Статья

Novel coronavirus disease (COVID-19) and cytokine storms. For more effective treatments from the viewpoints of an inflammatory pathophysiology perspective

S. Yokota, Y. Kuroiwa, K. Nishioka,
2020

Novel Coronavirus Disease (COVID-19) swept the world and led to a global pandemic. SARS-CoV-2, which is thought to have derived from bats as their reservoir hosts, has over time and similarly as with SARS-CoV, combined with human angiotensin converting enzyme 2 (ACE2). Thus, this caused infections in cells and established them into a human infectious disease (COVID-19). Against this viral invasion, the human body starts to activate the innate immune system in producing and releasing proinflammatory cytokines such as IL-6, IL-1β, IL-8, TNF-α, and other chemokines such as G-CSF, IP10, MCPl, to develop an increase the inflammatory responses. In the case of COVID-19, it revealed that excessive inflammatory responses occur, and that the exaggerated proinflammatory cytokines and chemokines are detected in COVID-19 patients’ sera resulting in cytokine release syndrome (CRS) or cytokine storm (CS). This causes coagulation abnormalities, excessive oxidation development, vital organ damages, immune system failure, and finally, progresses to disseminated intravascular coagulation (DIC) and multiple organ failure (MOF). Additionally, excessive inflammatory responses lead to mitochondrial dysfunction due to progressive and persistent stress which leads to cells and mitochondrial fracturing products containing mitochondrial DNA and damaged cell debris which in turn are involved in the chronic excessive inflammation as damage-associated molecular patterns (DAMPs). Thus, respiratory infection progressively leads to DIC from acute respiratory distress syndrome (ARDS) including vascular endothelial cell damages and coagulation-fibrinolysis system disorders. Then, this worsens to central nervous system disorders, renal failure, liver failure, and finally to MOF. With regards to treatments for COVID-19, the followings are progressive and multiple steps for mitigating the excessive inflammatory response and subsequent cytokine storm in patients. Firstly, the administering of Favipiravir for the suppression of SARS-CoV-2, and Nafamostat for the inhibition of ACE2 function should be considered. Then, the administration of anti-rheumatic drugs (monoclonal antibodies which combine with the leading cytokines (IL-1β, IL-6) and/or cytokine receptors such as Tocilizumab). Finally, melatonin may be effective under recognition of the pathology of CRS/CS for the improvement of mitochondrial function. The paper will further explore these subjects with reports mostly from China and Europe.

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  • 1. Version of Record от 2020-01-01

Метаданные

Об авторах
  • S. Yokota
    Yokohama City University, Fuji Toranomon Orthopaedic Hospital, Japanese Foundation Cancer Research, Japan College of Fibromyalgia Investigation
  • Y. Kuroiwa
    Yokohama City University, Teikyo University School of Medicine, Research Fellow of Japan Society
  • K. Nishioka
    Japanese Foundation Cancer Research, National Graduate Institute for Policy Studies, Japan Foundation, A.I. Yevdokimov Moscow State University of Medicine and Dentistry, St. Marianna University School of Medicine
Название журнала
  • Infectious Diseases: News, Opinions, Training
Том
  • 9
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  • 4
Страницы
  • 13-25
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  • undefined
Тип документа
  • journal article
Тип лицензии Creative Commons
  • CC BY
Правовой статус документа
  • Свободная лицензия
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  • scopus