COVID-19: more than a cytokine storm

• Published in: Critical care (London, England) Vol. 24; no. 1; p. 549
• Main Authors: Riva, Giovanni, Nasillo, Vincenzo, Tagliafico, Enrico, Trenti, Tommaso, Comoli, Patrizia, Luppi, Mario
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 04.09.2020; BioMed Central; BMC
• Subjects: B cells; Coronavirus Infections - complications; Coronavirus Infections - epidemiology; Coronaviruses; COVID-19; Critical care; Cytokine Release Syndrome - virology; Cytokine storm; Cytokines; Humans; Immunotherapy; Ipilimumab; Lymphocytes; Nivolumab; Pandemics; Pembrolizumab; Pneumonia, Viral - complications; Pneumonia, Viral - epidemiology
• ISSN: 1364-8535; 1466-609X; 1364-8535; 1366-609X
• DOI: 10.1186/s13054-020-03267-w

[...]in those COVID-19 patients showing massive hyperinflammation, a clinical diagnosis of sHLH/MAS may be appropriate and deserves further investigation at the histological level. [...]severe COVID-19 has appeared as a peculiar clinicopathologic entity—yet poorly understood from a mechanistic viewpoint—which however, by definition, may represent a novel form of viral sepsis, being characterized by (a) T cell deficiencies, with early and progressive lymphopenia; (b) systemic hyperinflammation, with a peculiar time-course, often increasing at a late phase, when coagulopathy and fatal organ damage may eventually occur; and (c) COVID-19-associated coagulopathy, displaying some unique clinical and laboratory findings, compared with either disseminated intravascular coagulation or sepsis-induced coagulopathy [10]. [...]to maximize potential benefits of different immunotherapeutic approaches against COVID-19, adequate patients’ selection is warranted, possibly performed on the basis of putative biomarkers and immune profiles predictive of response. [...]by considering the typical disease course, often prolonged for several weeks, the optimal timing for these treatments should be defined. [...]it seems conceivable that, during SARS-CoV-2 infection, especially in elderly patients and less frequently in young people, something can go wrong at the delicate interface between effective viral clearance and T cell tolerance.