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Editorial
. 2022 Feb;149(2):565-568.
doi: 10.1016/j.jaci.2021.10.025. Epub 2021 Nov 2.

Immune health grades: Finding resilience in the COVID-19 pandemic and beyond

Vincent C Marconi  1 , Venkatesh Krishnan  2 , E Wesley Ely  3 , Monty Montano  4
Affiliations
Editorial

Immune health grades: Finding resilience in the COVID-19 pandemic and beyond

Vincent C Marconi et al. J Allergy Clin Immunol. 2022 Feb.
No abstract available

Keywords: COVID-19; HIV; Immunologic resilience; aging; influenza.

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Figures

Fig 1
Fig 1
A, This 3-dimensional model is a depiction of immune resilience (IR) as a composite landscape of immunocompetence (IC) and inflammation (IF). In the landscape, a history of antigenic exposures is represented as arrow trajectories that flow along the contours of this landscape. Over the life course, these trajectories are also influenced by genetic factors and the environment. In terms of clinical interpretation, those individuals with the highest levels of IC and the lowest levels of IF possess the greatest immune resilience within a given population (ie, the ideal IHG of IChi-IFlo). Conversely, those individuals with the lowest levels of IC and the highest levels of IF (ie, IClo-IFhi) would be at greatest risk of complications from infectious diseases, including COVID-19, HIV-1, and influenza. B, Dynamic balance model of immunomodulation. The arrow and direction of the wave form depict an idealized dynamic transition in a person with severe COVID-19 at the leftmost time point, who then improves with therapy toward the right side (homeostatic balance). The cellular changes in severe COVID-19 align with decreased IC driven by reduced antigen-presenting dendritic cells and reduced NK cells (lower waves). Increased viral load–induced IF is driven by neutrophils, monocytes, and macrophage cells (upper waves). Additional aspects of COVID-19 pathogenesis, including the humoral response and coagulation cascade, are not featured in this model. Immune modulating interventions for COVID-19 will need to balance the reduction in sequelae from an increased inflammatory burden while maintaining robust viral clearance pathways.
See this image and copyright information in PMC

Comment on

  • Immunologic resilience and COVID-19 survival advantage.
    Lee GC, Restrepo MI, Harper N, Manoharan MS, Smith AM, Meunier JA, Sanchez-Reilly S, Ehsan A, Branum AP, Winter C, Winter L, Jimenez F, Pandranki L, Carrillo A, Perez GL, Anzueto A, Trinh H, Lee M, Hecht JM, Martinez-Vargas C, Sehgal RT, Cadena J, Walter EA, Oakman K, Benavides R, Pugh JA; South Texas Veterans Health Care System COVID-19 Team; Letendre S, Steri M, Orrù V, Fiorillo E, Cucca F, Moreira AG, Zhang N, Leadbetter E, Agan BK, Richman DD, He W, Clark RA, Okulicz JF, Ahuja SK. Lee GC, et al. J Allergy Clin Immunol. 2021 Nov;148(5):1176-1191. doi: 10.1016/j.jaci.2021.08.021. Epub 2021 Sep 8. J Allergy Clin Immunol. 2021. PMID: 34508765 Free PMC article.

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