On the Alert for Cytokine Storm: Immunopathology in <scp>COVID</scp>‐19

Henderson, Lauren A.; Canna, Scott; Schulert, Grant S.; Volpi, Stefano; Lee, Pui Y.; Kernan, Kate F.; Caricchio, Roberto; Mahmud, Shawn A.; Hazen, Melissa; Halyabar, Olha; Hoyt, Kacie J.; Han, Joseph; Grom, Alexei A.; Gattorno, Marco; Ravelli, Angelo; Benedetti, Fabrizio; Behrens, Edward M.; Cron, Randy Q.; Nigrovic, Peter A.

doi:10.1002/art.41285

Cited by 603 publications

(633 citation statements)

References 17 publications

(19 reference statements)

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“…To that end, several serologic markers have been proposed, such as the presence of thrombocytopenia, lymphopenia, and increased levels of D-dimer and ferritin [46]. Some authors have also reported a role for IL-6 and IL-10 in monitoring COVID-19 patients.…”

Section: Figurementioning

confidence: 99%

Cytokine Release Syndrome in COVID-19 Patients, A New Scenario for an Old Concern: The Fragile Balance between Infections and Autoimmunity

Picchianti-Diamanti

Rosado

Pioli

et al. 2020

IJMS

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On 7 January 2020, researchers isolated and sequenced in China from patients with severe pneumonitis a novel coronavirus, then called SARS-CoV-2, which rapidly spread worldwide, becoming a global health emergency. Typical manifestations consist of flu-like symptoms such as fever, cough, fatigue, and dyspnea. However, in about 20% of patients, the infection progresses to severe interstitial pneumonia and can induce an uncontrolled host-immune response, leading to a life-threatening condition called cytokine release syndrome (CRS). CRS represents an emergency scenario of a frequent challenge, which is the complex and interwoven link between infections and autoimmunity. Indeed, treatment of CRS involves the use of both antivirals to control the underlying infection and immunosuppressive agents to dampen the aberrant pro-inflammatory response of the host. Several trials, evaluating the safety and effectiveness of immunosuppressants commonly used in rheumatic diseases, are ongoing in patients with COVID-19 and CRS, some of which are achieving promising results. However, such a use should follow a multidisciplinary approach, be accompanied by close monitoring, be tailored to patient's clinical and serological features, and be initiated at the right time to reach the best results. Autoimmune patients receiving immunosuppressants could be prone to SARS-CoV-2 infections; however, suspension of the ongoing therapy is contraindicated to avoid disease flares and a consequent increase in the infection risk.

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Section: Figurementioning

confidence: 99%

Cytokine Release Syndrome in COVID-19 Patients, A New Scenario for an Old Concern: The Fragile Balance between Infections and Autoimmunity

Picchianti-Diamanti

Rosado

Pioli

et al. 2020

IJMS

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“…It is currently thought that SARS-CoV2 induces a type of cytokine storm, with fever, thrombocytopenia, lymphopenia, coagulopathy, hepatic damage, macrophage activation, and eventually ARDS and septic shock with multiple organ failure. [8][9][10] Early studies show interleukin-6 (Il-6) elevation may correlate with an increased severity of COVID-19, and some have suggested using it as a marker for severity assessment. 11,12 Blockade of Il-6 has shown promise as a treatment for the hyperinflammatory response of COVID-19 and additional trials are ongoing.…”

Section: Accepted Articlementioning

confidence: 99%

“…11,12 Blockade of Il-6 has shown promise as a treatment for the hyperinflammatory response of COVID-19 and additional trials are ongoing. 9,10 As CGRP is known to enhance cytokine dependent Il-6 production, 13 one might hypothesize that our newer migraine treatments that block the CGRP pathway might also help mitigate the hyperinflammatory response in severe cases of COVID-19.…”

Section: Accepted Articlementioning

confidence: 99%

Could CGRP Antagonists Be Helpful in the Fight Against COVID‐19?

Robertson

2020

Headache

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“…The severe lung and systemic inflammatory manifestations observed in severe acute respiratory distress syndrome-coronavirus-2 (SARS-CoV-2) infection, have led to the hypothesis of a hyperinflammatory mechanism, more dependent on the host response than on direct viral cellular damage (1,2). Certain parallelisms with other cytokine storm situations, such as macrophage activation syndrome (MAS) or chimeric antigen receptor T cells (CAR-T) associated systemic inflammatory syndromes have been invoked in support.…”

Section: Introductionmentioning

confidence: 99%

Prevalence of Hospital PCR Confirmed COVID-19 Cases in Patients with Chronic Inflammatory and Autoimmune Rheumatic Diseases

Pablos

Abásolo-Alcazar

Álvaro‐Gracia

et al. 2020

Preprint

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Background. The susceptibility of patients with rheumatic diseases, and the risks or benefits of immunosuppressive therapies for COVID-19 are unknown. Methods.We performed a retrospective study with patients under follow-up in rheumatology departments from seven hospitals in Spain. We matched updated databases of rheumatology patients with SARS-CoV-2 positive PCR tests performed in the hospital to the same reference populations. Incidences of PCR+ confirmed COVID-19 were compared among groups. Results.Patients with chronic inflammatory diseases had 1.32-fold higher prevalence of hospital PCR+ COVID-19 than the reference population (0.76% vs 0.58%). Systemic autoimmune or immune mediated diseases (AI/IMID) patients showed a significant increase, whereas inflammatory arthritis (IA) or systemic lupus erythematosus (SLE) patients did not. COVID-19 cases in some but not all diagnostic groups had older ages than cases in the reference population. IA patients on targeted-synthetic or biological disease-modifying antirheumatic drugs (ts/bDMARD), but not those on conventional-synthetic (csDMARD), had a greater prevalence despite a similar age distribution. Conclusion.Patients with AI/IMID show a variable risk of hospital diagnosed COVID-19. Interplay of aging, therapies, and disease specific factors seem to contribute. These data provide a basis to improve preventive recommendations to rheumatic patients and to analyze the specific factors involved in COVID-19 susceptibility.All rights reserved. No reuse allowed without permission.(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

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On the Alert for Cytokine Storm: Immunopathology in COVID‐19

Cited by 603 publications

References 17 publications

Cytokine Release Syndrome in COVID-19 Patients, A New Scenario for an Old Concern: The Fragile Balance between Infections and Autoimmunity

Cytokine Release Syndrome in COVID-19 Patients, A New Scenario for an Old Concern: The Fragile Balance between Infections and Autoimmunity

Could CGRP Antagonists Be Helpful in the Fight Against COVID‐19?

Prevalence of Hospital PCR Confirmed COVID-19 Cases in Patients with Chronic Inflammatory and Autoimmune Rheumatic Diseases

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