COVID-19 and cytokine storm syndrome: are there lessons from macrophage activation syndrome?
COVID-19 and cytokine storm syndrome: are there lessons from macrophage activation syndrome?
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DOI：
10.1016/j.trsl.2021.03.002
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发表时间：
2021-06
期刊：
影响因子：
--
通讯作者：
Schulert GS
中科院分区：
文献类型：
--
作者：
Ombrello MJ;Schulert GS
尽管对“细胞因子风暴”的兴趣在过去十年激增，但在2020年，当有人提出一部分COVID-19患者出现一种细胞因子风暴时，这种兴趣被大量放大。细胞因子风暴综合征（CSS）的概念包括各种条件或情况下，合并周围的潜在致命的过度炎症与血流动力学损害和多器官功能障碍综合征。巨噬细胞活化综合征（MAS）是CSS的一种原型形式，在风湿性疾病，特别是全身性幼年特发性关节炎的背景下发展。MAS的治疗在很大程度上依赖于皮质类固醇和细胞因子抑制剂，这已被证明是MAS以及其他形式的CSS的救命疗法。在SARS-CoV 2被确认为人类病原体后的几个月内，出现了COVID-19患者的过度炎症描述。医生们立即努力为这些患者确定最佳治疗策略，尽管临床上存在差异，例如与COVID-19相关的显著凝血障碍伴内皮损伤，但借鉴了MAS和其他CSS的经验。在COVID-19中使用抗细胞因子药物治疗患者的初步报告是有希望的，但最近对这些药物进行的大型、对照更好的研究结果喜忧参半，表明其病理生理学更为复杂。在这里，我们讨论了COVID-19中MAS和过度炎症之间的临床特征、免疫学参数和治疗反应数据的比较如何为CSS的病理生理学提供新的见解。
Although interest in “cytokine storms” has surged over the past decade, it was massively amplified in 2020 when it was suggested that a subset of patients with COVID-19 developed a form of cytokine storm. The concept of cytokine storm syndromes (CSS) encompasses diverse conditions or circumstances that coalesce around potentially lethal hyperinflammation with hemodynamic compromise and multiple organ dysfunction syndrome. Macrophage activation syndrome (MAS) is a prototypic form of CSS that develops in the context of rheumatic diseases, particularly systemic juvenile idiopathic arthritis. The treatment of MAS relies heavily upon corticosteroids and cytokine inhibitors, which have proven to be lifesaving therapies in MAS, as well as in other forms of CSS. Within months of the recognition of SARS-CoV2 as a human pathogen, descriptions of COVID-19 patients with hyperinflammation emerged. Physicians immediately grappled with identifying optimal therapeutic strategies for these patients, and despite clinical distinctions such as marked coagulopathy with endothelial injury associated with COVID-19, borrowed from the experiences with MAS and other CSS. Initial reports of patients treated with anti-cytokine agents in COVID-19 were promising, but recent large, better-controlled studies of these agents have had mixed results suggesting a more complex pathophysiology. Here, we discuss how the comparison of clinical features, immunologic parameters and therapeutic response data between MAS and hyperinflammation in COVID-19 can provide new insight into the pathophysiology of CSS.
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影响因子：
25.4
作者：
Guaraldi, Giovanni;Meschiari, Marianna;Mussini, Cristina
通讯作者：
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DOI：
10.1126/science.abd4585
发表时间：
2020-10-23
期刊：
Science (New York, N.Y.)
影响因子：
--
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