Immunopathology and immunotherapeutic strategies in severe acute respiratory syndrome coronavirus 2 infection

Rev Med Virol. 2020 Sep;30(5):e2123. doi: 10.1002/rmv.2123. Epub 2020 Jul 9.

Abstract

The outbreak of coronavirus disease 2019 (COVID-19) and pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become a major concern globally. As of 14 April 2020, more than 1.9 million COVID-19 cases have been reported in 185 countries. Some patients with COVID-19 develop severe clinical manifestations, while others show mild symptoms, suggesting that dysregulation of the host immune response contributes to disease progression and severity. In this review, we have summarized and discussed recent immunological studies focusing on the response of the host immune system and the immunopathology of SARS-CoV-2 infection as well as immunotherapeutic strategies for COVID-19. Immune evasion by SARS-CoV-2, functional exhaustion of lymphocytes, and cytokine storm have been discussed as part of immunopathology mechanisms in SARS-CoV-2 infection. Some potential immunotherapeutic strategies to control the progression of COVID-19, such as passive antibody therapy and use of interferon αβ and IL-6 receptor (IL-6R) inhibitor, have also been discussed. This may help us to understand the immune status of patients with COVID-19, particularly those with severe clinical presentation, and form a basis for further immunotherapeutic investigations.

Keywords: COVID-19; SARS-CoV-2; coronavirus; immune response; immunotherapeutic.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Antibodies, Monoclonal, Humanized / therapeutic use*
  • Antiviral Agents / therapeutic use*
  • Betacoronavirus / drug effects
  • Betacoronavirus / immunology
  • Betacoronavirus / pathogenicity
  • COVID-19
  • COVID-19 Serotherapy
  • Coronavirus Infections / drug therapy*
  • Coronavirus Infections / immunology
  • Coronavirus Infections / therapy
  • Coronavirus Infections / virology
  • Cytokine Release Syndrome / immunology
  • Cytokine Release Syndrome / prevention & control*
  • Cytokine Release Syndrome / virology
  • Disease Progression
  • Gene Expression Regulation
  • Humans
  • Immune Evasion / drug effects*
  • Immune Evasion / genetics
  • Immune Evasion / immunology
  • Immunization, Passive / methods
  • Immunologic Factors / therapeutic use*
  • Interferon Type I / therapeutic use*
  • Lymphocytes / drug effects
  • Lymphocytes / immunology
  • Lymphocytes / virology
  • Molecular Targeted Therapy / methods
  • Pandemics
  • Pneumonia, Viral / drug therapy*
  • Pneumonia, Viral / immunology
  • Pneumonia, Viral / virology
  • Receptors, Interleukin-6 / antagonists & inhibitors
  • Receptors, Interleukin-6 / genetics
  • Receptors, Interleukin-6 / immunology
  • SARS-CoV-2
  • Severity of Illness Index
  • Signal Transduction

Substances

  • Antibodies, Monoclonal, Humanized
  • Antiviral Agents
  • Immunologic Factors
  • Interferon Type I
  • Receptors, Interleukin-6
  • tocilizumab