tetano
Editor, Senior Moderator
Front Immunol
. 2022 Feb 21;13:821818.
doi: 10.3389/fimmu.2022.821818. eCollection 2022.
Chronic Inflammation Might Protect Hemodialysis Patients From Severe COVID-19
Barbara Prietl[SUP] 1 2 [/SUP], Balazs Odler[SUP] 3 [/SUP], Alexander H Kirsch[SUP] 3 [/SUP], Katharina Artinger[SUP] 3 [/SUP], Manfred Eigner[SUP] 4 [/SUP], Sabine Schmaldienst[SUP] 4 [/SUP], Verena Pfeifer[SUP] 1 2 [/SUP], Stefanie Stanzer[SUP] 1 [/SUP], Anita Eberl[SUP] 5 [/SUP], Reingard Raml[SUP] 5 [/SUP], Thomas Pieber[SUP] 1 2 [/SUP], Alexander R Rosenkranz[SUP] 3 [/SUP], Marianne Brodmann[SUP] 6 [/SUP], Philipp Eller[SUP] 7 [/SUP], Kathrin Eller[SUP] 3 [/SUP]
Affiliations
Abstract
Hemodialysis patients (HD) are expected to have excess mortality in coronavirus disease 2019 (COVID-19). This was challenged by a recent study reporting HD patients to have comparable mortality and less ICU admissions when hospitalized with COVID-19. An altered immune system due to chronic inflammation might protect HD-patients from severe COVID-19. Therefore, we aimed to describe the peripheral blood immune phenotype in HD-patients and respective controls with COVID-19.
Methods: Sixty-four patients (31 HD, 33 non-HD) with PCR-confirmed COVID-19 and 16 control patients (10 HD, 6 non-HD) were prospectively included. According to symptoms, COVID-19 patients were categorized as asymptomatic/mild, moderate or severe COVID-19 phenotypes. Cytokine profiling and immune phenotyping was performed.
Results: Th1 and Th17 plasma cytokine levels were highly increased in HD patients without COVID-19 and were not significantly regulated during COVID-19. In non-HD COVID-19 patients these cytokines increased significantly with disease severity. While all patients with moderate or severe COVID-19 showed hallmarks of COVID-19 such as decreased CD3[SUP]+[/SUP], CD4[SUP]+[/SUP] and CD8[SUP]+[/SUP] and CD4[SUP]+[/SUP]CD25[SUP]hi[/SUP]FoxP3[SUP]+[/SUP] regulatory T cells, significantly increased CD38[SUP]+[/SUP]CD8[SUP]+[/SUP] effector memory and CD38[SUP]+[/SUP]CD8[SUP]+[/SUP] TEMRA T cells were detected in moderate/severe COVID-19 HD patients, which was not observed in non-HD patients with moderate or severe COVID-19. Furthermore, CD161[SUP]+[/SUP]CD8[SUP]+[/SUP] T cells decreased significantly in non-HD COVID-19 patients dependent on disease severity, but not in HD patients. Dynamics of B cells and subtypes were comparable in HD and non-HD COVID-19 patients.
Conclusions: HD patients might be protected from severe COVID-19 due to their chronic inflammatory state with increased CD38[SUP]+[/SUP]CD8[SUP]+[/SUP] effector memory and TEMRA T cells as well as CD161[SUP]+[/SUP]CD8[SUP]+[/SUP] T cells.
Keywords: CD8+ T cells; COVID-19; cytokines; hemodialysis patients; inflammation.
. 2022 Feb 21;13:821818.
doi: 10.3389/fimmu.2022.821818. eCollection 2022.
Chronic Inflammation Might Protect Hemodialysis Patients From Severe COVID-19
Barbara Prietl[SUP] 1 2 [/SUP], Balazs Odler[SUP] 3 [/SUP], Alexander H Kirsch[SUP] 3 [/SUP], Katharina Artinger[SUP] 3 [/SUP], Manfred Eigner[SUP] 4 [/SUP], Sabine Schmaldienst[SUP] 4 [/SUP], Verena Pfeifer[SUP] 1 2 [/SUP], Stefanie Stanzer[SUP] 1 [/SUP], Anita Eberl[SUP] 5 [/SUP], Reingard Raml[SUP] 5 [/SUP], Thomas Pieber[SUP] 1 2 [/SUP], Alexander R Rosenkranz[SUP] 3 [/SUP], Marianne Brodmann[SUP] 6 [/SUP], Philipp Eller[SUP] 7 [/SUP], Kathrin Eller[SUP] 3 [/SUP]
Affiliations
- PMID: 35265078
- PMCID: PMC8901184
- DOI: 10.3389/fimmu.2022.821818
Abstract
Hemodialysis patients (HD) are expected to have excess mortality in coronavirus disease 2019 (COVID-19). This was challenged by a recent study reporting HD patients to have comparable mortality and less ICU admissions when hospitalized with COVID-19. An altered immune system due to chronic inflammation might protect HD-patients from severe COVID-19. Therefore, we aimed to describe the peripheral blood immune phenotype in HD-patients and respective controls with COVID-19.
Methods: Sixty-four patients (31 HD, 33 non-HD) with PCR-confirmed COVID-19 and 16 control patients (10 HD, 6 non-HD) were prospectively included. According to symptoms, COVID-19 patients were categorized as asymptomatic/mild, moderate or severe COVID-19 phenotypes. Cytokine profiling and immune phenotyping was performed.
Results: Th1 and Th17 plasma cytokine levels were highly increased in HD patients without COVID-19 and were not significantly regulated during COVID-19. In non-HD COVID-19 patients these cytokines increased significantly with disease severity. While all patients with moderate or severe COVID-19 showed hallmarks of COVID-19 such as decreased CD3[SUP]+[/SUP], CD4[SUP]+[/SUP] and CD8[SUP]+[/SUP] and CD4[SUP]+[/SUP]CD25[SUP]hi[/SUP]FoxP3[SUP]+[/SUP] regulatory T cells, significantly increased CD38[SUP]+[/SUP]CD8[SUP]+[/SUP] effector memory and CD38[SUP]+[/SUP]CD8[SUP]+[/SUP] TEMRA T cells were detected in moderate/severe COVID-19 HD patients, which was not observed in non-HD patients with moderate or severe COVID-19. Furthermore, CD161[SUP]+[/SUP]CD8[SUP]+[/SUP] T cells decreased significantly in non-HD COVID-19 patients dependent on disease severity, but not in HD patients. Dynamics of B cells and subtypes were comparable in HD and non-HD COVID-19 patients.
Conclusions: HD patients might be protected from severe COVID-19 due to their chronic inflammatory state with increased CD38[SUP]+[/SUP]CD8[SUP]+[/SUP] effector memory and TEMRA T cells as well as CD161[SUP]+[/SUP]CD8[SUP]+[/SUP] T cells.
Keywords: CD8+ T cells; COVID-19; cytokines; hemodialysis patients; inflammation.