Immune dysregulation and system pathology in COVID-19

Virulence. 2021 Dec;12(1):918-936. doi: 10.1080/21505594.2021.1898790.

Abstract

The coronavirus disease 19 (COVID-19) caused by the novel coronavirus known as SARS-CoV-2 has caused a global public health crisis. As of 7 January 2021, 87,640,402 confirmed cases and 1,891,692 mortalities have been reported worldwide. Studies focusing on the epidemiological and clinical characteristics of COVID-19 patients have suggested a dysregulated immune response characterized by lymphopenia and cytokine storm in these patients. The exaggerated immune response induced by the cytokine storm causes septic shock, acute respiratory distress syndrome (ARDS), and/or multiple organs failure, which increases the fatality rate of patients with SARS-CoV-2 infection. Herein, we review the recent research progress on epidemiology, clinical features, and system pathology in COVID-19. Moreover, we summarized the recent therapeutic strategies, which are either approved, under clinical trial, and/or under investigation by the local or global health authorities. We assume that treatments should focus on the use of antiviral drugs in combination with immunomodulators as well as treatment of the underlying comorbidities.

Keywords: SARS-COV-2; ards and multiple organs failure; covid-19; cytokine release syndrome; lymphopenia; pathogenesis.

Publication types

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

MeSH terms

  • Adaptive Immunity
  • Antiviral Agents / therapeutic use
  • COVID-19 / immunology*
  • COVID-19 / pathology*
  • COVID-19 / virology
  • COVID-19 Drug Treatment
  • Cytokine Release Syndrome / drug therapy
  • Cytokine Release Syndrome / immunology
  • Cytokine Release Syndrome / pathology
  • Cytokine Release Syndrome / virology
  • Humans
  • Immunity, Innate
  • Immunologic Factors / therapeutic use
  • Lymphopenia / drug therapy
  • Lymphopenia / immunology
  • Lymphopenia / pathology
  • Lymphopenia / virology
  • SARS-CoV-2 / immunology
  • SARS-CoV-2 / pathogenicity*
  • Viral Load

Substances

  • Antiviral Agents
  • Immunologic Factors

Grants and funding

This work was supported by the National Natural Science Foundation of China (No. 81770180) and Hubei Provincial Natural Science Fund for Creative Research Groups (2018CFA018).