The journey of SARS-CoV-2 in human hosts: a review of immune responses, immunosuppression, and their consequences

Virulence. 2021 Dec;12(1):1771-1794. doi: 10.1080/21505594.2021.1929800.

Abstract

Coronavirus disease 2019 (COVID-19) is a highly infectious viral disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Laboratory findings from a significant number of patients with COVID-19 indicate the occurrence of leukocytopenia, specifically lymphocytopenia. Moreover, infected patients can experience contrasting outcomes depending on lymphocytopenia status. Patients with resolved lymphocytopenia are more likely to recover, whereas critically ill patients with signs of unresolved lymphocytopenia develop severe complications, sometimes culminating in death. Why immunodepression manifests in patients with COVID-19 remains unclear. Therefore, the evaluation of clinical symptoms and laboratory findings from infected patients is critical for understanding the disease course and its consequences. In this review, we take a logical approach to unravel the reasons for immunodepression in patients with COVID-19. Following the footprints of the virus within host tissues, from entry to exit, we extrapolate the mechanisms underlying the phenomenon of immunodepression.

Keywords: COVID-19; SARS-CoV-2; coronavirus; cytokine storm; immunosuppression; leukocytopenia; lymphocytopenia; severe acute respiratory syndrome coronavirus 2.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • COVID-19 / immunology*
  • COVID-19 / pathology
  • Cell Death
  • Cytokine Release Syndrome / immunology
  • Cytokine Release Syndrome / pathology
  • Cytokines / metabolism
  • Humans
  • Immune Tolerance*
  • Immunity
  • Lymphopenia / immunology
  • Lymphopenia / pathology
  • SARS-CoV-2 / pathogenicity*
  • SARS-CoV-2 / physiology
  • Virus Replication

Substances

  • Cytokines

Grants and funding

The authors extend their appreciation to the Deputyship for Research & Innovation, “Ministry of Education” in Saudi Arabia for funding this research work through the project number IFKSURP-106;