Cytokine release syndrome: inhibition of pro-inflammatory cytokines as a solution for reducing COVID-19 mortality

Negar Moradian; Mahdi Gouravani; Mohammad Amin Salehi; Arash Heidari; Melika Shafeghat; Michael R Hamblin; Nima Rezaei

doi:10.1684/ecn.2020.0451

Cytokine release syndrome: inhibition of pro-inflammatory cytokines as a solution for reducing COVID-19 mortality

Eur Cytokine Netw. 2020 Sep 1;31(3):81-93. doi: 10.1684/ecn.2020.0451.

Authors

Negar Moradian¹, Mahdi Gouravani¹, Mohammad Amin Salehi¹, Arash Heidari¹, Melika Shafeghat¹, Michael R Hamblin², Nima Rezaei³

Affiliations

¹ Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
² Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, 40 Blossom Street, Boston, MA, 02114, USA, Laser Research Centre, Faculty of Health Science, University of Johannesburg, Doornfontein 2028, South Africa, Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Boston, MA, 02114, USA.
³ Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran, Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.

Abstract

Coronavirus disease (COVID-19) reached pandemic proportions at the beginning of 2020 and continues to be a worldwide concern. End organ damage and acute respiratory distress syndrome are the leading causes of death in severely or critically ill patients. The elevated cytokine levels in severe patients in comparison with mildly affected patients suggest that cytokine release syndrome (CRS) occurs in the severe form of the disease. In this paper, the significant role of pro-inflammatory cytokines, including IL-1, IL-6, and TNF-alpha, and their mechanism of action in the CRS cascade is explained. Potential therapeutic approaches involving anti-IL-6 and anti-TNF-alpha antibodies to fight COVID-19 and reduce mortality rate in severe cases are also discussed.

Keywords: COVID-19; Corona virus; cytokine release syndrome; treatment.

Publication types

Review

MeSH terms

Antibodies / therapeutic use*
COVID-19 Drug Treatment*
COVID-19* / blood
COVID-19* / complications
COVID-19* / mortality
Cytokine Release Syndrome* / blood
Cytokine Release Syndrome* / drug therapy
Cytokine Release Syndrome* / etiology
Cytokine Release Syndrome* / mortality
Humans
Interleukin-6 / antagonists & inhibitors*
Interleukin-6 / blood
Pandemics*
SARS-CoV-2 / metabolism*
Tumor Necrosis Factor-alpha / antagonists & inhibitors*
Tumor Necrosis Factor-alpha / blood

Substances

Antibodies
IL6 protein, human
Interleukin-6
Tumor Necrosis Factor-alpha