The Role of Cytokines including Interleukin-6 in COVID-19 induced Pneumonia and Macrophage Activation Syndrome-Like Disease
By D. McGonagle, K. Sharif, A. O’Regan, C. Bridgewood. Autoimmunity Reviews, 2020
1,495 citations recorded by the source corpus.
Severe COVID-19 associated pneumonia patients may exhibit features of systemic hyper-inflammation designated under the umbrella term of macrophage activation syndrome (MAS) or cytokine storm, also known as secondary haemophagocytic lymphohistocytosis (sHLH). This is distinct from HLH associated with immunodeficiency states termed primary HLH -with radically different therapy strategies in both situations. COVID-19 infection with MAS typically occurs in subjects with adult respiratory distress syndrome (ARDS) and historically, non-survival in ARDS was linked to sustained IL-6 and IL-1 elevation. We provide a model for the classification of MAS to stratify the MAS-like presentation in COVID-19 pneumonia and explore the complexities of discerning ARDS from MAS. We discuss the potential impact of timing of anti-cytokine therapy on viral clearance and the impact of such therapy on intra-pulmonary macrophage activation and emergent pulmonary vascular disease.
Subfields: Hematology, Immunology, Neurology
View Paper: https://www.semanticscholar.org/paper/572660385b011914f3bbde74ca53054d0441def7
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Citations in the corpus
- COVID-19 update: Covid-19-associated coagulopathy (2020, background): “Similarly, the broad category of macrophage activation syndrome or secondary HLH has been applied to acknowledge some of the pulmonary findings of Covid-19 pneumonia and concomitant suppression of CD4+T cell interferon-γ production that collectively yield a hyper-inflammatory immunosuppressive state”
- IL-6 in inflammation, autoimmunity and cancer (2020, background): “Therefore, SARS-CoV-1 and SARS-CoV-2 infection activate both NF-κ B and STAT3, key elements of the IL-6 Amp, to cause cytokine storm (12, 13, 15, 349, 350).”
- Should we stimulate or suppress immune responses in COVID-19? Cytokine and anti-cytokine interventions (2020, neutral): “Not only is IL-6 a major mediator within the cytokine storm, its levels have been closely correlated with ARDS severity and outcome, along with blood SARS-CoV-2 viral load [71,74,118].”
- Strengthening the Immune System and Reducing Inflammation and Oxidative Stress through Diet and Nutrition: Considerations during the COVID-19 Crisis (2020, neutral): “hyper-inflammation together with multiorgan failure [57,58].”