Immunosuppression drug-related and clinical manifestation of Coronavirus disease 2019: A therapeutical hypothesis

Romanelli, Antonio; Mascolo, Silvia

doi:10.1111/ajt.15905

Cited by 86 publications

(91 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…[17][18][19] In a func- 14,22 Counter-intuitively, immunosuppression has been proposed as a therapeutic option or "protective factor" by tampering the immune response that contributes to hyperinflammatory injury to the lungs from elevated cytokines. 4,23 The COVID-19 pandemic has being referred to as a gerolavic (from Greek, géros "old man" and epilavís, "harmful") infection because of substantially higher infection rates, severity, and lethality in the elderly population known to have immunosenescence. 24 If a suppressed or senescent immune system is "protective" from inflammatory injury, one would argue that the elderly population should be less susceptible to COVID-related mortality, contrary to reality.…”

Section: Discussionmentioning

confidence: 99%

COVID‐19 pneumonia in kidney transplant recipients: Focus on immunosuppression management

Chen

Farghaly

Cham

et al. 2020

Transplant Infectious Dis

View full text Add to dashboard Cite

The coronavirus disease of 2019, also known as COVID-19, has been declared a global pandemic due to its rapid spread and illness severity. As of June 14, 2020, over two million cases of COVID-19 have been reported in the United States, with over 115 000 deaths and counting. New York State in particular has become the epicenter of the virus, with the highest number of reported cases in the world. 1,2 This widespread disease is caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), a single-stranded

show abstract

Section: Discussionmentioning

confidence: 99%

COVID‐19 pneumonia in kidney transplant recipients: Focus on immunosuppression management

Chen

Farghaly

Cham

et al. 2020

Transplant Infectious Dis

View full text Add to dashboard Cite

show abstract

“…12 The current prevailing assumption is that immunosuppression is an additive risk that would predispose HTx patients to a more severe disease course. However, the pathognomonic inflammatory surge [13][14][15] that actuates severe COVID-19 disease could be attenuated in an immunocompromised host potentially leading to improved outcomes 16 in some patients. With the exception of the report by Latif et al, 12 the published experience of COVID-19 in HTx is sparse and largely encapsulated within a broader transplant umbrella encompassing kidney transplant series, 17,18 heterogeneous cohorts of solid organ transplants, 19,20 and isolated case reports in patients with a remote history of HTx.…”

Section: Introductionmentioning

confidence: 99%

COVID‐19 in recent heart transplant recipients: Clinicopathologic features and early outcomes

Lima

Gibson

Vullaganti

et al. 2020

Transplant Infectious Dis

View full text Add to dashboard Cite

Background: The impact of COVID-19 on heart transplant (HTx) recipients remains unclear, particularly in the early post-transplant period. Methods: We share novel insights from our experience in five HTx patients with COVID-19 (three within 2 months post-transplant) from our institution at the epicenter of the pandemic. Results: All five exhibited moderate (requiring hospitalization, n = 3) or severe (requiring ICU and/or mechanical ventilation, n = 2) illness. Both cases with severe illness were transplanted approximately 6 weeks before presentation and acquired COVID-19 through community spread. All five patients were on immunosuppressive therapy with mycophenolate mofetil (MMF) and tacrolimus, and three that were transplanted within the prior 2 months were additionally on prednisone. The two cases with severe illness had profound lymphopenia with markedly elevated C-reactive protein, procalcitonin, and ferritin. All had bilateral ground-glass opacities on chest imaging. MMF was discontinued in all five, and both severe cases received convalescent plasma. All three recent transplants underwent routine endomyocardial biopsies, revealing mild (n = 1) or no acute cellular rejection (n = 2), and no visible viral particles on electron microscopy. Within 30 days of admission, the two cases with severe illness remain hospitalized but have clinically improved, while the other three have been discharged.

show abstract

“…Furthermore, methylprednisolone pulse therapy (30 mg/kg/day or 1 g/day for adults) is used for 3 or more consecutive days for severe infectious disease and immune-mediated diseases such as MP pneumonia, lupus nephritis, KD, acute central nervous system diseases, and even advanced chronic kidney diseases, 117,118) although the diseases are rare in older individuals. During this pandemic, some organ transplant recipients treated with T-cell suppressants seem to be protected from pneumonia, 119) and older patients receiving anticancer drugs can recover from severe COVID-19. 120) ARDS patients treated with corticosteroids and convalescent plasma show the rapid resolution of pneumonia lesions and clinical improvement.…”

Section: Treatmentmentioning

confidence: 99%

Immunopathogenesis of COVID-19 and early immunomodulators

2020

View full text Add to dashboard Cite

The novel coronavirus disease 2019 (COVID-19) is spreading globally. Although its etiologic agent is discovered as severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), there are many unsolved issues in COVID-19 and other infectious diseases. The causes of different clinical phenotypes and incubation periods among individuals, species specificity, and cytokine storm with lymphopenia as well as the mechanism of damage to organ cells are unknown. It has been suggested that in viral pneumonia, virus itself is not a direct cause of acute lung injury; rather, aberrant immune reactions of the host to the insults from viral infection are responsible. According to its epidemiological and clinical characteristics, SARS-CoV-2 may be a virus with low virulence in nature that has adapted to the human species. Current immunological concepts have limited ability to explain such unsolved issues, and a presumed immunopathogenesis of COVID-19 is presented under the proteinhomeostasis-system hypothesis. Every disease, including COVID-19, has etiological substances controlled by the host immune system according to size and biochemical properties. Patients with severe pneumonia caused by SARS-CoV-2 show more severe hypercytokinemia with corresponding lymphocytopenia than patients with mild pneumonia; thus, early immunomodulator treatment, including corticosteroids, has been considered. However, current guidelines recommend their use only for patients with advanced pneumonia or acute respiratory distress syndrome. Since the immunopathogenesis of pneumonia may be the same for all patients regardless of age or severity and the critical immune-mediated lung injury may begin in the early stage of the disease, early immunomodulator treatment, including corticosteroids and intravenous immunoglobulin, can help reduce morbidity and possibly mortality rates of older patients with underlying conditions.

show abstract

Immunosuppression drug-related and clinical manifestation of Coronavirus disease 2019: A therapeutical hypothesis

Cited by 86 publications

References 5 publications

COVID‐19 pneumonia in kidney transplant recipients: Focus on immunosuppression management

COVID‐19 pneumonia in kidney transplant recipients: Focus on immunosuppression management

COVID‐19 in recent heart transplant recipients: Clinicopathologic features and early outcomes

Immunopathogenesis of COVID-19 and early immunomodulators

Contact Info

Product

Resources

About