Immune reactivity during COVID-19 : Implications for treatment

Copyright © 2021 European Federation of Immunological Societies. Published by Elsevier B.V. All rights reserved..

Clinical symptoms of COVID-19 include fever, cough, and fatigue which may progress to acute respiratory distress syndrome (ARDS). The main hematological laboratory findings associated with the severe form of disease are represented by lymphopenia and eosinopenia which mostly occur in the elderly population characterized by cardiovascular comorbidities and immunosenescence. Besides, increased levels of D-dimer, procalcitonin, and C reactive protein (CRP) seem to be powerful prognostic biomarkers helping to predict the onset of coagulopathy. The host immune response to SARS-CoV-2 can lead to an aberrant inflammatory response or "cytokine storm" which contributes to the severity of illness. At immunological level, patients affected by a severe form of COVID-19 show poor clinical trajectories characterized by differential "immunotypes" for which T cell response seems to play a critical role in understanding pathogenic mechanisms of disease. Also, patients with mild to severe COVID-19 displayed macrophage activation syndrome (MAS), very low human leukocyte antigen D related (HLA-DR) expression with a parallel reduction of CD04+ lymphocytes, CD19 lymphocytes, and natural killer (NK) cells. Corticosteroids resulted the best therapy for the immune dysregulation whereas repurposing of tocilizumab (IL-6 receptor antagonist) appears to have mixed results in patients with COVID-19. Besides, anticoagulative therapy was associated with reduced in-hospital mortality and need of intubation among COVID-19 patients. Furthermore, the beneficial use of intravenous immunoglobulin (IVIG) and passive immunotherapy with convalescent plasma needs to be validated in large controlled clinical trials. In this review, we summarize the main hematological parameters with a prognostic value in COVID-19 and the basis of immunological reactivity during COVID-19, with a focus on ongoing clinical trials evaluating immune targets as possible therapeutic strategies.

Media Type:

Electronic Article
Cover Image
cover

Year of Publication:

2021

Contained In:

Immunology letters - Vol. 231 (2021), p. 28-34

Language:

English

Contributors:

Napoli, Claudio
Benincasa, Giuditta
Criscuolo, Clelia
Faenza, Mario
Liberato, Cinzia
Rusciano, Mariangela

Urls:

Volltext

Keywords:

Antibodies, Monoclonal, Humanized
Anticoagulants
COVID-19
Cytokine Release Syndrome
Drug Repositioning
Drug Therapy, Combination
Drug therapy
Glucocorticoids
Hospital Mortality
Humans
I031V2H011
Immune response
Immunization, Passive
Immunoglobulins, Intravenous
Immunosuppressive Agents
Immunotherapy
Journal Article
Laboratory indexes
Prognosis
Randomized Controlled Trials as Topic
Review
SARS-CoV-2
Severity of Illness Index
Tocilizumab
Treatment Outcome

Notes:

Date Completed 16.02.2021

Date Revised 16.02.2021

published: Print-Electronic

Citation Status MEDLINE

Copyright: From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Physical Description:

Online-Ressource

doi:

10.1016/j.imlet.2021.01.001

PMID:

33421440

PPN (Catalogue-ID):

NLM320870642