Alterations in T and B cell function persist in convalescent COVID-19 patients

Halima Ali Shuwa, Tovah Shaw, Sean Knight, Kelly Wemyss, Flora Mcclure, Laurence Pearmain, Ian Prise, Christopher Jagger, David Morgan, Saba Khan, Oliver Brand, Elizabeth Mann, Andrew Ustianowski, Nawar Diar Bakerly, Paul Dark, Christopher E Brightling, Seema Brij, Timothy Felton, Angela Simpson, John GraingerTracy Hussell, Joanne Konkel, Madhvi Menon

Research output: Contribution to journalArticlepeer-review


Background: Emerging studies indicate that some coronavirus disease 2019 (COVID-19) patients suffer from persistent symptoms, including breathlessness and chronic fatigue; however, the long-term immune response in these patients presently remains ill-defined. Methods: Here, we describe the phenotypic and functional characteristics of B and T cells in hospitalized COVID-19 patients during acute disease and at 3–6 months of convalescence. Findings: We report that the alterations in B cell subsets observed in acute COVID-19 patients were largely recovered in convalescent patients. In contrast, T cells from convalescent patients displayed continued alterations with persistence of a cytotoxic program evident in CD8 + T cells as well as elevated production of type 1 cytokines and interleukin-17 (IL-17). Interestingly, B cells from patients with acute COVID-19 displayed an IL-6/IL-10 cytokine imbalance in response to Toll-like receptor activation, skewed toward a pro-inflammatory phenotype. Whereas the frequency of IL-6 + B cells was restored in convalescent patients irrespective of clinical outcome, the recovery of IL-10 + B cells was associated with the resolution of lung pathology. Conclusions: Our data detail lymphocyte alterations in previously hospitalized COVID-19 patients up to 6 months following hospital discharge and identify 3 subgroups of convalescent patients based on distinct lymphocyte phenotypes, with 1 subgroup associated with poorer clinical outcome. We propose that alterations in B and T cell function following hospitalization with COVID-19 could affect longer-term immunity and contribute to some persistent symptoms observed in convalescent COVID-19 patients. Funding: Provided by UKRI, Lister Institute of Preventative Medicine, the Wellcome Trust, The Kennedy Trust for Rheumatology Research, and 3M Global Giving.

Original languageEnglish
Pages (from-to)720-+
Issue number6
Publication statusPublished - 11 Jun 2021


  • B cells
  • COVID-19
  • T cells
  • Translation to patients
  • convalescent patients
  • long COVID
  • viral Infection
  • Cytokines
  • Interleukin-10
  • Humans
  • Interleukin-6
  • CD8-Positive T-Lymphocytes
  • SARS-CoV-2


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