Immune Alterations in a Patient with SARS-CoV-2-Related Acute Respiratory Distress Syndrome
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ORIGINAL ARTICLE
Immune Alterations in a Patient with SARS-CoV-2-Related Acute Respiratory Distress Syndrome Lila Bouadma 1,2 & Aurélie Wiedemann 3 & Juliette Patrier 1 & Mathieu Surénaud 3 & Paul-Henri Wicky 1 & Emile Foucat 3 & Jean-Luc Diehl 4 & Boris P. Hejblum 5 & Fabrice Sinnah 1 & Etienne de Montmollin 1 & Christine Lacabaratz 3 & Rodolphe Thiébaut 5,6 & J. F. Timsit 1,2 & Yves Lévy 3,7 Received: 29 April 2020 / Accepted: 27 July 2020 # The Author(s) 2020
Abstract We report a longitudinal analysis of the immune response associated with a fatal case of COVID-19 in Europe. This patient exhibited a rapid evolution towards multiorgan failure. SARS-CoV-2 was detected in multiple nasopharyngeal, blood, and pleural samples, despite antiviral and immunomodulator treatment. Clinical evolution in the blood was marked by an increase (2–3-fold) in differentiated effector T cells expressing exhaustion (PD-1) and senescence (CD57) markers, an expansion of antibody-secreting cells, a 15-fold increase in γδ T cell and proliferating NK-cell populations, and the total disappearance of monocytes, suggesting lung trafficking. In the serum, waves of a pro-inflammatory cytokine storm, Th1 and Th2 activation, and markers of T cell exhaustion, apoptosis, cell cytotoxicity, and endothelial activation were observed until the fatal outcome. This case underscores the need for well-designed studies to investigate complementary approaches to control viral replication, the source of the hyperinflammatory status, and immunomodulation to target the pathophysiological response. The investigation was conducted as part of an overall French clinical cohort assessing patients with COVID-19 and registered in clinicaltrials.gov under the following number: NCT04262921. Keywords COVID-19 . T cells . cytokines . immune dysfunction
Introduction First reported in December 2019 in China [1, 2], SARS-CoV2 (a beta coronavirus) can cause a respiratory syndrome that
manifests a clinical pathology resembling mild upper respiratory-tract disease (common cold-like symptoms) and occasionally severe lower respiratory-tract illness and extrapulmonary manifestations, leading to multiorgan failure and
Lila Bouadma and Aurélie Wiedemann are co-first authors. JF Timsit and Yves Lévy are co-last authors. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10875-020-00839-x) contains supplementary material, which is available to authorized users. * Yves Lévy [email protected] 1
APHP- Hôpital Bichat – Médecine Intensive et Réanimation des Maladies Infectieuses, Paris, France
2
UMR 1137 - IAME Team 5 – DeSCID: Decision Sciences in Infectious Diseases, Control and Care, Inserm/Univ Paris Diderot, Sorbonne Paris Cité, Paris, France
3
Vaccine Research Institute, Faculté de Médecine, INSERM U955, Université Paris-Est Créteil, Créteil, France
4
APHP, Hôpital Georges Pompidou, Médecine Intensive Reanimation, Paris, France
5
Univ. Bordeaux, Department of Public Health, Inserm Bordeaux Population Health Research Centre, In
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