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Sudo K, Kinoshita M, Kawaguchi K, Kushimoto K, Yoshii R, Inoue K, Yamasaki M, Matsuyama T, Kooguchi K, Takashima Y, Tanaka M, Matsumoto K, Tashiro K, Inaba T, Ohta B, Sawa T. Case study observational research: inflammatory cytokines in the bronchial epithelial lining fluid of COVID-19 patients with acute hypoxemic respiratory failure. Crit Care 2024; 28:134. [PMID: 38654351 PMCID: PMC11036702 DOI: 10.1186/s13054-024-04921-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 04/17/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND In this study, the concentrations of inflammatory cytokines were measured in the bronchial epithelial lining fluid (ELF) and plasma in patients with acute hypoxemic respiratory failure (AHRF) secondary to severe coronavirus disease 2019 (COVID-19). METHODS We comprehensively analyzed the concentrations of 25 cytokines in the ELF and plasma of 27 COVID-19 AHRF patients. ELF was collected using the bronchial microsampling method through an endotracheal tube just after patients were intubated for mechanical ventilation. RESULTS Compared with those in healthy volunteers, the concentrations of interleukin (IL)-6 (median 27.6 pmol/L), IL-8 (1045.1 pmol/L), IL-17A (0.8 pmol/L), IL-25 (1.5 pmol/L), and IL-31 (42.3 pmol/L) were significantly greater in the ELF of COVID-19 patients than in that of volunteers. The concentrations of MCP-1 and MIP-1β were significantly greater in the plasma of COVID-19 patients than in that of volunteers. The ELF/plasma ratio of IL-8 was the highest among the 25 cytokines, with a median of 737, and the ELF/plasma ratio of IL-6 (median: 218), IL-1β (202), IL-31 (169), MCP-1 (81), MIP-1β (55), and TNF-α (47) were lower. CONCLUSIONS The ELF concentrations of IL-6, IL-8, IL-17A, IL-25, and IL-31 were significantly increased in COVID-19 patients. Although high levels of MIP-1 and MIP-1β were also detected in the blood samples collected simultaneously with the ELF samples, the results indicated that lung inflammation was highly compartmentalized. Our study demonstrated that a comprehensive analysis of cytokines in the ELF is a feasible approach for understanding lung inflammation and systemic interactions in patients with severe pneumonia.
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Affiliation(s)
- Kazuki Sudo
- Department of Anesthesiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajiicho 465, Kawaramachi-Hirokoji Agaru, Kamigyo, Kyoto, 602-8566, Japan
- Division of Intensive Care, Hospital of Kyoto Prefectural University of Medicine, Kajiicho 465, Kawaramachi-Hirokoji Agaru, Kamigyo, Kyoto, 602-8566, Japan
| | - Mao Kinoshita
- Department of Anesthesiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajiicho 465, Kawaramachi-Hirokoji Agaru, Kamigyo, Kyoto, 602-8566, Japan
| | - Ken Kawaguchi
- Department of Anesthesiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajiicho 465, Kawaramachi-Hirokoji Agaru, Kamigyo, Kyoto, 602-8566, Japan
| | - Kohsuke Kushimoto
- Department of Anesthesiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajiicho 465, Kawaramachi-Hirokoji Agaru, Kamigyo, Kyoto, 602-8566, Japan
| | - Ryogo Yoshii
- Division of Intensive Care, Hospital of Kyoto Prefectural University of Medicine, Kajiicho 465, Kawaramachi-Hirokoji Agaru, Kamigyo, Kyoto, 602-8566, Japan
| | - Keita Inoue
- Division of Intensive Care, Hospital of Kyoto Prefectural University of Medicine, Kajiicho 465, Kawaramachi-Hirokoji Agaru, Kamigyo, Kyoto, 602-8566, Japan
| | - Masaki Yamasaki
- Division of Intensive Care, Hospital of Kyoto Prefectural University of Medicine, Kajiicho 465, Kawaramachi-Hirokoji Agaru, Kamigyo, Kyoto, 602-8566, Japan
- Department of Anesthesia, Kyoto First Red-Cross Hospital, Honmachi 15-749, Higashiyama, Kyoto, 605-0981, Japan
| | - Tasuku Matsuyama
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kajiicho 465, Kawaramachi-Hirokoji Agaru, Kamigyo, Kyoto, 602-8566, Japan
| | - Kunihiko Kooguchi
- Division of Intensive Care, Hospital of Kyoto Prefectural University of Medicine, Kajiicho 465, Kawaramachi-Hirokoji Agaru, Kamigyo, Kyoto, 602-8566, Japan
| | - Yasuo Takashima
- Department of Genomic Medical Sciences, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajiicho 465, Kawaramachi-Hirokoji Agaru, Kamigyo, Kyoto, 602-8566, Japan
| | - Masami Tanaka
- Department of Genomic Medical Sciences, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajiicho 465, Kawaramachi-Hirokoji Agaru, Kamigyo, Kyoto, 602-8566, Japan
| | - Kazumichi Matsumoto
- Division of Clinical Laboratory, Hospital of Kyoto Prefectural University of Medicine, Kajiicho 465, Kawaramachi-Hirokoji Agaru, Kamigyo, Kyoto, 602-8566, Japan
| | - Kei Tashiro
- Department of Genomic Medical Sciences, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajiicho 465, Kawaramachi-Hirokoji Agaru, Kamigyo, Kyoto, 602-8566, Japan
| | - Tohru Inaba
- Division of Clinical Laboratory, Hospital of Kyoto Prefectural University of Medicine, Kajiicho 465, Kawaramachi-Hirokoji Agaru, Kamigyo, Kyoto, 602-8566, Japan
- Department of Infection Control and Laboratory Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajiicho 465, Kawaramachi-Hirokoji Agaru, Kamigyo, Kyoto, 602-8566, Japan
| | - Bon Ohta
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kajiicho 465, Kawaramachi-Hirokoji Agaru, Kamigyo, Kyoto, 602-8566, Japan
| | - Teiji Sawa
- Department of Anesthesiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajiicho 465, Kawaramachi-Hirokoji Agaru, Kamigyo, Kyoto, 602-8566, Japan.
- Hospital of Kyoto Prefectural University of Medicine, Kajiicho 465, Kawaramachi-Hirokoji Agaru, Kamigyo, Kyoto, 602-8566, Japan.
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Moga E, Lynton-Pons E, Domingo P. The Robustness of Cellular Immunity Determines the Fate of SARS-CoV-2 Infection. Front Immunol 2022; 13:904686. [PMID: 35833134 PMCID: PMC9271749 DOI: 10.3389/fimmu.2022.904686] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 05/27/2022] [Indexed: 12/11/2022] Open
Abstract
Two years after the appearance of the SARS-CoV-2 virus, the causal agent of the current global pandemic, it is time to analyze the evolution of the immune protection that infection and vaccination provide. Cellular immunity plays an important role in limiting disease severity and the resolution of infection. The early appearance, breadth and magnitude of SARS-CoV-2 specific T cell response has been correlated with disease severity and it has been thought that T cell responses may be sufficient to clear infection with minimal disease in COVID-19 patients with X-linked or autosomal recessive agammaglobulinemia. However, our knowledge of the phenotypic and functional diversity of CD8+ cytotoxic lymphocytes, CD4+ T helper cells, mucosal-associated invariant T (MAIT) cells and CD4+ T follicular helper (Tfh), which play a critical role in infection control as well as long-term protection, is still evolving. It has been described how CD8+ cytotoxic lymphocytes interrupt viral replication by secreting antiviral cytokines (IFN-γ and TNF-α) and directly killing infected cells, negatively correlating with stages of disease progression. In addition, CD4+ T helper cells have been reported to be key pieces, leading, coordinating and ultimately regulating antiviral immunity. For instance, in some more severe COVID-19 cases a dysregulated CD4+ T cell signature may contribute to the greater production of pro-inflammatory cytokines responsible for pathogenic inflammation. Here we discuss how cellular immunity is the axis around which the rest of the immune system components revolve, since it orchestrates and leads antiviral response by regulating the inflammatory cascade and, as a consequence, the innate immune system, as well as promoting a correct humoral response through CD4+ Tfh cells. This review also analyses the critical role of cellular immunity in modulating the development of high-affinity neutralizing antibodies and germinal center B cell differentiation in memory and long-lived antibody secreting cells. Finally, since there is currently a high percentage of vaccinated population and, in some cases, vaccine booster doses are even being administered in certain countries, we have also summarized newer approaches to long-lasting protective immunity and the cross-protection of cellular immune response against SARS-CoV-2.
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Affiliation(s)
- Esther Moga
- Department of Immunology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Barcelona, Spain,*Correspondence: Esther Moga,
| | - Elionor Lynton-Pons
- Department of Immunology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Pere Domingo
- Unidad de enfermedades infecciosas, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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