Characterization of the cytokine storm reflects hyperinflammatory endothelial dysfunction in COVID-19

Sims, J.T., Krishnan, V., Chang, C.-Y., Engle, S.M., Casalini, G., Rodgers, G.H., Bivi, N., Nickoloff, B.J., Konrad, R.J., de Bono, S., Higgs, R.E., Benschop, R.J., Ottaviani, S. ORCID: 0000-0002-8830-9947, Cardoso, A., Nirula, A., Corbellino, M. and Stebbing, J., 2021. Characterization of the cytokine storm reflects hyperinflammatory endothelial dysfunction in COVID-19. Journal of Allergy and Clinical Immunology, 147 (1), pp. 107-111. ISSN 0091-6749

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Abstract

Background: Physicians treating patients with coronavirus disease 2019 (COVID-19) increasingly believe that the hyperinflammatory acute stage of COVID-19 results in a cytokine storm. The circulating biomarkers seen across the spectrum of COVID-19 have not been characterized compared with healthy controls, but such analyses are likely to yield insights into the pursuit of interventions that adequately reduce the burden of these cytokine storms.

Objective: To identify and characterize the host inflammatory response to severe acute respiratory syndrome coronavirus 2 infection, we assessed levels of proteins related to immune responses and cardiovascular disease in patients stratified as mild, moderate, and severe versus matched healthy controls.

Methods: Blood samples from adult patients hospitalized with COVID-19 were analyzed using high-throughput and ultrasensitive proteomic platforms and compared with age- and sex-matched healthy controls to provide insights into differential regulation of 185 markers.

Results: Results indicate a dominant hyperinflammatory milieu in the circulation and vascular endothelial damage markers within patients with COVID-19, and strong biomarker association with patient response as measured by Ordinal Scale. As patients progress, we observe statistically significant dysregulation of IFN-γ, IL-1RA, IL-6, IL-10, IL-19, monocyte chemoattractant protein (MCP)-1, MCP-2, MCP-3, CXCL9, CXCL10, CXCL5, ENRAGE, and poly (ADP-ribose) polymerase 1. Furthermore, in a limited series of patients who were sampled frequently, confirming reliability and reproducibility of our assays, we demonstrate that intervention with baricitinib attenuates these circulating biomarkers associated with the cytokine storm.

Conclusions: These wide-ranging circulating biomarkers show an association with increased disease severity and may help stratify patients and selection of therapeutic options. They also provide insights into mechanisms of severe acute respiratory syndrome coronavirus 2 pathogenesis and the host response.

Item Type: Journal article
Publication Title: Journal of Allergy and Clinical Immunology
Creators: Sims, J.T., Krishnan, V., Chang, C.-Y., Engle, S.M., Casalini, G., Rodgers, G.H., Bivi, N., Nickoloff, B.J., Konrad, R.J., de Bono, S., Higgs, R.E., Benschop, R.J., Ottaviani, S., Cardoso, A., Nirula, A., Corbellino, M. and Stebbing, J.
Publisher: Elsevier
Date: January 2021
Volume: 147
Number: 1
ISSN: 0091-6749
Identifiers:
NumberType
10.1016/j.jaci.2020.08.031DOI
1537727Other
Rights: © 2020 The Authors. Published by Elsevier Inc. on behalf of the American Academy of Allergy, Asthma & Immunology. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Divisions: Schools > School of Science and Technology
Record created by: Laura Ward
Date Added: 14 Apr 2022 09:31
Last Modified: 14 Apr 2022 09:31
URI: http://irep.ntu.ac.uk/id/eprint/46132

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