Immune interventions in COVID-19: a matter of time?

Immune interventions in COVID-19: a matter of time?
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DOI:
10.1038/s41385-021-00464-w
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发表时间:
2022-03
期刊:
影响因子:
8
通讯作者:
Hermine O
Hermine O
中科院分区:
医学1区
文献类型:
--
作者:
Plaçais L;Richier Q;Noël N;Lacombe K;Mariette X;Hermine O

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由于COVID-19大流行仍在持续,且考虑到迄今为止抗病毒策略缺乏疗效,以及导致组织病变和肺炎的反应性炎症过度,因此比以往任何时候都更需要针对免疫反应失调的有效治疗。在严重的COVID-19中,免疫调节和免疫抑制药物被重新利用,结果截然不同。治疗给药时间的异质性可能是造成这些差异的原因。事实上,许多研究包括不同感染时间点的患者,可能隐藏了时间适应性干预的有益效果。我们的目标是回顾来自动物模型和纵向人体研究的关于β-冠状病毒感染中免疫反应动力学的现有数据,并提出严重COVID-19时间轴的四步模型。然后,我们讨论了免疫干预的临床试验结果与管理的时间,最后提出了一个时间框架,以划定每种治疗的最佳时间点。
As the COVID-19 pandemic is still ongoing, and considering the lack of efficacy of antiviral strategies to this date, and the reactive hyperinflammation leading to tissue lesions and pneumonia, effective treatments targeting the dysregulated immune response are more than ever required. Immunomodulatory and immunosuppressive drugs have been repurposed in severe COVID-19 with contrasting results. The heterogeneity in the timing of treatments administrations could be accountable for these discrepancies. Indeed, many studies included patients at different timepoints of infection, potentially hiding the beneficial effects of a time-adapted intervention. We aim to review the available data on the kinetics of the immune response in beta-coronaviruses infections, from animal models and longitudinal human studies, and propose a four-step model of severe COVID-19 timeline. Then, we discuss the results of the clinical trials of immune interventions with regards to the timing of administration, and finally suggest a time frame in order to delineate the best timepoint for each treatment.
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