Interview: Professor Klenerman, thank you for doing this update with us today on
the immune system response to the SARS-CoV-2 virus,
your last interview with us on this topic being in July this year.
What are some of the main changes in the understanding of the mechanisms
of how the immune system responds to SARS-CoV-2?
Prof. Klenerman: I think the principles were established reasonably early about the major responses.
I guess in the last few months
there haven't been huge surprises,
but quite a lot of refinement about these responses.
Much more is known about the stability of the responses as
well because we've just had more time to study them, and
of course, many more patients have been studied now.
I think the main messages are still that there's a blunted early innate response,
but later on, in people who are very sick,
the innate response takes over in a very dysregulated way.
Some of the papers have used that word
'dysregulation', it's a coordination of the immune response
later in the disease and seems to be a problem in the people who are sickest, and
there's a bit of debate over whether it's best described as a 'cytokine storm'.
But it's an OK description of something which is quite chaotic,
I think that's probably the point to get across, and that's not unique to COVID
but it is quite striking in these patients.
In some of the white blood cell subsets that are triggered by those cytokines
(the neutrophils, and the myeloid set of cells and monocytes),
there are some quite striking changes.
Then with the lymphocytes, which are more responsive for adaptive immunity,
we know a good deal more about the quality of the neutralizing antibodies,