Are Serum Interleukin 6 and Surfactant Protein D Levels Associated with the Clinical Course of COVID-19?

Kerget, Buğra; Kerget, Ferhan; Koçak, Abdullah Osman; Kızıltunç, Ahmet; Araz, Ömer; Uçar, Elif Yılmazel; Akgün, Metin

doi:10.1007/s00408-020-00393-8

Cited by 68 publications

(74 citation statements)

References 26 publications

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“…Similarly, SP‐D levels increase in respiratory distress syndromes triggered by septic shock as well as in patients affected by severe COVID‐19 alveolar disruption [24].…”

Section: Discussionmentioning

confidence: 99%

Tocilizumab in COVID‐19 interstitial pneumonia

et al. 2021

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Background Published reports on tocilizumab in COVID‐19 pneumonitis show conflicting results due to weak designs or heterogeneity in critical methodological issues. Methods This open‐label trial, structured according to Simon's optimal design, aims to identify factors predicting which patients could benefit from anti‐IL6 strategies and to enhance the design of unequivocal and reliable future randomized trials. A total of 46 patients with COVID‐19 pneumonia needing of oxygen therapy to maintain SO2 > 93% and with recent worsening of lung function received a single infusion of tocilizumab. Clinical and biological markers were measured to test their predictive values. Primary end point was early and sustained clinical response. Results Twenty‐one patients fulfilled pre‐defined response criteria. Lower levels of IL‐6 at 24 h after tocilizumab infusion ( P = 0.049) and higher baseline values of PaO2/FiO2 ( P = 0.008) predicted a favourable response. Conclusions Objective clinical response rate overcame the pre‐defined threshold of 30%. Efficacy of tocilizumab to improve respiratory function in patients selected according to our inclusion criteria warrants investigations in randomized trials.

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“…Similarly, SP‐D levels increase in respiratory distress syndromes triggered by septic shock as well as in patients affected by severe COVID‐19 alveolar disruption [24].…”

Section: Discussionmentioning

confidence: 99%

Tocilizumab in COVID‐19 interstitial pneumonia

et al. 2021

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“…This increase in vascular permeability causes fluid accumulation in lung tissue and the interstitial area, resulting in an acute setting of respiratory failure. Positive results have been reported that IL-1 and IL-6 antagonists can be used to control this setting 13,14 .…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the relationship between KIM-1 and suPAR level in COVID-19 patients and a different perspective on suPAR

Kerget

Kerget²,

Aksakal³

et al. 2021

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Objective: COVID-19 is one of the most important health problems concerning the last century and our knowledge of the disease is still limited. In our study, we aimed to compare serum-soluble urokinase plasminogen activator receptor (suPAR) and kidney injury molecule-1 (KIM-1) level with clinical course in COVID-19 patients. Methods: Our study included 102 patients over the age of 18 who were diagnosed with Covid-19 between September 2020 and December 2020 by taking nasopharyngeal swap and using real time PCR method and 30 volunteer medical personnel over the age of 18 who were PCR negative after the nasopharyngeal swap. KİM-1 and suPAR were measured by enzyme-linked immunosorbent assay. Results: NLR, LDH, prothrombin time, CRP, PaO2/FiO2, D-Dimer, ferritin and fibrinogen levels, which have been mentioned in previous studies to be of prognostic importance for COVID-19, were observed to be higher in the severely ill group (p=0,001, 0,001, 0,05, 0,001, 0,001, 0,005, 0,001, 0,001 respectively). suPAR and KIM-1 levels were statistically significantly higher in patient groups compared to the control group (p=0.001 for all). While suPAR level was statistically significantly lower in severe patients compared to moderate patients (p=0.034), KIM-1 level was observed to be higher in severe patients (p=0.001). Conclusion: The increased level of KIM-1 in severe patients, which is thought to play an important role in the endocytosis of SARS-CoV-2 to the cell, may have an important place for the therapeutic target in the future. SuPAR can be considered to play an important role especially in the defense mechanism and fibrinolysis and its decreased level in severe patients may be associated with poor prognosis in the early period. However, extensive studies are needed to reach a definitive opinion about suPAR.

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“…Plasma levels of SP-D have been found to be elevated in severe acute respiratory syndrome (SARS)-related pneumonia, potentially through leakage from the damaged lung into the blood ( 40 ). Furthermore, recent studies have shown that COVID-19 patients who went on to develop macrophage activation syndrome had significantly higher serum levels of SP-D on admission and that SP-A and SP-D serum levels correlated with more severe COVID-19 disease ( 41 , 42 ). Thus, early work suggests a role for SP-D in SARS-CoV-2 infection, which may modulate infection and the pathologic host inflammatory response.…”

Section: Anti-viral Functions Of Sp-a and Sp-dmentioning

confidence: 99%

SP-A and SP-D: Dual Functioning Immune Molecules With Antiviral and Immunomodulatory Properties

2021

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Surfactant proteins A (SP-A) and D (SP-D) are soluble innate immune molecules which maintain lung homeostasis through their dual roles as anti-infectious and immunomodulatory agents. SP-A and SP-D bind numerous viruses including influenza A virus, respiratory syncytial virus (RSV) and human immunodeficiency virus (HIV), enhancing their clearance from mucosal points of entry and modulating the inflammatory response. They also have diverse roles in mediating innate and adaptive cell functions and in clearing apoptotic cells, allergens and other noxious particles. Here, we review how the properties of these first line defense molecules modulate inflammatory responses, as well as host-mediated immunopathology in response to viral infections. Since SP-A and SP-D are known to offer protection from viral and other infections, if their levels are decreased in some disease states as they are in severe asthma and chronic obstructive pulmonary disease (COPD), this may confer an increased risk of viral infection and exacerbations of disease. Recombinant molecules of SP-A and SP-D could be useful in both blocking respiratory viral infection while also modulating the immune system to prevent excessive inflammatory responses seen in, for example, RSV or coronavirus disease 2019 (COVID-19). Recombinant SP-A and SP-D could have therapeutic potential in neutralizing both current and future strains of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus as well as modulating the inflammation-mediated pathology associated with COVID-19. A recombinant fragment of human (rfh)SP-D has recently been shown to neutralize SARS-CoV-2. Further work investigating the potential therapeutic role of SP-A and SP-D in COVID-19 and other infectious and inflammatory diseases is indicated.

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Are Serum Interleukin 6 and Surfactant Protein D Levels Associated with the Clinical Course of COVID-19?

Cited by 68 publications

References 26 publications

Tocilizumab in COVID‐19 interstitial pneumonia

Tocilizumab in COVID‐19 interstitial pneumonia

Evaluation of the relationship between KIM-1 and suPAR level in COVID-19 patients and a different perspective on suPAR

SP-A and SP-D: Dual Functioning Immune Molecules With Antiviral and Immunomodulatory Properties

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