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Future perspective: biologic agents in patients with severe COVID-19
Arzu Didem Yalcin1,2, Ata Nevzat Yalcin3
1Department of Internal Medicine, Allergy and Clinical Immunology Section, Biotechnology and Moleculer Biology Unit, Academia Sinica, Genomics Research Center, Taipei, Taiwan.
Immunopharmacology and Immunotoxicology
|September 5, 2020
Summary
Monoclonal antibodies (mAbs) targeting the cytokine storm in COVID-19 may worsen disease if they don't also inhibit the virus. Combination therapies are proposed for severe cases.
Area of Science:
- Virology
- Immunology
- Pharmacology
Background:
- SARS-CoV-2, a beta-coronavirus, triggers a significant immune response.
- This response involves the release of numerous cytokines and mediators, potentially leading to a cytokine storm.
- Cytokine storm can cause multi-organ damage, including myocardial, lung, and hepatorenal injury.
Purpose of the Study:
- To investigate the hypothesis that monoclonal antibodies (mAbs) inhibiting the immune response, but not the virus itself, may exacerbate severe COVID-19.
- To explore the role of specific cytokine antagonists like anakinra, tocilizumab, and omalizumab.
- To propose combination therapies for severe COVID-19 cases.
Main Methods:
- Review of existing literature on SARS-CoV-2 pathogenesis and cytokine storm.
- Analysis of the mechanisms of action for therapeutic monoclonal antibodies (mAbs).
- Examination of potential synergistic effects of mAbs with antiviral drugs.
Main Results:
- Uncontrolled adaptive/hyperimmune responses (cytokine storm) at the endothelium level can lead to severe COVID-19.
- Anakinra, tocilizumab, and omalizumab target key inflammatory mediators (IL-1, IL-6, IgE).
- Combination of mAbs with remdesivir and/or favipiravir is proposed for severe COVID-19.
Conclusions:
- Therapeutic strategies targeting the cytokine storm require careful consideration of their impact on the antiviral immune response.
- Monoclonal antibodies (mAbs) show promise in managing severe COVID-19, particularly when combined with antivirals.
- Further research into combination therapies is warranted for critical COVID-19 patients.
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