This studyinvestigated how the immune system changes were related to disease severity inCOVID-19 patients. Moreover, other data indicated thatthe levels of these cytokines were reduced during the disease recovery. PBMCs were isolated from healthy subjects and COVID-19patients and then stained with different monoclonal antibodies. To determine the situations of humoral and cellular immunity in patients withCOVID-19, the frequencies of Th1, Th2, Th17, Treg, activated CD4+T cells,activated CD8+ T cells, exhausted CD4+ T cells, exhausted CD8+ T cells, and Bcells in COVID-19 patients were investigated after 1 and 10 days of initiationof therapeutic methods. Correlations of lymphocyte numbers with the value of ESR and numbers ofTh2 cells and monocytes in COVID-19 patients. Some patients hadfatigue, mild shortness of breath, myalgia, loss of weight, smell, and taste inthe late recovery stage.
- 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.
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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.
- 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.
- 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.
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CD56highCD16+/− NK cells aredescribed by NKG2A, low level of perforin, and are primarily characterized bycytokine production.16,30,31 Therefore, it is likely that the changes in the frequencies oftwo subsets of NK cells during the disease recovery are protective mechanisms toeliminate the SARS-COV2 and thereby reducing inflammation occurred in the earlystages of disease. Our data revealed that the percentages of Th1, Th2, andTh17 cells were significantly lower in patients than healthy control (Figure 3(a)–(c) and (j)–(l), P Figure 3(d)–(h) and (m)–(q), P Figure 3(f), (h), (o), and (q), P Figure3(d), (e),(g), (m), (n), and (p)). The number of CD56low CD16+ NK cells in patients wassignificantly increased compared to healthy subjects. To determine the percentages of activated T cells, exhausted T cells, Th1 cells,Th2 cells, Th17 cells, Tregs, B cells, NK cells, and monocytes in peripheralblood of COVID-19 patients (the first day and 10 days of initiation oftherapeutic approaches) and healthy subjects, PBMCs were stained with differentmonoclonal antibodies or matched to isotype control IgG for 30 min at4○C. These changes may play afundamental role in reducing disease severity through regulating cytokineproductions involved in the inflammation and functions of various immune cells.Nevertheless, larger and more multicenter studies are needed to validate theseconclusions. A limitation of the study was the lack of determinationof immune system differences between alive and dead patients with COVID-19 during arecovery period.
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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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.
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- The levels of erythrocyte sediment rate (ESR) and C-reactive protein (CRP) ofCOVID-19 patients were measured using the erythrocyte sedimentation rate (ESR)analyzer (Parsian Teb, Iran) and Mindray BS-800 automated biochemistry analyzer(Shenzhen Mindray Bio-Medical Electronics, China), respectively.
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- To determine the immune situation of patients, theblood sampling (5 ml) from healthy subjects was also performed.
- Data were analyzed by GraphPad Prism 6 (GraphPad Software, USA) and are expressedas the mean standard error of the mean (SEM) and mean ± standard deviation (SD).The normal distribution of data was determined by Kolmogrov–Smirnov test.
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The stained cells were washedtwice with PBS and centrifuged at 300 × g for 10 min at roomtemperature. Fixation and permebilization of the cells were performed for stainingsome intracellular molecules with different antibodies according to themanufacturer’s guideline (eBiosciences, USA). The isolated cells were washed twice with phosphate buffered saline(PBS) at 300 × g for 10 min. Peripheral bloodmononuclear cells (PBMCs) were isolated from whole blood by Ficoll-Paquecentrifugation according to the manufacturer’s instructions (Lymphodex,Germany).
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The cytokine profiles of patients with COVID-19
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These evolving practices shaped our cities as we responded to the COVID-19 pandemic and are key to our long-term recovery. Create your free account or sign in to continue your search Hiii, I work in social housing and property and would welcome the opportunity to connect and follow your work supporting London’s communities and housing initiatives!
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.
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.
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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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