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Immune Alterations in a Patient with SARS-CoV-2-Related Acute Respiratory Distress Syndrome.
J Clin Immunol. 2020 11; 40(8):1082-1092.JC

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.

Authors+Show Affiliations

APHP- Hôpital Bichat - Médecine Intensive et Réanimation des Maladies Infectieuses, Paris, France. UMR 1137 - IAME Team 5 - DeSCID: Decision Sciences in Infectious Diseases, Control and Care, Inserm/Univ Paris Diderot, Sorbonne Paris Cité, Paris, France.Vaccine Research Institute, Faculté de Médecine, INSERM U955, Université Paris-Est Créteil, Créteil, France.APHP- Hôpital Bichat - Médecine Intensive et Réanimation des Maladies Infectieuses, Paris, France.Vaccine Research Institute, Faculté de Médecine, INSERM U955, Université Paris-Est Créteil, Créteil, France.APHP- Hôpital Bichat - Médecine Intensive et Réanimation des Maladies Infectieuses, Paris, France.Vaccine Research Institute, Faculté de Médecine, INSERM U955, Université Paris-Est Créteil, Créteil, France.APHP, Hôpital Georges Pompidou, Médecine Intensive Reanimation, Paris, France.Univ. Bordeaux, Department of Public Health, Inserm Bordeaux Population Health Research Centre, Inria SISTM, UMR 1219, Vaccine Research Institute (VRI), Créteil, France.APHP- Hôpital Bichat - Médecine Intensive et Réanimation des Maladies Infectieuses, Paris, France.APHP- Hôpital Bichat - Médecine Intensive et Réanimation des Maladies Infectieuses, Paris, France.Vaccine Research Institute, Faculté de Médecine, INSERM U955, Université Paris-Est Créteil, Créteil, France.Univ. Bordeaux, Department of Public Health, Inserm Bordeaux Population Health Research Centre, Inria SISTM, UMR 1219, Vaccine Research Institute (VRI), Créteil, France. CHU Bordeaux, Bordeaux, France.APHP- Hôpital Bichat - Médecine Intensive et Réanimation des Maladies Infectieuses, Paris, France. UMR 1137 - IAME Team 5 - DeSCID: Decision Sciences in Infectious Diseases, Control and Care, Inserm/Univ Paris Diderot, Sorbonne Paris Cité, Paris, France.Vaccine Research Institute, Faculté de Médecine, INSERM U955, Université Paris-Est Créteil, Créteil, France. yves.levy@aphp.fr. Assistance Publique-Hôpitaux de Paris, Service Immunologie Clinique, Groupe Henri-Mondor Albert-Chenevier, Créteil, France. yves.levy@aphp.fr.

Pub Type(s)

Case Reports
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

32829467

Citation

Bouadma, Lila, et al. "Immune Alterations in a Patient With SARS-CoV-2-Related Acute Respiratory Distress Syndrome." Journal of Clinical Immunology, vol. 40, no. 8, 2020, pp. 1082-1092.
Bouadma L, Wiedemann A, Patrier J, et al. Immune Alterations in a Patient with SARS-CoV-2-Related Acute Respiratory Distress Syndrome. J Clin Immunol. 2020;40(8):1082-1092.
Bouadma, L., Wiedemann, A., Patrier, J., Surénaud, M., Wicky, P. H., Foucat, E., Diehl, J. L., Hejblum, B. P., Sinnah, F., de Montmollin, E., Lacabaratz, C., Thiébaut, R., Timsit, J. F., & Lévy, Y. (2020). Immune Alterations in a Patient with SARS-CoV-2-Related Acute Respiratory Distress Syndrome. Journal of Clinical Immunology, 40(8), 1082-1092. https://doi.org/10.1007/s10875-020-00839-x
Bouadma L, et al. Immune Alterations in a Patient With SARS-CoV-2-Related Acute Respiratory Distress Syndrome. J Clin Immunol. 2020;40(8):1082-1092. PubMed PMID: 32829467.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Immune Alterations in a Patient with SARS-CoV-2-Related Acute Respiratory Distress Syndrome. AU - Bouadma,Lila, AU - Wiedemann,Aurélie, AU - Patrier,Juliette, AU - Surénaud,Mathieu, AU - Wicky,Paul-Henri, AU - Foucat,Emile, AU - Diehl,Jean-Luc, AU - Hejblum,Boris P, AU - Sinnah,Fabrice, AU - de Montmollin,Etienne, AU - Lacabaratz,Christine, AU - Thiébaut,Rodolphe, AU - Timsit,J F, AU - Lévy,Yves, Y1 - 2020/08/22/ PY - 2020/04/29/received PY - 2020/07/27/accepted PY - 2020/8/24/pubmed PY - 2020/10/28/medline PY - 2020/8/24/entrez KW - COVID-19 KW - T cells KW - cytokines KW - immune dysfunction SP - 1082 EP - 1092 JF - Journal of clinical immunology JO - J Clin Immunol VL - 40 IS - 8 N2 - 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. SN - 1573-2592 UR - https://www.unboundmedicine.com/medline/citation/32829467/Immune_Alterations_in_a_Patient_with_SARS_CoV_2_Related_Acute_Respiratory_Distress_Syndrome_ L2 - https://doi.org/10.1007/s10875-020-00839-x DB - PRIME DP - Unbound Medicine ER -