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[2016.05] Comparative and kinetic analysis of viral shedding and immunological responses in MERS patientsrepresenting a broad spectrum of disease severity.
2016/06/24

 2016 May 5;6:25359. doi: 10.1038/srep25359.

Comparative and kinetic analysis of viral shedding and immunological responses in MERS patientsrepresenting a broad spectrum of disease severity.

Min CK1,2Cheon S3Ha NY1,2Sohn KM3Kim Y1,2Aigerim A1,2Shin HM1,2Choi JY2,4Inn KS5Kim JH6Moon JY7Choi MS1Cho NH1,2,8Kim YS3.

Author information

  • 1Department of Microbiology and Immunology, Seoul National University College of Medicine, Seoul, Republic of Korea.
  • 2Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea.
  • 3Division of Infectious Diseases, Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Republic of Korea.
  • 4Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.
  • 5Department of Pharmaceutical Science, College of Pharmacy, Kyung Hee University, Seoul, Republic of Korea.
  • 6Department of Radiology, Chungnam National University School of Medicine, Daejeon, Republic of Korea.
  • 7Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Republic of Korea.
  • 8Institute of Endemic Disease, Seoul National University Medical Research Center and Bundang Hospital, Seoul, Republic of Korea.

Abstract

Despite the ongoing spread of MERS, there is limited knowledge of the factors affecting its severity and outcomes. We analyzed clinical data and specimens from fourteen MERS patients treated in a hospital who collectively represent a wide spectrum of disease severity, ranging from mild febrile illness to fatal pneumonia, and classified the patients into four groups based on severity and mortality. Comparative and kinetic analyses revealed that high viral loads, weak antibody responses, and lymphopenia accompanying thrombocytopenia were associated with diseasemortality, whereas persistent and gradual increases in lymphocyte responses might be required for effective immunity against MERS-CoV infection. Leukocytosis, primarily due to increased neutrophils and monocytes, was generally observed in more severe and fatal cases. The blood levels of cytokines such as IL-10, IL-15, TGF-β, and EGF were either positively or negatively correlated with disease mortality. Robust induction of various chemokines with differential kinetics was more prominent in patients that recovered from pneumonia than in patients with mild febrile illness or deceased patients. The correlation of the virological and immunological responses with disease severity and mortality, as well as theirresponses to current antiviral therapy, may have prognostic significance during the early phase of MERS. 

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