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Immunomodulation as Treatment for Severe Coronavirus Disease 2019: A Systematic Review of Current Modalities and Future Directions
In severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, viral load peaks early and declines quickly after symptom onset. Severe coronavirus disease 2019 (COVID-19) is marked by aberrant innate and adaptive immune responses with an abnormal cytokine profile and multiorgan system dy...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7717185/ https://www.ncbi.nlm.nih.gov/pubmed/33216852 http://dx.doi.org/10.1093/cid/ciaa1759 |
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author | Meyerowitz, Eric A Sen, Pritha Schoenfeld, Sara R Neilan, Tomas G Frigault, Matthew J Stone, John H Kim, Arthur Y Mansour, Michael K |
author_facet | Meyerowitz, Eric A Sen, Pritha Schoenfeld, Sara R Neilan, Tomas G Frigault, Matthew J Stone, John H Kim, Arthur Y Mansour, Michael K |
author_sort | Meyerowitz, Eric A |
collection | PubMed |
description | In severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, viral load peaks early and declines quickly after symptom onset. Severe coronavirus disease 2019 (COVID-19) is marked by aberrant innate and adaptive immune responses with an abnormal cytokine profile and multiorgan system dysfunction that persists well after viral clearance. A purely antiviral treatment strategy may therefore be insufficient, and antiviral agents have not shown a benefit later in the illness course. A number of immunomodulatory strategies are being tested, including corticosteroids, cytokine and anticytokine therapies, small molecule inhibitors, and cellular therapeutics. To date, the only drug to show a mortality benefit for COVID-19 in a randomized, controlled trial is dexamethasone. However, there remains uncertainty about which patients may benefit most and about longer-term complications, including secondary infections. Here, we review the immune dysregulation of severe COVID-19 and the existing data behind various immunomodulatory strategies, and we consider future directions of study. |
format | Online Article Text |
id | pubmed-7717185 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-77171852020-12-09 Immunomodulation as Treatment for Severe Coronavirus Disease 2019: A Systematic Review of Current Modalities and Future Directions Meyerowitz, Eric A Sen, Pritha Schoenfeld, Sara R Neilan, Tomas G Frigault, Matthew J Stone, John H Kim, Arthur Y Mansour, Michael K Clin Infect Dis Online Only Articles In severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, viral load peaks early and declines quickly after symptom onset. Severe coronavirus disease 2019 (COVID-19) is marked by aberrant innate and adaptive immune responses with an abnormal cytokine profile and multiorgan system dysfunction that persists well after viral clearance. A purely antiviral treatment strategy may therefore be insufficient, and antiviral agents have not shown a benefit later in the illness course. A number of immunomodulatory strategies are being tested, including corticosteroids, cytokine and anticytokine therapies, small molecule inhibitors, and cellular therapeutics. To date, the only drug to show a mortality benefit for COVID-19 in a randomized, controlled trial is dexamethasone. However, there remains uncertainty about which patients may benefit most and about longer-term complications, including secondary infections. Here, we review the immune dysregulation of severe COVID-19 and the existing data behind various immunomodulatory strategies, and we consider future directions of study. Oxford University Press 2020-11-20 /pmc/articles/PMC7717185/ /pubmed/33216852 http://dx.doi.org/10.1093/cid/ciaa1759 Text en © The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com. https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_modelThis article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model) |
spellingShingle | Online Only Articles Meyerowitz, Eric A Sen, Pritha Schoenfeld, Sara R Neilan, Tomas G Frigault, Matthew J Stone, John H Kim, Arthur Y Mansour, Michael K Immunomodulation as Treatment for Severe Coronavirus Disease 2019: A Systematic Review of Current Modalities and Future Directions |
title | Immunomodulation as Treatment for Severe Coronavirus Disease 2019: A Systematic Review of Current Modalities and Future Directions |
title_full | Immunomodulation as Treatment for Severe Coronavirus Disease 2019: A Systematic Review of Current Modalities and Future Directions |
title_fullStr | Immunomodulation as Treatment for Severe Coronavirus Disease 2019: A Systematic Review of Current Modalities and Future Directions |
title_full_unstemmed | Immunomodulation as Treatment for Severe Coronavirus Disease 2019: A Systematic Review of Current Modalities and Future Directions |
title_short | Immunomodulation as Treatment for Severe Coronavirus Disease 2019: A Systematic Review of Current Modalities and Future Directions |
title_sort | immunomodulation as treatment for severe coronavirus disease 2019: a systematic review of current modalities and future directions |
topic | Online Only Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7717185/ https://www.ncbi.nlm.nih.gov/pubmed/33216852 http://dx.doi.org/10.1093/cid/ciaa1759 |
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