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Asymptomatic COVID-19: disease tolerance with efficient anti-viral immunity against SARS-CoV-2.

Yi-Hao ChanSiew-Wai FongChek-Meng PohGuillaume CarissimoNicholas Kim-Wah YeoSiti Naqiah AmrunYun Shan GohJackwee LimWeili XuRhonda Sin-Ling CheeAnthony Torres-RuestaCheryl Yi-Pin LeeMatthew Zirui TayZi Wei ChangWen-Hsin Sandy LeeBei WangSeow Yen TanShirin KalimuddinBarnaby Edward YoungYee Sin LeoCheng-I WangBernett Teck Kwong LeeOlaf RotzschkeDavid Chien Boon LyeShanshan W HowlandLisa F P Ng
Published in: EMBO molecular medicine (2021)
The immune responses and mechanisms limiting symptom progression in asymptomatic cases of SARS-CoV-2 infection remain unclear. We comprehensively characterized transcriptomic profiles, cytokine responses, neutralization capacity of antibodies, and cellular immune phenotypes of asymptomatic patients with acute SARS-CoV-2 infection to identify potential protective mechanisms. Compared to symptomatic patients, asymptomatic patients had higher counts of mature neutrophils and lower proportion of CD169+ expressing monocytes in the peripheral blood. Systemic levels of pro-inflammatory cytokines were also lower in asymptomatic patients, accompanied by milder pro-inflammatory gene signatures. Mechanistically, a more robust systemic Th2 cell signature with a higher level of virus-specific Th17 cells and a weaker yet sufficient neutralizing antibody profile against SARS-CoV-2 was observed in asymptomatic patients. In addition, asymptomatic COVID-19 patients had higher systemic levels of growth factors that are associated with cellular repair. Together, the data suggest that asymptomatic patients mount less pro-inflammatory and more protective immune responses against SARS-CoV-2 indicative of disease tolerance. Insights from this study highlight key immune pathways that could serve as therapeutic targets to prevent disease progression in COVID-19.
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