BTK Inhibitors in Cancer Patients with COVID-19: "The Winner Will be the One Who Controls That Chaos" (Napoleon Bonaparte)
BTK Inhibitors in Cancer Patients with COVID-19: "The Winner Will be the One Who Controls That Chaos" (Napoleon Bonaparte)
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DOI：
10.1158/1078-0432.ccr-20-1427
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发表时间：
2020-07-15
影响因子：
11.5
通讯作者：
Mato, Anthony R.
中科院分区：
文献类型：
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作者：
Chong, Elise A.;Roeker, Lindsey E.;Mato, Anthony R.
随着新冠肺炎(SARS-CoV-2)大流行的蔓延以及布鲁顿酪氨酸激酶抑制剂(BTKi)治疗新冠肺炎感染患者的数量增加，我们必须考虑停止使用BTKi对我们的患者的利弊。BTK在巨噬细胞极化过程中发挥积极作用，有利于BTKI的延续。通过调节关键的转录因子，BTK可能调节经典的M1和M2极化刺激下游的巨噬细胞极化，并缓解与新冠肺炎相关的高炎症状态。支持停用BTKi，我们注意到继发感染和体液免疫受损的潜在风险增加。我们假设，通过减弱M1极化来钝化SARS-CoV-2的高炎性反应的潜在好处超过了体液免疫受损的潜在风险，更不用说BTKi中断后B细胞恶性肿瘤的快速进展风险。在此基础上，我们建议新冠肺炎患者继续行BTKi治疗。
As the SARS-CoV-2 (COVID-19) pandemic spreads and the number of Bruton's tyrosine kinase inhibitor (BTKi)-treated COVID-19-affected patients grows, we must consider the pros and cons of BTKi discontinuation for our patients. In favor of BTKi continuation, BTK plays an active role in macrophage polarization. By modulating key transcription factors, BTK may regulate macrophage polarization downstream of classic M1 and M2 polarizing stimuli and mitigate the hyperinflammatory state associated with COVID-19. In favor of BTKi discontinuation, we note a potentially increased risk of secondary infections and impaired humoral immunity. We hypothesize that the potential benefit of blunting a hyperinflammatory response to SARS-CoV-2 through attenuation of M1 polarization outweighs the potential risk of impaired humoral immunity, not to mention the risk of rapid progression of B-cell malignancy following BTKi interruption. On the basis of this, we suggest continuing BTKi in patients with COVID-19.