Department of Immunology, School of Medicine, Tarbiat Modares University, Tehran, Iran.
Metabolic Disorders Research Center, Golestan University of Medical Sciences, Gorgan, Iran.
Viral Immunol. 2023 Nov;36(9):579-592. doi: 10.1089/vim.2023.0045. Epub 2023 Oct 5.
Despite knowledge gaps in understanding the full spectrum of the hyperinflammatory phase caused by SARS-CoV-2, according to the World Health Organization (WHO), COVID-19 is still the leading cause of death worldwide. Susceptible people to severe COVID-19 are those with underlying medical conditions or those with dysregulated and senescence-associated immune responses. As the immune system undergoes aging in the elderly, such drastic changes predispose them to various diseases and affect their responsiveness to infections, as seen in COVID-19. At-risk groups experience poor prognosis in terms of disease recovery. Changes in the quantity and quality of immune cell function have been described in numerous literature sites. Impaired immune cell function along with age-related metabolic changes can lead to features such as hyperinflammatory response, immunosenescence, and inflammaging in COVID-19. Inflammaging is related to the increased activity of the most inflammatory factors and is the main cause of age-related diseases and tissue failure in the elderly. Since hyperinflammation is a common feature of most severe cases of COVID-19, this pathway, which is not fully understood, leads to immunosenescence and inflammaging in some individuals, especially in the elderly and those with comorbidities. In this review, we shed some light on the age-related abnormalities of innate and adaptive immune cells and how hyperinflammatory immune responses contribute to the inflammaging process, leading to clinical deterioration. Further, we provide insights into immunomodulation-based therapeutic approaches, which are potentially important considerations in vaccine design for elderly populations.
尽管人们对由 SARS-CoV-2 引起的超炎症期的全貌了解有限，但根据世界卫生组织（WHO）的说法，COVID-19 仍然是全球死亡的主要原因。易患严重 COVID-19 的人是那些有潜在医疗条件的人或那些免疫反应失调和衰老相关的人。随着老年人免疫系统的衰老，这种剧烈的变化使他们容易患上各种疾病，并影响他们对感染的反应能力，如在 COVID-19 中所见。高危人群在疾病恢复方面的预后较差。在许多文献中都描述了免疫细胞功能的数量和质量的变化。随着年龄的增长，免疫细胞功能的受损以及与年龄相关的代谢变化可能导致 COVID-19 中出现过度炎症反应、免疫衰老和炎症老化等特征。炎症老化与最具炎症性的因素的活性增加有关，是老年人与年龄相关疾病和组织衰竭的主要原因。由于过度炎症是大多数 COVID-19 严重病例的共同特征，因此这条途径尚不完全清楚，导致某些人（特别是老年人和有合并症的人）出现免疫衰老和炎症老化。在这篇综述中，我们探讨了与年龄相关的先天和适应性免疫细胞的异常，以及过度炎症免疫反应如何导致炎症老化过程，导致临床恶化。此外，我们提供了对基于免疫调节的治疗方法的深入了解，这在为老年人群设计疫苗方面是一个重要的考虑因素。
