Cytokine Release Syndrome in COVID-19 Patients, A New Scenario for an Old Concern: The Fragile Balance between Infections and Autoimmunity
On 7 January 2020, researchers isolated and sequenced in China from patients with severe pneumonitis a novel coronavirus, then called SARS-CoV-2, which rapidly spread worldwide, becoming a global health emergency. Typical manifestations consist of flu-like symptoms such as fever, cough, fatigue, and...
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MDPI AG
2020-05-01
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| Series: | International Journal of Molecular Sciences |
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| Online Access: | https://www.mdpi.com/1422-0067/21/9/3330 |
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| author | Andrea Picchianti Diamanti Maria Manuela Rosado Claudio Pioli Giorgio Sesti Bruno Laganà |
| author_facet | Andrea Picchianti Diamanti Maria Manuela Rosado Claudio Pioli Giorgio Sesti Bruno Laganà |
| author_sort | Andrea Picchianti Diamanti |
| collection | DOAJ |
| description | On 7 January 2020, researchers isolated and sequenced in China from patients with severe pneumonitis a novel coronavirus, then called SARS-CoV-2, which rapidly spread worldwide, becoming a global health emergency. Typical manifestations consist of flu-like symptoms such as fever, cough, fatigue, and dyspnea. However, in about 20% of patients, the infection progresses to severe interstitial pneumonia and can induce an uncontrolled host-immune response, leading to a life-threatening condition called cytokine release syndrome (CRS). CRS represents an emergency scenario of a frequent challenge, which is the complex and interwoven link between infections and autoimmunity. Indeed, treatment of CRS involves the use of both antivirals to control the underlying infection and immunosuppressive agents to dampen the aberrant pro-inflammatory response of the host. Several trials, evaluating the safety and effectiveness of immunosuppressants commonly used in rheumatic diseases, are ongoing in patients with COVID-19 and CRS, some of which are achieving promising results. However, such a use should follow a multidisciplinary approach, be accompanied by close monitoring, be tailored to patient’s clinical and serological features, and be initiated at the right time to reach the best results. Autoimmune patients receiving immunosuppressants could be prone to SARS-CoV-2 infections; however, suspension of the ongoing therapy is contraindicated to avoid disease flares and a consequent increase in the infection risk. |
| first_indexed | 2024-03-10T19:58:42Z |
| format | Article |
| id | doaj.art-b93a344feda741a49938ede664181767 |
| institution | Directory Open Access Journal |
| issn | 1661-6596 1422-0067 |
| language | English |
| last_indexed | 2024-03-10T19:58:42Z |
| publishDate | 2020-05-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | International Journal of Molecular Sciences |
| spelling | doaj.art-b93a344feda741a49938ede6641817672023-11-19T23:48:10ZengMDPI AGInternational Journal of Molecular Sciences1661-65961422-00672020-05-01219333010.3390/ijms21093330Cytokine Release Syndrome in COVID-19 Patients, A New Scenario for an Old Concern: The Fragile Balance between Infections and AutoimmunityAndrea Picchianti Diamanti0Maria Manuela Rosado1Claudio Pioli2Giorgio Sesti3Bruno Laganà4Department of Clinical and Molecular Medicine, Sant’Andrea University Hospital, Sapienza University of Rome, 00182 Rome, ItalyResearch Consultant in Immunology, 00100 Rome, ItalyLaboratory of Biomedical Technologies, Division of Health Protection Technologies, Ente per le Nuove Tecnologie, L’energia e l’Ambiente (ENEA), 00196 Rome, ItalyDepartment of Clinical and Molecular Medicine, Sant’Andrea University Hospital, Sapienza University of Rome, 00182 Rome, ItalyDepartment of Clinical and Molecular Medicine, Sant’Andrea University Hospital, Sapienza University of Rome, 00182 Rome, ItalyOn 7 January 2020, researchers isolated and sequenced in China from patients with severe pneumonitis a novel coronavirus, then called SARS-CoV-2, which rapidly spread worldwide, becoming a global health emergency. Typical manifestations consist of flu-like symptoms such as fever, cough, fatigue, and dyspnea. However, in about 20% of patients, the infection progresses to severe interstitial pneumonia and can induce an uncontrolled host-immune response, leading to a life-threatening condition called cytokine release syndrome (CRS). CRS represents an emergency scenario of a frequent challenge, which is the complex and interwoven link between infections and autoimmunity. Indeed, treatment of CRS involves the use of both antivirals to control the underlying infection and immunosuppressive agents to dampen the aberrant pro-inflammatory response of the host. Several trials, evaluating the safety and effectiveness of immunosuppressants commonly used in rheumatic diseases, are ongoing in patients with COVID-19 and CRS, some of which are achieving promising results. However, such a use should follow a multidisciplinary approach, be accompanied by close monitoring, be tailored to patient’s clinical and serological features, and be initiated at the right time to reach the best results. Autoimmune patients receiving immunosuppressants could be prone to SARS-CoV-2 infections; however, suspension of the ongoing therapy is contraindicated to avoid disease flares and a consequent increase in the infection risk.https://www.mdpi.com/1422-0067/21/9/3330SARS-CoV-2COVID-19rheumatoid arthritiscytokine release syndromeautoimmunityimmunomodulation |
| spellingShingle | Andrea Picchianti Diamanti Maria Manuela Rosado Claudio Pioli Giorgio Sesti Bruno Laganà Cytokine Release Syndrome in COVID-19 Patients, A New Scenario for an Old Concern: The Fragile Balance between Infections and Autoimmunity International Journal of Molecular Sciences SARS-CoV-2 COVID-19 rheumatoid arthritis cytokine release syndrome autoimmunity immunomodulation |
| title | Cytokine Release Syndrome in COVID-19 Patients, A New Scenario for an Old Concern: The Fragile Balance between Infections and Autoimmunity |
| title_full | Cytokine Release Syndrome in COVID-19 Patients, A New Scenario for an Old Concern: The Fragile Balance between Infections and Autoimmunity |
| title_fullStr | Cytokine Release Syndrome in COVID-19 Patients, A New Scenario for an Old Concern: The Fragile Balance between Infections and Autoimmunity |
| title_full_unstemmed | Cytokine Release Syndrome in COVID-19 Patients, A New Scenario for an Old Concern: The Fragile Balance between Infections and Autoimmunity |
| title_short | Cytokine Release Syndrome in COVID-19 Patients, A New Scenario for an Old Concern: The Fragile Balance between Infections and Autoimmunity |
| title_sort | cytokine release syndrome in covid 19 patients a new scenario for an old concern the fragile balance between infections and autoimmunity |
| topic | SARS-CoV-2 COVID-19 rheumatoid arthritis cytokine release syndrome autoimmunity immunomodulation |
| url | https://www.mdpi.com/1422-0067/21/9/3330 |
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