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. 2020 Oct 6;11:581338. doi: 10.3389/fimmu.2020.581338

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Copyright © 2020 Notz, Schmalzing, Wedekink, Schlesinger, Gernert, Herrmann, Sorger, Weismann, Schmid, Sitter, Schlegel, Kranke, Wischhusen, Meybohm and Lotz

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

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T cell subsets were differentiated by flow cytometry (representative gating, A) and demonstrated considerably reduced CD3+ CD8+ T cells and CD3+ CD4+ CCR7+ CD45RA+ naïve T helper cells. Both fractions slowly increased during treatment with a maximum between days 11 and 21. Absolute numbers of naïve T helper cells remained far below the reference range throughout ICU therapy (B–D). CD3+ γδ+ T cells were also significantly reduced at admission and only partly replenished (E), whereas CD3+ CD56/CD16+ natural killer T (NKT)-like cells increased towards the end of ICU treatment (F). A declining CD4+/CD8+ ratio reflected these changes (G). Overall, these findings suggest that severe COVID-19-induced ARDS was accompanied by a T cell response with a delayed cytotoxic reaction. Relative cell counts on the left of each pair of graphs are contrasted with absolute cell numbers on the right, respectively. FSC, forward scatter; SSC, side scatter; HC, healthy controls; TCR, T cell receptor.