key: cord-0952920-v4orfsko
authors: Farina, A.; Labriola, R.; Ialongo, C.; Suppa, M.; Viggiani, V.; Lucarelli, M.; Anastasi, E.; Angeloni, A.
title: “Transient plasma cell dyscrasia in COVID-19 patients linked to IL-6 triggering.”
date: 2021-03-20
journal: Microbes Infect
DOI: 10.1016/j.micinf.2021.104808
sha: c4be05c44f4c37196eac138fccebda1b17b0b6d9
doc_id: 952920
cord_uid: v4orfsko

An unusual clonal gammopathy was reported in COVID-19 patient but whether this anomaly is related or not to the disease has not yet been clarified. To this aim, we selected a cohort of 35 COVID-19 patients swab positive and investigated serological levels of IL-6, immune response to major viral antigens and electrophoretic profile. Elevated levels of IL-6 were accompanied by a significative humoral response to viral Spike protein, revealing an altered electrophoretic profile in the gamma region. We can conclude that elevated levels of IL-6 triggers humoral response inducing a transient plasma cell dyscrasia in severe COVID-19 patients.

on the viral envelope whereas N is a component of the viral nucleocapsid. These 28 proteins play a key role not only as structural viral elements, but also as the main 29 target of humoral response [3, 4] . 30 Within 7 days after the onset of the disease, the immune system should eliminate the 31 virus, giving rise to the patient's recovery. When this not does occur, the respiratory-32 like illness could progress to severe pneumonia, systemic inflammation often with a 33 poor prognosis [5] . 34 Emerging evidence suggests that severity and poor prognosis in COVID-19 patients 35 could be related to an excessive response of the immune system, mainly 36 J o u r n a l P r e -p r o o f characterized by the abnormal release of circulating cytokines, event known as 37 "cytokine storm" [6] . Release of a plethora of cytokines plays a pivotal role in 38 exacerbate patients conditions, from pneumonia through acute respiratory distress 39 syndrome (ARDS), cumulating in systemic inflammation and ultimately multi-40 system organ failure [7] . Several cytokines such as IL-1, IL-2, IL-10, TNF-α and IFN-41 γ are responsible of this "storm" in COVID-19 patients, however, a crucial role seems 42 to be played by IL-6, whose increased levels in the serum have been correlated with Control first international standard 89/548IL-6 detection range was between 1,5 84 and 5.000 pg/ml, as a clinical cut-off we considered 7,0 pg/ml. 

3.1 Increased levels of IL-6 in COVID-19 patients. 126 We started to assay IL-6 levels in a cohort of 35 patient at the hospital admittance. 127 Thirty-three out of thirty-five patients showed higher levels of IL-6 (median IL-6 128 level was 31.5 pg/mL; IQR: 7 pg/mL) at the first withdrawal. Concerning N ab presence, in the T0, antibodies against N were grouped mostly in 148 the I quartile range. 149 We then assayed ab expression in T1 and observed that N titer were moderately 150 increased in the II quartile range and part were regressed in the I quartile range. 151 Moreover, analyzing the group with higher ab titers (III quartile range), we also 152 observed a statistically significative difference between anti-S ab respect to anti-N 153 ab. This difference was detectable in the 1st (*P<0,05) as well as in the 2nd (*P< 154 0,0015) withdrawal. Presented results are summarize in Table 1 . 

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