Interleukin-1 and the NLRP3 inflammasome in COVID-19: Pathogenetic and therapeutic implications

Nicola Potere1, Marco Giuseppe Del Buono2, Roberto Caricchio3

  • 1Department of Medicine and Ageing Sciences and Department of Innovative Technologies in Medicine and Dentistry, G. D'Annunzio University, Chieti, Italy.

Ebiomedicine
|October 9, 2022
PubMed

Insights

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection triggers the NLRP3 inflammasome, worsening COVID-19. Blocking interleukin-1 (IL-1) with anakinra improved survival in moderate-to-severe cases.

Area of Science:

  • Immunology
  • Virology
  • Pathophysiology

Background:

  • Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can lead to a hyperinflammatory response, worsening COVID-19 outcomes.
  • The SARS-CoV-2 interaction with angiotensin-converting enzyme 2 (ACE2) activates the NACHT, leucine-rich repeat, and pyrin domain-containing protein 3 (NLRP3) inflammasome.
  • Enhanced NLRP3 inflammasome activity correlates with increased COVID-19 severity and poorer prognosis.

Purpose of the Study:

  • To review the role of NLRP3 inflammasome and IL-1β in COVID-19 pathogenesis.
  • To discuss clinical trials investigating IL-1 inhibition for COVID-19 treatment.

Main Methods:

  • Review of current scientific literature on NLRP3 inflammasome activation in COVID-19.
  • Analysis of evidence linking inflammasome activity to disease severity, pulmonary injury, and hypercoagulability.
  • Summary of findings from clinical trials, including the SAVE-MORE trial, evaluating IL-1 blockers.

Main Results:

  • NLRP3 inflammasome activation and subsequent IL-1β release contribute to lung injury and hypercoagulability in COVID-19.
  • Observational studies and the SAVE-MORE trial demonstrated promising results with IL-1 blockers like anakinra.
  • Early anakinra treatment in the SAVE-MORE trial significantly reduced hospital stay and improved survival in moderate-to-severe COVID-19 patients.

Conclusions:

  • The NLRP3 inflammasome and IL-1β play a significant pathogenetic role in severe COVID-19.
  • Targeting IL-1 signaling represents a promising therapeutic strategy for managing moderate-to-severe COVID-19.

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