COVID-19 and immunological regulations - from basic and translational aspects to clinical implications

Area of Science:

• Immunology and Virology
• Infectious Diseases
• Pharmacology

Background:

• The SARS-CoV-2 pandemic presents significant medical challenges beyond acute infection.
• COVID-19 is increasingly recognized to induce substantial immunological alterations.
• These alterations affect key factors relevant to disease pathogenesis and treatment.

Purpose of the Study:

• To review the current knowledge on SARS-CoV-2/COVID-19 interactions with various immune mediators.
• To discuss the implications of these interactions for therapeutic modulation.
• To assess the feasibility of continuing immunomodulatory therapies during the pandemic.

Main Methods:

• Comprehensive literature review on SARS-CoV-2 and immune system interactions.
• Analysis of the impact on acute phase inflammation, T-cell responses (Type 1, 17, 2), B-cell immunity, and checkpoint regulators.
• Evaluation of orally available small molecule pathways (JAK, PDE4, calcineurin) and non-specific immunomodulators.

Main Results:

• SARS-CoV-2 interacts with numerous immune mediators, including TNF, IL-6, IL-12, IL-17, IL-4, and IgE.
• Checkpoint regulators (PD-1, PD-L1, CTLA4) and signaling pathways (JAK, PDE4, calcineurin) are affected.
• Various immunomodulatory drugs (glucocorticosteroids, methotrexate, etc.) and innate immune mechanisms are discussed in context.

Conclusions:

• Understanding SARS-CoV-2's impact on immunological factors is key for therapeutic development.
• Many immunomodulatory treatments can likely be continued during COVID-19, with careful consideration.
• Some existing therapies may even offer benefits in managing COVID-19 symptoms.