Dynamic changes in monocytes subsets in COVID-19 patients

Hum Immunol. 2021 Mar;82(3):170-176. doi: 10.1016/j.humimm.2020.12.010. Epub 2020 Dec 26.


Background: Coronavirus disease 2019 (COVID-19) is affecting the whole world and threatening human health. We aim to investigate the immunological characteristics of monocytes in critical patients with COVID-19.

Methods: The number and immune status of monocytes were detected by flow cytometry in 32 COVID-19 patients and 18 healthy individuals.

Results: In critical patients with COVID-19, the absolute number of total monocytes and CD16- monocytes was significantly decreased but CD16+ pro-inflammatory monocytes was increased compared to healthy controls. Antigen presentation potential of monocytes, as measured by HLA-DR expression, was suppressed, while their inflammatory phenotype (CD38 expression) was enhanced. Cytokine levels showed sustained increases in critical patients. And the levels of IL-6 were positively correlated with CD16+ monocytes number. IL-6 and IL-10 levels were negatively correlated with HLA-DR expression of monocytes. During the recovery of COVID-19 patients, the count and immune status of monocyte subsets were restored by degrees. HLA-DR+ monocytes possessed good sensitivity and specificity for predicting the incidence of critical patients with COVID-19.

Conclusions: In critical patients with COVID-19, decline in number and HLA-DR expression of monocytes might lead to decreased antigen presentation potential and thus immunosuppression, while increased CD16+ pro-inflammatory monocytes might mediate hyperinflammation. HLA-DR+ monocytes might be a meaningful assisted indicator to predict the incidence of critical patients with COVID-19.

Keywords: Antigen presentation; COVID-19; Hyperinflammation; Monocytes.

MeSH terms

  • ADP-ribosyl Cyclase 1 / immunology
  • Aged
  • Antigen Presentation
  • COVID-19 / blood
  • COVID-19 / immunology*
  • Case-Control Studies
  • Cytokines / immunology
  • Female
  • Flow Cytometry
  • HLA-DR Antigens / immunology
  • Humans
  • Inflammation / immunology
  • Male
  • Middle Aged
  • Monocytes / immunology*
  • Phenotype
  • Receptors, IgG / immunology


  • Cytokines
  • HLA-DR Antigens
  • Receptors, IgG
  • ADP-ribosyl Cyclase 1