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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...

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Autores principales: Rondovic, Goran, Djordjevic, Dragan, Udovicic, Ivo, Stanojevic, Ivan, Zeba, Snjezana, Abazovic, Tanja, Vojvodic, Danilo, Abazovic, Dzihan, Khan, Wasim, Surbatovic, Maja
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9599155/
https://www.ncbi.nlm.nih.gov/pubmed/36289881
http://dx.doi.org/10.3390/biomedicines10102620
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author Rondovic, Goran
Djordjevic, Dragan
Udovicic, Ivo
Stanojevic, Ivan
Zeba, Snjezana
Abazovic, Tanja
Vojvodic, Danilo
Abazovic, Dzihan
Khan, Wasim
Surbatovic, Maja
author_facet Rondovic, Goran
Djordjevic, Dragan
Udovicic, Ivo
Stanojevic, Ivan
Zeba, Snjezana
Abazovic, Tanja
Vojvodic, Danilo
Abazovic, Dzihan
Khan, Wasim
Surbatovic, Maja
author_sort Rondovic, Goran
collection PubMed
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.
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spelling pubmed-95991552022-10-27 From Cytokine Storm to Cytokine Breeze: Did Lessons Learned from Immunopathogenesis Improve Immunomodulatory Treatment of Moderate-to-Severe COVID-19? Rondovic, Goran Djordjevic, Dragan Udovicic, Ivo Stanojevic, Ivan Zeba, Snjezana Abazovic, Tanja Vojvodic, Danilo Abazovic, Dzihan Khan, Wasim Surbatovic, Maja Biomedicines Review 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. MDPI 2022-10-18 /pmc/articles/PMC9599155/ /pubmed/36289881 http://dx.doi.org/10.3390/biomedicines10102620 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
Rondovic, Goran
Djordjevic, Dragan
Udovicic, Ivo
Stanojevic, Ivan
Zeba, Snjezana
Abazovic, Tanja
Vojvodic, Danilo
Abazovic, Dzihan
Khan, Wasim
Surbatovic, Maja
From Cytokine Storm to Cytokine Breeze: Did Lessons Learned from Immunopathogenesis Improve Immunomodulatory Treatment of Moderate-to-Severe COVID-19?
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 Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9599155/
https://www.ncbi.nlm.nih.gov/pubmed/36289881
http://dx.doi.org/10.3390/biomedicines10102620
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