Other results of the currentstudy revealed that the percentage of another subset of NK cells(CD56highCD16+/− NK cells) was significantly increased atthe first day of recovery. TheCD56lowCD16+ NK cells have high expression levels ofkiller inhibitory receptors, the maturation marker (CD57), and natural andantibody-dependent cellular cytotoxicity which is mediated by releasing high levelsof perforin and enhanced killing.16,30,31 These findings suggest thatthe reduced number of CD56lowCD16+ NK cells may contribute todisease susceptibility in the early stages of disease. COVID-19, as a pandemic disease, is responsible for considerable mortality and morbidity.25 Immune system functions have fundamental role in the pathogenesis and outcomeof disease.26 Therefore, the current study focused on determining how immune system changesduring a recovery were correlated to disease severity. Thepercentages of Th1, Th2, Th17, Tregs, exhausted CD4+ T cells, exhaustedCD8+ T cells, activated CD4+ T cells, activated CD8+ T cells, and Bcells were assessed using flow cytometry (a–i) and then analyzed (j–r).The depicted results are representative of 57 independent experimentsfor COVID-19 patients at the first day of treatment, 51 independentexperiments for COVID-19 patients in 10 days of treatment, and 40independent experiments for healthy groups. The frequencies of innate immune cells in COVID-19 and control subjects.The percentages of CD56low CD16+ NK cells,CD56high CD16+/− NK cells, and monocytes werestudied by flow cytometry (a and b) and then analyzed (c–e).
- The demographic, laboratory, and clinical characteristics of COVID-19 andhealthy subjects.
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Study subjects
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The CD3+ cell population was also determined using the gating oflymphocyte population and was then used to measure the percentages of B cells(CD3− CD19+ CD22+ cells), exhausted CD4+ T cells (CD3+ CD4+ PD-1+ cells),exhausted CD8+ T cells (CD3+ CD8+ PD-1+ cells), CD56lowCD16+ NK cells (CD3− CD56lowCD16+ cells), and CD56high CD16+/− NK cells(CD3−CD56high CD16+/− cells). Afterwards, the lymphocyte population was gatedto assess the frequencies of the CD4+ cells which were used to determine thepercentages of Th1 cells (CD4+ T-bet+ IFN-γ+ cells), Th2 cells (CD4+ IL-4+GATA3+ cells), Th17 cells (CD4+ IL-17α+ RORγt+ cells), Tregs (CD4+CD127low FoxP3+ cells), and activated CD4+ T cells (CD4+ CD25+CD69+ cells). At the first day (the early recovery stage) and 10 days of initiation oftherapeutic methods (the late recovery stage), heparinized blood samples (5 ml)were obtained from patients. All patients had pulmonary involvement and were not on treatment withdrugs influencing the immune system and antibodies production (i.e. steroids,sulfasalazine, phenytoin, and antimalarial drugs) prior to study initiation.
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In this regard, the FlowJosoftware (v10.1, FlowJo, Ashland, OR, USA) was used to gate lymphocytepopulation using forward and side scatter to exclude debris or dead cells fromthe analysis of different cells. The cell markers used to determine thefrequencies of the stained cells are indicated in Table 1. The percentages of the stained cells were measured by a FACSCalibursystem (Becton Dickinson, San Jose, CA).
The stained cells were washedtwice with PBS and centrifuged at 300 × g for 10 min at roomtemperature. Fixation and permebilization of the cells were performed for stainingsome intracellular molecules with different antibodies according to themanufacturer’s guideline (eBiosciences, USA). The isolated cells were washed twice with phosphate buffered saline(PBS) at 300 × g for 10 min. Peripheral bloodmononuclear cells (PBMCs) were isolated from whole blood by Ficoll-Paquecentrifugation according to the manufacturer’s instructions (Lymphodex,Germany).
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Figure 2.
Moreover, Qinet al. indicated that suppressor and helper T cell percentages were lower inpatients than normal group. In the next step, the adaptive immune system of COVID-19 subjects was studied after 1and 10 days of initiation of therapeutic methods. In an attempt to discover the frequency of other cells of innateimmunity, the number of monocytes was also assessed. As shown inFigure 4(a)–(d),statistically significant reduction in the levels of pro-inflammatory cytokines(IL-1α, IL-1β, IL-6, and TNF-α) in patients were observed during a recovery,with the exception of IL-1β level (P Figure 4(e),P Figure 4(f)). Having considered that severe COVID-19 is largely related to a cytokine storm,cytokine profiles of COVID patients were assessed during a recovery.
DataResilience
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- In an attempt to discover the frequency of other cells of innateimmunity, the number of monocytes was also assessed.
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- The frequencies of innate immune cells in COVID-19 and control subjects.The percentages of CD56low CD16+ NK cells,CD56high CD16+/− NK cells, and monocytes werestudied by flow cytometry (a and b) and then analyzed (c–e).
- It is thought that the reduced numbers of activated CD4+ T cells and Bcells are related to different therapeutic approaches used to reduce inflammationand their impacts.
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- Moreover, other data indicated thatthe levels of these cytokines were reduced during the disease recovery.
The RRF funding amounts shown for measures are based on the initial cost estimates provided by the Member States included in the recovery and resilience plans and may as such differ from finalized Commission financial reports, which follow eventual project implementation. The map exclusively serves information purposes and is not an exhaustive database of projects supported by the Recovery and Resilience Facility. Improving access to and the quality of general, vocational, and higher education; focusing on digital education, early childhood education and care; supporting youth employment. The funding amounts shown reflect the initial cost estimates included in the national recovery and resilience plans. It is not an exhaustive database of projects supported by the Facility and will be regularly updated as the implementation progresses.
Having considered that innate immunity provides the early line of defense againstviral infections, some innate immune cells were studied in the course of 10 daysafter initiation of treatment, which is almost a period that the disease isdeteriorated and may result in death or recovery from COVID-19.27,28 Our datashowed that CD56lowCD16+ NK cell number was significantlylower in the early stage of recovery than the late stage of recovery; however itsfrequency was noticeably increased compared to healthy subjects. Moreover, the authors have shown that CD4+and CD8+ T cell numbers were notably decreased.17 In agreement with previous study, our data revealed that the frequencies ofTh cells (Th1, Th2, and Th17 cells) in patients were significantly lower in theearly recovery stage than the late recovery stage and healthy individuals. B cells showed an increasedpercentage in patients compared to healthy subjects, while this increase wassignificantly reduced in the late stage of recovery (Figure 3(i) and (r),P Open in a new tabThe percentages of adaptive immune cells in COVID-19 and healthyindividuals. Its frequency wassignificantly higher in the late recovery stage than early recovery stage (Figure 2(a) and (c),P highCD16+/− NK cells in the early stage of recovery was significantlyincreased in comparison with the late stage of recovery and healthy individuals(Figure 2(a) and(d),P Figure2(b) and (e),P Open in a new tabThe frequencies of innate immune cells in COVID-19 and control subjects.The percentages of CD56low CD16+ NK cells,CD56high CD16+/− NK cells, and monocytes werestudied by flow cytometry (a and b) and then analyzed (c–e).
To determine cytokine profiles in COVID-19 patients, the plasma samples wereobtained from whole blood (5 ml) of participants and the levels of IL-1α, IL-1β,TNF-α, IL-6, TGF-β1, and IL-10 cytokines revery play login were measured using an Enzyme-linkedimmunoasorbent assay (ELISA) kit (Karmania Pars Gene, Iran) according themanufacturer’s instructions. Thepatients suffered from clinical signs and symptoms of COVID-19 at least 3–5 daysbefore going to a COVID-19 center to start therapeutic approaches. Some studies havereported that COVID-19 patients had the reduced number of Tregs in peripheral blood.22 It is not the first time that coronavirusfamily causes a severe respiratory disease. SMART Takes is a monthly newsletter filled with content about self-empowered, practical, and evidence-informed recovery.
The resultsare representative of 57 independent experiments for COVID-19 patientsat the first day of treatment, 51 independent experiments for COVID-19patients in 10 days of treatment, and 40 independent experiments forhealthy individuals. The demographic, laboratory, and clinical characteristics of COVID-19 andhealthy subjects. Table2 depicts the demographic and other characteristics of COVID-19 andhealthy subjects. Of the 57 patients, 51 (89.48%) weredischarged from hospital and 6 (10.52%) died during the study. Antibodies used for determing the changes of the immune system ofCOVID-19 patients by flow cytometry.
In disagreement with other reports showing increasedfrequency of B cells in the late stage of recovery,17 we observed that the percentage of this cell was decreased followingrecovery. Moreinterestingly, the percentages of exhausted CD4+ T cells and exhausted CD8+ T cellswere higher in the early stage of recovery than the late stage of recovery. Thisobservation was in contrast with previous study showing severe cases of COVID-19tend to have lower percentages of monocytes.24 This discrepancy may be attributed to disease stage which patients wereevaluated.
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