COVID-19 immunology research - what do we know and what are the research priorities?

Arne Akbar, Danny Altmann, Maria Elena Bottazzi, Judith Breuer, Adrian Hayday, Tracy Hussell, Paul Klenerman, Clare Lloyd, Janet Lord, Peter Openshaw, Ruth Payne, Ultan Power, Ken Smith, Ryan Thwaites, Xiao-Ning Xu, Doug Brown, Jennie Evans, Elizabeth Bohm, Sarah Ritchie, Abigail Bloy

Research output: Book/ReportCommissioned report

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Abstract

SARS-CoV-2* is a novel coronavirus that causes the disease COVID-19*. Scientific investigation of the disease is unprecedented and based on a remarkable mobilisation of international expertise and data sharing. The UK is at the forefront of immunological research globally and is contributing at the highest level to tackling the pandemic. Much has been learnt about who the disease affects and its mechanisms, leading to new therapeutics and prevention prospects.

This report aims to summarise what we know, and what we do not, about the immunology of COVID-19*, and set immunology research priorities. An asterisk (*) denotes words that appear in the glossary (Annex 4).

SARS-CoV-2* is more highly infectious than the SARS1* virus, and COVID-19* has become a deadly pandemic. Until we have a protective vaccine or effective therapeutics, social (physical) distancing is the most effective control measure available to control to virus.

Studies are underway to discover the number of us that have been infected with and so have specific antibody to SARS-CoV-2* (‘sero-prevalence’*). However, scaling lab-based antibody tests to commercial equivalents is challenging; some high-throughput tests may produce false-positives to antibodies against other coronaviruses, like the common cold. Questions also remain around to what extent the antibody response mounted by thoses exposed to SARS-CoV-2* can protect against future infection, and what role immune cells including T lymphocytes* may play in protective immunity. This means ‘antibody-positive passports’ cannot be relied upon at this stage.

Exposure to higher doses of the virus may lead to more severe disease, so the use of personal protective equipment by healthcare workers is particularly important. Although we do not yet have good tests for infectiousness, studies suggest that people with severe disease may remain infectious for longer than those who experience mild symptoms. Physical distancing therefore remains crucial while we learn more about the spread of this disease and what types of immunity are most protective, and for how long.

Elucidating biomarkers to identify which people may develop more severe disease will be extremely valuable to predict and prevent intensive care admissions, and some candidates are being explored. The ability to precisely manipulate the immune response to encourage protective responses and decrease immune-mediated organ damage will be vital to manage the disease outbreak and limit deaths from COVID-19*. This can be achieved through immune modulators*, anti-inflammatory drugs and antiviral therapies.

Vaccine or effective therapeutics are the only realistic prospect of long-term outbreak control and the ultimate lifting of social restrictions. It is absolutely vital that efforts to develop these are supported. There are promising vaccines at various stages of development, but these must be verified as safe and able to induce protective immunity, and their effectiveness carefully assessed by different groups of researchers.

This expert advisory group has identified 13 immunology research priorities, many of which have the potential to deliver results within the next 12-18 months and lead to rapid public health impacts. However, there are many more research questions that can help to optimise our response to COVID-19*, which are explored in this rapid review and continue to develop in the growing evidence base. Key assumptions relied upon by the scientific community and this group include:
• Prior infection will confer some protection against future infections
• The disease is highly variable, ranging from asymptomatic to lethal
• Dysregulated immune responses may contribute to severe disease
• Immunity will differ across the population (for example, by age, sex, ethnicity, occupation and location)
• Immune protection will provide greatest benefit to those most vulnerable
Original languageEnglish
PublisherBritish Society for Immunology
Number of pages23
Publication statusPublished - 01 May 2020

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