Prevention and treatment of COVID‐19 disease by controlled modulation of innate immunity

• Published in: European journal of immunology Vol. 50; no. 7; pp. 932 - 938
• Main Authors: Schijns, Virgil, Lavelle, Ed C.
• Format: Journal Article
• Language: English
• Published: Germany Wiley Subscription Services, Inc 01.07.2020; John Wiley and Sons Inc
• Subjects: Animals; Anti-Inflammatory Agents - adverse effects; Anti-Inflammatory Agents - therapeutic use; Antiviral agents; Antiviral Agents - adverse effects; Antiviral Agents - therapeutic use; Betacoronavirus - physiology; Bronchitis; Coronaviridae; Coronavirus Infections - drug therapy; Coronavirus Infections - immunology; Coronavirus Infections - pathology; Coronavirus Infections - prevention & control; Coronavirus Infections - therapy; Coronaviruses; COVID-19; COVID-19 Serotherapy; cytokine; Cytokine storm; Developmental stages; Highlights; Humans; Immune response; Immunity (Disease); Immunity, Innate - drug effects; Immunization, Passive; Immunomodulation; Immunosuppressive agents; Immunotherapy; Immunotherapy - methods; Inflammation; Innate immunity; lung; Pandemics; Pandemics - prevention & control; Pneumonia, Viral - drug therapy; Pneumonia, Viral - immunology; Pneumonia, Viral - pathology; Pneumonia, Viral - prevention & control; Public health; Respiratory diseases; Respiratory tract; Review|Clinical; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2; COVID-19; cytokine; lung; SARS-CoV-2; innate immunity
• ISSN: 0014-2980; 1521-4141
• DOI: 10.1002/eji.202048693

The recent outbreak of coronavirus disease 2019 (COVID‐19), triggered by the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) poses an enormous threat to global public health and economies. Human coronaviruses normally cause no or mild respiratory disease but in the past two decades, potentially fatal coronavirus infections have emerged, causing respiratory tract illnesses such as pneumonia and bronchitis. These include severe acute respiratory syndrome coronavirus (SARS‐CoV), followed by the Middle East respiratory syndrome coronavirus (MERS‐CoV), and recently the SARS‐CoV‐2 coronavirus outbreak that emerged in Wuhan, China, in December 2019. Currently, most COVID‐19 patients receive traditional supportive care including breathing assistance. To halt the ongoing spread of the pandemic SARS‐CoV‐2 coronavirus and rescue individual patients, established drugs and new therapies are under evaluation. Since it will be some time until a safe and effective vaccine will be available, the immediate priority is to harness innate immunity to accelerate early antiviral immune responses. Second, since excessive inflammation is a major cause of pathology, targeted anti‐inflammatory responses are being evaluated to reduce inflammation‐induced damage to the respiratory tract and cytokine storms. Here, we highlight prominent immunotherapies at various stages of development that aim for augmented anti‐coronavirus immunity and reduction of pathological inflammation. Innate immune responses to SARS‐CoV‐2 play a decisive role in the outcome of infection. Insufficient or inappropriate responses will lead to increased viremia and cytokine storms while optimal activation or training of innate cells and production of anti‐viral cytokines can control infection and allow a return to homeostasis.