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• W3018418935 abstract "Eosinophils are circulating and tissue-resident leukocytes that have potent proinflammatory effects in a number of diseases. Recently, eosinophils have been shown to have various other functions, including immunoregulation and antiviral activity. Eosinophil levels vary dramatically in a number of clinical settings, especially following eosinophil-targeted therapy, which is now available to selectively deplete these cells. There are key coronavirus disease 2019 (COVID-19)-related questions concerning eosinophils whose answers affect recommended prevention and care. First, do patients with eosinophilia-associated diseases have an altered course of COVID-19? Second, do patients with eosinopenia (now intentionally induced by biological drugs) have unique COVID-19 susceptibility and/or disease course? This is a particularly relevant question because eosinopenia is associated with acute respiratory deterioration during infection with the severe acute respiratory syndrome coronavirus 2, the causative agent of COVID-19. Third, do eosinophils contribute to the lung pathology induced during COVID-19 and will they contribute to immunopotentiation potentially associated with emerging COVID-19 vaccines? Herein, we address these timely questions and project considerations during the emerging COVID-19 pandemic. Eosinophils are circulating and tissue-resident leukocytes that have potent proinflammatory effects in a number of diseases. Recently, eosinophils have been shown to have various other functions, including immunoregulation and antiviral activity. Eosinophil levels vary dramatically in a number of clinical settings, especially following eosinophil-targeted therapy, which is now available to selectively deplete these cells. There are key coronavirus disease 2019 (COVID-19)-related questions concerning eosinophils whose answers affect recommended prevention and care. First, do patients with eosinophilia-associated diseases have an altered course of COVID-19? Second, do patients with eosinopenia (now intentionally induced by biological drugs) have unique COVID-19 susceptibility and/or disease course? This is a particularly relevant question because eosinopenia is associated with acute respiratory deterioration during infection with the severe acute respiratory syndrome coronavirus 2, the causative agent of COVID-19. Third, do eosinophils contribute to the lung pathology induced during COVID-19 and will they contribute to immunopotentiation potentially associated with emerging COVID-19 vaccines? Herein, we address these timely questions and project considerations during the emerging COVID-19 pandemic. Eosinophils normally account for only a small percentage of circulating leukocytes (1%-3%), but their levels can vary in various disease states.1Rothenberg M.E. Eosinophilia.N Engl J Med. 1998; 338: 1592-1600Crossref PubMed Scopus (936) Google Scholar, 2Burris D. Rosenberg C.E. Schwartz J.T. Zhang Y. Eby M.D. Abonia J.P. et al.Pediatric hypereosinophilia: characteristics, clinical manifestations, and diagnoses.J Allergy Clin Immunol Pract. 2019; 7: 2750-2758.e2Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar, 3Schwartz J.T. Fulkerson P.C. An approach to the evaluation of persistent hypereosinophilia in pediatric patients.Front Immunol. 2018; 9: 1944Crossref PubMed Scopus (27) Google Scholar Their level is clinically relevant because eosinophils are potent proinflammatory cells, primarily due to their preformed granules, which are packed with cytotoxic proteins, including major basic protein (one of the most basically charged molecules in the body), eosinophil peroxidase, and 2 RNAses (eosinophil cationic protein and eosinophil neurotoxin). In addition to their proinflammatory effects, evidence is emerging, albeit primarily in mice, that eosinophils have pleotropic roles as regulatory cells involved in protective immunity, including antiviral responses and shaping diverse physiological responses, such as organ development and metabolism. Although eosinophils are normally considered blood cells, they reside in various tissues. Most notably, eosinophils reside in the gastrointestinal tract, which is their primary residence, and the lung, where a population of regulatory eosinophils, which have unique features compared with inflammatory eosinophils, has been identified.4Weller P.F. Spencer L.A. Functions of tissue-resident eosinophils.Nat Rev Immunol. 2017; 17: 746-760Crossref PubMed Scopus (285) Google Scholar There are a number of diseases associated with eosinophil expansion in which eosinophils are causally related to the disease pathology, such as subsets of moderate and severe asthma. Accordingly, a number of clinically approved biological antibody-based precision therapies are now available that directly target eosinophils, resulting in eosinophil depletion.5Busse W. Chupp G. Nagase H. Albers F.C. Doyle S. Shen Q. et al.Anti-IL-5 treatments in patients with severe asthma by blood eosinophil thresholds: indirect treatment comparison.J Allergy Clin Immunol. 2019; 143: 190-200.e20Abstract Full Text Full Text PDF PubMed Scopus (158) Google Scholar These drugs include those that neutralize the eosinophil growth and activating factor IL-5 (eg, mepolizumab and reslizumab) and drugs that directly induce eosinophil depletion by antibody-dependent cellular cytotoxicity (eg, the anti–IL-5 receptor drug benralizumab).6Katial R.K. Bensch G.W. Busse W.W. Chipps B.E. Denson J.L. Gerber A.N. et al.Changing paradigms in the treatment of severe asthma: the role of biologic therapies.J Allergy Clin Immunol Pract. 2017; 5: S1-S14Abstract Full Text Full Text PDF PubMed Scopus (49) Google Scholar These drugs have remarkable beneficial effects in a growing number of diseases, including asthma, hypereosinophilic syndrome, and eosinophilic granulomatous polyangiitis (formerly known as Churg Strauss syndrome), and additional clinical indications are actively being pursued. As a result, there is now an increasing number of patients with biological drug–induced eosinopenia.7Laidlaw T.M. Buchheit K.M. Biologics in chronic rhinosinusitis with nasal polyposis.Ann Allergy Asthma Immunol. 2020; 124: 326-332Abstract Full Text Full Text PDF PubMed Scopus (42) Google Scholar Although patients with abnormally low eosinophil levels (referred to as eosinopenia) might be considered at risk for diseases normally controlled by eosinophils, there have been no major side effects associated with these therapies to date. In addition to biological drug–induced eosinopenia, eosinophil depletion occurs in response to multiple triggers of acute inflammation,8Bass D.A. Behavior of eosinophil leukocytes in acute inflammation, II: eosinophil dynamics during acute inflammation.J Clin Invest. 1975; 56: 870-879Crossref PubMed Scopus (95) Google Scholar including during sepsis, and multiple studies have consistently shown that low eosinophil levels correlate with poor outcome in critically ill patients.9Lavoignet C.E. Le Borgne P. Chabrier S. Bidoire J. Slimani H. Chevrolet-Lavoignet J. et al.White blood cell count and eosinopenia as valuable tools for the diagnosis of bacterial infections in the ED.Eur J Clin Microbiol Infect Dis. 2019; 38: 1523-1532Crossref PubMed Scopus (28) Google Scholar There are now key coronavirus disease 2019 (COVID-19)-related questions concerning eosinophils whose answers affect recommended prevention and care. First, do patients with eosinophilia-associated diseases have an altered course of COVID-19? Second, do patients with eosinopenia have unique COVID-19 disease features? This is a particularly relevant question because eosinopenia has already been reported in patients with acute respiratory deterioration during infection with severe acute respiratory syndrome (SARS) coronavirus (CoV) 2 (SARS-CoV-2), the causative agent of COVID-19.10Zhang JJ, Dong X, Cao YY, Yuan YD, Yang YB, Yan YQ, et al. Clinical characteristics of 140 patients infected with SARS-CoV-2 in Wuhan, China [published online ahead of print February 19, 2020]. Allergy. https://doi.org/10.1111/all.14238.Google Scholar Third, do eosinophils contribute to the lung pathology induced during COVID-19 and will they contribute to adverse events associated with emerging COVID-19 vaccines? Indeed, eosinophil-associated lung pathology is known to occur following certain viral infections (eg, respiratory syncytial virus [RSV]) and importantly is a known complication in previous severe acute respiratory syndrome coronavirus 1 (SARS-CoV-1) vaccination studies (see Table I).11Deming D. Sheahan T. Heise M. Yount B. Davis N. Sims A. et al.Vaccine efficacy in senescent mice challenged with recombinant SARS-CoV bearing epidemic and zoonotic spike variants.PLoS Med. 2006; 3: e525Crossref PubMed Scopus (213) Google Scholar, 12Du L. Zhao G. He Y. Guo Y. Zheng B.J. Jiang S. et al.Receptor-binding domain of SARS-CoV spike protein induces long-term protective immunity in an animal model.Vaccine. 2007; 25: 2832-2838Crossref PubMed Scopus (140) Google Scholar, 13Yasui F. Kai C. Kitabatake M. Inoue S. Yoneda M. Yokochi S. et al.Prior immunization with severe acute respiratory syndrome (SARS)-associated coronavirus (SARS-CoV) nucleocapsid protein causes severe pneumonia in mice infected with SARS-CoV.J Immunol. 2008; 181: 6337-6348Crossref PubMed Scopus (195) Google Scholar, 14Bolles M. Deming D. Long K. Agnihothram S. Whitmore A. Ferris M. et al.A double-inactivated severe acute respiratory syndrome coronavirus vaccine provides incomplete protection in mice and induces increased eosinophilic proinflammatory pulmonary response upon challenge.J Virol. 2011; 85: 12201-12215Crossref PubMed Scopus (360) Google Scholar, 15Tseng C.T. Sbrana E. Iwata-Yoshikawa N. Newman P.C. Garron T. Atmar R.L. et al.Immunization with SARS coronavirus vaccines leads to pulmonary immunopathology on challenge with the SARS virus.PLoS One. 2012; 7e35421Crossref PubMed Scopus (417) Google Scholar, 16Iwata-Yoshikawa N. Uda A. Suzuki T. Tsunetsugu-Yokota Y. Sato Y. Morikawa S. et al.Effects of Toll-like receptor stimulation on eosinophilic infiltration in lungs of BALB/c mice immunized with UV-inactivated severe acute respiratory syndrome-related coronavirus vaccine.J Virol. 2014; 88: 8597-8614Crossref PubMed Scopus (97) Google Scholar, 17Honda-Okubo Y. Barnard D. Ong C.H. Peng B.H. Tseng C.T. Petrovsky N. Severe acute respiratory syndrome-associated coronavirus vaccines formulated with delta inulin adjuvants provide enhanced protection while ameliorating lung eosinophilic immunopathology.J Virol. 2015; 89: 2995-3007Crossref PubMed Scopus (150) Google Scholar On the basis of previous experience with SARS-CoV vaccines, it is expected that COVID-19 vaccines will need careful safety evaluations for immunopotentiation that might increase infectivity and/or eosinophilic infiltration.18Chen W.H. Strych U. Hotez P.J. Bottazzi M.E. The SARS-CoV-2 vaccine pipeline: an overview.Curr Trop Med Rep. 2020; : 1-4PubMed Google ScholarTable ISARS-CoV-1 murine vaccine studiesStudyVaccine typeSARS-CoV-1 antigenAdjuvantBooster roundsNeutralizing antibodiesVaccine-induced pathologyDeming et al,11Deming D. Sheahan T. Heise M. Yount B. Davis N. Sims A. et al.Vaccine efficacy in senescent mice challenged with recombinant SARS-CoV bearing epidemic and zoonotic spike variants.PLoS Med. 2006; 3: e525Crossref PubMed Scopus (213) Google Scholar 2006Recombinant viral particleS protein (VRP-S)None1× (3-7 wk after first)YesNoNucleocapsid (VRP-N)None1× (3-7 wk after first)NoYes, severe (lymph + eos)Du et al,12Du L. Zhao G. He Y. Guo Y. Zheng B.J. Jiang S. et al.Receptor-binding domain of SARS-CoV spike protein induces long-term protective immunity in an animal model.Vaccine. 2007; 25: 2832-2838Crossref PubMed Scopus (140) Google Scholar 2007Subunit vaccine: S protein RBDRBD318-510-hFc∗Fusion protein of SARS-CoV-1 RBD (193 amino acids long) and Fc domain of human IgG1.Initial: Freund’s complete adjuvant Boosters: Freund’s incomplete adjuvant3× (every3 wk ×2, final at 12 mo)YesNoYasui et al,13Yasui F. Kai C. Kitabatake M. Inoue S. Yoneda M. Yokochi S. et al.Prior immunization with severe acute respiratory syndrome (SARS)-associated coronavirus (SARS-CoV) nucleocapsid protein causes severe pneumonia in mice infected with SARS-CoV.J Immunol. 2008; 181: 6337-6348Crossref PubMed Scopus (195) Google Scholar 2008Recombinant viral particleSpike (S)NoneNoneYes (9 d after infection)Yes, mild (neu)Nucleocapsid (nuc)NoneNoneNo (9 d after infection)Yes, severe (eos + neu)Membrane (M)NoneNoneNo (9 d after infection)NoEnvelope (E)NoneNoneNo (9 d after infection)NoNuc + M + E + SNoneNoneYes (9 d after infection)Yes, severe (eos + neu)Bolles et al,14Bolles M. Deming D. Long K. Agnihothram S. Whitmore A. Ferris M. et al.A double-inactivated severe acute respiratory syndrome coronavirus vaccine provides incomplete protection in mice and induces increased eosinophilic proinflammatory pulmonary response upon challenge.J Virol. 2011; 85: 12201-12215Crossref PubMed Scopus (360) Google Scholar 2011DIV (formalin/UV)Whole virus± Alum1× (2-3 wk after first)Yes (DIV + alum)(4 d, after infection)Yes; eos (4 d, after infection)Whole virus± Alum1× (2-3 wk after first)NDYes; eos + neu + mac (4 d after infection)Whole virus± Alum1× (2-3 wk after first)NDYes; eos + neu + mac (4 d after infection)Tseng et al,15Tseng C.T. Sbrana E. Iwata-Yoshikawa N. Newman P.C. Garron T. Atmar R.L. et al.Immunization with SARS coronavirus vaccines leads to pulmonary immunopathology on challenge with the SARS virus.PLoS One. 2012; 7e35421Crossref PubMed Scopus (417) Google Scholar 2012DIV (formalin/UV)Whole virus± Alum1× (4 wk after first)Yes (2 mo after booster)Yes; eos (2 d after infection)(reduced + alum)Beta propiolactone–inactivated virus (BPV)Whole virus± Alum1× (4 wk after first)Yes (2 mo after booster)Yes; eos (2 d after infection)(no difference + alum)Subunit vaccine: Full-length S proteinSpike (S)± Alum1× (4 wk after first)Yes (2 mo after booster)Yes; eos (2 d after infection)(reduced + alum)Chimeric virus-like particle (VLP)Spike (S)± Alum1× (4 wk after first)Yes (2 mo after booster)Yes; eos (2 d after infection)(no difference + alum)Iwata-Yoshikawa et al,16Iwata-Yoshikawa N. Uda A. Suzuki T. Tsunetsugu-Yokota Y. Sato Y. Morikawa S. et al.Effects of Toll-like receptor stimulation on eosinophilic infiltration in lungs of BALB/c mice immunized with UV-inactivated severe acute respiratory syndrome-related coronavirus vaccine.J Virol. 2014; 88: 8597-8614Crossref PubMed Scopus (97) Google Scholar 2014UV-inactivated whole virus (UV-V)Whole virus± Alum1× (6-7 wk after first)Yes (before infection and 3 d and 10 d after infection)Yes; eos, lymphWhole virus± TLR agonists1× (6-7 wk after first)Yes (before infection and 3 d and 10 d after infection)NoHonda-Okubo et al,17Honda-Okubo Y. Barnard D. Ong C.H. Peng B.H. Tseng C.T. Petrovsky N. Severe acute respiratory syndrome-associated coronavirus vaccines formulated with delta inulin adjuvants provide enhanced protection while ameliorating lung eosinophilic immunopathology.J Virol. 2015; 89: 2995-3007Crossref PubMed Scopus (150) Google Scholar 2015Subunit vaccine: Partially truncated S proteinSpikeΔTM (SΔTM)± Alum1× (3 wk after first)Yes (3 d after infection)Yes, severe eos (6 d after infection)SpikeΔTM (SΔTM)± Advax11× (3 wk after first)Yes (3 d after infection)Yes, mild eos (6 d after infection)SpikeΔTM (SΔTM)± Advax21× (3 wk after first)Yes (3 d after infection)NoDIV, Double-inactivated whole virus; eos, eosinophil; lymph, lymphocyte; mac, alveolar macrophage; ND, not done; neu, neutrophil; RBD, receptor-binding domain; SΔTM, Spike protein-transmembrane domain deleted; UV, ultraviolet light; VRP, virus replicon particle; VV, vaccinia; V, virus.Alum, Aluminum salts; TLR agonist [LPS, poly(I:C), poly(U)]; Advax1, delta inulin microparticles; Advax2, delta inulin microparticles and CpG.∗ Fusion protein of SARS-CoV-1 RBD (193 amino acids long) and Fc domain of human IgG1. Open table in a new tab DIV, Double-inactivated whole virus; eos, eosinophil; lymph, lymphocyte; mac, alveolar macrophage; ND, not done; neu, neutrophil; RBD, receptor-binding domain; SΔTM, Spike protein-transmembrane domain deleted; UV, ultraviolet light; VRP, virus replicon particle; VV, vaccinia; V, virus. Alum, Aluminum salts; TLR agonist [LPS, poly(I:C), poly(U)]; Advax1, delta inulin microparticles; Advax2, delta inulin microparticles and CpG. The role of eosinophils in mucosal immune responses in the respiratory tract has largely focused on the detrimental impact that these cells can have in inflammatory responses due to their potent proinflammatory function. However, preclinical studies (mainly in mice) have shown that eosinophils are equipped with an assortment of molecular tools that enable them to recognize, respond, and orchestrate antiviral responses to respiratory viruses.19Flores-Torres A.S. Salinas-Carmona M.C. Salinas E. Rosas-Taraco A.G. Eosinophils and respiratory viruses.Viral Immunol. 2019; 32: 198-207Crossref PubMed Scopus (59) Google Scholar Human eosinophils express several endosomal Toll-like receptors (TLRs), including TLR3, TLR7, and TLR9, that detect viral microbe–associated molecular patterns.20Mansson A. Fransson M. Adner M. Benson M. Uddman R. Bjornsson S. et al.TLR3 in human eosinophils: functional effects and decreased expression during allergic rhinitis.Int Arch Allergy Immunol. 2010; 151: 118-128Crossref PubMed Scopus (31) Google Scholar, 21Nagase H. Okugawa S. Ota Y. Yamaguchi M. Tomizawa H. Matsushima K. et al.Expression and function of Toll-like receptors in eosinophils: activation by Toll-like receptor 7 ligand.J Immunol. 2003; 171: 3977-3982Crossref PubMed Scopus (263) Google Scholar, 22Wong C.K. Cheung P.F. Ip W.K. Lam C.W. Intracellular signaling mechanisms regulating toll-like receptor-mediated activation of eosinophils.Am J Respir Cell Mol Biol. 2007; 37: 85-96Crossref PubMed Scopus (138) Google Scholar TLR7 enables eosinophils to recognize single-stranded RNA viruses such as coronavirus, and stimulating this receptor in human eosinophils triggers eosinophil cytokine production, degranulation, superoxide and nitric oxide (NO) generation, and prolonged cellular survival.21Nagase H. Okugawa S. Ota Y. Yamaguchi M. Tomizawa H. Matsushima K. et al.Expression and function of Toll-like receptors in eosinophils: activation by Toll-like receptor 7 ligand.J Immunol. 2003; 171: 3977-3982Crossref PubMed Scopus (263) Google Scholar, 22Wong C.K. Cheung P.F. Ip W.K. Lam C.W. Intracellular signaling mechanisms regulating toll-like receptor-mediated activation of eosinophils.Am J Respir Cell Mol Biol. 2007; 37: 85-96Crossref PubMed Scopus (138) Google Scholar, 23Drake M.G. Bivins-Smith E.R. Proskocil B.J. Nie Z. Scott G.D. Lee J.J. et al.Human and mouse eosinophils have antiviral activity against parainfluenza virus.Am J Respir Cell Mol Biol. 2016; 55: 387-394Crossref PubMed Scopus (72) Google Scholar Eosinophil-derived neurotoxin (EDN/RNAse2) and eosinophil cationic protein (ECP/RNAse3) from human eosinophils reduce infectivity of RSV by a ribonuclease-dependent mechanism.24Domachowske J.B. Dyer K.D. Adams A.G. Leto T.L. Rosenberg H.F. Eosinophil cationic protein/RNase 3 is another RNase A-family ribonuclease with direct antiviral activity.Nucleic Acids Res. 1998; 26: 3358-3363Crossref PubMed Scopus (170) Google Scholar,25Domachowske J.B. Dyer K.D. Bonville C.A. Rosenberg H.F. Recombinant human eosinophil-derived neurotoxin/RNase 2 functions as an effective antiviral agent against respiratory syncytial virus.J Infect Dis. 1998; 177: 1458-1464Crossref PubMed Scopus (241) Google Scholar Both human and murine eosinophils produce NO via inducible NO synthase, which can have direct antiviral effects on parainfluenza virus and RSV.23Drake M.G. Bivins-Smith E.R. Proskocil B.J. Nie Z. Scott G.D. Lee J.J. et al.Human and mouse eosinophils have antiviral activity against parainfluenza virus.Am J Respir Cell Mol Biol. 2016; 55: 387-394Crossref PubMed Scopus (72) Google Scholar,26Phipps S. Lam C.E. Mahalingam S. Newhouse M. Ramirez R. Rosenberg H.F. et al.Eosinophils contribute to innate antiviral immunity and promote clearance of respiratory syncytial virus.Blood. 2007; 110: 1578-1586Crossref PubMed Scopus (235) Google Scholar,27Su Y.C. Townsend D. Herrero L.J. Zaid A. Rolph M.S. Gahan M.E. et al.Dual proinflammatory and antiviral properties of pulmonary eosinophils in respiratory syncytial virus vaccine-enhanced disease.J Virol. 2015; 89: 1564-1578Crossref PubMed Scopus (30) Google Scholar Eosinophils are able to produce extracellular traps composed of eosinophilic granule proteins bound to genomic and mitochondrial DNA, and murine eosinophils can release these DNA traps in response to RSV infection in vitro,28Silveira J.S. Antunes G.L. Gassen R.B. Breda R.V. Stein R.T. Pitrez P.M. et al.Respiratory syncytial virus increases eosinophil extracellular traps in a murine model of asthma.Asia Pac Allergy. 2019; 9: e32Crossref PubMed Google Scholar especially in oxidative lung tissue environments.29Yousefi S. Sharma S.K. Stojkov D. Germic N. Aeschlimann S. Ge M.Q. et al.Oxidative damage of SP-D abolishes control of eosinophil extracellular DNA trap formation.J Leukoc Biol. 2018; 104: 205-214Crossref PubMed Scopus (24) Google Scholar Eosinophils are also capable of quickly mobilizing preformed granule pools of TH1 cytokines, including IL-12 and IFN-γ, which are important for mounting effective antiviral immune responses.30Davoine F. Lacy P. Eosinophil cytokines, chemokines, and growth factors: emerging roles in immunity.Front Immunol. 2014; 5: 570Crossref PubMed Scopus (201) Google Scholar In a murine model of allergic asthma, pulmonary eosinophils upregulate MHC-I and CD86 in response to influenza virus infection, where they can directly interact with CD8+ T cells and promote the recruitment of virus-specific CD8+ T cells into the lungs to enhance antiviral immunity.31Samarasinghe A.E. Melo R.C. Duan S. LeMessurier K.S. Liedmann S. Surman S.L. et al.Eosinophils promote antiviral immunity in mice infected with influenza A virus.J Immunol. 2017; 198: 3214-3226Crossref PubMed Scopus (112) Google Scholar Activated murine and human eosinophils also express MHC-II molecules and costimulatory molecules and can function as antigen-presenting cells for viral antigens, leading to T-cell activation and cytokine secretion.32Del Pozo V. De Andres B. Martin E. Cardaba B. Fernandez J.C. Gallardo S. et al.Eosinophil as antigen-presenting cell: activation of T cell clones and T cell hybridoma by eosinophils after antigen processing.Eur J Immunol. 1992; 22: 1919-1925Crossref PubMed Scopus (110) Google Scholar,33Handzel Z.T. Busse W.W. Sedgwick J.B. Vrtis R. Lee W.M. Kelly E.A. et al.Eosinophils bind rhinovirus and activate virus-specific T cells.J Immunol. 1998; 160: 1279-1284PubMed Google Scholar IL-5 transgenic mice, which constitutively overproduce IL-5 and have systemic eosinophilia, have accelerated viral clearance during infection with RSV.26Phipps S. Lam C.E. Mahalingam S. Newhouse M. Ramirez R. Rosenberg H.F. et al.Eosinophils contribute to innate antiviral immunity and promote clearance of respiratory syncytial virus.Blood. 2007; 110: 1578-1586Crossref PubMed Scopus (235) Google Scholar Conversely, mice genetically engineered to be eosinophil-deficient have lower viral clearance of RSV than do wild-type controls.26Phipps S. Lam C.E. Mahalingam S. Newhouse M. Ramirez R. Rosenberg H.F. et al.Eosinophils contribute to innate antiviral immunity and promote clearance of respiratory syncytial virus.Blood. 2007; 110: 1578-1586Crossref PubMed Scopus (235) Google Scholar Adoptive transfer of eosinophils from Aspergillus fumigatus antigen–sensitized mice into the airways of influenza virus–infected mice decreases viral titers and increases virus-specific CD8+ T cells in comparison to that of animals who did not receive eosinophils.31Samarasinghe A.E. Melo R.C. Duan S. LeMessurier K.S. Liedmann S. Surman S.L. et al.Eosinophils promote antiviral immunity in mice infected with influenza A virus.J Immunol. 2017; 198: 3214-3226Crossref PubMed Scopus (112) Google Scholar Interestingly, human subjects with asthma were treated with the antieosinophil drug mepolizumab (an anti–IL-5 humanized mAb) or placebo and subsequently challenged with rhinovirus; mepolizumab-treated patients demonstrated significant increases in their rhinovirus viral titers in the upper airway, supporting an antiviral role for eosinophils.34Sabogal Pineros Y.S. Bal S.M. van de Pol M.A. Dierdorp B.S. Dekker T. Dijkhuis A. et al.Anti-IL-5 in mild asthma alters rhinovirus-induced macrophage, B-cell, and neutrophil responses (MATERIAL): a placebo-controlled, double-blind study.Am J Respir Crit Care Med. 2019; 199: 508-517Crossref PubMed Scopus (56) Google Scholar Although these data substantiate the antiviral potential of eosinophils, the clinical significance of eosinophils in antiviral responses in human disease continues to remain debatable. Patients with eosinophilic asthma have an increased risk for viral-induced asthma exacerbations, and there is mounting evidence that patients with eosinophilic asthma may actually have reduced innate responses against respiratory viruses.35Bjerregaard A. Laing I.A. Backer V. Sverrild A. Khoo S.K. 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Barker P. et al.Efficacy and safety of benralizumab for patients with severe asthma uncontrolled with high-dosage inhaled corticosteroids and long-acting beta2-agonists (SIROCCO): a randomised, multicentre, placebo-controlled phase 3 trial.Lancet. 2016; 388: 2115-2127Abstract Full Text Full Text PDF PubMed Scopus (916) Google Scholar, 39Busse W.W. Bleecker E.R. FitzGerald J.M. Ferguson G.T. Barker P. Sproule S. et al.Long-term safety and efficacy of benralizumab in patients with severe, uncontrolled asthma: 1-year results from the BORA phase 3 extension trial.Lancet Respir Med. 2019; 7: 46-59Abstract Full Text Full Text PDF PubMed Scopus (202) Google Scholar, 40FitzGerald J.M. Bleecker E.R. Nair P. Korn S. Ohta K. Lommatzsch M. et al.Benralizumab, an anti-interleukin-5 receptor alpha monoclonal antibody, as add-on treatment for patients with severe, uncontrolled, eosinophilic asthma (CALIMA): a randomised, double-blind, placebo-controlled phase 3 trial.Lancet. 2016; 388: 2128-2141Abstract Full Text Full Text PDF PubMed Scopus (936) Google Scholar, 41Jackson D.J. Korn S. Mathur S.K. Barker P. Meka V.G. Martin U.J. et al.Safety of eosinophil-depleting therapy for severe, eosinophilic asthma: focus on benralizumab.Drug Saf. 2020; 43: 409-425Crossref PubMed Scopus (35) Google Scholar, 42Lugogo N. Domingo C. Chanez P. Leigh R. Gilson M.J. Price R.G. et al.Long-term efficacy and safety of mepolizumab in patients with severe eosinophilic asthma: a multi-center, open-label, phase IIIb study.Clin Ther. 2016; 38: 2058-2070.e1Abstract Full Text Full Text PDF PubMed Scopus (200) Google Scholar, 43Winthrop K.L. Mariette X. Silva J.T. Benamu E. Calabrese L.H. Dumusc A. et al.ESCMID Study Group for Infections in Compromised Hosts (ESGICH) Consensus Document on the safety of targeted and biological therapies: an infectious diseases perspective (Soluble immune effector molecules [II]: agents targeting interleukins, immunoglobulins and complement factors).Clin Microbiol Infect. 2018; 24: S21-S40PubMed Google Scholar Rosenberg et al44Rosenberg H.F. Domachowske J.B. Eosinophils, eosinophil ribonucleases, and their role in host defense against respiratory virus pathogens.J Leukoc Biol. 2001; 70: 691-698Crossref PubMed Google Scholar suggested that eosinophils in the respiratory tract might represent a “double-edged sword,” promoting antiviral responses against some respiratory viruses that could become dysregulated during allergic disease given their increased numbers and/or activation status, ultimately resulting in an exaggerated host response that can lead to host tissue damage. The growing number of biologic agents that target eosinophils may be useful tools to help clarify the role eosinophils have in different antiviral responses. Taken together, although preclinical studies have demonstrated antiviral activity for eosinophils, their clinical relevance in immune responses to different respiratory viruses remains unclear and needs further investigation. Rhinovirus, RSV, and influenza virus are common triggers of viral-induced asthma exacerbations, whereas coronaviruses are far less common triggers for acute" @default.
• W3018418935 created "2020-05-01" @default.
• W3018418935 creator A5004520793 @default.
• W3018418935 creator A5056639915 @default.
• W3018418935 creator A5068993336 @default.
• W3018418935 date "2020-07-01" @default.
• W3018418935 modified "2023-10-16" @default.
• W3018418935 title "Eosinophil responses during COVID-19 infections and coronavirus vaccination" @default.
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