Cytokine storm intervention in the early stages of COVID-19 pneumonia

Xinjuan Sun, Tianyuan Wang, Dayong Cai, Zhiwei Hu, Jin'an Chen, Hui Liao, Liming Zhi, Hongxia Wei, Zhihong Zhang, Yuying Qiu, Jing Wang, Aiping Wang, Xinjuan Sun, Tianyuan Wang, Dayong Cai, Zhiwei Hu, Jin'an Chen, Hui Liao, Liming Zhi, Hongxia Wei, Zhihong Zhang, Yuying Qiu, Jing Wang, Aiping Wang

Abstract

Clinical intervention in patients with corona virus disease 2019 (COVID-19) has demonstrated a strong upregulation of cytokine production in patients who are critically ill with SARS-CoV2-induced pneumonia. In a retrospective study of 41 patients with COVID-19, most patients with SARS-CoV-2 infection developed mild symptoms, whereas some patients later developed aggravated disease symptoms, and eventually passed away because of multiple organ dysfunction syndrome (MODS), as a consequence of a severe cytokine storm. Guidelines for the diagnosis and treatment of SARS-CoV-2 infected pneumonia were first published January 30th, 2020; these guidelines recommended for the first time that cytokine monitoring should be applied in severely ill patients to reduce pneumonia related mortality. The cytokine storm observed in COVID-19 illness is also an important component of mortality in other viral diseases, including SARS, MERS and influenza. In view of the severe morbidity and mortality of COVID-19 pneumonia, we review the current understanding of treatment of human coronavirus infections from the perspective of a dysregulated cytokine and immune response.

Keywords: COVID-19; Cytokine storm; Inflammation; Lung damage; SARS-CoV2.

Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.

Figures

Fig. 1
Fig. 1
Schematic representation of clinical features versus pathogenic inflammatory cytokine response in SARS-CoV-2 infections.
Fig. 2
Fig. 2
A summary of the process of onset SARS-CoV2 pathogenesis with potential treatment options against the virus-induced cytokine storm.

References

    1. Wu J.T., Leung K., Leung G.M. Nowcasting and forecasting the potential domestic and international spread of the 2019-nCoV outbreak originating in Wuhan, China: a modelling study. Lancet. 2020
    1. Huang C., Wang Y., Li X. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497–506.
    1. Jin Y.H., Cai L., Cheng Z.S. A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus (2019-nCoV) infected pneumonia (standard version) Mil. Med. Res. 2020;7(1):4.
    1. Shimabukuro-Vornhagen A., Godel P., Subklewe M. Cytokine release syndrome. J. Immunother. Cancer. 2018;6(1):56.
    1. Tanaka T., Narazaki M., Kishimoto T. Immunotherapeutic implications of IL-6 blockade for cytokine storm. Immunotherapy. 2016;8(8):959–970.
    1. Hunter C.A., Jones S.A. IL-6 as a keystone cytokine in health and disease. Nat. Immunol. 2015;16(5):448–457.
    1. Pathan N., Hemingway C.A., Alizadeh A.A. Role of interleukin 6 in myocardial dysfunction of meningococcal septic shock. Lancet. 2004;363(9404):203–209.
    1. Hay K.A., Hanafi L.A., Li D. Kinetics and biomarkers of severe cytokine release syndrome after CD19 chimeric antigen receptor-modified T-cell therapy. Blood. 2017;130(21):2295–2306.
    1. Wang D., Hu B., Hu C. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA. 2020
    1. Osterholm M.T. Preparing for the next pandemic. N. Engl. J. Med. 2005;352(18):1839–1842.
    1. Teijaro J.R., Walsh K.B., Rice S., Rosen H., Oldstone M.B. Mapping the innate signaling cascade essential for cytokine storm during influenza virus infection. Proc. Natl. Acad. Sci. U. S. A. 2014;111(10):3799–3804.
    1. Reghunathan R., Jayapal M., Hsu L.Y. Expression profile of immune response genes in patients with Severe Acute Respiratory Syndrome. BMC Immunol. 2005;6:2.
    1. Chien J.Y., Hsueh P.R., Cheng W.C., Yu C.J., Yang P.C. Temporal changes in cytokine/chemokine profiles and pulmonary involvement in severe acute respiratory syndrome. Respirology. 2006;11(6):715–722.
    1. Min C.K., Cheon S., Ha N.Y. Comparative and kinetic analysis of viral shedding and immunological responses in MERS patients representing a broad spectrum of disease severity. Sci. Rep. 2016;6:25359.
    1. Tsang K., Zhong N.S. SARS: pharmacotherapy. Respirology. 2003;8(Suppl):S25–S30.
    1. Xu Z., Shi L., Wang Y. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Respir. Med. 2020
    1. Tian S.H., Hu W., Niu L., Liu H., Xu H., Xiao S. Pulmonary pathology of early phase SARS-COV-2 pneumonia. Preprints. 2020
    1. Bajema K.L., Oster A.M., McGovern O.L. Persons evaluated for 2019 novel coronavirus - United States, January 2020. MMWR Morb. Mortal. Wkly. Rep. 2020;69(6):166–170.
    1. Menachery V.D., Schafer A., Burnum-Johnson K.E. MERS-CoV and H5N1 influenza virus antagonize antigen presentation by altering the epigenetic landscape. Proc. Natl. Acad. Sci. U. S. A. 2018;115(5) E1012-E21.
    1. Ho J.C., Ooi G.C., Mok T.Y. High-dose pulse versus nonpulse corticosteroid regimens in severe acute respiratory syndrome. Am. J. Respir. Crit. Care Med. 2003;168(12):1449–1456.
    1. Yam L.Y., Lau A.C., Lai F.Y. Corticosteroid treatment of severe acute respiratory syndrome in Hong Kong. J. Infect. 2007;54(1):28–39.
    1. Stockman L.J., Bellamy R., Garner P. SARS: systematic review of treatment effects. PLoS Med. 2006;3(9):e343.
    1. Wang D., Hu B., Hu C. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA. 2020
    1. Chen N., Zhou M., Dong X. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395(10223):507–513.
    1. Xu Z., Shi L., Wang Y. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Respir. Med. 2020
    1. Omrani A.S., Saad M.M., Baig K. Ribavirin and interferon alfa-2a for severe Middle East respiratory syndrome coronavirus infection: a retrospective cohort study. Lancet Infect. Dis. 2014;14(11):1090–1095.
    1. Channappanavar R., Fehr A.R., Vijay R. Dysregulated type I interferon and inflammatory monocyte-macrophage responses cause lethal pneumonia in SARS-CoV-infected mice. Cell Host Microbe. 2016;19(2):181–193.
    1. Imai Y., Kuba K., Neely G.G. Identification of oxidative stress and Toll-like receptor 4 signaling as a key pathway of acute lung injury. Cell. 2008;133(2):235–249.
    1. Shirey K.A., Lai W., Scott A.J. The TLR4 antagonist Eritoran protects mice from lethal influenza infection. Nature. 2013;497(7450):498–502.
    1. Teijaro J.R., Walsh K.B., Cahalan S. Endothelial cells are central orchestrators of cytokine amplification during influenza virus infection. Cell. 2011;146(6):980–991.
    1. McQueen J., Jardine A., Kingdom J., Templeton A., Whittle M.J., Connell J.M. Interaction of angiotensin II and atrial natriuretic peptide in the human fetoplacental unit. Am. J. Hypertens. 1990;3(8 Pt 1):641–644.
    1. Leuschner F., Dutta P., Gorbatov R. Therapeutic siRNA silencing in inflammatory monocytes in mice. Nat. Biotechnol. 2011;29(11):1005–1010.
    1. Silvester W. Mediator removal with CRRT: complement and cytokines. Am. J. Kidney Dis. 1997;30(5 Suppl. 4):S38–S43.

Source: PubMed

スポンサーと協力者

医学的状態

薬物療法

3
購読する