Cytokine Storm in COVID-19-Immunopathological Mechanisms, Clinical Considerations, and Therapeutic Approaches: The REPROGRAM Consortium Position Paper
Cytokine Storm in COVID-19-Immunopathological Mechanisms, Clinical Considerations, and Therapeutic Approaches: The REPROGRAM Consortium Position Paper
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DOI：
10.3389/fimmu.2020.01648
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发表时间：
2020-07-10
影响因子：
7.3
通讯作者：
Kutty, Shelby
中科院分区：
文献类型：
--
作者：
Bhaskar, Sonu;Sinha, Akansha;Kutty, Shelby
细胞因子风暴是一种急性炎症反应，可能导致许多情况下的危重疾病，包括病毒感染、癌症、败血症和多器官衰竭。这一现象已经在感染SARS-CoV-2的危重患者中被牵连，这种新型冠状病毒与新冠肺炎有关。经历细胞因子风暴的新冠肺炎危重患者被认为预后更差，病死率更高。在感染SARS-CoV-2的患者中，细胞因子风暴似乎在新冠肺炎的几种严重表现的发病机制中起着重要作用：急性呼吸窘迫综合征、血栓栓塞性疾病，如大血管闭塞引起的急性缺血性中风和心肌梗死，脑炎、急性肾脏损伤和血管炎(儿童为川崎样综合征，成人为肾血管炎)。了解细胞因子风暴的发病机制不仅有助于揭示该病的风险因素，还有助于制定治疗策略，以调节免疫反应，改善严重疾病高危新冠肺炎患者的预后。在这篇文章中，我们概述了细胞因子风暴及其在新冠肺炎环境中的影响，并确定了可能成为治疗靶点的潜在途径或生物标志物。利用专家意见、新出现的证据和以病例为基础的方法，这份立场文件从预后和治疗的角度提供了对细胞因子风暴的关键见解。
Cytokine storm is an acute hyperinflammatory response that may be responsible for critical illness in many conditions including viral infections, cancer, sepsis, and multi-organ failure. The phenomenon has been implicated in critically ill patients infected with SARS-CoV-2, the novel coronavirus implicated in COVID-19. Critically ill COVID-19 patients experiencing cytokine storm are believed to have a worse prognosis and increased fatality rate. In SARS-CoV-2 infected patients, cytokine storm appears important to the pathogenesis of several severe manifestations of COVID-19: acute respiratory distress syndrome, thromboembolic diseases such as acute ischemic strokes caused by large vessel occlusion and myocardial infarction, encephalitis, acute kidney injury, and vasculitis (Kawasaki-like syndrome in children and renal vasculitis in adult). Understanding the pathogenesis of cytokine storm will help unravel not only risk factors for the condition but also therapeutic strategies to modulate the immune response and deliver improved outcomes in COVID-19 patients at high risk for severe disease. In this article, we present an overview of the cytokine storm and its implications in COVID-19 settings and identify potential pathways or biomarkers that could be targeted for therapy. Leveraging expert opinion, emerging evidence, and a case-based approach, this position paper provides critical insights on cytokine storm from both a prognostic and therapeutic standpoint.