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- The depicted results arerepresentative of 40 independent experiments for control group, 57independent experiments for COVID-19 patients at the first day oftreatment, and 51 independent experiments for COVID-19 patients in10 days of treatment.
- Having considered that severe COVID-19 is largely related to a cytokine storm,cytokine profiles of COVID patients were assessed during a recovery.
- B cells showed an increasedpercentage in patients compared to healthy subjects, while this increase wassignificantly reduced in the late stage of recovery (Figure 3(i) and (r),P Open in a new tabThe percentages of adaptive immune cells in COVID-19 and healthyindividuals.
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Moreover, Qinet al. indicated that suppressor and helper T cell percentages were lower inpatients than normal group. In the next step, the adaptive immune system of COVID-19 subjects was studied after 1and 10 days of initiation of therapeutic methods. In an attempt to discover the frequency of other cells of innateimmunity, the number of monocytes was also assessed. As shown inFigure 4(a)–(d),statistically significant reduction in the levels of pro-inflammatory cytokines(IL-1α, IL-1β, IL-6, and TNF-α) in patients were observed during a recovery,with the exception of IL-1β level (P Figure 4(e),P Figure 4(f)). Having considered that severe COVID-19 is largely related to a cytokine storm,cytokine profiles of COVID patients were assessed during a recovery.
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In this regard, the FlowJosoftware (v10.1, FlowJo, Ashland, OR, USA) was used to gate lymphocytepopulation using forward and side scatter to exclude debris or dead cells fromthe analysis of different cells. The cell markers used to determine thefrequencies of the stained cells are indicated in Table 1. The percentages of the stained cells were measured by a FACSCalibursystem (Becton Dickinson, San Jose, CA).
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Investigations of cytokines and other inflammatory factors
The resultsare representative of 57 independent experiments for COVID-19 patientsat the first day of treatment, 51 independent experiments for COVID-19patients in 10 days of treatment, and 40 independent experiments forhealthy individuals. The demographic, laboratory, and clinical characteristics of COVID-19 andhealthy subjects. Table2 depicts the demographic and other characteristics of COVID-19 andhealthy subjects. Of the 57 patients, 51 (89.48%) weredischarged from hospital and 6 (10.52%) died during the study. Antibodies used for determing the changes of the immune system ofCOVID-19 patients by flow cytometry.
In disagreement with other reports showing increasedfrequency of B cells in the late stage of recovery,17 we observed that the percentage of this cell was decreased followingrecovery. Moreinterestingly, the percentages of exhausted CD4+ T cells and exhausted CD8+ T cellswere higher in the early stage of recovery than the late stage of recovery. Thisobservation was in contrast with previous study showing severe cases of COVID-19tend to have lower percentages of monocytes.24 This discrepancy may be attributed to disease stage which patients wereevaluated.
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- Moreover, other data indicated thatthe levels of these cytokines were reduced during the disease recovery.
- In an attempt to discover the frequency of other cells of innateimmunity, the number of monocytes was also assessed.
- The cell markers used to determine thefrequencies of the stained cells are indicated in Table 1.
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The number of lymphocytes in peripheral blood of COVID-19 patients in the earlyand late stages of recovery and healthy subjects were assessed by an automatedcell counter system UF-100® (Sysmex, Kobe, Japan) within 3 h aftercollecting blood samples. The results of this study provide evidence to show that COVID-19 patients, who needto hospitalization, had some changes in the immune system during the diseaserecovery to improve and regulate immune responses. Thesefindings were consistent with other reports indicating the number of CD8+ T cellswas markedly decreased and its function was exhausted in COVID-19 patients.29 In contrast with the percentage of activated CD4+ T cell which was increasedin the early stage of recovery, the activated CD8+ T cell had the reduced frequency;however its number was significantly increased in the late stage of recovery, unlikeactivated CD4+ T cell number. The results indicated thatpatients had the reduced number of lymphocyte in comparison with healthy subjects.In line with this finding, Qin et al. declared that patients with COVID-19 had areduction in T cell number accompanied by the severity of the disease. We observed that COVID-19patients had significantly higher percentage of monocytes in the early stage ofrecovery than those in the late stage of recovery and healthy subjects.
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The CD3+ cell population was also determined using the gating oflymphocyte population and was then used to measure the percentages of B cells(CD3− CD19+ CD22+ cells), exhausted CD4+ T cells (CD3+ CD4+ PD-1+ cells),exhausted CD8+ T cells (CD3+ CD8+ PD-1+ cells), CD56lowCD16+ NK cells (CD3− CD56lowCD16+ cells), and CD56high CD16+/− NK cells(CD3−CD56high CD16+/− cells). Afterwards, the lymphocyte population was gatedto assess the frequencies of the CD4+ cells which were used to determine thepercentages of Th1 cells (CD4+ T-bet+ IFN-γ+ cells), Th2 cells (CD4+ IL-4+GATA3+ cells), Th17 cells (CD4+ IL-17α+ RORγt+ cells), Tregs (CD4+CD127low FoxP3+ cells), and activated CD4+ T cells (CD4+ CD25+CD69+ cells). At the first day (the early recovery stage) and 10 days of initiation oftherapeutic methods (the late recovery stage), heparinized blood samples (5 ml)were obtained from patients. All patients had pulmonary involvement and were not on treatment withdrugs influencing the immune system and antibodies production (i.e. steroids,sulfasalazine, phenytoin, and antimalarial drugs) prior to study initiation.
Having considered that innate immunity provides the early line of defense againstviral infections, some innate immune cells were studied in the course of 10 daysafter initiation of treatment, which is almost a period that the disease isdeteriorated and may result in death or recovery from COVID-19.27,28 Our datashowed that CD56lowCD16+ NK cell number was significantlylower in the early stage of recovery than the late stage of recovery; however itsfrequency was noticeably increased compared to healthy subjects. Moreover, the authors have shown that CD4+and CD8+ T cell numbers were notably decreased.17 In agreement with previous study, our data revealed that the frequencies ofTh cells (Th1, Th2, and Th17 cells) in patients were significantly lower in theearly recovery stage than the late recovery stage and healthy individuals. B cells showed an increasedpercentage in patients compared to healthy subjects, while this increase wassignificantly reduced in the late stage of recovery (Figure 3(i) and (r),P Open in a new tabThe percentages of adaptive immune cells revery play login in COVID-19 and healthyindividuals. Its frequency wassignificantly higher in the late recovery stage than early recovery stage (Figure 2(a) and (c),P highCD16+/− NK cells in the early stage of recovery was significantlyincreased in comparison with the late stage of recovery and healthy individuals(Figure 2(a) and(d),P Figure2(b) and (e),P Open in a new tabThe frequencies of innate immune cells in COVID-19 and control subjects.The percentages of CD56low CD16+ NK cells,CD56high CD16+/− NK cells, and monocytes werestudied by flow cytometry (a and b) and then analyzed (c–e).
In this study, the mean ± SD of age of patients was 67.8 ± 15.18, while it was66.01 ± 7.11 in healthy subjects. In thisstudy, CD8+ CD25+ CD69+ cells and CD14+ CD16+ CD11b+ cells were respectivelyconsidered as the activated CD8+ T cells and monocytes. To determine the immune situation of patients, theblood sampling (5 ml) from healthy subjects was also performed. This is an analytical observational (case-control) study performed on 57 patientswith COVID-19, who were referred to a COVID-19 center, Isfahan, Iran from March2020 to April 2020, and 40 healthy individuals without any the signs andsymptoms of acute respiratory infections and other health problems affected theimmune system. Although the pathogenesis of COVID-19 is not well understood yet, defects in functionand/or regulation of the immune system such as the storm of inflammatory cytokinesand lymphopenia can contribute to the intensity of pathogenic coronavirusinfections.11–13 In despite ofsome reports pointing to impacts of immune responses in the pathogenesis of COVID-19,14 the accurate roles of immune cells in developing or inhibiting the diseaseare unknown.