People Critically Ill with COVID-19 and People with Lupus Share Similar Immune-Response Features

People with severe cases of COVID-19 display a similar immune-system response as people with active lupus, according to recent findings. Like people with active lupus, those with critical cases of COVID-19 appear to demonstrate an exaggerated immune response characterized by intense extrafollicular B cell activation – B cells are responsible for producing antibodies to fight infection. While the role of extrafollicular response in fighting infections and the potential of this response to expand autoreactive B cells remain to be determined in humans, it seems likely that the balance between their protective and pathogenic effects may be at play in the final outcome of the infection.

The study’s results suggest that extrafollicular B cell activation is associated with COVID-19 disease severity and poor outcomes, and subsets of people with COVID-19 may particularly benefit from targeted immunomodulatory (immune-system affecting) treatments or more general anti-inflammatory therapies like dexamethasone.

The findings come from Emory University, where researchers observed that critically ill patients with COVID-19 demonstrated hallmark dysfunctional B cell patterns typical during acute lupus flares. Although people with severe cases of COVID-19 had higher levels of antibody-secreting cells and produced a high concentration of neutralizing antibodies to fight off the infection, they also presented with elevated inflammatory markers and multiorgan failure. Four of the 10 critically ill cases observed in the study were fatal.

While other studies have reported autoantibody production in the acute phase of COVID-19, it remains unclear whether the disease results in clinically significant long-term autoantibody production. Additionally, most of the people with severe COVID-19 presentation were African American, and African Americans with severe cases of lupus also typically display extrafollicular B cell activation. The role of underlying conditions and health disparities in both COVID-19 and lupus deserves further scientific investigation.

Senior author Ignacio Sanz, MD, Chief of the Division of Rheumatology, Department of Medicine, Emory University School of Medicine, adds, “Given the similarities between severe B cell responses in lupus and COVID-19 in African American patients, understanding the mechanisms underlying B cell dysregulation in COVID-19 infection could yield important clues regarding lupus pathogenesis and shed light into the best approach to COVID-19 vaccination in people with lupus. “

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