Cytokine storm intervention in the early stages of COVID-19 pneumonia

Cytokine Growth Factor Rev. 2020 Jun:53:38-42. doi: 10.1016/j.cytogfr.2020.04.002. Epub 2020 Apr 25.

Abstract

Clinical intervention in patients with corona virus disease 2019 (COVID-19) has demonstrated a strong upregulation of cytokine production in patients who are critically ill with SARS-CoV2-induced pneumonia. In a retrospective study of 41 patients with COVID-19, most patients with SARS-CoV-2 infection developed mild symptoms, whereas some patients later developed aggravated disease symptoms, and eventually passed away because of multiple organ dysfunction syndrome (MODS), as a consequence of a severe cytokine storm. Guidelines for the diagnosis and treatment of SARS-CoV-2 infected pneumonia were first published January 30th, 2020; these guidelines recommended for the first time that cytokine monitoring should be applied in severely ill patients to reduce pneumonia related mortality. The cytokine storm observed in COVID-19 illness is also an important component of mortality in other viral diseases, including SARS, MERS and influenza. In view of the severe morbidity and mortality of COVID-19 pneumonia, we review the current understanding of treatment of human coronavirus infections from the perspective of a dysregulated cytokine and immune response.

Keywords: COVID-19; Cytokine storm; Inflammation; Lung damage; SARS-CoV2.

Publication types

  • Review

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use
  • Antibodies, Monoclonal / therapeutic use
  • Betacoronavirus / immunology*
  • COVID-19
  • Continuous Renal Replacement Therapy / methods
  • Coronavirus Infections / drug therapy
  • Coronavirus Infections / immunology
  • Coronavirus Infections / pathology*
  • Cytokine Release Syndrome / drug therapy
  • Cytokine Release Syndrome / pathology*
  • Cytokines / biosynthesis
  • Cytokines / blood*
  • Female
  • Humans
  • Interferon-alpha / therapeutic use
  • Male
  • Multiple Organ Failure / immunology
  • Multiple Organ Failure / mortality*
  • Multiple Organ Failure / pathology
  • Pandemics
  • Pneumonia, Viral / drug therapy
  • Pneumonia, Viral / immunology
  • Pneumonia, Viral / pathology*
  • Polyethylene Glycols / therapeutic use
  • Recombinant Proteins / therapeutic use
  • Retrospective Studies
  • SARS-CoV-2

Substances

  • Adrenal Cortex Hormones
  • Antibodies, Monoclonal
  • Cytokines
  • Interferon-alpha
  • Recombinant Proteins
  • Polyethylene Glycols
  • peginterferon alfa-2a
  • siltuximab