Autoinflammatory and autoimmune conditions at the crossroad of COVID-19

• Published in: Journal of autoimmunity Vol. 114; p. 102506
• Main Authors: Rodríguez, Yhojan, Novelli, Lucia, Rojas, Manuel, De Santis, Maria, Acosta-Ampudia, Yeny, Monsalve, Diana M., Ramírez-Santana, Carolina, Costanzo, Antonio, Ridgway, William M., Ansari, Aftab A., Gershwin, M. Eric, Selmi, Carlo, Anaya, Juan-Manuel
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.11.2020
• Subjects: Adaptive Immunity - genetics; Antiphospholipid syndrome; Autoimmune Diseases - diagnosis; Autoimmune Diseases - immunology; Autoimmune Diseases - therapy; Autoimmune Diseases - virology; Autoimmunity; Betacoronavirus - immunology; Betacoronavirus - isolation & purification; Clinical Laboratory Techniques; Coronavirus Infections - diagnosis; Coronavirus Infections - epidemiology; Coronavirus Infections - immunology; Coronavirus Infections - therapy; COVID-19; COVID-19 Testing; Critical Illness; Cytokine Release Syndrome - diagnosis; Cytokine Release Syndrome - immunology; Cytokine Release Syndrome - therapy; Cytokine Release Syndrome - virology; Cytokine storm syndrome; Cytopenia; Female; Genetic Predisposition to Disease; Guillain-Barré syndrome; Humans; Immunity, Innate - genetics; Immunization, Passive - methods; Inflammation Mediators - blood; Inflammation Mediators - immunology; Kawasaki disease; Macrophage Activation - genetics; Macrophage Activation - immunology; Male; Pandemics; Pneumonia, Viral - diagnosis; Pneumonia, Viral - epidemiology; Pneumonia, Viral - immunology; Pneumonia, Viral - therapy; Risk Factors; SARS-CoV-2; Severity of Illness Index; Sex Factors; Vaccines; COVID-19; Autoimmunity; SARS-CoV-2; Kawasaki disease; Cytokine storm syndrome; Vaccines; Cytopenia; Guillain-Barré syndrome; Antiphospholipid syndrome
• ISSN: 0896-8411; 1095-9157
• DOI: 10.1016/j.jaut.2020.102506

Coronavirus disease 2019 (COVID-19) has been categorized as evolving in overlapping phases. First, there is a viral phase that may well be asymptomatic or mild in the majority, perhaps 80% of patients. The pathophysiological mechanisms resulting in minimal disease in this initial phase are not well known. In the remaining 20% of cases, the disease may become severe and/or critical. In most patients of this latter group, there is a phase characterized by the hyperresponsiveness of the immune system. A third phase corresponds to a state of hypercoagulability. Finally, in the fourth stage organ injury and failure occur. Appearance of autoinflammatory/autoimmune phenomena in patients with COVID-19 calls attention for the development of new strategies for the management of life-threatening conditions in critically ill patients. Antiphospholipid syndrome, autoimmune cytopenia, Guillain-Barré syndrome and Kawasaki disease have each been reported in patients with COVID-19. Here we present a scoping review of the relevant immunological findings in COVID-19 as well as the current reports about autoinflammatory/autoimmune conditions associated with the disease. These observations have crucial therapeutic implications since immunomodulatory drugs are at present the most likely best candidates for COVID-19 therapy. Clinicians should be aware of these conditions in patients with COVID-19, and these observations should be considered in the current development of vaccines. •Autoimmune and autoinflammatory conditions may be triggered by SARS-CoV-2.•Bystander activation and molecular mimicry could explain the appearance of these conditions.•In severe and critical patients, a cytokine storm syndrome (CSS) and a hypercoagulable state occur and may overlap.•CSS may promote the appearance of autoimmune and autoinflammatory-like conditions.•These observations should be considered in the current development of vaccines.