Cited by 714SARS-CoV-2 and COVID-19 ResearchCOVID-19 Clinical Research Studiesinterferon and immune responses

The DOI matches its Crossref record; 194 of the 194 references it cites were found in a registry or an index; none of the 147 sources its claims cite is checked for support yet.

COVID-19 and the human innate immune system

Open access

Abstract

The introduction of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) into the human population represents a tremendous medical and economic crisis. Innate immunity-as the first line of defense of our immune system-plays a central role in combating this novel virus. Here, we provide a conceptual framework for the interaction of the human innate immune system with SARS-CoV-2 to link the clinical observations with experimental findings that have been made during the first year of the pandemic. We review evidence that variability in innate immune system components among humans is a main contributor to the heterogeneous disease courses observed for coronavirus disease 2019 (COVID-19), the disease spectrum induced by SARS-CoV-2. A better understanding of the pathophysiological mechanisms observed for cells and soluble mediators involved in innate immunity is a prerequisite for the development of diagnostic markers and therapeutic strategies targeting COVID-19. However, this will also require additional studies addressing causality of events, which so far are lagging behind.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

This review proposes a conceptual framework for how the human innate immune system interacts with SARS-CoV-2 and argues that host innate variability, especially in type I interferon responses, is a major driver of heterogeneous COVID-19 courses. It synthesizes first-year pandemic evidence and calls for causal, longitudinal studies to guide stratification and therapy.

Key findings

  • Disease heterogeneity is attributed mainly to host and environmental factors rather than viral genetics; 10%–20% of symptomatic patients develop severe or critical disease, while mutations such as D614G increase infectivity but do not explain the broad clinical spectrum.
  • Type I interferon immunity is central: SARS-CoV-2 antagonizes it at multiple points, and severe COVID-19 has been linked to loss-of-function variants in TLR3, IRF7, and IRF9 pathways in an estimated 3.5% of severe cases, autoantibodies against type I interferons in more than 10% of severe cases, and X-chromosomal TLR7 variants in young ICU patients.
  • Severe disease involves an early transient interferon/ISG wave followed by hyperinflammation with elevated IL-6, TNF, and other mediators, alongside immunosuppressive myeloid changes such as HLA-DRlo monocytes, PD-L1-expressing neutrophils, emergency myelopoiesis, and neutrophil extracellular trap formation; the “cytokine storm” label is debated, with viral sepsis proposed as an alternative description.
  • Age and inflammaging are major risk factors, and a chromosome 3 risk locus inherited from Neanderthals is carried by about 50% of people in South Asia and about 16% in Europe; trained immunity via BCG is under investigation, with 21 BCG trials and 3 VPM1002 trials registered as of early 2021.

Methods

  • Narrative/conceptual review rather than primary research; it integrates clinical observations, genetic association and sequencing studies, single-cell omics, proteomics, and animal-model findings from the first year of the pandemic.
  • The authors organize the discussion around a five-phase disease trajectory and a systems-medicine framework linking clinical investigation, computational modeling, and experimental validation.
  • No systematic search strategy, meta-analysis, or new patient cohort is described.

Limitations

  • The authors state that causality of events is still lagging behind and that larger longitudinal and mechanistic studies are urgently needed; many cited findings are preliminary or correlative.
  • Evident from the text: the review covers mainly early-pandemic literature, does not perform a formal quality assessment, and notes that therapeutic conclusions await results from ongoing randomized trials.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1016/j.cell.2021.02.029

Cites

0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Verification

Claims the paper makes

0 of 147 cited sources checked · 0 supported · 0 flagged

Show all 59 claims

  • It may state two separate claims as one. 53
  • Probably not a substantial claim. 9
  • The quote only partly states this claim. 4
60 of 60
  • The authors state this as an assumption.

    The majority of humankind does not have an extended cross-reaction to other viruses of the coronavirus family.

    “assuming that the majority of humankind does not have an extended cross-reaction to other viruses of the coronavirus family (Braun et al., 2020; Grifoni et al., 2020; Mateus et al., 2020)”
  • The authors state this as an assumption.

    Most steps of the interaction between the virus and the host follow a normal distribution of attributes or parameters required to describe the outcome of the interaction.

    “Bearing in mind that most of the steps of the interaction between the virus and the host will follow a normal distribution of attributes or parameters required to describe the outcome of the interaction”
  • The paper relies on this without support.

    The virus counteracts the type I IFN system.

    “Because SARS-CoV-2 antagonizes the type I IFN system”
  • The paper relies on this without support.

    COVID-19 is clinically heterogeneous.

    “Because COVID-19 presents with such heterogeneity”
4 of 4

Claims other papers make about this one

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Citations

Cites

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Show all 194 references

Research works printed but not linked: 2

  1. de Chaisemartin, 2020, BCG vaccination in infancy does not protect against COVID-19. Evidence from a natural experiment in Sweden, Clin. Infect. Dis.
  2. Muus, 2021, Integrated analyses of single-cell atlases reveal age, gender, and smoking status associations with cell type-specific expression of mediators of SARS-CoV-2 viral entry and highlights inflammatory programs in putative target cells, Nat Med.

Cited by

Sorted by citations

Items 101–200 of 612

Metadata

Authors
Schultze, J. L., & Aschenbrenner, A. C.
Affiliations
University of Bonn (DE)
Corresponding author
Schultze, Joachim L.
Venue
Cell
Publisher
Elsevier BV
Published
2021-04
Volume
184
Issue
7
Pages
1671-1692
ISSN
0092-8674 (ISSN-L)
OpenAlex
W3131820551
Cited by
714
References
202
Citations by year
2026: 30 · 2025: 57 · 2024: 96 · 2023: 174 · 2022: 235 · 2021: 122
FWCI
18.40
Type
journal article
Language
en
Open access
Locations
  • Cell (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • DZNE Pub (submittedVersion)
Funders
Rheinische Friedrich-Wilhelms-Universität Bonn
Topics
  • Health Sciences › Medicine › Infectious Diseases › SARS-CoV-2 and COVID-19 Research
  • Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
  • Life Sciences › Immunology and Microbiology › Immunology › interferon and immune responses
Keywords
COVID-19 pandemic, SARS-CoV-2, innate immunity, disease heterogeneity, soluble immune mediators, pathophysiology, diagnostic biomarkers, treatment options, host-virus interaction
MeSH terms
Host Microbial Interactions, COVID-19, SARS-CoV-2, Humans, Immunity, Innate, Severity of Illness Index

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