Reduction and Functional Exhaustion of T Cells in Patients with Coronavirus Disease 2019 (COVID-19)

<jats:title>Summary</jats:title><jats:sec><jats:title>BACKGROUND</jats:title><jats:p>The outbreak of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has posed great threat to human health, which has been declared a public health emergency of international concern (PHEIC) by the WHO. T cells play a critical role in antiviral immunity but their numbers and functional state in COVID-19 patients remain largely unclear.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>We retrospectively reviewed the counts of total T cells, CD4<jats:sup>+</jats:sup>, CD8<jats:sup>+</jats:sup>T cell subsets, and serum cytokine concentration from inpatient data of 522 patients with laboratory-confirmed COVID-19, admitted into two hospitals in Wuhan from December 2019 to January 2020, and 40 healthy controls, who came to the hospitals for routine physical examination. In addition, the expression of T cell exhaustion markers PD-1 and Tim-3 were measured by flow cytometry in the peripheral blood of 14 COVID-19 cases.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>The number of total T cells, CD4<jats:sup>+</jats:sup>and CD8<jats:sup>+</jats:sup>T cells were dramatically reduced in COVID-19 patients, especially among elderly patients (⩾60 years of age) and in patients requiring Intensive Care Unit (ICU) care. Counts of total T cells, CD8<jats:sup>+</jats:sup>T cells or CD4<jats:sup>+</jats:sup>T cells lower than 800/μL, 300/μL, or 400/μL, respectively, are negatively correlated with patient survival. Statistical analysis demonstrated that T cell numbers are negatively correlated to serum IL-6, IL-10 and TNF-α concentration, with patients in decline period showing reduced IL-6, IL-10 and TNF-α concentrations and restored T cell counts. Finally, T cells from COVID-19 patients have significantly higher levels of the exhausted marker PD-1 as compared to health controls. Moreover, increasing PD-1 and Tim-3 expression on T cells could be seen as patients progressed from prodromal to overtly symptomatic stages, further indicative of T cell exhaustion.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>T cell counts are reduced significantly in COVID-19 patients, and the surviving T cells appear functionally exhausted. Non-ICU patients, with total T cells, CD8<jats:sup>+</jats:sup>T cells CD4<jats:sup>+</jats:sup>T cells counts lower than 800/μL, 300/μL, and 400/μL, respectively, may still require aggressive intervention even in the immediate absence of more severe symptoms due to a high risk for further deterioration in condition.</jats:p></jats:sec>