1
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Tsukalov I, Sánchez-Cerrillo I, Rajas O, Avalos E, Iturricastillo G, Esparcia L, Buzón MJ, Genescà M, Scagnetti C, Popova O, Martin-Cófreces N, Calvet-Mirabent M, Marcos-Jimenez A, Martínez-Fleta P, Delgado-Arévalo C, de Los Santos I, Muñoz-Calleja C, Calzada MJ, González Álvaro I, Palacios-Calvo J, Alfranca A, Ancochea J, Sánchez-Madrid F, Martin-Gayo E. NFκB and NLRP3/NLRC4 inflammasomes regulate differentiation, activation and functional properties of monocytes in response to distinct SARS-CoV-2 proteins. Nat Commun 2024; 15:2100. [PMID: 38453949 PMCID: PMC10920883 DOI: 10.1038/s41467-024-46322-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 02/22/2024] [Indexed: 03/09/2024] Open
Abstract
Increased recruitment of transitional and non-classical monocytes in the lung during SARS-CoV-2 infection is associated with COVID-19 severity. However, whether specific innate sensors mediate the activation or differentiation of monocytes in response to different SARS-CoV-2 proteins remain poorly characterized. Here, we show that SARS-CoV-2 Spike 1 but not nucleoprotein induce differentiation of monocytes into transitional or non-classical subsets from both peripheral blood and COVID-19 bronchoalveolar lavage samples in a NFκB-dependent manner, but this process does not require inflammasome activation. However, NLRP3 and NLRC4 differentially regulated CD86 expression in monocytes in response to Spike 1 and Nucleoprotein, respectively. Moreover, monocytes exposed to Spike 1 induce significantly higher proportions of Th1 and Th17 CD4 + T cells. In contrast, monocytes exposed to Nucleoprotein reduce the degranulation of CD8 + T cells from severe COVID-19 patients. Our study provides insights in the differential impact of innate sensors in regulating monocytes in response to different SARS-CoV-2 proteins, which might be useful to better understand COVID-19 immunopathology and identify therapeutic targets.
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Affiliation(s)
- Ilya Tsukalov
- Medicine Faculty, Universidad Autónoma de Madrid, Madrid, Spain
| | - Ildefonso Sánchez-Cerrillo
- Immunology Unit from Hospital Universitario La Princesa, Instituto Investigación Sanitaria-Princesa IIS-IP, Madrid, Spain
- CIBER Infectious Diseases (CIBERINFECC), Instituto de Salud Carlos III, Madrid, Spain
| | - Olga Rajas
- Pneumology Unit from Hospital Universitario La Princesa, Madrid, Spain
| | - Elena Avalos
- Pneumology Unit from Hospital Universitario La Princesa, Madrid, Spain
| | | | - Laura Esparcia
- Medicine Faculty, Universidad Autónoma de Madrid, Madrid, Spain
- Immunology Unit from Hospital Universitario La Princesa, Instituto Investigación Sanitaria-Princesa IIS-IP, Madrid, Spain
| | - María José Buzón
- Infectious Diseases Department, Institut de Recerca Hospital Univesritari Vall d'Hebrón (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Meritxell Genescà
- Infectious Diseases Department, Institut de Recerca Hospital Univesritari Vall d'Hebrón (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Camila Scagnetti
- Immunology Unit from Hospital Universitario La Princesa, Instituto Investigación Sanitaria-Princesa IIS-IP, Madrid, Spain
| | - Olga Popova
- Medicine Faculty, Universidad Autónoma de Madrid, Madrid, Spain
| | - Noa Martin-Cófreces
- Medicine Faculty, Universidad Autónoma de Madrid, Madrid, Spain
- Immunology Unit from Hospital Universitario La Princesa, Instituto Investigación Sanitaria-Princesa IIS-IP, Madrid, Spain
| | - Marta Calvet-Mirabent
- Medicine Faculty, Universidad Autónoma de Madrid, Madrid, Spain
- Immunology Unit from Hospital Universitario La Princesa, Instituto Investigación Sanitaria-Princesa IIS-IP, Madrid, Spain
| | - Ana Marcos-Jimenez
- Medicine Faculty, Universidad Autónoma de Madrid, Madrid, Spain
- Immunology Unit from Hospital Universitario La Princesa, Instituto Investigación Sanitaria-Princesa IIS-IP, Madrid, Spain
| | - Pedro Martínez-Fleta
- Medicine Faculty, Universidad Autónoma de Madrid, Madrid, Spain
- Immunology Unit from Hospital Universitario La Princesa, Instituto Investigación Sanitaria-Princesa IIS-IP, Madrid, Spain
| | - Cristina Delgado-Arévalo
- Immunology Unit from Hospital Universitario La Princesa, Instituto Investigación Sanitaria-Princesa IIS-IP, Madrid, Spain
| | - Ignacio de Los Santos
- CIBER Infectious Diseases (CIBERINFECC), Instituto de Salud Carlos III, Madrid, Spain
- Infectious Diseases Unit from Hospital Universitario La Princesa, Madrid, Spain
| | - Cecilia Muñoz-Calleja
- Immunology Unit from Hospital Universitario La Princesa, Instituto Investigación Sanitaria-Princesa IIS-IP, Madrid, Spain
- CIBER Infectious Diseases (CIBERINFECC), Instituto de Salud Carlos III, Madrid, Spain
| | - María José Calzada
- Medicine Faculty, Universidad Autónoma de Madrid, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Isidoro González Álvaro
- Rheumatology Department from Hospital Universitario La Princesa. Instituto de Investigación Sanitaria-Princesa IIS-IP, Madrid, Spain
| | - José Palacios-Calvo
- Department of Pathology, Hospital Universitario Ramón y Cajal. Instituto Ramón y Cajal de Investigaciones Sanitarias (IRYCIS), Universidad de Alcalá. Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain
| | - Arantzazu Alfranca
- Immunology Unit from Hospital Universitario La Princesa, Instituto Investigación Sanitaria-Princesa IIS-IP, Madrid, Spain
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
| | - Julio Ancochea
- Pneumology Unit from Hospital Universitario La Princesa, Madrid, Spain
| | - Francisco Sánchez-Madrid
- Medicine Faculty, Universidad Autónoma de Madrid, Madrid, Spain
- Immunology Unit from Hospital Universitario La Princesa, Instituto Investigación Sanitaria-Princesa IIS-IP, Madrid, Spain
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
| | - Enrique Martin-Gayo
- Medicine Faculty, Universidad Autónoma de Madrid, Madrid, Spain.
- Immunology Unit from Hospital Universitario La Princesa, Instituto Investigación Sanitaria-Princesa IIS-IP, Madrid, Spain.
- CIBER Infectious Diseases (CIBERINFECC), Instituto de Salud Carlos III, Madrid, Spain.
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2
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Martínez-Fleta P, Vicente-Rabaneda EF, Triguero-Martínez A, Roy-Vallejo E, Uriarte-Ecenarro M, Gutiérrez-Rodríguez F, Quiroga-Colina P, Romero-Robles A, Montes N, García-Castañeda N, Mejía-Abril GP, García-Vadillo JA, Llorente-Cubas I, Villagrasa JR, Serra López-Matencio JM, Ancochea J, Urzainqui A, Esparcia-Pinedo L, Alfranca A, de la Fuente H, García-Vicuña R, Sánchez-Madrid F, González-Álvaro I, Castañeda S. Beneficial effect of temporary methotrexate interruption on B and T cell responses upon SARS-CoV-2 vaccination in patients with rheumatoid arthritis or psoriatic arthritis. NPJ Vaccines 2024; 9:21. [PMID: 38291047 PMCID: PMC10827732 DOI: 10.1038/s41541-024-00805-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 01/02/2024] [Indexed: 02/01/2024] Open
Abstract
B and T cell responses were evaluated in patients with rheumatoid arthritis (RA) or psoriatic arthritis (PsA) after 1 or 2 weeks of methotrexate (MTX) withdrawal following each COVID-19 vaccine dose and compared with those who maintained MTX. Adult RA and PsA patients treated with MTX were recruited and randomly assigned to 3 groups: MTX-maintenance (n = 72), MTX-withdrawal for 1 week (n = 71) or MTX-withdrawal for 2 weeks (n = 73). Specific antibodies to several SARS-CoV-2 antigens and interferon (IFN)-γ and interleukin (IL)-21 responses were assessed. MTX withdrawal in patients without previous COVID-19 was associated with higher levels of anti-RBD IgG and neutralising antibodies, especially in the 2-week withdrawal group and with higher IFN-γ secretion upon stimulation with pools of SARS-CoV-2 S peptides. No increment of RA/PsA relapses was detected across groups. Our data indicate that two-week MTX interruption following COVID-19 vaccination in patients with RA or PsA improves humoral and cellular immune responses.
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Affiliation(s)
- Pedro Martínez-Fleta
- Department of Immunology, Hospital Universitario de La Princesa IIS-Princesa (Instituto de Investigación Sanitaria del Hospital Universitario de La Princesa), Madrid, Spain
| | - Esther F Vicente-Rabaneda
- Department of Rheumatology, Hospital Universitario de La Princesa IIS-Princesa (Instituto de Investigación Sanitaria del Hospital Universitario de La Princesa), Madrid, Spain
| | - Ana Triguero-Martínez
- Department of Rheumatology, Hospital Universitario de La Princesa IIS-Princesa (Instituto de Investigación Sanitaria del Hospital Universitario de La Princesa), Madrid, Spain
| | - Emilia Roy-Vallejo
- Department of Internal Medicine, Hospital Universitario de La Princesa IIS-Princesa (Instituto de Investigación Sanitaria del Hospital Universitario de La Princesa), Madrid, Spain
| | - Miren Uriarte-Ecenarro
- Department of Rheumatology, Hospital Universitario de La Princesa IIS-Princesa (Instituto de Investigación Sanitaria del Hospital Universitario de La Princesa), Madrid, Spain
| | - Francisco Gutiérrez-Rodríguez
- Department of Rheumatology, Hospital Universitario de La Princesa IIS-Princesa (Instituto de Investigación Sanitaria del Hospital Universitario de La Princesa), Madrid, Spain
| | - Patricia Quiroga-Colina
- Department of Rheumatology, Hospital Universitario de La Princesa IIS-Princesa (Instituto de Investigación Sanitaria del Hospital Universitario de La Princesa), Madrid, Spain
| | - Ana Romero-Robles
- Department of Rheumatology, Hospital Universitario de La Princesa IIS-Princesa (Instituto de Investigación Sanitaria del Hospital Universitario de La Princesa), Madrid, Spain
| | - Nuria Montes
- Department of Rheumatology, Hospital Universitario de La Princesa IIS-Princesa (Instituto de Investigación Sanitaria del Hospital Universitario de La Princesa), Madrid, Spain
| | - Noelia García-Castañeda
- Department of Rheumatology, Hospital Universitario de La Princesa IIS-Princesa (Instituto de Investigación Sanitaria del Hospital Universitario de La Princesa), Madrid, Spain
| | - Gina P Mejía-Abril
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Instituto Teófilo Hernando, Instituto de Investigación Sanitaria La Princesa (IP), Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Jesús A García-Vadillo
- Department of Rheumatology, Hospital Universitario de La Princesa IIS-Princesa (Instituto de Investigación Sanitaria del Hospital Universitario de La Princesa), Madrid, Spain
- Department of Medicine, Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Irene Llorente-Cubas
- Department of Rheumatology, Hospital Universitario de La Princesa IIS-Princesa (Instituto de Investigación Sanitaria del Hospital Universitario de La Princesa), Madrid, Spain
| | - José R Villagrasa
- Department of Preventive Medicine, Hospital Universitario de La Princesa IIS-Princesa (Instituto de Investigación Sanitaria del Hospital Universitario de La Princesa), Madrid, Spain
| | - José M Serra López-Matencio
- Department of Hospital Pharmacy, Hospital Universitario de La Princesa IIS-Princesa (Instituto de Investigación Sanitaria del Hospital Universitario de La Princesa), Madrid, Spain
| | - Julio Ancochea
- Department of Medicine, Universidad Autónoma de Madrid (UAM), Madrid, Spain
- Department of Pneumology, Hospital Universitario de La Princesa IIS-Princesa (Instituto de Investigación Sanitaria del Hospital Universitario de La Princesa), Madrid, Spain
- Cátedra UAM-Roche, EPID-Future, Department of Medicine, Universidad Autónoma de Madrid (UAM), Madrid, Spain
- Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Ana Urzainqui
- Department of Immunology, Hospital Universitario de La Princesa IIS-Princesa (Instituto de Investigación Sanitaria del Hospital Universitario de La Princesa), Madrid, Spain
| | - Laura Esparcia-Pinedo
- Department of Immunology, Hospital Universitario de La Princesa IIS-Princesa (Instituto de Investigación Sanitaria del Hospital Universitario de La Princesa), Madrid, Spain
| | - Arantzazu Alfranca
- Department of Immunology, Hospital Universitario de La Princesa IIS-Princesa (Instituto de Investigación Sanitaria del Hospital Universitario de La Princesa), Madrid, Spain
- Department of Medicine, Universidad Autónoma de Madrid (UAM), Madrid, Spain
- CIBER Cardiovascular CIBERCV, Madrid, Spain
| | - Hortensia de la Fuente
- Department of Immunology, Hospital Universitario de La Princesa IIS-Princesa (Instituto de Investigación Sanitaria del Hospital Universitario de La Princesa), Madrid, Spain
- CIBER Cardiovascular CIBERCV, Madrid, Spain
| | - Rosario García-Vicuña
- Department of Rheumatology, Hospital Universitario de La Princesa IIS-Princesa (Instituto de Investigación Sanitaria del Hospital Universitario de La Princesa), Madrid, Spain
- Department of Medicine, Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Francisco Sánchez-Madrid
- Department of Immunology, Hospital Universitario de La Princesa IIS-Princesa (Instituto de Investigación Sanitaria del Hospital Universitario de La Princesa), Madrid, Spain
- Department of Medicine, Universidad Autónoma de Madrid (UAM), Madrid, Spain
- CIBER Cardiovascular CIBERCV, Madrid, Spain
| | - Isidoro González-Álvaro
- Department of Rheumatology, Hospital Universitario de La Princesa IIS-Princesa (Instituto de Investigación Sanitaria del Hospital Universitario de La Princesa), Madrid, Spain.
| | - Santos Castañeda
- Department of Rheumatology, Hospital Universitario de La Princesa IIS-Princesa (Instituto de Investigación Sanitaria del Hospital Universitario de La Princesa), Madrid, Spain.
- Cátedra UAM-Roche, EPID-Future, Department of Medicine, Universidad Autónoma de Madrid (UAM), Madrid, Spain.
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3
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Esparcia-Pinedo L, Lancho-Sánchez Á, Tsukalov I, Pacheco MI, Martínez-Fleta P, Pérez-Miés B, Palacios-Calvo J, Sánchez-Madrid F, Martín-Gayo E, Alfranca A. T regulatory lymphocytes specific for SARS-CoV-2 display increased functional plasticity. Clin Immunol 2023; 256:109806. [PMID: 37827267 DOI: 10.1016/j.clim.2023.109806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 09/22/2023] [Accepted: 10/07/2023] [Indexed: 10/14/2023]
Abstract
The study of phenotypic and functional characteristics of immune cells involved in host response to SARS-CoV-2 is relevant for understanding COVID-19 pathogenesis and individual differences in disease progression. We have analyzed chemokine receptor expression in SARS-CoV-2-specific CD4+ T lymphocytes from vaccinated donors, and have found an increase of CCR9+ and CCR6+ cells. CCR9+ specific CD4+ cells are enriched in T regulatory (Treg) lymphocytes. These cells specifically show heterogeneous regulatory activity, associated with different profiles of CCR9/CCR6 expression, individual differences in IL-10 and IL-17 production, and variable FoxP3 and Notch4 expression. A higher heterogeneity in FoxP3 is selectively observed in convalescent individuals within vaccinated population. Accordingly, SARS-CoV-2-specific CD4+ lymphocytes from COVID-19 patients are also enriched in CCR9+ and CCR6+ cells. CCR6+ specific Treg lymphocytes are mainly increased in critically ill individuals, indicating a preferential role for these cells in lung injury pathogenesis. We provide experimental evidence for a SARS-CoV-2-specific Treg population with increased plasticity, which may contribute to the differential pathogenic response against SARS-CoV-2 among individuals, and underlie the development of autoimmune conditions following SARS-CoV-2 infection.
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Affiliation(s)
- Laura Esparcia-Pinedo
- Immunology Department, Hospital Universitario de La Princesa and Instituto de Investigación Sanitaria Princesa, Madrid, Spain
| | - Ángel Lancho-Sánchez
- Immunology Department, Hospital Universitario de La Princesa and Instituto de Investigación Sanitaria Princesa, Madrid, Spain
| | | | - María I Pacheco
- Medical Oncology Department Hospital Universitario de La Princesa, and Instituto de Investigación Sanitaria Princesa, Madrid, Spain
| | - Pedro Martínez-Fleta
- Immunology Department, Hospital Universitario de La Princesa and Instituto de Investigación Sanitaria Princesa, Madrid, Spain
| | - Belén Pérez-Miés
- Pathology Department, Ramón y Cajal University Hospital, CIBERONC, IRYCIS and University of Alcalá, Madrid, Spain
| | - José Palacios-Calvo
- Pathology Department, Ramón y Cajal University Hospital, CIBERONC, IRYCIS and University of Alcalá, Madrid, Spain
| | - Francisco Sánchez-Madrid
- Immunology Department, Hospital Universitario de La Princesa and Instituto de Investigación Sanitaria Princesa, Madrid, Spain; Universidad Autónoma de Madrid, Madrid, Spain; Centro de Investigación Biomédica en Red Cardiovascular, CIBERCV, 28029 Madrid, Spain
| | - Enrique Martín-Gayo
- Universidad Autónoma de Madrid, Madrid, Spain; Centro de Investigación Biomédica en Red Enfermedades Infecciosas, CIBERINFEC, 28029 Madrid, Spain
| | - Arantzazu Alfranca
- Immunology Department, Hospital Universitario de La Princesa and Instituto de Investigación Sanitaria Princesa, Madrid, Spain; Universidad Autónoma de Madrid, Madrid, Spain; Centro de Investigación Biomédica en Red Cardiovascular, CIBERCV, 28029 Madrid, Spain.
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4
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Calvet-Mirabent M, Sánchez-Cerrillo I, Martín-Cófreces N, Martínez-Fleta P, de la Fuente H, Tsukalov I, Delgado-Arévalo C, Calzada MJ, de Los Santos I, Sanz J, García-Fraile L, Sánchez-Madrid F, Alfranca A, Muñoz-Fernández MÁ, Buzón MJ, Martín-Gayo E. Antiretroviral therapy duration and immunometabolic state determine efficacy of ex vivo dendritic cell-based treatment restoring functional HIV-specific CD8+ T cells in people living with HIV. EBioMedicine 2022; 81:104090. [PMID: 35665682 PMCID: PMC9301875 DOI: 10.1016/j.ebiom.2022.104090] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 05/11/2022] [Accepted: 05/18/2022] [Indexed: 12/12/2022] Open
Abstract
Background Dysfunction of CD8+ T cells in people living with HIV-1 (PLWH) receiving anti-retroviral therapy (ART) has restricted the efficacy of dendritic cell (DC)-based immunotherapies against HIV-1. Heterogeneous immune exhaustion and metabolic states of CD8+ T cells might differentially associate with dysfunction. However, specific parameters associated to functional restoration of CD8+ T cells after DC treatment have not been investigated. Methods We studied association of restoration of functional HIV-1-specific CD8+ T cell responses after stimulation with Gag-adjuvant-primed DC with ART duration, exhaustion, metabolic and memory cell subsets profiles. Findings HIV-1-specific CD8+ T cell responses from a larger proportion of PLWH on long-term ART (more than 10 years; LT-ARTp) improved polyfunctionality and capacity to eliminate autologous p24+ infected CD4+ T cells in vitro. In contrast, functional improvement of CD8+ T cells from PLWH on short-term ART (less than a decade; ST-ARTp) after DC treatment was limited. This was associated with lower frequencies of central memory CD8+ T cells, increased co-expression of PD1 and TIGIT and reduced mitochondrial respiration and glycolysis induction upon TCR activation. In contrast, CD8+ T cells from LT-ARTp showed increased frequencies of TIM3+ PD1− cells and preserved induction of glycolysis. Treatment of dysfunctional CD8+ T cells from ST-ARTp with combined anti-PD1 and anti-TIGIT antibodies plus a glycolysis promoting drug restored their ability to eliminate infected CD4+ T cells. Interpretation Together, our study identifies specific immunometabolic parameters for different PLWH subgroups potentially useful for future personalized DC-based HIV-1 vaccines. Funding NIH (R21AI140930), MINECO/FEDER RETOS (RTI2018-097485-A-I00) and CIBERINF grants.
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Affiliation(s)
- Marta Calvet-Mirabent
- Immunology Unit from Hospital Universitario de La Princesa and Instituto de Investigación Sanitaria Princesa, Madrid, Spain; Universidad Autónoma de Madrid, Madrid, Spain
| | - Ildefonso Sánchez-Cerrillo
- Immunology Unit from Hospital Universitario de La Princesa and Instituto de Investigación Sanitaria Princesa, Madrid, Spain; Universidad Autónoma de Madrid, Madrid, Spain
| | - Noa Martín-Cófreces
- Immunology Unit from Hospital Universitario de La Princesa and Instituto de Investigación Sanitaria Princesa, Madrid, Spain; Universidad Autónoma de Madrid, Madrid, Spain; Centro de Investigación Biomédica en Red Cardiovascular, CIBERCV, 28029 Madrid, Spain
| | - Pedro Martínez-Fleta
- Immunology Unit from Hospital Universitario de La Princesa and Instituto de Investigación Sanitaria Princesa, Madrid, Spain
| | - Hortensia de la Fuente
- Immunology Unit from Hospital Universitario de La Princesa and Instituto de Investigación Sanitaria Princesa, Madrid, Spain; Centro de Investigación Biomédica en Red Cardiovascular, CIBERCV, 28029 Madrid, Spain
| | | | - Cristina Delgado-Arévalo
- Immunology Unit from Hospital Universitario de La Princesa and Instituto de Investigación Sanitaria Princesa, Madrid, Spain; Universidad Autónoma de Madrid, Madrid, Spain
| | | | - Ignacio de Los Santos
- Infectious Diseases Unit from Hospital Universitario de La Princesa, Madrid, Spain; Centro de Investigación Biomédica en Red Infecciosas, CIBERINF, 28029 Madrid, Spain
| | - Jesús Sanz
- Infectious Diseases Unit from Hospital Universitario de La Princesa, Madrid, Spain; Centro de Investigación Biomédica en Red Infecciosas, CIBERINF, 28029 Madrid, Spain
| | - Lucio García-Fraile
- Infectious Diseases Unit from Hospital Universitario de La Princesa, Madrid, Spain; Centro de Investigación Biomédica en Red Infecciosas, CIBERINF, 28029 Madrid, Spain
| | - Francisco Sánchez-Madrid
- Immunology Unit from Hospital Universitario de La Princesa and Instituto de Investigación Sanitaria Princesa, Madrid, Spain; Universidad Autónoma de Madrid, Madrid, Spain; Centro de Investigación Biomédica en Red Cardiovascular, CIBERCV, 28029 Madrid, Spain
| | - Arantzazu Alfranca
- Immunology Unit from Hospital Universitario de La Princesa and Instituto de Investigación Sanitaria Princesa, Madrid, Spain
| | - María Ángeles Muñoz-Fernández
- Immunology Section, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Maria J Buzón
- Infectious Diseases Department, Institut de Recerca Hospital Univesritari Vall d'Hebrón (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Enrique Martín-Gayo
- Immunology Unit from Hospital Universitario de La Princesa and Instituto de Investigación Sanitaria Princesa, Madrid, Spain; Universidad Autónoma de Madrid, Madrid, Spain; Centro de Investigación Biomédica en Red Infecciosas, CIBERINF, 28029 Madrid, Spain.
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5
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Martínez-Fleta P, Vera-Tomé P, Jiménez-Fernández M, Requena S, Roy-Vallejo E, Sanz-García A, Lozano-Prieto M, López-Sanz C, Vara A, Lancho-Sánchez Á, Martín-Gayo E, Muñoz-Calleja C, Alfranca A, González-Álvaro I, Galván-Román JM, Aspa J, de la Fuente H, Sánchez-Madrid F. A Differential Signature of Circulating miRNAs and Cytokines Between COVID-19 and Community-Acquired Pneumonia Uncovers Novel Physiopathological Mechanisms of COVID-19. Front Immunol 2022; 12:815651. [PMID: 35087533 PMCID: PMC8787267 DOI: 10.3389/fimmu.2021.815651] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 12/21/2021] [Indexed: 12/20/2022] Open
Abstract
Coronavirus Disease 2019 (COVID-19) pneumonia is a life-threatening infectious disease, especially for elderly patients with multiple comorbidities. Despite enormous efforts to understand its underlying etiopathogenic mechanisms, most of them remain elusive. In this study, we compared differential plasma miRNAs and cytokines profiles between COVID-19 and other community-acquired pneumonias (CAP). A first screening and subsequent validation assays in an independent cohort of patients revealed a signature of 15 dysregulated miRNAs between COVID-19 and CAP patients. Additionally, multivariate analysis displayed a combination of 4 miRNAs (miR-106b-5p, miR-221-3p, miR-25-3p and miR-30a-5p) that significantly discriminated between both pathologies. Search for targets of these miRNAs, combined with plasma protein measurements, identified a differential cytokine signature between COVID-19 and CAP that included EGFR, CXCL12 and IL-10. Significant differences were also detected in plasma levels of CXCL12, IL-17, TIMP-2 and IL-21R between mild and severe COVID-19 patients. These findings provide new insights into the etiopathological mechanisms underlying COVID-19.
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Affiliation(s)
- Pedro Martínez-Fleta
- Department of Immunology, Hospital Universitario de La Princesa IIS-IP (Instituto de Investigación Sanitaria del Hospital Universitario de La Princesa), Madrid, Spain
| | - Paula Vera-Tomé
- Department of Immunology, Hospital Universitario de La Princesa IIS-IP (Instituto de Investigación Sanitaria del Hospital Universitario de La Princesa), Madrid, Spain
| | - María Jiménez-Fernández
- Department of Immunology, Hospital Universitario de La Princesa IIS-IP (Instituto de Investigación Sanitaria del Hospital Universitario de La Princesa), Madrid, Spain
| | - Silvia Requena
- Department of Immunology, Hospital Universitario de La Princesa IIS-IP (Instituto de Investigación Sanitaria del Hospital Universitario de La Princesa), Madrid, Spain
| | - Emilia Roy-Vallejo
- Department of Internal Medicine, Hospital Universitario de La Princesa IIS-IP (Instituto de Investigación Sanitaria del Hospital Universitario de La Princesa), Madrid, Spain
| | - Ancor Sanz-García
- Data Analysis Unit, Hospital Universitario de La Princesa IIS-IP (Instituto de Investigación Sanitaria del Hospital Universitario de La Princesa), Madrid, Spain
| | - Marta Lozano-Prieto
- Department of Immunology, Hospital Universitario de La Princesa IIS-IP (Instituto de Investigación Sanitaria del Hospital Universitario de La Princesa), Madrid, Spain
| | - Celia López-Sanz
- Department of Immunology, Hospital Universitario de La Princesa IIS-IP (Instituto de Investigación Sanitaria del Hospital Universitario de La Princesa), Madrid, Spain
| | - Alicia Vara
- Department of Immunology, Hospital Universitario de La Princesa IIS-IP (Instituto de Investigación Sanitaria del Hospital Universitario de La Princesa), Madrid, Spain
| | - Ángel Lancho-Sánchez
- Biobank, Hospital Universitario de La Princesa IIS-IP (Instituto de Investigación Sanitaria del Hospital Universitario de La Princesa), Madrid, Spain
| | - Enrique Martín-Gayo
- Department of Immunology, Hospital Universitario de La Princesa IIS-IP (Instituto de Investigación Sanitaria del Hospital Universitario de La Princesa), Madrid, Spain.,Department of Medicine, Universidad Autónoma de Madrid (IIS-IP), Madrid, Spain
| | - Cecilia Muñoz-Calleja
- Department of Immunology, Hospital Universitario de La Princesa IIS-IP (Instituto de Investigación Sanitaria del Hospital Universitario de La Princesa), Madrid, Spain.,Department of Medicine, Universidad Autónoma de Madrid (IIS-IP), Madrid, Spain
| | - Arantzazu Alfranca
- Department of Immunology, Hospital Universitario de La Princesa IIS-IP (Instituto de Investigación Sanitaria del Hospital Universitario de La Princesa), Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Isidoro González-Álvaro
- Department of Immunology, Hospital Universitario de La Princesa IIS-IP (Instituto de Investigación Sanitaria del Hospital Universitario de La Princesa), Madrid, Spain.,Department of Rheumatology, Hospital Universitario de La Princesa IIS-IP (Instituto de Investigación Sanitaria del Hospital Universitario de La Princesa), Madrid, Spain
| | - José María Galván-Román
- Department of Internal Medicine, Hospital Universitario de La Princesa IIS-IP (Instituto de Investigación Sanitaria del Hospital Universitario de La Princesa), Madrid, Spain
| | - Javier Aspa
- Department of Pneumology, Hospital Universitario de La Princesa IIS-IP (Instituto de Investigación Sanitaria del Hospital Universitario de La Princesa), Madrid, Spain
| | - Hortensia de la Fuente
- Department of Immunology, Hospital Universitario de La Princesa IIS-IP (Instituto de Investigación Sanitaria del Hospital Universitario de La Princesa), Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Francisco Sánchez-Madrid
- Department of Immunology, Hospital Universitario de La Princesa IIS-IP (Instituto de Investigación Sanitaria del Hospital Universitario de La Princesa), Madrid, Spain.,Department of Medicine, Universidad Autónoma de Madrid (IIS-IP), Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
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6
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Esparcia-Pinedo L, Martínez-Fleta P, Ropero N, Vera-Tomé P, Reyburn HT, Casasnovas JM, Rodríguez Frade JM, Valés-Gómez M, Vilches C, Martín-Gayo E, Muñoz-Calleja C, Sanchez-Madrid F, Alfranca A. CD4+ T Cell Immune Specificity Changes After Vaccination in Healthy And COVID-19 Convalescent Subjects. Front Immunol 2022; 12:755891. [PMID: 35126347 PMCID: PMC8807633 DOI: 10.3389/fimmu.2021.755891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 12/29/2021] [Indexed: 11/18/2022] Open
Abstract
The immune response promoted by SARS-CoV-2 vaccination is relevant to develop novel vaccines and optimized prevention strategies. We analyzed the adaptive immunity in healthy donors (HD) and convalescent individuals (CD), before and after administering BNT162b2 vaccine. Our results revealed specific changes in CD4+ T cell reactivity profile in vaccinated HD and CD, with an increase in S1 and S2 positive individuals, proportionally higher for S2. On the contrary, NCAP reactivity observed in HD and CD patients was no longer detectable after vaccination. Despite the substantial antibody response in CD, MPro-derived peptides did not elicit CD4+ lymphocyte activation in our assay in either condition. HD presented an increment in anti-S and anti-RBD IgG after first dose vaccination, which increased after the second vaccination. Conversely, anti-S and anti-RBD IgG and IgA titers increased in already positive CD after first dose administration, remaining stable after second dose inoculation. Interestingly, we found a strong significant correlation between S1-induced CD4+ response and anti-S IgA pre-vaccination, which was lost after vaccine administration.
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Affiliation(s)
- Laura Esparcia-Pinedo
- Immunology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
| | - Pedro Martínez-Fleta
- Immunology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
| | - Noelia Ropero
- Immunology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
| | - Paula Vera-Tomé
- Immunology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
| | - Hugh T. Reyburn
- Department of Immunology and Oncology, Centro Nacional de Biotecnologia/Consejo Superior de Investigaciones Científicas (CSIC), Madrid, Spain
| | - José M. Casasnovas
- Department of Macromolecular Structures, Centro Nacional de Biotecnologia/Consejo Superior de Investigaciones Científicas (CSIC), Madrid, Spain
| | - José M. Rodríguez Frade
- Department of Immunology and Oncology, Centro Nacional de Biotecnologia/Consejo Superior de Investigaciones Científicas (CSIC), Madrid, Spain
| | - Mar Valés-Gómez
- Department of Immunology and Oncology, Centro Nacional de Biotecnologia/Consejo Superior de Investigaciones Científicas (CSIC), Madrid, Spain
| | - Carlos Vilches
- Immunogenetics and Histocompatibility, Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana, Madrid, Spain
| | - Enrique Martín-Gayo
- Immunology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
- Department of Medicine, School of Medicine, Universidad Autónoma of Madrid, Madrid, Spain
| | - Cecilia Muñoz-Calleja
- Immunology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
- Department of Medicine, School of Medicine, Universidad Autónoma of Madrid, Madrid, Spain
| | - Francisco Sanchez-Madrid
- Immunology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
- Department of Medicine, School of Medicine, Universidad Autónoma of Madrid, Madrid, Spain
- Cardiovascular Centre for Biomedical Research Network (CIBER CV) Health Institute Carlos III, Madrid, Spain
| | - Arantzazu Alfranca
- Immunology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
- Department of Medicine, School of Medicine, Universidad Autónoma of Madrid, Madrid, Spain
- Cardiovascular Centre for Biomedical Research Network (CIBER CV) Health Institute Carlos III, Madrid, Spain
- *Correspondence: Arantzazu Alfranca,
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7
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Cáceres-Martell Y, Fernández-Soto D, Campos-Silva C, García-Cuesta EM, Casasnovas JM, Navas-Herrera D, Beneítez-Martínez A, Martínez-Fleta P, Alfranca A, Sánchez-Madrid F, Escudero-López G, Vilches C, Jara-Acevedo R, Reyburn HT, Rodríguez-Frade JM, Valés-Gómez M. Single-reaction multi-antigen serological test for comprehensive evaluation of SARS-CoV-2 patients by flow cytometry. Eur J Immunol 2021; 51:2633-2640. [PMID: 34358329 PMCID: PMC8420214 DOI: 10.1002/eji.202149319] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 08/02/2021] [Accepted: 08/04/2021] [Indexed: 12/15/2022]
Abstract
Here, we describe a new, simple, highly multiplexed serological test that generates a more complete picture of seroconversion than single antigen‐based assays. Flow cytometry is used to detect multiple Ig isotypes binding to four SARS‐CoV‐2 antigens: the Spike glycoprotein, its RBD fragment (the main target for neutralizing antibodies), the nucleocapsid protein, and the main cysteine‐like protease in a single reaction. Until now, most diagnostic serological tests measured antibodies to only one antigen and in some laboratory‐confirmed patients no SARS‐CoV‐2‐specific antibodies could be detected. Our data reveal that while most patients respond against all the viral antigens tested, others show a marked bias to make antibodies against either proteins exposed on the viral particle or those released after cellular infection. With this assay, it was possible to discriminate between patients and healthy controls with 100% confidence. Analysing the response of multiple Ig isotypes to the four antigens in combination may also help to establish a correlation with the severity degree of disease. A more detailed description of the immune responses of different patients to SARS‐CoV‐2 virus might provide insight into the wide array of clinical presentations of COVID‐19.
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Affiliation(s)
- Yaiza Cáceres-Martell
- Department of Immunology and Oncology, National Centre for Biotechnology, CNB-CSIC, Madrid, Spain
| | - Daniel Fernández-Soto
- Department of Immunology and Oncology, National Centre for Biotechnology, CNB-CSIC, Madrid, Spain
| | - Carmen Campos-Silva
- Department of Immunology and Oncology, National Centre for Biotechnology, CNB-CSIC, Madrid, Spain
| | - Eva M García-Cuesta
- Department of Immunology and Oncology, National Centre for Biotechnology, CNB-CSIC, Madrid, Spain
| | - Jose M Casasnovas
- Department of Macromolecular Structures, National Centre for Biotechnology, CNB-CSIC, Madrid, Spain
| | | | | | | | - Arantzazu Alfranca
- Immunology Department, Hospital Universitario La Princesa IIS-IP, Madrid, Spain.,CIBER Cardiovascular Department, Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana, Majadahonda, Spain
| | - Francisco Sánchez-Madrid
- Immunology Department, Hospital Universitario La Princesa IIS-IP, Madrid, Spain.,CIBER Cardiovascular Department, Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana, Majadahonda, Spain
| | - Gabriela Escudero-López
- Internal Medicine Department, Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana, Majadahonda, Spain
| | - Carlos Vilches
- Immunology Department, Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana, Majadahonda, Spain
| | | | - Hugh T Reyburn
- Department of Immunology and Oncology, National Centre for Biotechnology, CNB-CSIC, Madrid, Spain
| | - José M Rodríguez-Frade
- Department of Immunology and Oncology, National Centre for Biotechnology, CNB-CSIC, Madrid, Spain
| | - Mar Valés-Gómez
- Department of Immunology and Oncology, National Centre for Biotechnology, CNB-CSIC, Madrid, Spain
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8
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Marcos-Jiménez A, Sánchez-Alonso S, Alcaraz-Serna A, Esparcia L, López-Sanz C, Sampedro-Núñez M, Mateu-Albero T, Sánchez-Cerrillo I, Martínez-Fleta P, Gabrie L, Del Campo Guerola L, Rodríguez-Frade JM, Casasnovas JM, Reyburn HT, Valés-Gómez M, López-Trascasa M, Martín-Gayo E, Calzada MJ, Castañeda S, de la Fuente H, González-Álvaro I, Sánchez-Madrid F, Muñoz-Calleja C, Alfranca A. Deregulated cellular circuits driving immunoglobulins and complement consumption associate with the severity of COVID-19 patients. Eur J Immunol 2021; 51:634-647. [PMID: 33251605 PMCID: PMC7753288 DOI: 10.1002/eji.202048858] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 10/16/2020] [Accepted: 11/27/2020] [Indexed: 12/24/2022]
Abstract
SARS‐CoV‐2 infection causes an abrupt response by the host immune system, which is largely responsible for the outcome of COVID‐19. We investigated whether the specific immune responses in the peripheral blood of 276 patients were associated with the severity and progression of COVID‐19. At admission, dramatic lymphopenia of T, B, and NK cells is associated with severity. Conversely, the proportion of B cells, plasmablasts, circulating follicular helper T cells (cTfh) and CD56–CD16+ NK‐cells increased. Regarding humoral immunity, levels of IgM, IgA, and IgG were unaffected, but when degrees of severity were considered, IgG was lower in severe patients. Compared to healthy donors, complement C3 and C4 protein levels were higher in mild and moderate, but not in severe patients, while the activation peptide of C5 (C5a) increased from the admission in every patient, regardless of their severity. Moreover, total IgG, the IgG1 and IgG3 isotypes, and C4 decreased from day 0 to day 10 in patients who were hospitalized for more than two weeks, but not in patients who were discharged earlier. Our study provides important clues to understand the immune response observed in COVID‐19 patients, associating severity with an imbalanced humoral response, and identifying new targets for therapeutic intervention.
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Affiliation(s)
- Ana Marcos-Jiménez
- Department of Immunology, Biomedical Research Institute La Princesa Hospital (IIS-IP), Madrid, Spain
| | - Santiago Sánchez-Alonso
- Department of Immunology, Biomedical Research Institute La Princesa Hospital (IIS-IP), Madrid, Spain
| | - Ana Alcaraz-Serna
- Department of Immunology, Biomedical Research Institute La Princesa Hospital (IIS-IP), Madrid, Spain
| | - Laura Esparcia
- Department of Immunology, Biomedical Research Institute La Princesa Hospital (IIS-IP), Madrid, Spain
| | - Celia López-Sanz
- Department of Immunology, Biomedical Research Institute La Princesa Hospital (IIS-IP), Madrid, Spain
| | - Miguel Sampedro-Núñez
- Department of Endocrinology, La Princesa Hospital, Madrid, Spain.,School of Medicine, Department of Medicine, Universidad Autónoma of Madrid, Madrid, Spain
| | - Tamara Mateu-Albero
- Department of Immunology, Biomedical Research Institute La Princesa Hospital (IIS-IP), Madrid, Spain
| | | | - Pedro Martínez-Fleta
- Department of Immunology, Biomedical Research Institute La Princesa Hospital (IIS-IP), Madrid, Spain
| | - Ligia Gabrie
- Department of Immunology, Biomedical Research Institute La Princesa Hospital (IIS-IP), Madrid, Spain
| | - Luciana Del Campo Guerola
- Department of Immunology, Biomedical Research Institute La Princesa Hospital (IIS-IP), Madrid, Spain
| | | | | | | | | | | | - Enrique Martín-Gayo
- Department of Immunology, Biomedical Research Institute La Princesa Hospital (IIS-IP), Madrid, Spain.,School of Medicine, Department of Medicine, Universidad Autónoma of Madrid, Madrid, Spain
| | - María José Calzada
- Department of Immunology, Biomedical Research Institute La Princesa Hospital (IIS-IP), Madrid, Spain.,School of Medicine, Department of Medicine, Universidad Autónoma of Madrid, Madrid, Spain
| | - Santos Castañeda
- Department of Immunology, Biomedical Research Institute La Princesa Hospital (IIS-IP), Madrid, Spain
| | - Hortensia de la Fuente
- Department of Immunology, Biomedical Research Institute La Princesa Hospital (IIS-IP), Madrid, Spain
| | - Isidoro González-Álvaro
- Department of Immunology, Biomedical Research Institute La Princesa Hospital (IIS-IP), Madrid, Spain
| | - Francisco Sánchez-Madrid
- Department of Immunology, Biomedical Research Institute La Princesa Hospital (IIS-IP), Madrid, Spain.,School of Medicine, Department of Medicine, Universidad Autónoma of Madrid, Madrid, Spain
| | - Cecilia Muñoz-Calleja
- Department of Immunology, Biomedical Research Institute La Princesa Hospital (IIS-IP), Madrid, Spain.,School of Medicine, Department of Medicine, Universidad Autónoma of Madrid, Madrid, Spain
| | - Arantzazu Alfranca
- Department of Immunology, Biomedical Research Institute La Princesa Hospital (IIS-IP), Madrid, Spain
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9
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Sánchez-Cerrillo I, Landete P, Aldave B, Sánchez-Alonso S, Sánchez-Azofra A, Marcos-Jiménez A, Ávalos E, Alcaraz-Serna A, de Los Santos I, Mateu-Albero T, Esparcia L, López-Sanz C, Martínez-Fleta P, Gabrie L, Del Campo Guerola L, de la Fuente H, Calzada MJ, González-Álvaro I, Alfranca A, Sánchez-Madrid F, Muñoz-Calleja C, Soriano JB, Ancochea J, Martín-Gayo E. COVID-19 severity associates with pulmonary redistribution of CD1c+ DCs and inflammatory transitional and nonclassical monocytes. J Clin Invest 2020; 130:6290-6300. [PMID: 32784290 DOI: 10.1172/jci140335] [Citation(s) in RCA: 138] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 08/11/2020] [Indexed: 01/08/2023] Open
Abstract
SARS-CoV-2 is responsible for the development of coronavirus disease 2019 (COVID-19) in infected individuals, who can either exhibit mild symptoms or progress toward a life-threatening acute respiratory distress syndrome (ARDS). Exacerbated inflammation and dysregulated immune responses involving T and myeloid cells occur in COVID-19 patients with severe clinical progression. However, the differential contribution of specific subsets of dendritic cells and monocytes to ARDS is still poorly understood. In addition, the role of CD8+ T cells present in the lung of COVID-19 patients and relevant for viral control has not been characterized. Here, we have studied the frequencies and activation profiles of dendritic cells and monocytes present in the blood and lung of COVID-19 patients with different clinical severity in comparison with healthy individuals. Furthermore, these subpopulations and their association with antiviral effector CD8+ T cell subsets were also characterized in lung infiltrates from critical COVID-19 patients. Our results indicate that inflammatory transitional and nonclassical monocytes and CD1c+ conventional dendritic cells preferentially migrate from blood to lungs in patients with severe COVID-19. Thus, this study increases the knowledge of specific myeloid subsets involved in the pathogenesis of COVID-19 disease and could be useful for the design of therapeutic strategies for fighting SARS-CoV-2 infection.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Isidoro González-Álvaro
- Rheumatology Service from Hospital Universitario de la Princesa and Instituto de Investigación Sanitaria Princesa, Madrid, Spain
| | | | | | | | - Joan B Soriano
- Pneumology Department.,Universidad Autónoma de Madrid, and
| | - Julio Ancochea
- Pneumology Department.,Universidad Autónoma de Madrid, and
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10
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Martínez-Fleta P, Alfranca A, González-Álvaro I, Casasnovas JM, Fernández-Soto D, Esteso G, Cáceres-Martell Y, Gardeta S, López-Sanz C, Prat S, Mateu-Albero T, Gabrie L, López-Granados E, Sánchez-Madrid F, Reyburn HT, Rodríguez Frade JM, Valés-Gómez M. SARS-CoV-2 Cysteine-like Protease Antibodies Can Be Detected in Serum and Saliva of COVID-19-Seropositive Individuals. J Immunol 2020; 205:3130-3140. [PMID: 33148714 DOI: 10.4049/jimmunol.2000842] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 09/29/2020] [Indexed: 11/19/2022]
Abstract
Currently, there is a need for reliable tests that allow identification of individuals that have been infected with SARS-CoV-2 even if the infection was asymptomatic. To date, the vast majority of the serological tests for SARS-CoV-2-specific Abs are based on serum detection of Abs to either the viral spike glycoprotein (the major target for neutralizing Abs) or the viral nucleocapsid protein that is known to be highly immunogenic in other coronaviruses. Conceivably, exposure of Ags released from infected cells could stimulate Ab responses that might correlate with tissue damage and, hence, they may have some value as a prognostic indicator. We addressed whether other nonstructural viral proteins, not incorporated into the infectious viral particle, specifically the viral cysteine-like protease, might also be potent immunogens. Using ELISA tests, coating several SARS-CoV-2 proteins produced in vitro, we describe that COVID-19 patients make high titer IgG, IgM, and IgA Ab responses to the Cys-like protease from SARS-CoV-2, also known as 3CLpro or Mpro, and it can be used to identify individuals with positive serology against the coronavirus. Higher Ab titers in these assays associated with more-severe disease, and no cross-reactive Abs against prior betacoronavirus were found. Remarkably, IgG Abs specific for Mpro and other SARS-CoV-2 Ags can also be detected in saliva. In conclusion, Mpro is a potent Ag in infected patients that can be used in serological tests, and its detection in saliva could be the basis for a rapid, noninvasive test for COVID-19 seropositivity.
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Affiliation(s)
- Pedro Martínez-Fleta
- Immunology Department, University Teaching Hospital "La Princesa," La Princesa Health Research Institute, Madrid 28006, Spain
| | - Arantzazu Alfranca
- Immunology Department, University Teaching Hospital "La Princesa," La Princesa Health Research Institute, Madrid 28006, Spain.,Cardiovascular Centre for Biomedical Research Network, Health Institute Carlos III, Madrid 28029, Spain
| | - Isidoro González-Álvaro
- Immunology Department, University Teaching Hospital "La Princesa," La Princesa Health Research Institute, Madrid 28006, Spain.,Rheumatology Department, University Teaching Hospital "La Princesa," Madrid 28006, Spain
| | - Jose M Casasnovas
- Department of Macromolecular Structures, National Centre for Biotechnology-Spanish National Research Council, Madrid 28049, Spain
| | - Daniel Fernández-Soto
- Department of Immunology and Oncology, National Centre for Biotechnology, National Centre for Biotechnology-Spanish National Research Council, Madrid 28049, Spain; and
| | - Gloria Esteso
- Department of Immunology and Oncology, National Centre for Biotechnology, National Centre for Biotechnology-Spanish National Research Council, Madrid 28049, Spain; and
| | - Yaiza Cáceres-Martell
- Department of Immunology and Oncology, National Centre for Biotechnology, National Centre for Biotechnology-Spanish National Research Council, Madrid 28049, Spain; and
| | - Sofía Gardeta
- Department of Immunology and Oncology, National Centre for Biotechnology, National Centre for Biotechnology-Spanish National Research Council, Madrid 28049, Spain; and
| | - Celia López-Sanz
- Immunology Department, University Teaching Hospital "La Princesa," La Princesa Health Research Institute, Madrid 28006, Spain
| | - Salomé Prat
- Department of Macromolecular Structures, National Centre for Biotechnology-Spanish National Research Council, Madrid 28049, Spain
| | - Tamara Mateu-Albero
- Immunology Department, University Teaching Hospital "La Princesa," La Princesa Health Research Institute, Madrid 28006, Spain
| | - Ligia Gabrie
- Immunology Department, University Teaching Hospital "La Princesa," La Princesa Health Research Institute, Madrid 28006, Spain
| | | | - Francisco Sánchez-Madrid
- Immunology Department, University Teaching Hospital "La Princesa," La Princesa Health Research Institute, Madrid 28006, Spain.,Cardiovascular Centre for Biomedical Research Network, Health Institute Carlos III, Madrid 28029, Spain
| | - Hugh T Reyburn
- Department of Immunology and Oncology, National Centre for Biotechnology, National Centre for Biotechnology-Spanish National Research Council, Madrid 28049, Spain; and
| | - José M Rodríguez Frade
- Department of Immunology and Oncology, National Centre for Biotechnology, National Centre for Biotechnology-Spanish National Research Council, Madrid 28049, Spain; and
| | - Mar Valés-Gómez
- Department of Immunology and Oncology, National Centre for Biotechnology, National Centre for Biotechnology-Spanish National Research Council, Madrid 28049, Spain; and
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11
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Galván-Román JM, Rodríguez-García SC, Roy-Vallejo E, Marcos-Jiménez A, Sánchez-Alonso S, Fernández-Díaz C, Alcaraz-Serna A, Mateu-Albero T, Rodríguez-Cortes P, Sánchez-Cerrillo I, Esparcia L, Martínez-Fleta P, López-Sanz C, Gabrie L, Del Campo Guerola L, Suárez-Fernández C, Ancochea J, Canabal A, Albert P, Rodríguez-Serrano DA, Aguilar JM, Del Arco C, de Los Santos I, García-Fraile L, de la Cámara R, Serra JM, Ramírez E, Alonso T, Landete P, Soriano JB, Martín-Gayo E, Fraile Torres A, Zurita Cruz ND, García-Vicuña R, Cardeñoso L, Sánchez-Madrid F, Alfranca A, Muñoz-Calleja C, González-Álvaro I. IL-6 serum levels predict severity and response to tocilizumab in COVID-19: An observational study. J Allergy Clin Immunol 2020; 147:72-80.e8. [PMID: 33010257 PMCID: PMC7525244 DOI: 10.1016/j.jaci.2020.09.018] [Citation(s) in RCA: 128] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 09/07/2020] [Accepted: 09/17/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Patients with coronavirus disaese 2019 (COVID-19) can develop a cytokine release syndrome that eventually leads to acute respiratory distress syndrome requiring invasive mechanical ventilation (IMV). Because IL-6 is a relevant cytokine in acute respiratory distress syndrome, the blockade of its receptor with tocilizumab (TCZ) could reduce mortality and/or morbidity in severe COVID-19. OBJECTIVE We sought to determine whether baseline IL-6 serum levels can predict the need for IMV and the response to TCZ. METHODS A retrospective observational study was performed in hospitalized patients diagnosed with COVID-19. Clinical information and laboratory findings, including IL-6 levels, were collected approximately 3 and 9 days after admission to be matched with preadministration and postadministration of TCZ. Multivariable logistic and linear regressions and survival analysis were performed depending on outcomes: need for IMV, evolution of arterial oxygen tension/fraction of inspired oxygen ratio, or mortality. RESULTS One hundred forty-six patients were studied, predominantly males (66%); median age was 63 years. Forty-four patients (30%) required IMV, and 58 patients (40%) received treatment with TCZ. IL-6 levels greater than 30 pg/mL was the best predictor for IMV (odds ratio, 7.1; P < .001). Early administration of TCZ was associated with improvement in oxygenation (arterial oxygen tension/fraction of inspired oxygen ratio) in patients with high IL-6 (P = .048). Patients with high IL-6 not treated with TCZ showed high mortality (hazard ratio, 4.6; P = .003), as well as those with low IL-6 treated with TCZ (hazard ratio, 3.6; P = .016). No relevant serious adverse events were observed in TCZ-treated patients. CONCLUSIONS Baseline IL-6 greater than 30 pg/mL predicts IMV requirement in patients with COVID-19 and contributes to establish an adequate indication for TCZ administration.
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Affiliation(s)
- José María Galván-Román
- Internal Medicine Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
| | - Sebastián C Rodríguez-García
- Rheumatology Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
| | - Emilia Roy-Vallejo
- Internal Medicine Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
| | - Ana Marcos-Jiménez
- Immunology Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
| | - Santiago Sánchez-Alonso
- Immunology Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
| | - Carlos Fernández-Díaz
- Rheumatology Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
| | - Ana Alcaraz-Serna
- Immunology Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
| | - Tamara Mateu-Albero
- Immunology Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
| | - Pablo Rodríguez-Cortes
- Internal Medicine Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
| | - Ildefonso Sánchez-Cerrillo
- Immunology Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
| | - Laura Esparcia
- Immunology Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
| | - Pedro Martínez-Fleta
- Immunology Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
| | - Celia López-Sanz
- Immunology Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
| | - Ligia Gabrie
- Immunology Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
| | - Luciana Del Campo Guerola
- Immunology Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
| | - Carmen Suárez-Fernández
- Internal Medicine Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
| | - Julio Ancochea
- Pneumology Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
| | - Alfonso Canabal
- Intensive Care Unit, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
| | - Patricia Albert
- Intensive Care Unit, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
| | - Diego A Rodríguez-Serrano
- Intensive Care Unit, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
| | - Juan Mariano Aguilar
- Emergency Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
| | - Carmen Del Arco
- Emergency Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
| | - Ignacio de Los Santos
- Internal Medicine Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
| | - Lucio García-Fraile
- Internal Medicine Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
| | - Rafael de la Cámara
- Hematology Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
| | - José María Serra
- Hospital Pharmacy Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
| | - Esther Ramírez
- Hospital Pharmacy Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
| | - Tamara Alonso
- Pneumology Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
| | - Pedro Landete
- Pneumology Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
| | - Joan B Soriano
- Pneumology Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
| | - Enrique Martín-Gayo
- Immunology Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
| | - Arturo Fraile Torres
- Microbiology Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
| | - Nelly Daniela Zurita Cruz
- Microbiology Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
| | - Rosario García-Vicuña
- Rheumatology Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
| | - Laura Cardeñoso
- Microbiology Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
| | - Francisco Sánchez-Madrid
- Immunology Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain; Centro de Investigación Biomédica en Red - Enfermedades Cardiovasculares (CIBER CV), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Arantzazu Alfranca
- Immunology Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
| | - Cecilia Muñoz-Calleja
- Immunology Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
| | - Isidoro González-Álvaro
- Rheumatology Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain.
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12
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Chicharro P, Rodríguez-Jiménez P, Llamas-Velasco M, Montes N, Sanz-García A, Cibrian D, Vara A, Gómez MJ, Jiménez-Fernández M, Martínez-Fleta P, Sánchez-García I, Lozano-Prieto M, Triviño JC, Miñambres R, Sánchez-Madrid F, de la Fuente H, Dauden E. Expression of miR-135b in Psoriatic Skin and Its Association with Disease Improvement. Cells 2020; 9:cells9071603. [PMID: 32630692 PMCID: PMC7408353 DOI: 10.3390/cells9071603] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 06/29/2020] [Accepted: 06/30/2020] [Indexed: 12/17/2022] Open
Abstract
miRNAs have been associated with psoriasis since just over a decade. However, we are far from a complete understanding of their role during the development of this disease. Our objective was to characterize the cutaneous expression of miRNAs not previously described in psoriasis, the changes induced following the treatment with biologicals and their association with disease improvement. Next generation sequencing was performed from five skin samples from psoriasis patients (lesional and non-lesional skin) and five controls, and from this cohort, 12 microRNAs were selected to be analyzed in skin samples from 44 patients with plaque psoriasis. In 15 patients, an additional sample was obtained after three months of biological treatment. MiR-9-5p, miR-133a-3p and miR-375 were downregulated in the lesional skin of psoriasis patients. After treatment, expression of miR-133a-3p, miR-375, miR-378a and miR-135b in residual lesions returned towards the levels observed in non-lesional skin. The decrease in miR-135b levels after treatment with biologics was associated with both the improvement of patients evaluated through Psoriasis Area and Severity Index score and the decrease in local inflammatory response. Moreover, basal expression of miR-135b along with age was associated with the improvement of psoriasis, suggesting its possible usefulness as a prognostic biomarker.
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Affiliation(s)
- Pablo Chicharro
- Dermatology Department, Instituto de Investigación Sanitaria Hospital Universitario de la Princesa (IISP), 28006 Madrid, Spain; (P.C.); (P.R.-J.); (M.L.-V.); (E.D.)
| | - Pedro Rodríguez-Jiménez
- Dermatology Department, Instituto de Investigación Sanitaria Hospital Universitario de la Princesa (IISP), 28006 Madrid, Spain; (P.C.); (P.R.-J.); (M.L.-V.); (E.D.)
| | - Mar Llamas-Velasco
- Dermatology Department, Instituto de Investigación Sanitaria Hospital Universitario de la Princesa (IISP), 28006 Madrid, Spain; (P.C.); (P.R.-J.); (M.L.-V.); (E.D.)
| | - Nuria Montes
- Rheumatology Department, Instituto de Investigación Sanitaria Hospital Universitario de la Princesa (IISP), 28006 Madrid, Spain;
- Fisiología Vegetal, Departamento Ciencias Farmacéuticas y de la Salud, Facultad de Farmacia, Universidad San Pablo-CEU, 28003 Madrid, Spain
| | - Ancor Sanz-García
- Data Analysis Unit, Instituto de Investigación Sanitaria Hospital Universitario de la Princesa (IISP), 28006 Madrid, Spain;
| | - Danay Cibrian
- Immunology Department, Instituto de Investigación Sanitaria Hospital Universitario de la Princesa (IISP), 28006 Madrid, Spain; (D.C.); (A.V.); (M.J.-F.); (P.M.-F.); (I.S.-G.); (M.L.-P.); (F.S.-M.)
- CIBER de Enfermedades Cardiovasculares, Instituto de Salud Carlos III, 28009 Madrid, Spain
| | - Alicia Vara
- Immunology Department, Instituto de Investigación Sanitaria Hospital Universitario de la Princesa (IISP), 28006 Madrid, Spain; (D.C.); (A.V.); (M.J.-F.); (P.M.-F.); (I.S.-G.); (M.L.-P.); (F.S.-M.)
| | - Manuel J Gómez
- Bioinformatics Unit, Centro Nacional de Investigaciones Cardiovasculares (CNIC), 28029 Madrid, Spain;
| | - María Jiménez-Fernández
- Immunology Department, Instituto de Investigación Sanitaria Hospital Universitario de la Princesa (IISP), 28006 Madrid, Spain; (D.C.); (A.V.); (M.J.-F.); (P.M.-F.); (I.S.-G.); (M.L.-P.); (F.S.-M.)
| | - Pedro Martínez-Fleta
- Immunology Department, Instituto de Investigación Sanitaria Hospital Universitario de la Princesa (IISP), 28006 Madrid, Spain; (D.C.); (A.V.); (M.J.-F.); (P.M.-F.); (I.S.-G.); (M.L.-P.); (F.S.-M.)
| | - Inés Sánchez-García
- Immunology Department, Instituto de Investigación Sanitaria Hospital Universitario de la Princesa (IISP), 28006 Madrid, Spain; (D.C.); (A.V.); (M.J.-F.); (P.M.-F.); (I.S.-G.); (M.L.-P.); (F.S.-M.)
| | - Marta Lozano-Prieto
- Immunology Department, Instituto de Investigación Sanitaria Hospital Universitario de la Princesa (IISP), 28006 Madrid, Spain; (D.C.); (A.V.); (M.J.-F.); (P.M.-F.); (I.S.-G.); (M.L.-P.); (F.S.-M.)
| | - Juan C Triviño
- Sistemas Genómicos, 46980 Valencia, Spain; (J.C.T.); (R.M.)
| | | | - Francisco Sánchez-Madrid
- Immunology Department, Instituto de Investigación Sanitaria Hospital Universitario de la Princesa (IISP), 28006 Madrid, Spain; (D.C.); (A.V.); (M.J.-F.); (P.M.-F.); (I.S.-G.); (M.L.-P.); (F.S.-M.)
- CIBER de Enfermedades Cardiovasculares, Instituto de Salud Carlos III, 28009 Madrid, Spain
| | - Hortensia de la Fuente
- Immunology Department, Instituto de Investigación Sanitaria Hospital Universitario de la Princesa (IISP), 28006 Madrid, Spain; (D.C.); (A.V.); (M.J.-F.); (P.M.-F.); (I.S.-G.); (M.L.-P.); (F.S.-M.)
- CIBER de Enfermedades Cardiovasculares, Instituto de Salud Carlos III, 28009 Madrid, Spain
- Correspondence:
| | - Esteban Dauden
- Dermatology Department, Instituto de Investigación Sanitaria Hospital Universitario de la Princesa (IISP), 28006 Madrid, Spain; (P.C.); (P.R.-J.); (M.L.-V.); (E.D.)
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