Id |
Subject |
Object |
Predicate |
Lexical cue |
T133 |
0-92 |
Sentence |
denotes |
The IL-6 Blocker Tocilizumab Partially Rescues the Immune Dysregulation Driven by SARS-CoV-2 |
T134 |
93-264 |
Sentence |
denotes |
Sepsis-induced immunoparalysis is characterized by profound deficiency of monocytes for cytokine production upon ex vivo stimulation (Giamarellos-Bourboulis et al., 2011). |
T135 |
265-521 |
Sentence |
denotes |
Indeed, production of tumor necrosis factor-α (TNF-α) by LPS-stimulated peripheral blood mononuclear cells (PBMCs) of patients with bacterial CAP classified for immunoparalysis was significantly lower than in patients at an intermediate state (Figure 4 A). |
T136 |
522-681 |
Sentence |
denotes |
That was not the case for patients with pneumonia caused by SARS-CoV-2, in whom PBMCs showed sustained TNF-α production after stimulation with LPS (Figure 4B). |
T137 |
682-856 |
Sentence |
denotes |
The function of PBMCs in patients with SRF caused by 2009H1N1 was also impaired, and there was lower TNF-α production, a pattern different from COVID-19 patients (Figure 4C). |
T138 |
857-1013 |
Sentence |
denotes |
Surprisingly, stimulation of IL-1β was lower among patients with immune dysregulation than among patients with an intermediate immune state (Figures 4D–4F). |
T139 |
1014-1087 |
Sentence |
denotes |
IL-6, however, followed the stimulation pattern of TNF-α (Figures 4G–4I). |
T140 |
1088-1386 |
Sentence |
denotes |
This generated the hypothesis that in the case of SRF-aggravated pneumonia caused by SARS-CoV-2, there is a unique combination of defective antigen presentation and lymphopenia that leads to defective function of lymphoid cells, whereas monocytes remain potent for the production of TNF-α and IL-6. |
T141 |
1387-1467 |
Sentence |
denotes |
Figure 4 Main Features of Immune Dysregulation of Pneumonia Caused by SARS-CoV-2 |
T142 |
1468-1625 |
Sentence |
denotes |
(A) Production of TNF-α by PBMCs of patients with sepsis caused by bacterial CAP classified into intermediate state of immune activation and immunoparalysis. |
T143 |
1626-1789 |
Sentence |
denotes |
(B) Production of TNF-α by PBMCs of patients with CAP caused by SARS-CoV-2 classified into three states of immune activation: intermediate, dysregulation, and MAS. |
T144 |
1790-1918 |
Sentence |
denotes |
(C) Production of TNF-α by PBMCs of patients with SRF developing after infection caused by the 2009H1N1 virus and by SARS-CoV-2. |
T145 |
1919-2076 |
Sentence |
denotes |
(D) Production of IL-1β by PBMCs of patients with sepsis caused by bacterial CAP classified into intermediate state of immune activation and immunoparalysis. |
T146 |
2077-2240 |
Sentence |
denotes |
(E) Production of IL-1β by PBMCs of patients with CAP caused by SARS-CoV-2 classified into three states of immune activation: intermediate, dysregulation, and MAS. |
T147 |
2241-2369 |
Sentence |
denotes |
(F) Production of IL-1β by PBMCs of patients with SRF developing after infection caused by the 2009H1N1 virus and by SARS-CoV-2. |
T148 |
2370-2526 |
Sentence |
denotes |
(G) Production of IL-6 by PBMCs of patients with sepsis caused by bacterial CAP classified into intermediate state of immune activation and immunoparalysis. |
T149 |
2527-2682 |
Sentence |
denotes |
(H) Production of IL-6 by PBMCs of patients with CAP caused by SARS-CoV-2 classified into states of immune activation: intermediate, dysregulation and MAS. |
T150 |
2683-2810 |
Sentence |
denotes |
(I) Production of IL-6 by PBMCs of patients with SRF developing after infection caused by the 2009H1N1 virus and by SARS-CoV-2. |
T151 |
2811-2978 |
Sentence |
denotes |
(J–L) Serum amounts of TNF-α, IL-6, and CRP of patients with CAP caused by SARS-CoV-2 classified into states of immune activation: intermediate, dysregulation and MAS. |
T152 |
2979-3042 |
Sentence |
denotes |
Bars in each graphic represent mean values and standard errors. |
T153 |
3043-3169 |
Sentence |
denotes |
Statistical comparisons are indicated by the arrows; ns: non-significant; ∗p < 0.05; ∗∗p < 0.01; ∗∗∗p < 0.001; ∗∗∗∗p < 0.0001. |
T154 |
3170-3267 |
Sentence |
denotes |
Comparisons were done by the Mann-Whitney U test followed by correction for multiple comparisons. |
T155 |
3268-3425 |
Sentence |
denotes |
As a next step, we measured circulating concentrations of TNF-α, interferon-γ (IFN-γ), IL-6, and C-reactive protein (CRP) in patients infected by SARS-CoV-2. |
T156 |
3426-3568 |
Sentence |
denotes |
IFN-γ was below the limit of detection in all patients (data not shown), indicating that Th1 responses do not contribute to over-inflammation. |
T157 |
3569-3714 |
Sentence |
denotes |
No differences of circulating TNF-α concentrations were found between COVID-19 patients at the three states of immune classification (Figure 4J). |
T158 |
3715-3909 |
Sentence |
denotes |
In contrast, IL-6 and CRP concentrations were significantly higher among patients with immune dysregulation than among patients at an intermediate state of immune activation (Figures 4K and 4L). |
T159 |
3910-4138 |
Sentence |
denotes |
Given that IL-6 was below the limit of detection in some patients with immune dysregulation, we divided them into two groups as follows: seven patients with IL-6 below the limit of detection and 14 patients with detectable IL-6. |
T160 |
4139-4309 |
Sentence |
denotes |
Their severity was similar given that SOFA score and pneumonia severity indexes were similar (p values of comparisons were 0.937 and 0.877, respectively; data not shown). |
T161 |
4310-4500 |
Sentence |
denotes |
IL-6 is known to inhibit HLA-DR expression (Ohno et al., 2016), leading to the hypothesis that IL-6 over-production mediates the low HLA-DR expression on CD14 monocytes of COVID-19 patients. |
T162 |
4501-4820 |
Sentence |
denotes |
In agreement with this, negative correlation was found between serum amounts of IL-6 and the absolute number of HLA-DR molecules on CD14 monocytes of patients with COVID-19 but also between the absolute lymphocyte count and the absolute number of mHLA-DR on CD14 monocytes of patients with COVID-19 (Figures 5A and 5B). |
T163 |
4821-4999 |
Sentence |
denotes |
Furthermore, PBMCs from patients with immune dysregulation were cultured overnight in the presence of plasma of the COVID-19 patients, which was already shown to be rich in IL-6. |
T164 |
5000-5410 |
Sentence |
denotes |
The expression of HLA-DR on CD14 monocytes was strongly inhibited by COVID-19 plasma from patients with immune dysregulation but not by plasma from patients with an intermediate immune state of activation (Figures 5C–5F); the addition of the specific blocker of the IL-6 pathway Tocilizumab partially restored the expression of HLA-DR on monocytes of all patients with immune dysregulation (Figures 5E and 5F). |
T165 |
5411-5555 |
Sentence |
denotes |
Treatment with Tocilizumab in six patients was accompanied by increase of the absolute lymphocyte blood count within the first 24 h (Figure 5G). |
T166 |
5556-5635 |
Sentence |
denotes |
IL-6 was produced partly by CD14 monocytes and partly by CD4 cells (Figure 5H). |
T167 |
5636-5706 |
Sentence |
denotes |
Figure 5 Immune Dysregulation Caused by SARS-CoV-2 Is Mediated by IL-6 |
T168 |
5707-5820 |
Sentence |
denotes |
(A) Negative correlation between serum amounts of IL-6 and the absolute numbers of the mHLA-DR on CD14 monocytes. |
T169 |
5821-5909 |
Sentence |
denotes |
The Spearman’s (rs) co-efficient of correlation and the respective p value are provided. |
T170 |
5910-6018 |
Sentence |
denotes |
(B) Correlation between the absolute lymphocyte count and the absolute numbers of mHLA-DR on CD14 monocytes. |
T171 |
6019-6094 |
Sentence |
denotes |
The rs co-efficient of correlation and the respective p value are provided. |
T172 |
6095-6291 |
Sentence |
denotes |
(C) Changes of the absolute numbers of mHLA-DR on CD14 monocytes of four patients infected by SARS-CoV-2 with intermediate state of immune activation after incubation with medium and their plasma. |
T173 |
6292-6474 |
Sentence |
denotes |
(D) Changes of the MFI of HLA-DR on CD14 monocytes of four patients infected by SARS-CoV-2 with intermediate state of immune activation after incubation with medium and their plasma. |
T174 |
6475-6736 |
Sentence |
denotes |
(E) Changes of the absolute numbers of mHLA-DR on CD14 monocytes of eight patients infected by SARS-CoV-2 with immune dysregulation after incubation with medium and their plasma; modulation by the addition of the specific IL-6 blocker Tocilizumab is also shown. |
T175 |
6737-6984 |
Sentence |
denotes |
(F) Changes of the MFI of HLA-DR on CD14 monocytes of eight patients infected by SARS-CoV-2 with immune dysregulation after incubation with medium and their plasma; modulation by the addition of the specific IL-6 blocker tocilizumab is also shown. |
T176 |
6985-7099 |
Sentence |
denotes |
(G) Changes of the absolute lymphocyte count of six patients before and after start of treatment with Tocilizumab. |
T177 |
7100-7244 |
Sentence |
denotes |
(H) Intracellular staining for IL-6 in CD14 monocytes and in CD4 lymphocytes of three patients infected by SARS-CoV-2 with immune dysregulation. |
T178 |
7245-7341 |
Sentence |
denotes |
Statistical comparisons are indicated by the arrows; ns: non-significant; ∗p < 0.05; ∗∗p < 0.01. |