Article
作者: Hackney, Jason A. ; Shivram, Haridha ; Heiden, Jason Vander ; Overall, Chris ; Orozco, Luz ; Gao, Xia ; West, Nathan ; Qamra, Aditi ; Chang, Diana ; Chakrabarti, Arindam ; Choy, David F. ; Combes, Alexis J. ; Courau, Tristan ; Fragiadakis, Gabriela K. ; Rao, Arjun Arkal ; Ray, Arja ; Tsui, Jessica ; Hu, Kenneth ; Kuhn, Nicholas F. ; Krummel, Matthew F. ; Erle, David J. ; Kangelaris, Kirsten ; Sarma, Aartik ; Lyon, Zoe ; Calfee, Carolyn S. ; Woodruff, Prescott G. ; Ghale, Rajani ; Mick, Eran ; Byrne, Ashley ; Zha, Shoshana ; Langelier, Charles ; Hendrickson, Carolyn M. ; van der Wijst, Monique G. P. ; Hartoularos, George C. ; Grant, Tianna ; Bueno, Raymund ; Lee, David S. ; Greenland, John R. ; Sun, Yang ; Perez, Richard ; Ogorodnikov, Anton ; Ward, Alyssa ; Ye, Chun Jimmie ; Ramalingam, Thiru ; McBride, Jacqueline M. ; Cai, Fang ; Teterina, Anastasia ; Bao, Min ; Tsai, Larry ; Rosas, Ivan O. ; Regev, Aviv ; Kapadia, Sharookh B. ; Bauer, Rebecca N. ; Rosenberger, Carrie M.
Altered myeloid inflammation and lymphopenia are hallmarks of severe infections. We identified the upregulated EN-RAGE gene program in airway and blood myeloid cells from patients with acute lung injury from SARS-CoV-2 or other causes across 7 cohorts. This program was associated with greater clinical severity and predicted future mechanical ventilation and death. EN-RAGEhi myeloid cells express features consistent with suppressor cell functionality, including low HLA-DR and high PD-L1. Sustained EN-RAGE program expression in airway and blood myeloid cells correlated with clinical severity and increasing expression of T cell dysfunction markers. IL-6 upregulated many EN-RAGE program genes in monocytes in vitro. IL-6 signaling blockade by tocilizumab in a placebo-controlled clinical trial led to rapid normalization of EN-RAGE and T cell gene expression. This identifies IL-6 as a key driver of myeloid dysregulation associated with worse clinical outcomes in COVID-19 patients and provides insights into shared pathophysiological mechanisms in non-COVID-19 ARDS.