Can we use interleukin-6 (IL-6) blockade for coronavirus disease 2019 (COVID-19)-induced cytokine release syndrome (CRS)?

• Published in: Journal of autoimmunity Vol. 111; p. 102452
• Main Authors: Liu, Bingwen, Li, Min, Zhou, Zhiguang, Guan, Xuan, Xiang, Yufei
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.07.2020
• Subjects: Anti-Inflammatory Agents - therapeutic use; Antibodies, Monoclonal, Humanized - therapeutic use; Betacoronavirus - pathogenicity; Coronavirus disease 2019; Coronavirus Infections - pathology; COVID-19; Cytokine release syndrome; Cytokine Release Syndrome - therapy; Humans; Immunomodulation - drug effects; Interleukin-6; Interleukin-6 - antagonists & inhibitors; Interleukin-6 - blood; Pandemics; Pneumonia, Viral - pathology; SARS-CoV-2; Severe Acute Respiratory Syndrome - pathology; Tocilizumab; Cytokine release syndrome; Coronavirus disease 2019; Tocilizumab; Interleukin-6
• ISSN: 0896-8411; 1095-9157; 1095-9157
• DOI: 10.1016/j.jaut.2020.102452

The emergent outbreak of coronavirus disease 2019 (COVID-19) has caused a global pandemic. Acute respiratory distress syndrome (ARDS) and multiorgan dysfunction are among the leading causes of death in critically ill patients with COVID-19. The elevated inflammatory cytokines suggest that a cytokine storm, also known as cytokine release syndrome (CRS), may play a major role in the pathology of COVID-19. However, the efficacy of corticosteroids, commonly utilized antiinflammatory agents, to treat COVID-19-induced CRS is controversial. There is an urgent need for novel therapies to treat COVID-19-induced CRS. Here, we discuss the pathogenesis of severe acute respiratory syndrome (SARS)-induced CRS, compare the CRS in COVID-19 with that in SARS and Middle East respiratory syndrome (MERS), and summarize the existing therapies for CRS. We propose to utilize interleukin-6 (IL-6) blockade to manage COVID-19-induced CRS and discuss several factors that should be taken into consideration for its clinical application. •Cytokine release syndrome (CRS) contributes to life-threatening multiple organ dysfunction in coronavirus disease 2019 (COVID-19) and represents a potential therapeutic target.•Mechanistic understanding of CRS permits the design of novel immunotherapies.•Targeting key molecules within the inflammatory cytokine network, such as interleukin-6 (IL-6), is a novel strategy for COVID-19-induced CRS and warrants further investigation.