Studies have found TGF-β2 associated with asymptomatic, mild SARS-CoV-2 infection during pregnancy.

New preprint survey on Lancet preprint* The server has transforming growth factor (TGF) -β2 levels asymptomatic and mild in both convalescent mothers and women with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during childbirth. We have discovered that it may be related to the disease. The protective role of TGF-β2 has been demonstrated in the context of SARS-CoV-2 infection during pregnancy. This is expressed as the release of inflammatory cytokines and the reduced viral load. In vitro..

Background

The ongoing coronavirus disease 2019 (COVID-19) has had a devastating impact on the lives of millions of people around the world. However, data on the effects on pregnant women remain limited.

Several studies suggest that pregnant women with SARS-CoV-2 infection are at increased risk of severe symptoms, preterm birth, intensive care and / or the need for ventilators compared to non-pregnant women. I am. In addition, SARS-CoV-2 infection in the mother increases the likelihood of maternal and fetal death.

On the other hand, studies show that pregnant SARS-CoV-2 infected patients are not more likely to develop severe pneumonia than non-pregnant women. In addition, racial disparity also alters the effects of COVID-19 during pregnancy, which is further altered by social division.

In addition, studies on maternal immune responses, placental infections, and vertical transmissions after SARS-CoV-2 are primarily focused on. COVID-19 Symptoms In their third semester.

Research and findings

A new study investigated clinical and obstetric outcomes after SARS-CoV-2 infection in two groups of pregnant women, along with their association with immunological parameters.

This prospective cohort study was conducted between March and October 2020. Pregnant women who tested positive for the SARS-CoV-2 polymerase chain reaction (PCR) during pregnancy were included. The first group formed a convalescent cohort infected early in pregnancy, and the second group was an actively infected cohort diagnosed with SARS-Cov-2 infection at birth.

Samples of maternal (M) blood and vaginal discharge were collected at admission from participants in both study groups. Then a sample of amniotic fluid (AF)-for cesarean delivery. Umbilical cord segment; Amniotic membrane; Chorion; Cord blood (CB); Neonatal blood; Pharyngeal swabs were collected at or the day after delivery. In addition, breast milk was sampled 1-2 days after delivery.

Patient demographics were recorded along with SARS-CoV-2 infection status, severity of COVID-19 disease, infection during labor, recovery status, prepartum and postpartum complications, and neonatal outcomes. COVID-19 status was scored as 0 – asymptomatic. 1 – Mild with few symptoms and no need for ventilation. 2 – Moderate, hospitalization or ventilation required. 3 – Severe, requiring intensive care and discharged. 4 – Serious, requiring intensive care, dying or dead.

Of the 33 participants selected for biosample analysis, 23 were Africans. 48.5% showed active SARS-CoV-2 infection at birth and 51.5% were in recovery.

The results did not induce the presence of the virus in any biological sample. There were no vertical transmissions. Antibody measurements in maternal plasma and convalescent blood detected a significant dichotomy in the amniotic fluid antibody profile between the two cohorts.

Overall, 6 antibody clusters were identified. Clusters 2 and 5–viruses containing anti-receptor binding domain (RBD) and anti-N-terminal domain (NTD) / peplomer (S) protein antibodies were significantly higher among convalescent pregnant women. Cluster 3 showed a positive association with disease severity, whereas cluster 6 correlated with disease severity in this cohort.

AF profiling showed lower antibody levels than plasma samples in both study groups, but escalation of non-SARS-CoV-2 antibodies was during active infections higher than elevated SARS-CoV-2 specific antibodies. It was recorded in. Non-SARS-CoV-2 antibody titers correlated with the severity of COVID-19 disease in convalescent blood and maternal plasma samples during active SARS-Cov-2 infection.

Convalescent samples showed elevated antibodies to SARS-CoV-2 and other coronaviruses. Correlations were detected between almost all antibodies. HKU1 was an exception because it did not correlate with other antibody titers.

It was also noted that cytokines and chemokines stimulate migration and cell differentiation, stimulating inflammation, effector function, and tissue and immune homeostasis. TGF-β2 and TGF-β3 levels were also significantly elevated in AF when compared to plasma samples.Fractal Cain Level Convalescent plasma Inducible protein (IP) -10, granulocyte-macrophage colony stimulator (GM-CSF), and interleukin (IL) -1β were inversely correlated with disease severity, whereas COVID-19 disease severity There was a positive correlation with degree.

In maternal plasma, TGF-β2 levels and IL-21 were inversely proportional to the severity of the disease. Notably, fractalkine was significantly rich in convalescent plasma, while IL-27 and IL-15 were rich in maternal samples.

In addition, in convalescent plasma GM-CSF, TGF-β2, and monocyte chemotactic protein 3 (MCP-3), macrophage inflammatory protein-1α (MIP-1α), and IL-10 are disease severity. Was inversely proportional to. Interferon (IFN) pathways such as IP-10 are positively correlated with the severity of COVID-19, while anti-inflammatory markers such as TGF-β2 are correlated with lack of symptoms or mild symptoms. Was speculated. In addition, cytokines were inversely correlated with disease severity.

In newborns, markers of asymptomatic disease during active SARS-CoV-2 infection, such as TGF-β2 and IL-21, were inversely correlated with neonatal intensive care unit admission (NICU) and prenatal disease. Immunological parameters indicating moderate or severe infection, such as IP-10, IL-1β, and non-SARS-CoV-2 antibodies, are NICU hospitalization, basal metabolic rate (BMI), anemia, asthma, and supplemental There was a positive correlation with need. O2 therapy.

About the test In vitro A model of SARS-CoV-2 infection in normal human bronchial epithelial cells (NHBE) cells, TGF-β2 treatment of cytokines at both 0 and 72 hours after virus exposure compared to untreated cells. Triggered a clear profile. These findings suggest that TGF-β2 may provide sustained and elevated antiviral immunity.

Pretreatment of human tracheobronchial epithelial cells with TGF-β2 recorded a significant reduction in SARS-CoV-2 viral load and suppression of cytokine release at COVID-19 settings. Therefore, the general anti-inflammatory environment regulates the appropriate antiviral response and Cytokine storm – Characteristics of severe COVID-19 cases.

Therefore, the anti-inflammatory cytokine – TGF-β2 is inversely correlated with cytokines that exhibit a hyperimmune response in severe COVID-19, improving outcomes in pregnant COVID-19 patients. The results show that TGF-β2 interferes with SARS-CoV-2 replication in NHBE cells by maintaining a non-inflammatory environment and suppressing cytokines.

*Important Notices

The Lancet preprints publish unpeer-reviewed preliminary scientific reports that are considered definitive, guide clinical / health-related behaviors, and are treated as established information. Should not be.