The immunopathobiology of SARS-CoV-2 infection.

Patel, Milankumar; Shahjin, Farah; Cohen, Jacob D; Hasan, Mahmudul; Machhi, Jatin; Chugh, Heerak; Singh, Snigdha; Das, Srijanee; Kulkarni, Tanmay A; Herskovitz, Jonathan; Meigs, Douglas D; Chandra, Ramesh; Hettie, Kenneth S; Mosley, R Lee; Kevadiya, Bhavesh D; Gendelman, Howard E

Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can lead to coronavirus disease 2019 (COVID-19). Virus-specific immunity controls infection, transmission, and disease severity. With respect to disease severity, a spectrum of clinical outcomes can occur on the basis of the age, genetics, comorbidities, and immune responses in an infected person. Dysfunctions in innate and adaptive immunity commonly follow viral infection. These are heralded by altered mononuclear phagocyte differentiation, activation, intracellular killing and memory, effector, and regulatory T cell responses. All of such affect viral clearance and the progression of end-organ disease. Failures to produce effective controlled antiviral immunity leads to life-threatening end-organ disease that is typified by the acute respiratory distress syndrome. The most effective means to contain SARS-CoV-2 infection is by vaccination. While an arsenal of immunomodulators were developed for control of viral infection and subsequent COVID-19 disease, further research is required to enable therapeutic implementation.