SARS-CoV-2 infection results in a spectrum of outcomes from no symptoms to widely varying degrees of illness to death. A better understanding of the immune response to SARS-CoV-2 infection and subsequent, often excessive, inflammation may inform treatment decisions and reveal opportunities for therapy. We studied immune cell subpopulations and their associations with clinical parameters in a cohort of 26 patients with COVID-19. Following informed consent, we collected blood samples from hospitalized patients with COVID-19 within 72 h of admission. Flow cytometry was used to analyze white blood cell subpopulations. Plasma levels of cytokines and chemokines were measured using ELISA. Neutrophils undergoing neutrophil extracellular traps (NET) formation were evaluated in blood smears. We examined the immunophenotype of patients with COVID-19 in comparison to that of SARS-CoV-2 negative controls. A novel subset of pro-inflammatory neutrophils expressing a high level of dual endothelin-1 and VEGF signal peptide-activated receptor (DEspR) at the cell surface was found to be associated with elevated circulating CCL23, increased NETosis, and critical-severity COVID-19 illness. The potential to target this subpopulation of neutrophils to reduce secondary tissue damage caused by SARS-CoV-2 infection warrants further investigation.

Background: Patients resuscitated from cardiac arrest ( CA ) have highly variable neurological, circulatory, and systemic ischemia‐reperfusion injuries. After the initial hypoxic‐ischemic insult, a cascade of immune and inflammatory responses develops and is often fatal. The role of the immune response in pathophysiological characteristics and recovery is not well understood. We studied immune cell activity and its association with outcomes in a cohort of CA survivors. Methods and Results: After informed consent, we collected blood samples at intervals over a week after resuscitation from CA . We examined the expression of CD 39 and CD 73 (alias 5′‐nucleotidase), production of tumor necrosis factor‐α, generation of reactive oxygen species, and secretion of vascular endothelial growth factor by circulating myeloid and lymphoid cells, in comparison to cells obtained from control subjects before coronary artery bypass grafting surgery. The number of circulating total and CD 73‐expressing lymphocytes correlated with survival after CA . Incubation of immune cells, obtained from post‐ CA subjects, with AMP , a substrate for CD 73, resulted in inhibition of tumor necrosis factor‐α production and generation of reactive oxygen species. This effect was blocked by adenosine 5′‐(α, β‐methylene) diphosphate, a specific inhibitor of CD 73 and ZM 241385, an A2 adenosine receptor antagonist. We also found that AMP ‐dependent activation of CD 73 induces production of vascular endothelial growth factor. Conclusions: CD 73‐expressing lymphocytes mediate cellular protection from inflammation after CA through inhibition of proinflammatory activation of myeloid cells and promotion of vascular endothelial growth factor secretion. The contribution of CD 73 lymphocytes in the regulation of acute inflammation and tissue injury after CA warrants further study.

Bone marrow adipocytes are known to have a critical role within the bone marrow niche. However, our understanding of bone marrow adipose tissue expansion with obesity and the role it plays in immune cell regulation and osteoclastogenesis is limited. Here, we showed the expansion of bone marrow adipocytes promoted osteoclast differentiation and subsequently led to obesity-related trabecular and cortical bone loss through a stimulatory effect of the PD-1/PD-L1 axis. Bone marrow adipocytes isolated from obese mice had increased Mcp-1 expression, a key regulator of osteoclastogenesis and myeloid cell accumulation. With the increase in bone marrow adipose tissue-derived Mcp-1 , we found an increase in the number of PD-L1 ⁺ myeloid cells. While these cells inhibited activated T-cells, we found evidence of a stimulatory osteoclastogenic effect of PD-L1 ⁺ myeloid cells on PD-1-expressing osteoclast precursors. The inhibition of PD-1/PD-L1 signaling during early osteoclastogenesis prevented myeloid cell commitment and resulted in decreased cell fusion, supporting the role of PD-1/PD-L1 signaling in osteoclastogenesis. Using a bone marrow adipocyte depletion mouse model (BMAd- Pparg KO), we demonstrated that obese BMAd- Pparg KO mice had a reduced number of bone marrow PD-L1 ⁺ myeloid cells, accompanied by a decrease in PD-1 ⁺ osteoclast precursors. The reduction in these precursors resulted in fewer osteoclasts, subsequently leading to improved trabecular bone volume. Since osteoclasts are myeloid cell-derived, these results suggest that bone marrow adipocytes are critical for the commitment and differentiation of myeloid cells into osteoclasts. Targeting bone marrow adipogenesis could ameliorate enhanced osteoclastogenesis and provide a novel approach to treat obesity-related bone loss.