Abstract
BackgroundCoronavirus disease 2019 (COVID-19) is defined as an emerging infectious disease caused by severe acute respiratory syndrome coronavirus 2 and celiac disease (CD) is one of the autoimmune multiorgan diseases, which can be accompanied by an increased risk of viral infections. CD patients, especially untreated subjects, may be at greater risk of infections such as viral illnesses. Interleukin (IL)-6, CD4, CD25, and FOXP3 are known as genes affecting immune homeostasis and relate to the inflammation state. This study aimed to compare the expression levels of aforementioned genes in peripheral blood samples of CD and severe COVID-19 patients.MethodsSixty newly diagnosed CD patients with median age (mean ± SD) of 35.40 ± 24.12 years; thirty confirmed severe COVID-19 patients with median age (mean ± SD) of 59.67 ± 17.22, and 60 healthy subjects with median age (mean ± SD) of 35.6 ± 13.02 years; were recruited from March to September 2020. Fresh whole blood samples were collected, total RNA was obtained and cDNA synthesis was carried out. RNA expression levels of IL-6, CD4, CD25, and FOXP3 genes were assessed using real-time quantitative RT-PCR according to the 2−∆∆Ct formula. Statistical analysis was performed using SPSS (V.21) and GraphPad, Prism (V.6).ResultsWhile increased expression of CD4, CD25, and FOXP3 was observed in CD patients compared to the control group (p = 0.02, p = 0.03, and p < 0.0001 respectively) and COVID-19 patients group (p < 0.0001 for all of them), their expression levels in COVID-19 patients decreased compared to controls (p < 0.0001, p = 0.01, p = 0.007, respectively). Increased IL-6 expression was observed in both groups of patients compared to controls (p < 0.0001 for both of them).ConclusionsAlthough untreated CD patients may be at greater risk of developing into severe COVID-19 if they are infected by SARS-CoV-2 virus (due to their high expression of IL-6), increased expression of anti-inflammatory markers in these patients may be beneficial for them with the ability of reducing the severity of COVID-19 disease, which needs to be proven in future studies involving celiac patients infected with COVID-19.
Highlights
Coronavirus disease 2019 (COVID-19) is defined as an emerging infectious disease caused by severe acute respiratory syndrome coronavirus 2 and celiac disease (CD) is one of the autoimmune multiorgan diseases, which can be accompanied by an increased risk of viral infections
Due to the important role of Interleukin 6 (IL-6) and Regulatory T cells (Tregs) in celiac disease and coronavirus infection, and owing to the importance of Treg markers in their development and activity, this study aimed to evaluate the gene expression of IL-6, CD4, CD25, and
The results showed that the relative expression levels of CD4, CD25, and Forkhead box P3 (FOXP3) Messenger RNA (mRNA) were significantly increased in CD patients compared to the control group, (p = 0.02, p = 0.03, and p < 0.0001 respectively) and COVID-19 patients’ group, Fig. 1 Symptoms reported by COVID-19 and CD patients: most patients complained of two or more symptoms
Summary
Coronavirus disease 2019 (COVID-19) is defined as an emerging infectious disease caused by severe acute respiratory syndrome coronavirus 2 and celiac disease (CD) is one of the autoimmune multiorgan diseases, which can be accompanied by an increased risk of viral infections. Interleukin (IL)-6, CD4, CD25, and FOXP3 are known as genes affect‐ ing immune homeostasis and relate to the inflammation state. Gluten consumption changes the pro- and anti-inflammatory states and rises the production of pro-inflammatory cytokines leading to small intestinal inflammation in CD patients, which involves both innate and adaptive immune responses [3]. IL-6, as a pro-inflammatory agent, can stimulate the synthesis of acute-phase reactant proteins, and its overproduction is associated with inflammatory autoimmune disorders and uncontrolled intestinal inflammation (which takes place in CD) [5,6,7]. Numerous studies have linked IL-6 to the development of celiac disease [8]
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