Monocyte-driven atypical cytokine storm and aberrant neutrophil activation as key mediators of COVID-19 disease severity

Vanderbeke, L.; Van Mol, P.; Van Herck, Y.; De Smet, F.; Humblet-Baron, S.; Martinod, K.; Antoranz, A.; Arijs, I.; Boeckx, B.; Bosisio, F. M.; Casaer, M.; Dauwe, D.; De Wever, W.; Dooms, C.; Dreesen, E.; Emmaneel, A.; Filtjens, J.; Gouwy, M.; Gunst, J.; Hermans, G.; Jansen, S.; Lagrou, K.; Liston, A.; Lorent, N.; Meersseman, P.; Mercier, T.; Neyts, J.; Odent, J.; Panovska, D.; Penttila, P. A.; Pollet, E.; Proost, P.; Qian, J.; Quintelier, K.; Raes, J.; Rex, S.; Saeys, Y.; Sprooten, J.; Tejpar, S.; Testelmans, D.; Thevissen, K.; Van Buyten, T.; Vandenhaute, J.; Van Gassen, S.; Pereira, L. C. Velásquez; Vos, R.; Weynand, B.; Wilmer, A.; Yserbyt, J.; Garg, A. D.; Matthys, P.; Wouters, C.; Lambrechts, D.; Wauters, E.; Wauters, J.

Monocyte-driven atypical cytokine storm and aberrant neutrophil activation as key mediators of COVID-19 disease severity

L. Vanderbeke, P. Van Mol, Y. Van Herck, F. De Smet, S. Humblet-Baron, K. Martinod, A. Antoranz, I. Arijs, B. Boeckx, F. M. Bosisio, M. Casaer, D. Dauwe, W. De Wever, C. Dooms, E. Dreesen, A. Emmaneel, J. Filtjens, M. Gouwy, J. Gunst, G. Hermans, S. Jansen, K. Lagrou, A. Liston, N. Lorent, P. Meersseman, T. Mercier, J. Neyts, J. Odent, D. Panovska, P. A. Penttila, E. Pollet, P. Proost, J. Qian, K. Quintelier, J. Raes, S. Rex, Y. Saeys, J. Sprooten, S. Tejpar, D. Testelmans, K. Thevissen, T. Van Buyten, J. Vandenhaute, S. Van Gassen, L. C. Velásquez Pereira, R. Vos, B. Weynand, A. Wilmer, J. Yserbyt, A. D. Garg, P. Matthys, C. Wouters, D. Lambrechts, E. Wauters () and J. Wauters
Additional contact information
L. Vanderbeke: KU Leuven
P. Van Mol: VIB-KU Leuven
Y. Van Herck: KU Leuven
F. De Smet: KU Leuven
S. Humblet-Baron: KU Leuven
K. Martinod: KU Leuven
A. Antoranz: KU Leuven
I. Arijs: VIB-KU Leuven
B. Boeckx: VIB-KU Leuven
F. M. Bosisio: KU Leuven
M. Casaer: KU Leuven
D. Dauwe: KU Leuven
W. De Wever: KU Leuven
C. Dooms: KU Leuven
E. Dreesen: KU Leuven
A. Emmaneel: VIB-UGent
J. Filtjens: Rega Institute, KU Leuven
M. Gouwy: Rega Institute, KU Leuven
J. Gunst: KU Leuven
G. Hermans: KU Leuven
S. Jansen: Rega Institute, KU Leuven
K. Lagrou: KU Leuven
A. Liston: The Babraham Institute, Babraham Research Campus
N. Lorent: University Hospitals Leuven
P. Meersseman: KU Leuven
T. Mercier: KU Leuven
J. Neyts: Rega Institute, KU Leuven
J. Odent: University Hospitals Leuven
D. Panovska: KU Leuven
P. A. Penttila: KU Leuven
E. Pollet: University Hospitals Leuven
P. Proost: Rega Institute, KU Leuven
J. Qian: VIB-KU Leuven
K. Quintelier: VIB-UGent
J. Raes: KU Leuven, and VIB Center for Microbiology
S. Rex: KU Leuven
Y. Saeys: VIB-UGent
J. Sprooten: KU Leuven
S. Tejpar: KU Leuven
D. Testelmans: KU Leuven
K. Thevissen: KU Leuven
T. Van Buyten: Rega Institute, KU Leuven
J. Vandenhaute: Rega Institute, KU Leuven
S. Van Gassen: VIB-UGent
L. C. Velásquez Pereira: KU Leuven
R. Vos: KU Leuven
B. Weynand: KU Leuven
A. Wilmer: KU Leuven
J. Yserbyt: KU Leuven
A. D. Garg: KU Leuven
P. Matthys: Rega Institute, KU Leuven
C. Wouters: KU Leuven
D. Lambrechts: VIB-KU Leuven
E. Wauters: KU Leuven
J. Wauters: KU Leuven

Nature Communications, 2021, vol. 12, issue 1, 1-15

Abstract: Abstract Epidemiological and clinical reports indicate that SARS-CoV-2 virulence hinges upon the triggering of an aberrant host immune response, more so than on direct virus-induced cellular damage. To elucidate the immunopathology underlying COVID-19 severity, we perform cytokine and multiplex immune profiling in COVID-19 patients. We show that hypercytokinemia in COVID-19 differs from the interferon-gamma-driven cytokine storm in macrophage activation syndrome, and is more pronounced in critical versus mild-moderate COVID-19. Systems modelling of cytokine levels paired with deep-immune profiling shows that classical monocytes drive this hyper-inflammatory phenotype and that a reduction in T-lymphocytes correlates with disease severity, with CD8+ cells being disproportionately affected. Antigen presenting machinery expression is also reduced in critical disease. Furthermore, we report that neutrophils contribute to disease severity and local tissue damage by amplification of hypercytokinemia and the formation of neutrophil extracellular traps. Together our findings suggest a myeloid-driven immunopathology, in which hyperactivated neutrophils and an ineffective adaptive immune system act as mediators of COVID-19 disease severity.

Date: 2021
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DOI: 10.1038/s41467-021-24360-w

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