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

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...

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Bibliographic Details
Published in:Journal of autoimmunity 2020-07, Vol.111, p.102452-102452, Article 102452
Main Authors: Liu, Bingwen, Li, Min, Zhou, Zhiguang, Guan, Xuan, Xiang, Yufei
Format: Article
Language:English
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
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Summary: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.
ISSN:0896-8411
1095-9157
1095-9157
DOI:10.1016/j.jaut.2020.102452