Coronavirus disease 2019: investigational therapies in the prevention and treatment of hyperinflammation. (1st December 2020)

• Record Type: Journal Article
• Authors: Amigues, Isabelle; Pearlman, Alexander H; Patel, Aarat; Reid, Pankti; Robinson, Philip C.; Sinha, Rashmi; Kim, Alfred Hj; Youngstein, Taryn; Jayatilleke, Arundathi; Konig, Maximilian
• Is Part Of: Expert review of clinical immunology. Volume 16:Number 12(2020)
• Page Start: 1185
• Page End: 1204
• Publication Date: 2020-12-01
• Subjects: Coronavirus disease 2019 (COVID-19) -- hyperinflammation -- cytokine storm syndrome -- cytokine release syndrome -- hemophagocytic lymphohistiocytosis; Clinical immunology -- Periodicals; 616.079
• DOI: 10.1080/1744666X.2021.1847084
• Languages: English
• ISSNs: 1744-666X

Abstract

ABSTRACT: Introduction : The mortality of coronavirus disease 2019 (COVID-19) is frequently driven by an injurious immune response characterized by the development of acute respiratory distress syndrome (ARDS), endotheliitis, coagulopathy, and multi-organ failure. This spectrum of hyperinflammation in COVID-19 is commonly referred to as cytokine storm syndrome (CSS). Areas covered : Medline and Google Scholar were searched up until 15th of August 2020 for relevant literature. Evidence supports a role of dysregulated immune responses in the immunopathogenesis of severe COVID-19. CSS associated with SARS-CoV-2 shows similarities to the exuberant cytokine production in some patients with viral infection (e.g.SARS-CoV-1) and may be confused with other syndromes of hyperinflammation like the cytokine release syndrome (CRS) in CAR-T cell therapy. Interleukin (IL)-6, IL-8, and tumor necrosis factor-alpha have emerged as predictors of COVID-19 severity and in-hospital mortality. Expert opinion : Despite similarities, COVID-19-CSS appears to be distinct from HLH, MAS, and CRS, and the application of HLH diagnostic scores and criteria to COVID-19 is not supported by emerging data. While immunosuppressive therapy with glucocorticoids has shown a mortality benefit, cytokine inhibitors may hold promise as 'rescue therapies' in severe COVID-19. Given the arguably limited benefit in advanced disease, strategies to prevent the development of COVID-19-CSS are needed.