Cross-talk between the airway epithelium and activated immune cells defines severity in COVID-19

The clinical course of COVID-19 is highly variable, however, underlying host factors and determinants of severe disease are still unknown. Based on single-cell transcriptomes of nasopharyngeal and bronchial samples from clinically well-characterized patients presenting with moderate and critical severities, we reveal the different types and states of airway epithelial cells that are vulnerable for SARS-CoV-2 infection. In COVID-19 patients, we observed a two- to threefold increase of cells expressing the SARS-CoV-2 entry receptor ACE2 within the airway epithelial cell compartment. ACE2 is upregulated in epithelial cells through Interferon signals by immune cells suggesting that the viral defense system may increase the number of potentially susceptible cells in the respiratory epithelium. Infected epithelial cells recruit and activate immune cells by chemokine signaling. Recruited T lymphocytes and inflammatory macrophages were hyperactivated and showed a strong interaction with epithelial cells. In critical patients, increased expression of CCL2, CCL3, CCL5, CXCL9, CXCL10, IL8, IL1B and TNF in macrophages was identified as a likely cause of a hyperinflammatory lung pathology. Moreover, we observed exacerbated epithelial cell death, likely leading to lung injury and respiratory failure in fatal cases. Our study provides novel insights into the pathophysiology of COVID-19 and suggests an immunomodulatory therapy along the CCL2, CCL3/CCR1 axis as promising option to prevent and treat critical course of COVID-19.

Erythrocyte deformability and aggregation responses to intermittent and continuous artificial gravity exposure.

Artificial gravity protocols are used to improve g-tolerance of aviators and discussed as countermeasure during prolonged space flight. Little is known about the impact of artificial gravity on the red blood cells (RBC). The purpose of the study was to test how artificial gravity affects RBC deformability and aggregation, which are important determinants of microcirculation. Nine male subjects were exposed to two hypergravity protocols using a short arm human centrifuge: a continuous (CONT) protocol with constant +2Gz for 30min and an intermittent (INTER) protocol with repeated intervals of +2Gz and rest. Blood was sampled pre and post interventions to measure basal blood parameters, RBC nitrite, RBC deformability, aggregation, and to determine the shear rate balancing aggregation and disaggregation (γ at dIsc min). To test for orthostasis effects, five male subjects were asked to stay for 46min, corresponding to the length of the centrifuge protocols, with blood sampling pre and post intervention. Artificial gravity programs did not affect basal blood parameters or RBC nitrite levels; a marker for RBC deformability influencing nitric oxide. The INTER program did not affect any of the tested parameters. The CONT program did not remarkably affect RBC deformability or γ at dIsc min but significantly aggravated aggregation. Orthostasis effects were thus excluded. The results indicate that continuous artificial gravity, especially with higher g-forces applied, may negatively affect the RBC system and that for a prolonged space flight intermittent but not continuous artificial gravity might represent an appropriate countermeasure.