a longitudinal cohort of 40 adult patients with known COVID-19. Samples were collected at diagnosis and every 7 days until hospital discharge or death. As controls we also included a group of convalescent patients, and subjects who tested negative for COVID-19 by PCR. Clinical and laboratory data and were also collected. Multicolor flow cytometry was used to determine the presence and phenotype of B, T and natural killer (NK) cells. We also identified specific sub-populations (Tfh, activated/cytotoxic CD8 and NK) and assessed lymphoid exhaustion of different cell types such as naïve, memory T cells, or NK over time. Anti-Sars-CoV2 IgG and IgM antibody were detected using lateral flow method.

Results

We found that the absolute number of lymphocytes and monocytes was decreased starting at diagnosis and correlated with disease severity. Disease severity correlated with decreased NK and T cell. In severe COVID-19 cases, NK cell populations were strongly decreased over time in intubated patients while they recovered in patients who improved and were discharged. CD8+ were also decreased at disease onset and seemed to correlate with disease severity. A high percentage of CD4+ and CD8+ T cells showed an exhausted phenotype. All patients tested at admission had IgM antibody responses irrespective of the course of the disease. Further analyses are ongoing.

Conclusion

The characterization and role of the immune responses in COVID-19 evolution is still under investigation. Further characterization of viral and immune factors will help in identifying subjects at high risk of severe disease and targets for intervention.

Disclosures

All Authors: No reported disclosures

Neural basis of alertness and cognitive performance impairments during sleepiness. I. Effects of 24 h of sleep deprivation on waking human regional brain activity

The negative effects of sleep deprivation on alertness and cognitive performance suggest decreases in brain activity and function, primarily in the thalamus, a subcortical structure involved in alertness and attention, and in the prefrontal cortex, a region subserving alertness, attention, and higher-order cognitive processes. To test this hypothesis, 17 normal subjects were scanned for quantifiable brain activity changes during 85 h of sleep deprivation using positron emission tomography (PET) and (18)Fluorine-2-deoxyglucose ((18)FDG), a marker for regional cerebral metabolic rate for glucose (CMRglu) and neuronal synaptic activity. Subjects were scanned prior to and at 24-h intervals during the sleep deprivation period, for a total of four scans per subject. During each 30 min (18)FDG uptake, subjects performed a sleep deprivation-sensitive Serial Addition/Subtraction task. Polysomnographic monitoring confirmed that subjects were awake. Twenty-four hours of sleep deprivation, reported here, resulted in a significant decrease in global CMRglu, and significant decreases in absolute regional CMRglu in several cortical and subcortical structures. No areas of the brain evidenced a significant increase in absolute regional CMRglu. Significant decreases in relative regional CMRglu, reflecting regional brain reductions greater than the global decrease, occurred predominantly in the thalamus and prefrontal and posterior parietal cortices. Alertness and cognitive performance declined in association with these brain deactivations. This study provides evidence that short-term sleep deprivation produces global decreases in brain activity, with larger reductions in activity in the distributed cortico-thalamic network mediating attention and higher-order cognitive processes, and is complementary to studies demonstrating deactivation of these cortical regions during NREM and REM sleep.

Evaluation of health information provided on the Internet by airlines with destinations in tropical and sub-tropical countries

The travel industry is being called upon increasingly to provide health information for its clients. Websites of all 73 international airlines with tropical or sub-tropical destinations accessible via the International Air Transport Association homepage were evaluated for the quality of their health advice. Seven of the 73 homepages contained health information, six of which addressed health problems that might be encountered when travelling to tropical countries. Fifty-five of the 73 airlines had functional email addresses and were asked for pre-travel health advice on malaria prophylaxis using a fictitious scenario. Among the 25 airlines that replied, only half referred to malaria and a third gave wrong information about malaria endemicity in the destination area. The only two airlines that recommended a specific drug regimen correctly reflected the medical situation described in our fictitious email. In general, international airlines are not set up to provide health information.

The effects of L-dihydroxyphenylalanine on alertness and mood in alpha-methyl-para-tyrosine-treated healthy humans. Further evidence for the role of catecholamines in arousal and anxiety

Treatment with alpha-methyl-para-tyrosine (AMPT), a catecholamine synthesis inhibitor, has been shown to produce pronounced increases in sleepiness and mild increases in negative mood and anxiety when administered to healthy male adults. The present study was conducted to ascertain whether these effects of AMPT are secondary to decreases in brain catecholamines or whether they represent nonspecific drug effects. Forty-one healthy males were randomized to one of four treatment groups. (1) Treatment with AMPT alone (AMPT/placebo); (2) treatment with AMPT plus L-dopa/carbidopa (AMPT plus L-dopa/carbidopa); (3) treatment with L-dopa/carbidopa alone (placebo plus L-dopa/carbidopa); or (4) treatment with placebo alone (placebo plus placebo). Repeated measures of alertness, mood, and anxiety were obtained over a three-day period of drug treatment and following drug discontinuation. As before, AMPT treatment led to increased sleepines. In addition, AMPT treatment led to decreased calmness, increased tension and anger, and a trend for increased depression. Replacement of catecholamine stores with L-dopa reversed the effects of AMPT and was associated with a more rapid recovery from AMPT's effects. These findings indicate that AMPT's effects on alertness and anxiety are catecholamine-specific. Further, they provide additional evidence that catecholamines are involved in the regulation of normal states of arousal, and they are consistent with the view that brain catecholaminergic dysregulation is involved in pathological anxiety states.

Caffeine reversal of sleep deprivation effects on alertness and mood

This study assessed the ability of high doses of caffeine to reverse changes in alertness and mood produced by prolonged sleep deprivation. Fifty healthy, nonsmoking males between the ages of 18 and 32 served as volunteers. Following 49 h without sleep, caffeine (0, 150, 300, or 600 mg/70 kg, PO) was administered in a double-blind fashion. Measures of alertness were obtained with sleep onset tests, the Stanford Sleepiness Scale (SSS), and Visual Analog Scales (VAS). Sleep deprivation decreased onset to sleep from a rested average of 19.9 min to 7 min. Following the highest dose of caffeine tested, sleep onset averaged just over 10 min; sleep onset for the placebo group averaged 5 min. Scores on the SSS increased from a rested mean of 1.6-4.8 after sleep deprivation. Caffeine reduced this score to near rested values. Caffeine reversed sleep deprivation-induced changes in three subscales of the POMS (vigor, fatigue, and confusion) and produced values close to fully rested conditions on several VAS. Serum caffeine concentrations peaked 90 min after ingestion and remained elevated for 12 h. This study showed that caffeine was able to produce significant alerting and long-lasting beneficial mood effects in individuals deprived of sleep for 48 h.

The effects of 72 hours of sleep loss on psychological variables

A study was conducted on the effects of 72 hours of sleep loss and modified continuous operations on performance and psychological variables. This paper presents the results of self-report data of 12 subjects for the following psychological variables: sleepiness, affect, motivation, cognitive difficulties, and waking dreams. The relationship between the self-report measures and performance in a visual search and memory task is also examined. Most of the psychological variables are significantly affected by the number of days of sleep deprivation, all are significantly affected by hour of day; but only sleepiness, affect and motivation are also significantly affected by the interaction between these variables. The peak hours for self-reported psychological complaints are generally between 0400 and 0800, while the lowest number of complaints are usually reported in the afternoon/early evening, between 1600 and 2000. In addition, the results showed that (a) the amplitude of the circadian component of the psychological data increased over the period of sleep loss, and (b) psychological data were more highly correlated with a measure of general performance than with accuracy. The mechanisms of sleep deprivation underlying its effects on psychological and performance measures are discussed.

The topology of performance curves during 72 hours of sleep loss: a memory and search task

Three levels of working memory load of a visual search (Memory and Search) task were tested in a 72-hour sleep deprivation paradigm. General performance and accuracy decrease over time with monotonic and rhythmic components. The signal detection discriminability index, d', decreases monotonically with rhythmic variations. The index of response bias, β, shows no monotonic trend, but significant circadian rhythmicity. The extent of the monotonic and rhythmic changes in accuracy and in d’ is directly related to the level of working memory load. The amplitude of the circadian component of accuracy and d’ is enhanced for the higher levels of working memory load. The implication of potentiated circadian rhythmicity as a function of cumulative sleep loss is discussed.

Ultramicroscale determination of clinical chemical values for blood during the first four days of postnatal life

Ultramicro procedures requiring 5-10 mul of serum or blood per analysis were used in determining blood constituents of healthy full-term newborns during the first four days of life. The resulting values appeared to be influenced by age, sex, and race. Values for total protein, albumin, urea nitrogen, and uric acid in serum decreased with time; serum inorganic phosphorus and whole-blood aldosaccharoses increased. Serum from females had higher values than that from males for total proteins, albumin, and inorganic phosphorus. The values for serum calcium and alkaline phosphatase were consistently higher in Negro than in white infants; values for uric acid were higher in the latter.