Andrea Lombardi1, Elena Trombetta2, Alessandra Cattaneo2, Valeria Castelli1, Emanuele Palomba1, Mario Tirone2, Davide Mangioni1,3, Giuseppe Lamorte4, Maria Manunta4, Daniele Prati5, Ferruccio Ceriotti6, Roberta Gualtierotti7,8, Giorgio Costantino9, Stefano Aliberti7,10, Vittorio Scaravilli11, Giacomo Grasselli7,11, Andrea Gori1,3,7, Laura Porretti2, Alessandra Bandera1,3,7. 1. Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy. 2. Flow Cytometry and Cell Sorting Laboratory, Clinical Laboratory, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy. 3. Centre for Multidisciplinary Research in Health Science (MACH), University of Milano, Milano, Italy. 4. Translational Medicine and Biobank Unit, Department of Transfusion Medicine and Hematology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy. 5. Department of Transfusion Medicine and Hematology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy. 6. Clinical Laboratory, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy. 7. Department of Pathophysiology and Transplantation, University of Milano, Milano, Italy. 8. Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy. 9. Emergency Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy. 10. Respiratory Unit and Cystic Fibrosis Adult Center, Internal Medicine Department, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy. 11. Departement of Anaesthesia, Critical care and Emergency, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.
Abstract
Background: Severe acute respiratory syndrome coronavirus 2 is a recently discovered pathogen responsible of coronavirus disease 2019 (COVID-19). The immunological changes associated with this infection are largely unknown. Methods: We evaluated the peripheral blood mononuclear cells profile of 63 patients with COVID-19 at diagnosis. We also assessed the presence of association with inflammatory biomarkers and the 28-day mortality. Results: Lymphocytopenia was present in 51 of 63 (80.9%) patients, with a median value of 720 lymphocytes/µl (IQR 520-1,135). This reduction was mirrored also on CD8+ (128 cells/µl, IQR 55-215), natural killer (67 cells/µl, IQR 35-158) and natural killer T (31 cells/µl, IQR 11-78) cells. Monocytes were preserved in total number but displayed among them a subpopulation with a higher forward and side scatter properties, composed mainly of cells with a reduced expression of both CD14 and HLA-DR. Patients who died in the 28 days from admission (N=10, 15.9%), when compared to those who did not, displayed lower mean values of CD3+ (337.4 cells/µl vs 585.9 cells/µl; p=0.028) and CD4+ cells (232.2 cells/µl vs 381.1 cells/µl; p=0.042) and an higher percentage of CD8+/CD38+/HLA-DR+ lymphocytes (13.5% vs 7.6%; p=0.026). Discussion: The early phases of COVID-19 are characterized by lymphocytopenia, predominance of Th2-like lymphocytes and monocytes with altered immune profile, which include atypical mononuclear cells.
Background: Severe acute respiratory syndrome coronavirus 2 is a recently discovered pathogen responsible of coronavirus disease 2019 (COVID-19). The immunological changes associated with this infection are largely unknown. Methods: We evaluated the peripheral blood mononuclear cells profile of 63 patients with COVID-19 at diagnosis. We also assessed the presence of association with inflammatory biomarkers and the 28-day mortality. Results:Lymphocytopenia was present in 51 of 63 (80.9%) patients, with a median value of 720 lymphocytes/µl (IQR 520-1,135). This reduction was mirrored also on CD8+ (128 cells/µl, IQR 55-215), natural killer (67 cells/µl, IQR 35-158) and natural killer T (31 cells/µl, IQR 11-78) cells. Monocytes were preserved in total number but displayed among them a subpopulation with a higher forward and side scatter properties, composed mainly of cells with a reduced expression of both CD14 and HLA-DR. Patients who died in the 28 days from admission (N=10, 15.9%), when compared to those who did not, displayed lower mean values of CD3+ (337.4 cells/µl vs 585.9 cells/µl; p=0.028) and CD4+ cells (232.2 cells/µl vs 381.1 cells/µl; p=0.042) and an higher percentage of CD8+/CD38+/HLA-DR+ lymphocytes (13.5% vs 7.6%; p=0.026). Discussion: The early phases of COVID-19 are characterized by lymphocytopenia, predominance of Th2-like lymphocytes and monocytes with altered immune profile, which include atypical mononuclear cells.
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