Macrophage expression and prognostic significance of the long pentraxin PTX3 in COVID-19

Mantovani and colleagues report elevated circulating concentrations of the long pentraxin PTX3 in patients with severe COVID-19. Within this cohort, early detection of high PTX3 concentrations emerged as a strong predictor of decreased survival. Long pentraxin 3 (PTX3) is an essential component of humoral innate immunity, involved in resistance to selected pathogens and in the regulation of inflammation(1-3). The present study was designed to assess the presence and significance of PTX3 in Coronavirus Disease 2019 (COVID-19)(4-7). RNA-sequencing analysis of peripheral blood mononuclear cells, single-cell bioinformatics analysis and immunohistochemistry of lung autopsy samples revealed that myelomonocytic cells and endothelial cells express high levels of PTX3 in patients with COVID-19. Increased plasma concentrations of PTX3 were detected in 96 patients with COVID-19. PTX3 emerged as a strong independent predictor of 28-d mortality in multivariable analysis, better than conventional markers of inflammation, in hospitalized patients with COVID-19. The prognostic significance of PTX3 abundance for mortality was confirmed in a second independent cohort (54 patients). Thus, circulating and lung myelomonocytic cells and endothelial cells are a major source of PTX3, and PTX3 plasma concentration can serve as an independent strong prognostic indicator of short-term mortality in COVID-19.

Automated summary

In patients with severe COVID-19, elevated levels of long pentraxin PTX3 have been found to be a strong predictor of decreased survival. Myelomonocytic cells and endothelial cells in both blood and lung tissue are major sources of PTX3, with PTX3 plasma concentration serving as an independent prognostic indicator for short-term mortality in COVID-19 patients.