The Society for Immunotherapy of Cancer perspective on regulation of interleukin-6 signaling in COVID-19-related systemic inflammatory response
The Society for Immunotherapy of Cancer perspective on regulation of interleukin-6 signaling in COVID-19-related systemic inflammatory response
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DOI：
10.1136/jitc-2020-000930
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发表时间：
2020-01-01
影响因子：
10.9
通讯作者：
Ascierto, Paolo Antonio
中科院分区：
文献类型：
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作者：
Arnaldez, Fernanda, I;O'Day, Steven J.;Ascierto, Paolo Antonio
由新型冠状病毒SARS-CoV-2引起的大流行给世界各地的医疗系统带来了前所未有的负担。在经历严重疾病的患者中，急性呼吸窘迫通常伴有病理性免疫反应，有时被称为“细胞因子风暴”。在死于肺炎和缺氧的COVID-19患者中观察到的严重炎症状态的一个标志性特征是血清细胞因子显著升高，特别是干扰素γ、肿瘤坏死因子α、白细胞介素17（IL-17）、白细胞介素8（IL-8）和白细胞介素6（IL-6）。来自意大利、中国和美国疫情的初步经验表明，给予尼古丁调节疗法，特别是抗IL-6药物，可改善COVID-19重症患者的结局。虽然正在进行的试验正在研究抗IL-6疗法，但获得这些疗法是一个问题，特别是随着全球病例数量继续攀升。免疫学方法可能有助于确定替代药物，以调节COVID-19患者中观察到的病理性炎症。根据这些和其他免疫调节疗法的广泛经验，癌症免疫治疗学会提出了抗IL-6的潜在替代方案，这些替代方案也可能值得考虑用于管理严重COVID-19患者中可见的全身炎症反应和肺损害。
The pandemic caused by the novel coronavirus SARS-CoV-2 has placed an unprecedented burden on healthcare systems around the world. In patients who experience severe disease, acute respiratory distress is often accompanied by a pathological immune reaction, sometimes referred to as 'cytokine storm'. One hallmark feature of the profound inflammatory state seen in patients with COVID-19 who succumb to pneumonia and hypoxia is marked elevation of serum cytokines, especially interferon gamma, tumor necrosis factor alpha, interleukin 17 (IL-17), interleukin 8 (IL-8) and interleukin 6 (IL-6). Initial experience from the outbreaks in Italy, China and the USA has anecdotally demonstrated improved outcomes for critically ill patients with COVID-19 with the administration of cytokine-modulatory therapies, especially anti-IL-6 agents. Although ongoing trials are investigating anti-IL-6 therapies, access to these therapies is a concern, especially as the numbers of cases worldwide continue to climb. An immunology-informed approach may help identify alternative agents to modulate the pathological inflammation seen in patients with COVID-19. Drawing on extensive experience administering these and other immune-modulating therapies, the Society for Immunotherapy of Cancer offers this perspective on potential alternatives to anti-IL-6 that may also warrant consideration for management of the systemic inflammatory response and pulmonary compromise that can be seen in patients with severe COVID-19.