From Cytokine Storm to Cytokine Breeze: Did Lessons Learned from Immunopathogenesis Improve Immunomodulatory Treatment of Moderate-to-Severe COVID-19?
Complex immune response to infection has been highlighted, more than ever, during the COVID-19 pandemic. This review explores the immunomodulatory treatment of moderate-to-severe forms of this viral sepsis in the context of specific immunopathogenesis. Our objective is to analyze in detail the exist...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-10-01
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| Series: | Biomedicines |
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| Online Access: | https://www.mdpi.com/2227-9059/10/10/2620 |
| _version_ | 1797475030242689024 |
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| author | Goran Rondovic Dragan Djordjevic Ivo Udovicic Ivan Stanojevic Snjezana Zeba Tanja Abazovic Danilo Vojvodic Dzihan Abazovic Wasim Khan Maja Surbatovic |
| author_facet | Goran Rondovic Dragan Djordjevic Ivo Udovicic Ivan Stanojevic Snjezana Zeba Tanja Abazovic Danilo Vojvodic Dzihan Abazovic Wasim Khan Maja Surbatovic |
| author_sort | Goran Rondovic |
| collection | DOAJ |
| description | Complex immune response to infection has been highlighted, more than ever, during the COVID-19 pandemic. This review explores the immunomodulatory treatment of moderate-to-severe forms of this viral sepsis in the context of specific immunopathogenesis. Our objective is to analyze in detail the existing strategies for the use of immunomodulators in COVID-19. Immunomodulating therapy is very challenging; there are still underpowered or, in other ways, insufficient studies with inconclusive or conflicting results regarding a rationale for adding a second immunomodulatory drug to dexamethasone. Bearing in mind that a “cytokine storm” is not present in the majority of COVID-19 patients, it is to be expected that the path to the adequate choice of a second immunomodulatory drug is paved with uncertainty. Anakinra, a recombinant human IL-1 receptor antagonist, is a good choice in this setting. Yet, the latest update of the COVID-19 Treatment Guidelines Panel (31 May 2022) claims that there is insufficient evidence to recommend either for or against the use of anakinra for the treatment of COVID-19. EMA’s human medicines committee recommended extending the indication of anakinra to include treatment of COVID-19 in adult patients only recently (17 December 2021). It is obvious that this is still a work in progress, with few ongoing clinical trials. With over 6 million deaths from COVID-19, this is the right time to speed up this process. Our conclusion is that, during the course of COVID-19, the immune response is changing from the early phase to the late phase in individual patients, so immunomodulating therapy should be guided by individual responses at different time points. |
| first_indexed | 2024-03-09T20:38:20Z |
| format | Article |
| id | doaj.art-da8f69202f884e93b37384032c35f24f |
| institution | Directory Open Access Journal |
| issn | 2227-9059 |
| language | English |
| last_indexed | 2024-03-09T20:38:20Z |
| publishDate | 2022-10-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Biomedicines |
| spelling | doaj.art-da8f69202f884e93b37384032c35f24f2023-11-23T23:06:03ZengMDPI AGBiomedicines2227-90592022-10-011010262010.3390/biomedicines10102620From Cytokine Storm to Cytokine Breeze: Did Lessons Learned from Immunopathogenesis Improve Immunomodulatory Treatment of Moderate-to-Severe COVID-19?Goran Rondovic0Dragan Djordjevic1Ivo Udovicic2Ivan Stanojevic3Snjezana Zeba4Tanja Abazovic5Danilo Vojvodic6Dzihan Abazovic7Wasim Khan8Maja Surbatovic9Clinic of Anesthesiology and Intensive Therapy, Military Medical Academy, Crnotravska 17, 11000 Belgrade, SerbiaClinic of Anesthesiology and Intensive Therapy, Military Medical Academy, Crnotravska 17, 11000 Belgrade, SerbiaClinic of Anesthesiology and Intensive Therapy, Military Medical Academy, Crnotravska 17, 11000 Belgrade, SerbiaFaculty of Medicine of the Military Medical Academy, University of Defence, Crnotravska 17, 11000 Belgrade, SerbiaClinic of Anesthesiology and Intensive Therapy, Military Medical Academy, Crnotravska 17, 11000 Belgrade, SerbiaClinic of Anesthesiology and Intensive Therapy, Military Medical Academy, Crnotravska 17, 11000 Belgrade, SerbiaFaculty of Medicine of the Military Medical Academy, University of Defence, Crnotravska 17, 11000 Belgrade, SerbiaBiocell Hospital, Omladinskih Brigada 86a, 11000 Belgrade, SerbiaDivision of Trauma & Orthopaedic Surgery, University of Cambridge, Addenbrooke’s Hospital, Cambridge CB2 2QQ, UKClinic of Anesthesiology and Intensive Therapy, Military Medical Academy, Crnotravska 17, 11000 Belgrade, SerbiaComplex immune response to infection has been highlighted, more than ever, during the COVID-19 pandemic. This review explores the immunomodulatory treatment of moderate-to-severe forms of this viral sepsis in the context of specific immunopathogenesis. Our objective is to analyze in detail the existing strategies for the use of immunomodulators in COVID-19. Immunomodulating therapy is very challenging; there are still underpowered or, in other ways, insufficient studies with inconclusive or conflicting results regarding a rationale for adding a second immunomodulatory drug to dexamethasone. Bearing in mind that a “cytokine storm” is not present in the majority of COVID-19 patients, it is to be expected that the path to the adequate choice of a second immunomodulatory drug is paved with uncertainty. Anakinra, a recombinant human IL-1 receptor antagonist, is a good choice in this setting. Yet, the latest update of the COVID-19 Treatment Guidelines Panel (31 May 2022) claims that there is insufficient evidence to recommend either for or against the use of anakinra for the treatment of COVID-19. EMA’s human medicines committee recommended extending the indication of anakinra to include treatment of COVID-19 in adult patients only recently (17 December 2021). It is obvious that this is still a work in progress, with few ongoing clinical trials. With over 6 million deaths from COVID-19, this is the right time to speed up this process. Our conclusion is that, during the course of COVID-19, the immune response is changing from the early phase to the late phase in individual patients, so immunomodulating therapy should be guided by individual responses at different time points.https://www.mdpi.com/2227-9059/10/10/2620COVID-19moderate-to-severe pneumoniacytokinesimmunologicimmunosuppressionimmunotherapy |
| spellingShingle | Goran Rondovic Dragan Djordjevic Ivo Udovicic Ivan Stanojevic Snjezana Zeba Tanja Abazovic Danilo Vojvodic Dzihan Abazovic Wasim Khan Maja Surbatovic From Cytokine Storm to Cytokine Breeze: Did Lessons Learned from Immunopathogenesis Improve Immunomodulatory Treatment of Moderate-to-Severe COVID-19? Biomedicines COVID-19 moderate-to-severe pneumonia cytokines immunologic immunosuppression immunotherapy |
| title | From Cytokine Storm to Cytokine Breeze: Did Lessons Learned from Immunopathogenesis Improve Immunomodulatory Treatment of Moderate-to-Severe COVID-19? |
| title_full | From Cytokine Storm to Cytokine Breeze: Did Lessons Learned from Immunopathogenesis Improve Immunomodulatory Treatment of Moderate-to-Severe COVID-19? |
| title_fullStr | From Cytokine Storm to Cytokine Breeze: Did Lessons Learned from Immunopathogenesis Improve Immunomodulatory Treatment of Moderate-to-Severe COVID-19? |
| title_full_unstemmed | From Cytokine Storm to Cytokine Breeze: Did Lessons Learned from Immunopathogenesis Improve Immunomodulatory Treatment of Moderate-to-Severe COVID-19? |
| title_short | From Cytokine Storm to Cytokine Breeze: Did Lessons Learned from Immunopathogenesis Improve Immunomodulatory Treatment of Moderate-to-Severe COVID-19? |
| title_sort | from cytokine storm to cytokine breeze did lessons learned from immunopathogenesis improve immunomodulatory treatment of moderate to severe covid 19 |
| topic | COVID-19 moderate-to-severe pneumonia cytokines immunologic immunosuppression immunotherapy |
| url | https://www.mdpi.com/2227-9059/10/10/2620 |
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