PMC:7127009 / 9033-11251 JSONTXT

{"target":"https://pubannotation.org/docs/sourcedb/PMC/sourceid/7127009","sourcedb":"PMC","sourceid":"7127009","source_url":"https://www.ncbi.nlm.nih.gov/pmc/7127009","text":"The pulmonary complications in human CoViD-19 patients are due to an exuberant local inflammatory response with diffuse alveolar damage. Patients dying because of SARS have lung consolidation, edema and mucopurulent material in the bronchial tree. At microscopic examination, alterations such as diffuse alveolar damage, hyaline membrane and fibrin formation, neutrophils and macrophages infiltrates were detected in the interstitium and alveoli. Similar features were noted in the only human autopsy report available of MERS infection. Cytokines and chemokines play a key role in the immune response against viral infections, and their altered production has been demonstrated in both SARS and MERS coronavirus infections. Such altered levels have been shown to be likely due to the low synthesis of antiviral cytokines such as interferons (IFN)α or β and in concert increased levels of other pro-inflammatory cytokines/chemokines that have pathogenic consequences. Among them, interleukin (IL)-1, IL-6 and other pro-inflammatory cytokines were shown to be significantly more elevated in patients with severe compared to uncomplicated SARS or MERS infection [10,11]. Recent preliminary data from China reported high plasma levels of cytokines including IL-6, related to the severity and the prognosis of the disease with a clear implication for the occurrence of “cytokine storm” and CRS. Tocilizumab, an anti-IL-6 receptor antibody that has been used clinically to treat rheumatoid arthritis and other autoimmune diseases, has been used and approved for treatment of a variety of clinical conditions that include CRS. These have included clinical conditions such as those associated with chimeric antigen receptor T-cell (CAR-T) therapy that appears to induce severe or life-threatening cytokine release syndrome [12]. A single dose of tocilizumab was used in 21 patients in China suffering from severe respiratory syndrome during CoViD-19 infection, at the dosage of 400 mg intravenously, in addition to routine therapy. In a few days, 90% of patients recovered and lung opacities disappeared [13], suggesting that anti-IL-6 might be a powerful potential rescue therapy in respiratory distress syndrome of 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