Immunopathogenesis of Coronavirus-Induced Acute Respiratory Distress Syndrome (ARDS): Potential Infection-Associated Hemophagocytic Lymphohistiocytosis

Chao Quan; Caiyan Li; Han Ma; Yisha Li; Huali Zhang

doi:10.1128/CMR.00074-20

Immunopathogenesis of Coronavirus-Induced Acute Respiratory Distress Syndrome (ARDS): Potential Infection-Associated Hemophagocytic Lymphohistiocytosis

Clin Microbiol Rev. 2020 Oct 14;34(1):e00074-20. doi: 10.1128/CMR.00074-20. Print 2020 Oct 14.

Authors

Chao Quan^#^{1

2

3}, Caiyan Li^#^{1

2

3}, Han Ma^#^{2

3}, Yisha Li⁴, Huali Zhang^{4

2

3}

Affiliations

¹ Department of Rheumatology, Xiangya Hospital, Central South University, Changsha City, Hunan Province, China.
² Department of Pathophysiology, Xiangya School of Medicine, Central South University, Changsha City, Hunan Province, China.
³ Sepsis Translational Medicine Key Lab of Hunan Province, Central South University, Changsha City, Hunan Province, China.
⁴ Department of Rheumatology, Xiangya Hospital, Central South University, Changsha City, Hunan Province, China liyisha@csu.edu.cn zhanghuali@csu.edu.cn.

^# Contributed equally.

Abstract

The outbreak of coronavirus disease 2019 (COVID-19) in December 2019 in Wuhan, China, introduced the third highly pathogenic coronavirus into humans in the 21st century. Scientific advance after the severe acute respiratory syndrome coronavirus (SARS-CoV) epidemic and Middle East respiratory syndrome coronavirus (MERS-CoV) emergence enabled clinicians to understand the epidemiology and pathophysiology of SARS-CoV-2. In this review, we summarize and discuss the epidemiology, clinical features, and virology of and host immune responses to SARS-CoV, MERS-CoV, and SARS-CoV-2 and the pathogenesis of coronavirus-induced acute respiratory distress syndrome (ARDS). We especially highlight that highly pathogenic coronaviruses might cause infection-associated hemophagocytic lymphohistiocytosis, which is involved in the immunopathogenesis of human coronavirus-induced ARDS, and also discuss the potential implication of hemophagocytic lymphohistiocytosis therapeutics for combating severe coronavirus infection.

Keywords: acute respiratory distress syndrome; hemophagocytic lymphohistiocytosis; human coronavirus.

Publication types

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

MeSH terms

Betacoronavirus / genetics
Betacoronavirus / immunology
Betacoronavirus / pathogenicity
COVID-19
Coronavirus Infections / epidemiology*
Coronavirus Infections / immunology
Coronavirus Infections / mortality
Coronavirus Infections / physiopathology
Cytokine Release Syndrome / epidemiology*
Cytokine Release Syndrome / immunology
Cytokine Release Syndrome / mortality
Cytokine Release Syndrome / physiopathology
Host-Pathogen Interactions
Humans
Infectious Disease Incubation Period
Lung / immunology
Lung / physiopathology
Lung / virology
Lymphohistiocytosis, Hemophagocytic / epidemiology*
Lymphohistiocytosis, Hemophagocytic / immunology
Lymphohistiocytosis, Hemophagocytic / mortality
Lymphohistiocytosis, Hemophagocytic / physiopathology
Middle East Respiratory Syndrome Coronavirus / genetics
Middle East Respiratory Syndrome Coronavirus / immunology
Middle East Respiratory Syndrome Coronavirus / pathogenicity
Pandemics*
Phylogeny
Pneumonia, Viral / epidemiology*
Pneumonia, Viral / immunology
Pneumonia, Viral / mortality
Pneumonia, Viral / physiopathology
SARS-CoV-2
Severe Acute Respiratory Syndrome / epidemiology*
Severe Acute Respiratory Syndrome / immunology
Severe Acute Respiratory Syndrome / mortality
Severe Acute Respiratory Syndrome / physiopathology
Severe acute respiratory syndrome-related coronavirus / genetics
Severe acute respiratory syndrome-related coronavirus / immunology
Severe acute respiratory syndrome-related coronavirus / pathogenicity
Severity of Illness Index
Survival Analysis