A dynamic COVID-19 immune signature includes associations with poor prognosis

Nat Med. 2020 Oct;26(10):1623-1635. doi: 10.1038/s41591-020-1038-6. Epub 2020 Aug 17.

Abstract

Improved understanding and management of COVID-19, a potentially life-threatening disease, could greatly reduce the threat posed by its etiologic agent, SARS-CoV-2. Toward this end, we have identified a core peripheral blood immune signature across 63 hospital-treated patients with COVID-19 who were otherwise highly heterogeneous. The signature includes discrete changes in B and myelomonocytic cell composition, profoundly altered T cell phenotypes, selective cytokine/chemokine upregulation and SARS-CoV-2-specific antibodies. Some signature traits identify links with other settings of immunoprotection and immunopathology; others, including basophil and plasmacytoid dendritic cell depletion, correlate strongly with disease severity; while a third set of traits, including a triad of IP-10, interleukin-10 and interleukin-6, anticipate subsequent clinical progression. Hence, contingent upon independent validation in other COVID-19 cohorts, individual traits within this signature may collectively and individually guide treatment options; offer insights into COVID-19 pathogenesis; and aid early, risk-based patient stratification that is particularly beneficial in phasic diseases such as COVID-19.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Antibodies, Viral / immunology*
  • B-Lymphocyte Subsets / immunology
  • B-Lymphocytes / immunology*
  • Basophils / immunology
  • Betacoronavirus
  • Case-Control Studies
  • Cell Cycle
  • Chemokine CXCL10 / immunology
  • Chemokines / immunology
  • Cohort Studies
  • Coronavirus Infections / blood
  • Coronavirus Infections / immunology*
  • Cytokines / immunology*
  • Dendritic Cells / immunology*
  • Disease Progression
  • Female
  • Flow Cytometry
  • Hospitalization
  • Humans
  • Immunologic Memory
  • Immunophenotyping
  • Interleukin-10 / immunology
  • Interleukin-6 / immunology
  • Leukocyte Count
  • Lymphocyte Activation / immunology
  • Male
  • Middle Aged
  • Pandemics
  • Pneumonia, Viral / blood
  • Pneumonia, Viral / immunology*
  • Prognosis
  • Severity of Illness Index
  • T-Lymphocyte Subsets / immunology
  • T-Lymphocytes / immunology*
  • Up-Regulation

Substances

  • Antibodies, Viral
  • CXCL10 protein, human
  • Chemokine CXCL10
  • Chemokines
  • Cytokines
  • IL10 protein, human
  • IL6 protein, human
  • Interleukin-6
  • Interleukin-10

Supplementary concepts

  • COVID-19
  • severe acute respiratory syndrome coronavirus 2