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Cytokine Storm in COVID-19-Immunopathological Mechanisms, Clinical Considerations, and Therapeutic Approaches: The REPROGRAM Consortium Position Paper.
Front Immunol. 2020; 11:1648.FI

Abstract

Cytokine storm is an acute hyperinflammatory response that may be responsible for critical illness in many conditions including viral infections, cancer, sepsis, and multi-organ failure. The phenomenon has been implicated in critically ill patients infected with SARS-CoV-2, the novel coronavirus implicated in COVID-19. Critically ill COVID-19 patients experiencing cytokine storm are believed to have a worse prognosis and increased fatality rate. In SARS-CoV-2 infected patients, cytokine storm appears important to the pathogenesis of several severe manifestations of COVID-19: acute respiratory distress syndrome, thromboembolic diseases such as acute ischemic strokes caused by large vessel occlusion and myocardial infarction, encephalitis, acute kidney injury, and vasculitis (Kawasaki-like syndrome in children and renal vasculitis in adult). Understanding the pathogenesis of cytokine storm will help unravel not only risk factors for the condition but also therapeutic strategies to modulate the immune response and deliver improved outcomes in COVID-19 patients at high risk for severe disease. In this article, we present an overview of the cytokine storm and its implications in COVID-19 settings and identify potential pathways or biomarkers that could be targeted for therapy. Leveraging expert opinion, emerging evidence, and a case-based approach, this position paper provides critical insights on cytokine storm from both a prognostic and therapeutic standpoint.

Authors+Show Affiliations

Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Immunity Sub-committee†. Department of Neurology & Neurophysiology, Liverpool Hospital and South Western Sydney Local Health District, Sydney, NSW, Australia. Neurovascular Imaging Laboratory & NSW Brain Clot Bank, Ingham Institute for Applied Medical Research, The University of New South Wales, UNSW Medicine, Sydney, NSW, Australia.Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Immunity Sub-committee†. The University of New South Wales, UNSW Medicine, Sydney, NSW, Australia.Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Immunity Sub-committee†. Polish Mother's Memorial Hospital Research Institute, Lodz, Poland. Cardiovascular Research Centre, University of Zielona Góra, Zielona Gora, Poland. Department of Hypertension, Medical University of Lodz, Lodz, Poland.Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Immunity Sub-committee†. Department of Rheumatology, University Health Network and The University of Toronto, Toronto, ON, Canada.Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Immunity Sub-committee†. Department of Neurology, University of Regensburg, Regensburg, Germany.Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Immunity Sub-committee†. Department of Neurology, Ben Taub General Hospital and Alzheimer's Disease and Memory Disorders Center, Baylor College of Medicine, Houston, TX, United States.Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Immunity Sub-committee†. World Health Organisation, Country Office for India, NPSP, Madurai, India.Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Immunity Sub-committee†. Department of Neuromicrobiology, National Institute of Mental Health and Neurosciences, Bengaluru, India.Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Immunity Sub-committee†. Department of Pediatric and Congenital Cardiology, Blalock-Taussig-Thomas Heart Center, John Hopkins Hospital, Baltimore, MD, United States. Johns Hopkins Bloomberg School of Public Health, School of Medicine, John Hopkins University, Baltimore, MD, United States.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32754159

Citation

Bhaskar, Sonu, et al. "Cytokine Storm in COVID-19-Immunopathological Mechanisms, Clinical Considerations, and Therapeutic Approaches: the REPROGRAM Consortium Position Paper." Frontiers in Immunology, vol. 11, 2020, p. 1648.
Bhaskar S, Sinha A, Banach M, et al. Cytokine Storm in COVID-19-Immunopathological Mechanisms, Clinical Considerations, and Therapeutic Approaches: The REPROGRAM Consortium Position Paper. Front Immunol. 2020;11:1648.
Bhaskar, S., Sinha, A., Banach, M., Mittoo, S., Weissert, R., Kass, J. S., Rajagopal, S., Pai, A. R., & Kutty, S. (2020). Cytokine Storm in COVID-19-Immunopathological Mechanisms, Clinical Considerations, and Therapeutic Approaches: The REPROGRAM Consortium Position Paper. Frontiers in Immunology, 11, 1648. https://doi.org/10.3389/fimmu.2020.01648
Bhaskar S, et al. Cytokine Storm in COVID-19-Immunopathological Mechanisms, Clinical Considerations, and Therapeutic Approaches: the REPROGRAM Consortium Position Paper. Front Immunol. 2020;11:1648. PubMed PMID: 32754159.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cytokine Storm in COVID-19-Immunopathological Mechanisms, Clinical Considerations, and Therapeutic Approaches: The REPROGRAM Consortium Position Paper. AU - Bhaskar,Sonu, AU - Sinha,Akansha, AU - Banach,Maciej, AU - Mittoo,Shikha, AU - Weissert,Robert, AU - Kass,Joseph S, AU - Rajagopal,Santhosh, AU - Pai,Anupama R, AU - Kutty,Shelby, Y1 - 2020/07/10/ PY - 2020/06/02/received PY - 2020/06/19/accepted PY - 2020/8/6/entrez PY - 2020/8/6/pubmed PY - 2020/8/22/medline KW - COVID-19 KW - autoimmunity KW - critical care KW - cytokine storm KW - guidelines KW - immunological mechanisms KW - immunotherapies KW - neuroimmunology SP - 1648 EP - 1648 JF - Frontiers in immunology JO - Front Immunol VL - 11 N2 - Cytokine storm is an acute hyperinflammatory response that may be responsible for critical illness in many conditions including viral infections, cancer, sepsis, and multi-organ failure. The phenomenon has been implicated in critically ill patients infected with SARS-CoV-2, the novel coronavirus implicated in COVID-19. Critically ill COVID-19 patients experiencing cytokine storm are believed to have a worse prognosis and increased fatality rate. In SARS-CoV-2 infected patients, cytokine storm appears important to the pathogenesis of several severe manifestations of COVID-19: acute respiratory distress syndrome, thromboembolic diseases such as acute ischemic strokes caused by large vessel occlusion and myocardial infarction, encephalitis, acute kidney injury, and vasculitis (Kawasaki-like syndrome in children and renal vasculitis in adult). Understanding the pathogenesis of cytokine storm will help unravel not only risk factors for the condition but also therapeutic strategies to modulate the immune response and deliver improved outcomes in COVID-19 patients at high risk for severe disease. In this article, we present an overview of the cytokine storm and its implications in COVID-19 settings and identify potential pathways or biomarkers that could be targeted for therapy. Leveraging expert opinion, emerging evidence, and a case-based approach, this position paper provides critical insights on cytokine storm from both a prognostic and therapeutic standpoint. SN - 1664-3224 UR - https://www.unboundmedicine.com/medline/citation/32754159/Cytokine_Storm_in_COVID_19_Immunopathological_Mechanisms_Clinical_Considerations_and_Therapeutic_Approaches:_The_REPROGRAM_Consortium_Position_Paper_ L2 - https://doi.org/10.3389/fimmu.2020.01648 DB - PRIME DP - Unbound Medicine ER -