SARS-CoV-2 infection induces mixed M1/M2 phenotype in circulating monocytes and alterations in both dendritic cell and monocyte subsets

PLoS One. 2020 Dec 31;15(12):e0241097. doi: 10.1371/journal.pone.0241097. eCollection 2020.


Clinical manifestations of SARS-CoV-2 infection range from mild to critically severe. The aim of the study was to highlight the immunological events associated with the severity of SARS-CoV-2 infection, with an emphasis on cells of innate immunity. Thirty COVID-19 patients with mild/moderate symptoms and 27 patients with severe/critically severe symptoms were recruited from the Clinical Center of Kragujevac during April 2020. Flow cytometric analysis was performed to reveal phenotypic and functional alterations of peripheral blood cells and to correlate them with the severity of the disease. In severe cases, the number of T and B lymphocytes, dendritic cells, NK cells, and HLA-DR-expressing cells was drastically decreased. In the monocyte population proportion between certain subsets was disturbed and cells coexpressing markers of M1 and M2 monocytes were found in intermediate and non-classical subsets. In mild cases decline in lymphocyte number was less pronounced and innate immunity was preserved as indicated by an increased number of myeloid and activated dendritic cells, NK cells that expressed activation marker at the same level as in control and by low expression of M2 marker in monocyte population. In patients with severe disease, both innate and adoptive immunity are devastated, while in patients with mild symptoms decline in lymphocyte number is lesser, and the innate immunity is preserved.

Publication types

  • Clinical Trial

MeSH terms

  • Adaptive Immunity*
  • Adult
  • Aged
  • Aged, 80 and over
  • Antigens, Differentiation / immunology
  • COVID-19 / immunology*
  • COVID-19 / pathology
  • Dendritic Cells / immunology*
  • Dendritic Cells / pathology
  • Female
  • Flow Cytometry
  • HLA-DR Antigens / immunology
  • Humans
  • Immunity, Innate*
  • Killer Cells, Natural / immunology
  • Killer Cells, Natural / pathology
  • Male
  • Middle Aged
  • Monocytes / immunology*
  • Monocytes / pathology
  • SARS-CoV-2 / immunology*


  • Antigens, Differentiation
  • HLA-DR Antigens

Grants and funding

The authors received no specific funding for this work.