tetano
Editor, Senior Moderator
BMC Pulm Med
. 2020 Nov 16;20(1):301.
doi: 10.1186/s12890-020-01343-z.
Broncho-alveolar inflammation in COVID-19 patients: a correlation with clinical outcome
Laura Pandolfi[SUP] 1 [/SUP], Tommaso Fossali[SUP] 2 [/SUP], Vanessa Frangipane[SUP] 3 [/SUP], Sara Bozzini[SUP] 3 [/SUP], Monica Morosini[SUP] 3 [/SUP], Maura D'Amato[SUP] 3 [/SUP], Sara Lettieri[SUP] 4 [/SUP], Mario Urtis[SUP] 5 [/SUP], Alessandro Di Toro[SUP] 5 [/SUP], Laura Saracino[SUP] 6 [/SUP], Elena Percivalle[SUP] 7 [/SUP], Stefano Tomaselli[SUP] 6 [/SUP], Lorenzo Cavagna[SUP] 8 [/SUP], Emanuela Cova[SUP] 9 [/SUP], Francesco Mojoli[SUP] 10 [/SUP], Paola Bergomi[SUP] 2 [/SUP], Davide Ottolina[SUP] 2 [/SUP], Daniele Lilleri[SUP] 11 [/SUP], Angelo Guido Corsico[SUP] 4 [/SUP], Eloisa Arbustini[SUP] 5 [/SUP], Riccardo Colombo[SUP] 2 [/SUP], Federica Meloni[SUP] 4 [/SUP]
Affiliations
Abstract
Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) rapidly reached pandemic proportions. Given that the main target of SARS-CoV-2 are lungs leading to severe pneumonia with hyperactivation of the inflammatory cascade, we conducted a prospective study to assess alveolar inflammatory status in patients with moderate to severe COVID-19.
Methods: Diagnostic bronchoalveolar lavage (BAL) was performed in 33 adult patients with SARS-CoV-2 infection by real-time PCR on nasopharyngeal swab admitted to the Intensive care unit (ICU) (n = 28) and to the Intermediate Medicine Ward (IMW) (n = 5). We analyze the differential cell count, ultrastructure of cells and Interleukin (IL)6, 8 and 10 levels.
Results: ICU patients showed a marked increase in neutrophils (1.24 ? 10[SUP]5[/SUP] ml[SUP]- 1[/SUP], 0.85-2.07), lower lymphocyte (0.97 ? 10[SUP]5[/SUP] ml[SUP]- 1[/SUP], 0.024-0.34) and macrophages fractions (0.43 ? 10[SUP]5[/SUP] ml[SUP]- 1[/SUP], 0.34-1.62) compared to IMW patients (0.095 ? 10[SUP]5[/SUP] ml[SUP]- 1[/SUP], 0.05-0.73; 0.47 ? 10[SUP]5[/SUP] ml[SUP]- 1[/SUP], 0.28-1.01 and 2.14 ? 10[SUP]5[/SUP] ml[SUP]- 1[/SUP], 1.17-3.01, respectively) (p < 0.01). Study of ICU patients BAL by electron transmission microscopy showed viral particles inside mononuclear cells confirmed by immunostaining with anti-viral capsid and spike antibodies. IL6 and IL8 were significantly higher in ICU patients than in IMW (IL6 p < 0.01, IL8 p < 0.0001), and also in patients who did not survive (IL6 p < 0.05, IL8 p = 0.05 vs. survivors). IL10 did not show a significant variation between groups. Dividing patients by treatment received, lower BAL concentrations of IL6 were found in patients treated with steroids as compared to those treated with tocilizumab (p < 0.1) or antivirals (p < 0.05).
Conclusions: Alveolitis, associated with COVID-19, is mainly sustained by innate effectors which showed features of extensive activation. The burden of pro-inflammatory cytokines IL6 and IL8 in the broncho-alveolar environment is associated with clinical outcome.
Keywords: Bronchoalveolar lavage; COVID-19; Cytokines; Lung; SARS-CoV-2.
. 2020 Nov 16;20(1):301.
doi: 10.1186/s12890-020-01343-z.
Broncho-alveolar inflammation in COVID-19 patients: a correlation with clinical outcome
Laura Pandolfi[SUP] 1 [/SUP], Tommaso Fossali[SUP] 2 [/SUP], Vanessa Frangipane[SUP] 3 [/SUP], Sara Bozzini[SUP] 3 [/SUP], Monica Morosini[SUP] 3 [/SUP], Maura D'Amato[SUP] 3 [/SUP], Sara Lettieri[SUP] 4 [/SUP], Mario Urtis[SUP] 5 [/SUP], Alessandro Di Toro[SUP] 5 [/SUP], Laura Saracino[SUP] 6 [/SUP], Elena Percivalle[SUP] 7 [/SUP], Stefano Tomaselli[SUP] 6 [/SUP], Lorenzo Cavagna[SUP] 8 [/SUP], Emanuela Cova[SUP] 9 [/SUP], Francesco Mojoli[SUP] 10 [/SUP], Paola Bergomi[SUP] 2 [/SUP], Davide Ottolina[SUP] 2 [/SUP], Daniele Lilleri[SUP] 11 [/SUP], Angelo Guido Corsico[SUP] 4 [/SUP], Eloisa Arbustini[SUP] 5 [/SUP], Riccardo Colombo[SUP] 2 [/SUP], Federica Meloni[SUP] 4 [/SUP]
Affiliations
- PMID: 33198751
- DOI: 10.1186/s12890-020-01343-z
Abstract
Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) rapidly reached pandemic proportions. Given that the main target of SARS-CoV-2 are lungs leading to severe pneumonia with hyperactivation of the inflammatory cascade, we conducted a prospective study to assess alveolar inflammatory status in patients with moderate to severe COVID-19.
Methods: Diagnostic bronchoalveolar lavage (BAL) was performed in 33 adult patients with SARS-CoV-2 infection by real-time PCR on nasopharyngeal swab admitted to the Intensive care unit (ICU) (n = 28) and to the Intermediate Medicine Ward (IMW) (n = 5). We analyze the differential cell count, ultrastructure of cells and Interleukin (IL)6, 8 and 10 levels.
Results: ICU patients showed a marked increase in neutrophils (1.24 ? 10[SUP]5[/SUP] ml[SUP]- 1[/SUP], 0.85-2.07), lower lymphocyte (0.97 ? 10[SUP]5[/SUP] ml[SUP]- 1[/SUP], 0.024-0.34) and macrophages fractions (0.43 ? 10[SUP]5[/SUP] ml[SUP]- 1[/SUP], 0.34-1.62) compared to IMW patients (0.095 ? 10[SUP]5[/SUP] ml[SUP]- 1[/SUP], 0.05-0.73; 0.47 ? 10[SUP]5[/SUP] ml[SUP]- 1[/SUP], 0.28-1.01 and 2.14 ? 10[SUP]5[/SUP] ml[SUP]- 1[/SUP], 1.17-3.01, respectively) (p < 0.01). Study of ICU patients BAL by electron transmission microscopy showed viral particles inside mononuclear cells confirmed by immunostaining with anti-viral capsid and spike antibodies. IL6 and IL8 were significantly higher in ICU patients than in IMW (IL6 p < 0.01, IL8 p < 0.0001), and also in patients who did not survive (IL6 p < 0.05, IL8 p = 0.05 vs. survivors). IL10 did not show a significant variation between groups. Dividing patients by treatment received, lower BAL concentrations of IL6 were found in patients treated with steroids as compared to those treated with tocilizumab (p < 0.1) or antivirals (p < 0.05).
Conclusions: Alveolitis, associated with COVID-19, is mainly sustained by innate effectors which showed features of extensive activation. The burden of pro-inflammatory cytokines IL6 and IL8 in the broncho-alveolar environment is associated with clinical outcome.
Keywords: Bronchoalveolar lavage; COVID-19; Cytokines; Lung; SARS-CoV-2.