Cytokine Storm in COVID-19: The Current Evidence and Treatment Strategies

Severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) is the pathogen that causes coronavirus disease 2019 (COVID-19). As of 25 May 2020, the outbreak of COVID-19 has caused 347,192 deaths around the world. The current evidence showed that severely ill patients tend to have a high concentrati...

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Published in:	Frontiers in immunology Vol. 11; p. 1708
Main Authors:	Tang, Yujun, Liu, Jiajia, Zhang, Dingyi, Xu, Zhenghao, Ji, Jinjun, Wen, Chengping
Format:	Journal Article
Language:	English
Published:	Switzerland Frontiers Media S.A 10.07.2020
Subjects:	Adrenal Cortex Hormones - therapeutic use Animals Antibodies, Monoclonal, Humanized - pharmacology Antibodies, Monoclonal, Humanized - therapeutic use antimalarial agents Antimalarials - therapeutic use Artesunate - therapeutic use Betacoronavirus - immunology Coronavirus Infections - drug therapy Coronavirus Infections - immunology Coronavirus Infections - virology COVID-19 cytokine storm Hemoperfusion - methods Humans Hydroxychloroquine - therapeutic use Immunoglobulins, Intravenous - therapeutic use Immunology immunoregulation Interleukin-6 - antagonists & inhibitors Interleukin-6 - metabolism Mice Pandemics Pneumonia, Viral - drug therapy Pneumonia, Viral - immunology Pneumonia, Viral - virology Programmed Cell Death 1 Receptor - antagonists & inhibitors SARS-CoV-2 tocilizumab treatment strategies COVID-19 immunoregulation antimalarial agents tocilizumab treatment strategies cytokine storm
ISSN:	1664-3224, 1664-3224
Online Access:	Get full text
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Abstract	Severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) is the pathogen that causes coronavirus disease 2019 (COVID-19). As of 25 May 2020, the outbreak of COVID-19 has caused 347,192 deaths around the world. The current evidence showed that severely ill patients tend to have a high concentration of pro-inflammatory cytokines, such as interleukin (IL)-6, compared to those who are moderately ill. The high level of cytokines also indicates a poor prognosis in COVID-19. Besides, excessive infiltration of pro-inflammatory cells, mainly involving macrophages and T-helper 17 cells, has been found in lung tissues of patients with COVID-19 by postmortem examination. Recently, increasing studies indicate that the "cytokine storm" may contribute to the mortality of COVID-19. Here, we summarize the clinical and pathologic features of the cytokine storm in COVID-19. Our review shows that SARS-Cov-2 selectively induces a high level of IL-6 and results in the exhaustion of lymphocytes. The current evidence indicates that tocilizumab, an IL-6 inhibitor, is relatively effective and safe. Besides, corticosteroids, programmed cell death protein (PD)-1/PD-L1 checkpoint inhibition, cytokine-adsorption devices, intravenous immunoglobulin, and antimalarial agents could be potentially useful and reliable approaches to counteract cytokine storm in COVID-19 patients.
AbstractList	Severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) is the pathogen that causes coronavirus disease 2019 (COVID-19). As of 25 May 2020, the outbreak of COVID-19 has caused 347,192 deaths around the world. The current evidence showed that severely ill patients tend to have a high concentration of pro-inflammatory cytokines, such as interleukin (IL)-6, compared to those who are moderately ill. The high level of cytokines also indicates a poor prognosis in COVID-19. Besides, excessive infiltration of pro-inflammatory cells, mainly involving macrophages and T-helper 17 cells, has been found in lung tissues of patients with COVID-19 by postmortem examination. Recently, increasing studies indicate that the “cytokine storm” may contribute to the mortality of COVID-19. Here, we summarize the clinical and pathologic features of the cytokine storm in COVID-19. Our review shows that SARS-Cov-2 selectively induces a high level of IL-6 and results in the exhaustion of lymphocytes. The current evidence indicates that tocilizumab, an IL-6 inhibitor, is relatively effective and safe. Besides, corticosteroids, programmed cell death protein (PD)-1/PD-L1 checkpoint inhibition, cytokine-adsorption devices, intravenous immunoglobulin, and antimalarial agents could be potentially useful and reliable approaches to counteract cytokine storm in COVID-19 patients. Severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) is the pathogen that causes coronavirus disease 2019 (COVID-19). As of 25 May 2020, the outbreak of COVID-19 has caused 347,192 deaths around the world. The current evidence showed that severely ill patients tend to have a high concentration of pro-inflammatory cytokines, such as interleukin (IL)-6, compared to those who are moderately ill. The high level of cytokines also indicates a poor prognosis in COVID-19. Besides, excessive infiltration of pro-inflammatory cells, mainly involving macrophages and T-helper 17 cells, has been found in lung tissues of patients with COVID-19 by postmortem examination. Recently, increasing studies indicate that the "cytokine storm" may contribute to the mortality of COVID-19. Here, we summarize the clinical and pathologic features of the cytokine storm in COVID-19. Our review shows that SARS-Cov-2 selectively induces a high level of IL-6 and results in the exhaustion of lymphocytes. The current evidence indicates that tocilizumab, an IL-6 inhibitor, is relatively effective and safe. Besides, corticosteroids, programmed cell death protein (PD)-1/PD-L1 checkpoint inhibition, cytokine-adsorption devices, intravenous immunoglobulin, and antimalarial agents could be potentially useful and reliable approaches to counteract cytokine storm in COVID-19 patients.Severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) is the pathogen that causes coronavirus disease 2019 (COVID-19). As of 25 May 2020, the outbreak of COVID-19 has caused 347,192 deaths around the world. The current evidence showed that severely ill patients tend to have a high concentration of pro-inflammatory cytokines, such as interleukin (IL)-6, compared to those who are moderately ill. The high level of cytokines also indicates a poor prognosis in COVID-19. Besides, excessive infiltration of pro-inflammatory cells, mainly involving macrophages and T-helper 17 cells, has been found in lung tissues of patients with COVID-19 by postmortem examination. Recently, increasing studies indicate that the "cytokine storm" may contribute to the mortality of COVID-19. Here, we summarize the clinical and pathologic features of the cytokine storm in COVID-19. Our review shows that SARS-Cov-2 selectively induces a high level of IL-6 and results in the exhaustion of lymphocytes. The current evidence indicates that tocilizumab, an IL-6 inhibitor, is relatively effective and safe. Besides, corticosteroids, programmed cell death protein (PD)-1/PD-L1 checkpoint inhibition, cytokine-adsorption devices, intravenous immunoglobulin, and antimalarial agents could be potentially useful and reliable approaches to counteract cytokine storm in COVID-19 patients.
Author	Xu, Zhenghao Tang, Yujun Zhang, Dingyi Liu, Jiajia Ji, Jinjun Wen, Chengping
AuthorAffiliation	College of Basic Medical Science, Zhejiang Chinese Medical University , Hangzhou , China
AuthorAffiliation_xml	– name: College of Basic Medical Science, Zhejiang Chinese Medical University , Hangzhou , China
Author_xml	– sequence: 1 givenname: Yujun surname: Tang fullname: Tang, Yujun – sequence: 2 givenname: Jiajia surname: Liu fullname: Liu, Jiajia – sequence: 3 givenname: Dingyi surname: Zhang fullname: Zhang, Dingyi – sequence: 4 givenname: Zhenghao surname: Xu fullname: Xu, Zhenghao – sequence: 5 givenname: Jinjun surname: Ji fullname: Ji, Jinjun – sequence: 6 givenname: Chengping surname: Wen fullname: Wen, Chengping
BackLink	https://www.ncbi.nlm.nih.gov/pubmed/32754163$$D View this record in MEDLINE/PubMed
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Keywords	COVID-19 immunoregulation antimalarial agents tocilizumab treatment strategies cytokine storm
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Notes	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 ObjectType-Review-3 content type line 23 Edited by: Mario Clerici, University of Milan, Italy These authors have contributed equally to this work Reviewed by: Vijayakumar Velu, Emory University, United States; Sarah Rowland-Jones, University of Oxford, United Kingdom This article was submitted to Viral Immunology, a section of the journal Frontiers in Immunology
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Snippet	Severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) is the pathogen that causes coronavirus disease 2019 (COVID-19). As of 25 May 2020, the outbreak...
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SubjectTerms	Adrenal Cortex Hormones - therapeutic use Animals Antibodies, Monoclonal, Humanized - pharmacology Antibodies, Monoclonal, Humanized - therapeutic use antimalarial agents Antimalarials - therapeutic use Artesunate - therapeutic use Betacoronavirus - immunology Coronavirus Infections - drug therapy Coronavirus Infections - immunology Coronavirus Infections - virology COVID-19 cytokine storm Hemoperfusion - methods Humans Hydroxychloroquine - therapeutic use Immunoglobulins, Intravenous - therapeutic use Immunology immunoregulation Interleukin-6 - antagonists & inhibitors Interleukin-6 - metabolism Mice Pandemics Pneumonia, Viral - drug therapy Pneumonia, Viral - immunology Pneumonia, Viral - virology Programmed Cell Death 1 Receptor - antagonists & inhibitors SARS-CoV-2 tocilizumab treatment strategies
Title	Cytokine Storm in COVID-19: The Current Evidence and Treatment Strategies
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