Decreased Naïve T-cell Production Leading to Cytokine Storm as Cause of Increased COVID-19 Severity with Comorbidities

Aging, type 2 diabetes, and male gender are major risk factors leading to increased COVID-19 morbidity and mortality. Thymic production and the export of naive T cells decrease with aging through the effects of androgens in males and in type 2 diabetes. Furthermore, with aging, recovery of naive T-cell populations after bone marrow transplantation is delayed and associated with an increased risk of chronic graft vs. host disease. Severe COVID-19 and SARS infections are notable for severe T-cell depletion. In COVID-19, there is unique suppression of interferon signaling by infected respiratory tract cells with intact cytokine signaling. A decreased naive T-cell response likely contributes to an excessive inflammatory response and increases the odds of a cytokine storm. Treatments that improve naive T-cell production may prove to be vital COVID-19 therapies, especially for these high-risk groups. Key words: COVID-19, SARS-CoV-2, naive T cells, type 2 diabetes, cytokine storm