Distinct inflammatory profiles distinguish COVID-19 from influenza with limited contributions from cytokine storm
Philip A. Mudd, Jeremy Chase Crawford, Jackson S. Turner, Aisha Souquette, Daniel Reynolds, Diane E. Bender, James P. Bosanquet, Nitin J. Anand, David A. Striker, R. Scott Martin, Adrianus C. M. Boon, Stacey L. House, Kenneth E. Remy, Richard S. Hotchkiss, Rachel M. Presti, Jane A. O’Halloran, William G. Powderly, Paul G. Thomas, Ali H. Ellebedy
Abstract
We pursued a study of immune responses in coronavirus disease 2019 (COVID-19) and influenza patients. Compared to patients with influenza, patients with COVID-19 exhibited largely equivalent lymphocyte counts, fewer monocytes, and lower surface human leukocyte antigen (HLA)-class II expression on selected monocyte populations. Furthermore, decreased HLA-DR on intermediate monocytes predicted severe COVID-19 disease. In contrast to prevailing assumptions, very few (7 of 168) patients with COVID-19 exhibited cytokine profiles indicative of cytokine storm syndrome. After controlling for multiple factors including age and sample time point, patients with COVID-19 exhibited lower cytokine levels than patients with influenza. Up-regulation of IL-6, G-CSF, IL-1RA, and MCP1 predicted death in patients with COVID-19 but were not statistically higher than patients with influenza. Single-cell transcriptional profiling revealed profound suppression of interferon signaling among patients with COVID-19. When considered across the spectrum of peripheral immune profiles, patients with COVID-19 are less inflamed than patients with influenza.