SARS-CoV-2 Inflammatory Syndrome. Clinical Features and Rationale for Immunological Treatment

Abstract

The current pandemic coronavirus, SARS-CoV-2, is a global health emergency because of its highly contagious nature, the great number of patients requiring intensive care therapy, and the high fatality rate. In the absence of specific antiviral drugs, passive prophylaxis, or a vaccine, the treatment aim in these patients is to prevent the potent virus-induced inflammatory stimuli from leading to the acute respiratory distress syndrome (ARDS), which has a severe prognosis. Here, the mechanism of action and the rationale for employing immunological strategies, which range from traditional chemically synthesized drugs, anti-cytokine antibodies, human immunoglobulin for intravenous use, to vaccines, are reviewed.

Why is hyperglycaemia worsening COVID‐19 and its prognosis?

“…4 Cytokines, including IL-6 and TNF-alpha, have been found to be elevated in patients with severe COVID-19. 5 Inflammation generates insulin resistance. 6 Therefore, it is possible that during COVID-19, because of the huge production of cytokines, insulin resistance may be exacerbated or de novoinduced.…”

Future perspective: biologic agents in patients with severe COVID-19

“…However, IL-6 blockade also results in rapid reduction of serum IL-10, an immunosuppressive cytokine secreted by macrophages, which may mitigate concerns about prolonging viral clearance [50]. Many antiviral and anti-cytokine monoclonal antibodies are currently available for severe COVID-19, to be used alone or in combination, either at the initial disease stage or to protect patients from a cytokine relaseinflammatory syndrome, preventing ARDS [51]. In some cases, anti-IL6 mAb therapy was successful in stabilizing the alveolar-capillary membrane and preventing/reversing ARDS [52].…”

Hydroxychloroquine and Covid-19: A Cellular and Molecular Biology Based Update

“…According to Centers for Disease Control and Prevention (CDC), USA (available at https://www.cdc.gov/cor onavirus/2019-ncov/symptoms-testing/symptoms.html) and recent literature, Covid-19 infected people demonstrate a wide range of symptoms-ranging from mild symptoms to severe illness. Most common symptoms of confirmed positive Covid-19 patients were fever, cough, shortness of breath, myalgia or fatigue and sore throat; whereas, headache, chills, new loss of taste or smell, sputum production, diarrhea, and vomiting like symptoms may also occur [8][9][10][11][12].…”