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细菌合并感染的非典型反应和持续的中性粒细胞性支气管肺泡炎症将危重症 COVID-19 与流感区分开来。

Atypical response to bacterial coinfection and persistent neutrophilic bronchoalveolar inflammation distinguish critical COVID-19 from influenza.

机构信息

Laboratory of Molecular Immunology, Department of Microbiology, Immunology and Transplantation, Rega Institute, KU Leuven, Leuven, Belgium.

Brazilian Biosciences National Laboratory (LNBio), Brazilian Center for Research in Energy and Materials (CNPEM), Campinas, Brazil.

出版信息

JCI Insight. 2022 Jan 11;7(1):e155055. doi: 10.1172/jci.insight.155055.

Abstract

Neutrophils are recognized as important circulating effector cells in the pathophysiology of severe coronavirus disease 2019 (COVID-19). However, their role within the inflamed lungs is incompletely understood. Here, we collected bronchoalveolar lavage (BAL) fluids and parallel blood samples of critically ill COVID-19 patients requiring invasive mechanical ventilation and compared BAL fluid parameters with those of mechanically ventilated patients with influenza, as a non-COVID-19 viral pneumonia cohort. Compared with those of patients with influenza, BAL fluids of patients with COVID-19 contained increased numbers of hyperactivated degranulating neutrophils and elevated concentrations of the cytokines IL-1β, IL-1RA, IL-17A, TNF-α, and G-CSF; the chemokines CCL7, CXCL1, CXCL8, CXCL11, and CXCL12α; and the protease inhibitors elafin, secretory leukocyte protease inhibitor, and tissue inhibitor of metalloproteinases 1. In contrast, α-1 antitrypsin levels and net proteolytic activity were comparable in COVID-19 and influenza BAL fluids. During antibiotic treatment for bacterial coinfections, increased BAL fluid levels of several activating and chemotactic factors for monocytes, lymphocytes, and NK cells were detected in patients with COVID-19 whereas concentrations tended to decrease in patients with influenza, highlighting the persistent immunological response to coinfections in COVID-19. Finally, the high proteolytic activity in COVID-19 lungs suggests considering protease inhibitors as a treatment option.

摘要

中性粒细胞被认为是严重 2019 冠状病毒病(COVID-19)病理生理学中的重要循环效应细胞。然而,它们在发炎肺部中的作用尚未完全了解。在这里,我们收集了需要有创机械通气的重症 COVID-19 患者的支气管肺泡灌洗液(BAL)和并行血液样本,并将 BAL 液参数与流感的机械通气患者(作为非 COVID-19 病毒性肺炎队列)进行了比较。与流感患者相比,COVID-19 患者的 BAL 液中含有更多数量的过度激活脱颗粒中性粒细胞和升高的细胞因子白细胞介素-1β(IL-1β)、IL-1 受体拮抗剂(IL-1RA)、IL-17A、肿瘤坏死因子-α(TNF-α)和粒细胞集落刺激因子(G-CSF);趋化因子 C 趋化因子配体 7(CCL7)、CXCL1、CXCL8、CXCL11 和 CXCL12α;和蛋白酶抑制剂防御素、分泌白细胞蛋白酶抑制剂和金属蛋白酶组织抑制剂 1。相比之下,COVID-19 和流感的 BAL 液中α-1 抗胰蛋白酶水平和净蛋白水解活性相当。在针对细菌合并感染的抗生素治疗期间,COVID-19 患者的 BAL 液中几种激活和趋化因子的水平升高,这些因子可激活单核细胞、淋巴细胞和自然杀伤细胞,而流感患者的浓度则趋于下降,突出了 COVID-19 中对合并感染的持续免疫反应。最后,COVID-19 肺部的高蛋白水解活性表明考虑使用蛋白酶抑制剂作为治疗选择。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7d45/8765057/2f71d913ad96/jciinsight-7-155055-g042.jpg

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