Age-related decline of de novo T cell responsiveness as a cause of COVID-19 severity

Abstract

To the Editor, So far, little attention has been paid to the link between immunosenescence and the dramatic mortality rate of coronavirus disease 2019 (COVID-19) in older age groups. Indeed, the number of cases of COVID-19, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is very low among children and teenagers, in contrast to the increased frequency in adults and the elderly, who are also more at risk of developing very serious symptoms and death (Guan et al. 2020; Wu and McGoogan 2020). As shown in Fig. 1, a similar epidemiological profile was observed during previous coronavirus (severe acute respiratory syndrome coronavirus 1, SARS-CoV-1, and Middle east respiratory syndrome coronavirus, MERS-CoV) outbreaks (Jia et al. 2009; Salamatbakhsh et al. 2019). Notably, the same trend was also noted during West Nile virus and, with some exceptions in very young children, Ebolavirus outbreaks (Bower et al. 2016; Hayes et al. 2005). Likely this phenomenon is multifactorial. For instance, in elderly individuals with severe COVID-19, associated comorbidities are much more prevalent (Guan et al. 2020). In addition, the progressive accumulation of senescent cells during life may play a role in the vulnerability of old people to COVID-19, resulting in reduced functionality of the organs, such as the lungs, and facilitating conditions for the development of fibrosis. Moreover, senescent cells can generate a pro-inflammatory environment, referred to as SASP (for senescence-associated secretory phenotype), which includes many inflammatory cytokines (e.g., interleukin-6) and contributes to the basal hyperinflammatory status characteristic of the old person. This hyperinflammatory status might influence the expression of ACE2, CD147, cyclophilins, CD26, and other CoV-associated molecules in human tissues, thus favoring viral entry (Radzikowska et al. 2020). It likely also constitutes an already unbalanced pro-inflammatory background, on which the development of an exacerbated inflammatory response and acute respiratory distress syndrome may be facilitated upon SARS-CoV-2 infection