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Two people infected with the same strain of COVID-19 can have vastly different experiences. One might never even sniffle, and the other might end up on a ventilator. But why?

Since the start of the COVID-19 pandemic, researchers have been trying to figure out why someone develops a mild or severe case. One way to do that is by looking at T cells, which are white blood cells that mount an immune response—and specifically CD8⁺ T cells, "killer" T cells that have been shown to effectively fight back against COVID-19 infections.

But most studies examining what leads to different COVID-19 immune responses have not taken differences between individual immune systems into consideration.

Moriya Tsuji, a professor at the Texas A&M University School of Engineering Medicine, said one important factor is a group of genes called human leukocyte antigens (HLAs). These genes help determine how the immune system recognizes pieces of a virus and activates T cells, and different people carry different HLA types.

Understanding what causes differences in immune responses can guide treatment for people with COVID infections and lead to vaccines that spur long-lasting, durable responses.

Tsuji wanted to make direct comparisons of SARS-CoV-2 cellular responses in patients with the same HLA restrictions.

"It's like comparing oranges and apples. I wanted to compare a green apple to a red apple," he said.

To do that, he and researchers from the Columbia University Vagelos College of Physicians and Surgeons and the Federal University of Minas Gerais in Brazil looked at blood samples from 42 patients who were all HLA-A2-positive.

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