Abstract
Background: Thymosin alpha 1 (Tα1) had been used in the treatment of viral infections as an immune response modifier for many years. However, clinical benefits and the mechanism of Tα1 treatment for COVID-19 patients are still unclear.
Methods: We retrospectively reviewed the clinical outcomes of 76 severe COVID-19 cases admitted to 2 hospitals in Wuhan, China, from December 2019 to March 2020. The thymus output in peripheral blood mononuclear cells from COVID-19 patients was measured by T-cell receptor excision circles (TRECs). The levels of T-cell exhaustion markers programmed death-1 (PD-1) and T-cell immunoglobulin and mucin domain protein 3 (Tim-3) on CD8+ T cells were detected by flow cytometry.
Results: Compared with the untreated group, Tα1 treatment significantly reduced the mortality of severe COVID-19 patients (11.11% vs 30.00%, P = .044). Tα1 enhanced blood T-cell numbers in COVID-19 patients with severe lymphocytopenia. Under such conditions, Tα1 also successfully restored CD8+ and CD4+ T-cell numbers in elderly patients. Meanwhile, Tα1 reduced PD-1 and Tim-3 expression on CD8+ T cells from severe COVID-19 patients compared with untreated cases. It is of note that restoration of lymphocytopenia and acute exhaustion of T cells were roughly parallel to the rise of TRECs.
Conclusions: Tα1 treatment significantly reduced mortality of severe COVID-19 patients. COVID-19 patients with counts of CD8+ T cells or CD4+ T cells in circulation less than 400/μL or 650/μL, respectively, gained more benefits from Tα1. Tα1 reversed T-cell exhaustion and recovered immune reconstitution through promoting thymus output during severe acute respiratory syndrome-coronavirus 2 infection.
Keywords: COVID-19; SARS-CoV-2; T-cell exhaustion; immune reconstitution; thymosin alpha 1.
【저자키워드】 COVID-19, SARS-CoV-2, T-cell exhaustion, immune reconstitution, thymosin alpha 1, 【초록키워드】 Treatment, viral infection, immune response, Mortality, severe COVID-19, T cells, hospital, Infection, CD8+ T cells, elderly patients, viral infections, flow cytometry, immune, clinical outcomes, PD-1, Peripheral blood, Clinical outcome, Severe acute respiratory syndrome, T cell, Viral, Immunoglobulin, lymphocytopenia, Wuhan, Patient, Peripheral blood mononuclear cells, Alpha, CD4+ T cells, T-cell receptor, circulation, T-cell, mucin, respiratory, expression, T-cell exhaustion, mechanism, CD8+ T cell, CD4+ T cell, COVID-19 patients, Blood, marker, COVID-19 patient, mononuclear cells, protein 3, (PD-1, mononuclear cell, thymosin alpha 1, clinical benefits, domain, clinical benefit, severe COVID-19 patients, restoration, CD8+, thymosin, CD4+ T-cell, benefit, Wuhan, China, was measured, significantly, reduced, less, restored, conditions, reversed, severe COVID-19 patient, treatment for COVID-19, 【제목키워드】 reversion,