Evaluating the Immune Response in Treatment-Naive Hospitalised Patients With Influenza and COVID-19.

The worldwide COVID-19 pandemic has claimed millions of lives and has had a profound effect on global life. Understanding the body's immune response to SARS-CoV-2 infection is crucial in improving patient management and prognosis. In this study we compared influenza and SARS-CoV-2 infected patient cohorts to identify distinct blood transcript abundances and cellular composition to better understand the natural immune response associated with COVID-19, compared to another viral infection being influenza, and identify a prognostic signature of COVID-19 patient outcome. Clinical characteristics and peripheral blood were acquired upon hospital admission from two well characterised cohorts, a cohort of 88 patients infected with influenza and a cohort of 80 patients infected with SARS-CoV-2 during the first wave of the pandemic and prior to availability of COVID-19 treatments and vaccines. Gene transcript abundances, enriched pathways and cellular composition were compared between cohorts using RNA-seq. A genetic signature between COVID-19 survivors and non-survivors was assessed as a prognostic predictor of COVID-19 outcome. Contrasting immune responses were detected with an innate response elevated in influenza and an adaptive response elevated in COVID-19. Additionally ribosomal, mitochondrial oxidative stress and interferon signalling pathways differentiated the cohorts. An adaptive immune response was associated with COVID-19 survival, while an inflammatory response predicted death. A prognostic transcript signature, associated with circulating immunoglobulins, nucleosome assembly, cytokine production and T cell activation, was able to stratify COVID-19 patients likely to survive or die. This study provides a unique insight into the immune responses of treatment naïve patients with influenza or COVID-19. The comparison of immune response between COVID-19 survivors and non-survivors enables prognostication of COVID-19 patients and may suggest potential therapeutic strategies to improve survival.
Competing Interests: TC has received speaker fees, honoraria, travel reimbursement, and equipment and consumables free of charge for the purposes of research from BioFire diagnostics LLC and BioMerieux. TC has received discounted equipment and consumables for the purposes of research from QIAGEN. TC has received consultancy fees from Biofire diagnostics LLC, BioMerieux, Synairgen research Ltd, Randox laboratories Ltd and Cidara therapeutics. TC has been a member of advisory boards for Roche and Janssen and has received reimbursement for these. TC is member of two independent data monitoring committees for trials sponsored by Roche. TC has previously acted as the UK chief investigator for trials sponsored by Janssen. TC is currently a member of the NHSE COVID-19 Testing Technologies Oversight Group and the NHSE COVID-19 Technologies Validation Group. JS is a founding director, CEO, employee and shareholder in TopMD Precision Medicine Ltd. FS is a founding director, CTO, employee and shareholder in TopMD Precision Medicine Ltd. PS is a founding director, employee and shareholder in TopMD Precision Medicine Ltd. AG is an employee and shareholder in TopMD Precision Medicine Ltd. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
(Copyright © 2022 Legebeke, Lord, Penrice-Randal, Vallejo, Poole, Brendish, Dong, Hartley, Holloway, Lucas, Williams, Wheway, Strazzeri, Gardner, Schofield, Skipp, Hiscox, Polak, Clark and Baralle.)