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Covid-19 hyperinflammation and post-Covid-19 illness may be rooted in mast cell activation syndrome

OBJECTIVES: One-fifth of Covid-19 patients suffer a severe course of Covid-19 infection; however, the specific causes remain unclear. Mast cells (MCs) are activated by SARS-CoV-2. Although only recently recognized, MC activation syndrome (MCAS), usually due to acquired MC clonality, is a chronic mul...

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Autores principales: Afrin, Lawrence B., Weinstock, Leonard B., Molderings, Gerhard J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The Author(s). Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7529115/
https://www.ncbi.nlm.nih.gov/pubmed/32920235
http://dx.doi.org/10.1016/j.ijid.2020.09.016
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author Afrin, Lawrence B.
Weinstock, Leonard B.
Molderings, Gerhard J.
author_facet Afrin, Lawrence B.
Weinstock, Leonard B.
Molderings, Gerhard J.
author_sort Afrin, Lawrence B.
collection PubMed
description OBJECTIVES: One-fifth of Covid-19 patients suffer a severe course of Covid-19 infection; however, the specific causes remain unclear. Mast cells (MCs) are activated by SARS-CoV-2. Although only recently recognized, MC activation syndrome (MCAS), usually due to acquired MC clonality, is a chronic multisystem disorder with inflammatory and allergic themes, and an estimated prevalence of 17%. This paper describes a novel conjecture explaining how MCAS might cause a propensity for severe acute Covid-19 infection and chronic post-Covid-19 illnesses. METHODS: Observations of Covid-19 illness in patients with/without MCAS were compared with extensive clinical experience with MCAS. RESULTS: The prevalence of MCAS is similar to that of severe cases within the Covid-19-infected population. Much of Covid-19’s hyperinflammation is concordant with manners of inflammation which MC activation can drive. Drugs with activity against MCs or their mediators have preliminarily been observed to be helpful in Covid-19 patients. None of the authors’ treated MCAS patients with Covid-19 suffered severe infection, let alone mortality. CONCLUSIONS: Hyperinflammatory cytokine storms in many severely symptomatic Covid-19 patients may be rooted in an atypical response to SARS-CoV-2 by the dysfunctional MCs of MCAS rather than a normal response by normal MCs. If proven, this theory has significant therapeutic and prognostic implications.
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spelling pubmed-75291152020-10-02 Covid-19 hyperinflammation and post-Covid-19 illness may be rooted in mast cell activation syndrome Afrin, Lawrence B. Weinstock, Leonard B. Molderings, Gerhard J. Int J Infect Dis Perspective OBJECTIVES: One-fifth of Covid-19 patients suffer a severe course of Covid-19 infection; however, the specific causes remain unclear. Mast cells (MCs) are activated by SARS-CoV-2. Although only recently recognized, MC activation syndrome (MCAS), usually due to acquired MC clonality, is a chronic multisystem disorder with inflammatory and allergic themes, and an estimated prevalence of 17%. This paper describes a novel conjecture explaining how MCAS might cause a propensity for severe acute Covid-19 infection and chronic post-Covid-19 illnesses. METHODS: Observations of Covid-19 illness in patients with/without MCAS were compared with extensive clinical experience with MCAS. RESULTS: The prevalence of MCAS is similar to that of severe cases within the Covid-19-infected population. Much of Covid-19’s hyperinflammation is concordant with manners of inflammation which MC activation can drive. Drugs with activity against MCs or their mediators have preliminarily been observed to be helpful in Covid-19 patients. None of the authors’ treated MCAS patients with Covid-19 suffered severe infection, let alone mortality. CONCLUSIONS: Hyperinflammatory cytokine storms in many severely symptomatic Covid-19 patients may be rooted in an atypical response to SARS-CoV-2 by the dysfunctional MCs of MCAS rather than a normal response by normal MCs. If proven, this theory has significant therapeutic and prognostic implications. The Author(s). Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. 2020-11 2020-09-10 /pmc/articles/PMC7529115/ /pubmed/32920235 http://dx.doi.org/10.1016/j.ijid.2020.09.016 Text en © 2020 The Author(s) Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
spellingShingle Perspective
Afrin, Lawrence B.
Weinstock, Leonard B.
Molderings, Gerhard J.
Covid-19 hyperinflammation and post-Covid-19 illness may be rooted in mast cell activation syndrome
title Covid-19 hyperinflammation and post-Covid-19 illness may be rooted in mast cell activation syndrome
title_full Covid-19 hyperinflammation and post-Covid-19 illness may be rooted in mast cell activation syndrome
title_fullStr Covid-19 hyperinflammation and post-Covid-19 illness may be rooted in mast cell activation syndrome
title_full_unstemmed Covid-19 hyperinflammation and post-Covid-19 illness may be rooted in mast cell activation syndrome
title_short Covid-19 hyperinflammation and post-Covid-19 illness may be rooted in mast cell activation syndrome
title_sort covid-19 hyperinflammation and post-covid-19 illness may be rooted in mast cell activation syndrome
topic Perspective
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7529115/
https://www.ncbi.nlm.nih.gov/pubmed/32920235
http://dx.doi.org/10.1016/j.ijid.2020.09.016
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