The Immunobiology of SARS*

Annu Rev Immunol. 2007;25:443-72. doi: 10.1146/annurev.immunol.25.022106.141706.


Severe acute respiratory syndrome (SARS) presented as an atypical pneumonia that progressed to acute respiratory distress syndrome in approximately 20% of cases and was associated with a mortality of about 10%. The etiological agent was a novel coronavirus (CoV). Angiotensin-converting enzyme 2 is the functional receptor for SARS-CoV; DC-SIGN and CD209L (L-SIGN) can enhance viral entry. Although the virus infects the lungs, gastrointestinal tract, liver, and kidneys, the disease is limited to the lungs, where diffuse alveolar damage is accompanied by a disproportionately sparse inflammatory infiltrate. Pro-inflammatory cytokines and chemokines, particularly IP-10, IL-8, and MCP-1, are elevated in the lungs and peripheral blood, but there is an unusual lack of an antiviral interferon (IFN) response. The virus is susceptible to exogenous type I IFN but suppresses the induction of IFN. Innate immunity is important for viral clearance in the mouse model. Virus-specific neutralizing antibodies that develop during convalescence prevent reinfection in animal models.

Publication types

  • Research Support, N.I.H., Intramural
  • Review

MeSH terms

  • Angiotensin-Converting Enzyme 2
  • Animals
  • Antibodies, Viral / immunology*
  • Cell Adhesion Molecules / immunology
  • Chemokines / immunology*
  • Disease Models, Animal
  • Humans
  • Inflammation / immunology
  • Interferon Type I / immunology*
  • Lectins, C-Type / immunology
  • Organ Specificity
  • Peptidyl-Dipeptidase A / immunology
  • Receptors, Cell Surface / immunology
  • Severe Acute Respiratory Syndrome / immunology*
  • Severe acute respiratory syndrome-related coronavirus / immunology*


  • Antibodies, Viral
  • CLEC4M protein, human
  • Cell Adhesion Molecules
  • Chemokines
  • DC-specific ICAM-3 grabbing nonintegrin
  • Interferon Type I
  • Lectins, C-Type
  • Receptors, Cell Surface
  • Peptidyl-Dipeptidase A
  • ACE2 protein, human
  • Ace2 protein, mouse
  • Angiotensin-Converting Enzyme 2