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Harris J, Borg NA. The multifaceted roles of NLRP3-modulating proteins in virus infection. Front Immunol 2022; 13:987453. [PMID: 36110852 PMCID: PMC9468583 DOI: 10.3389/fimmu.2022.987453] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 08/11/2022] [Indexed: 12/14/2022] Open
Abstract
The innate immune response to viruses is critical for the correct establishment of protective adaptive immunity. Amongst the many pathways involved, the NLRP3 [nucleotide-binding oligomerisation domain (NOD)-like receptor protein 3 (NLRP3)] inflammasome has received considerable attention, particularly in the context of immunity and pathogenesis during infection with influenza A (IAV) and SARS-CoV-2, the causative agent of COVID-19. Activation of the NLRP3 inflammasome results in the secretion of the proinflammatory cytokines IL-1β and IL-18, commonly coupled with pyroptotic cell death. While this mechanism is protective and key to host defense, aberrant NLRP3 inflammasome activation causes a hyperinflammatory response and excessive release of cytokines, both locally and systemically. Here, we discuss key molecules in the NLRP3 pathway that have also been shown to have significant roles in innate and adaptive immunity to viruses, including DEAD box helicase X-linked (DDX3X), vimentin and macrophage migration inhibitory factor (MIF). We also discuss the clinical opportunities to suppress NLRP3-mediated inflammation and reduce disease severity.
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Affiliation(s)
- James Harris
- Cell Biology Assays Team, Biomedical Manufacturing, Commonwealth Scientific and Industrial Research Organisation (CSIRO), Clayton, VIC, Australia
- Centre for Inflammatory diseases, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Natalie A. Borg
- Immunity and Immune Evasion Laboratory, Chronic Infectious and Inflammatory Diseases Research, School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, Australia
- Infection and Immunity Program, Monash Biomedicine Discovery Institute and Department of Biochemistry and Molecular Biology, Monash University, Clayton, VIC, Australia
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Galimberti F, McBride J, Cronin M, Li Y, Fox J, Abrouk M, Herbst A, Kirsner RS. Evidence-based best practice advice for patients treated with systemic immunosuppressants in relation to COVID-19. Clin Dermatol 2020; 38:775-780. [PMID: 32419721 PMCID: PMC7224642 DOI: 10.1016/j.clindermatol.2020.05.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The emergence of the COVID-19 pandemic has led to significant uncertainty among physicians and patients about the safety of immunosuppressive medications used for the management of dermatologic conditions. We review available data on commonly used immunosuppressants and their effect on viral infections beyond COVID-19. Notably, the effect of some immunosuppressants on viruses related to SARS-CoV2, including SARS and MERS, has been previously investigated. In the absence of data on the effect of immunosuppressants on COVID-19, these data could be used to make clinical decisions on initiation and continuation of immunosuppressive medications during this pandemic. In summary, we recommend considering the discontinuation of oral Janus kinase (JAK) inhibitors and prednisone; considering the delay of rituximab infusion; and suggesting the careful continuation of cyclosporine, mycophenolate, azathioprine, methotrexate, and biologics in patients currently benefitting from such treatments.
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Affiliation(s)
- Fabrizio Galimberti
- Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Jeffrey McBride
- Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Megan Cronin
- Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Yumeng Li
- Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Joshua Fox
- Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Michael Abrouk
- Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Alexander Herbst
- Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Robert S Kirsner
- Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
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Clement Y, Jankie S, Pooransingh S, Ignacio D, Reid A, Sampson-Francis S, Giddings S, Watson H. A literature review of drugs for the treatment of COVID-19. CARIBBEAN MEDICAL JOURNAL 2020. [DOI: 10.48107/cmj.2020.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: To review the published evidence of repurposed drugs, antivirals and biologics for the treatment of COVID-19.
Materials and Methods: A literature review was conducted in several databases and research portals. Search terms included COVID-19, SARS-Cov-2, MERS, MERS-CoV, SARS, SARS-CoV, coronavirus, beta-coronavirus, influenza, pneumonia and several drugs considered for use in COVID-19.
Results: There is a paucity of clinical evidence regarding the safety and efficacy of most agents being considered for the treatment of COVID-19. However, based on promising preliminary research the US Food and Drugs Administration has authorized the emergency use of hydroxychloroquine and remdesivir for hospitalized COVID-19 patients. To date, the most robust evidence for lopinavir-ritonavir (LPV/r) found that it was no better than standard care. Overwhelming evidence suggests that corticosteroids increase mortality, nosocomial infections and lengthen hospitalization in SARS and MERS patients, and should be used cautiously in patients with severe respiratory symptoms. Additionally, low level evidence suggests that tocilizumab may be useful to reduce the cytokine storm precipitated by SARS-CoV-2 infection.
Conclusions: Hydroxychloroquine and remdesivir have surged to the front of the race to repurpose drugs in the fight against COVID-19. With hundreds of ongoing trials it is envisaged that indisputable evidence would be provided for prophylactic and therapeutic use of drugs and biologics within the next few months. However, in our setting it would be worthwhile to consider the availability and accessibility of some of these agents.
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Affiliation(s)
- Yuri Clement
- Department of Para-clinical Sciences, Faculty of Medical Sciences, The University of the West Indies, St, Augustine, Trinidad and Tobago
| | - Satish Jankie
- School of Pharmacy, Faculty of Medical Sciences, The University of the West Indies, St, Augustine, Trinidad and Tobago
| | - Shalini Pooransingh
- Department of Para-clinical Sciences, Faculty of Medical Sciences, The University of the West Indies, St, Augustine, Trinidad and Tobago
| | - Diane Ignacio
- School of Pharmacy, Faculty of Medical Sciences, The University of the West Indies, St, Augustine, Trinidad and Tobago
| | - Avril Reid
- Medical Sciences Library, Faculty of Medical Sciences, The University of the West Indies, St, Augustine, Trinidad and Tobago
| | - Shurla Sampson-Francis
- Department of Para-clinical Sciences, Faculty of Medical Sciences, The University of the West Indies, St, Augustine, Trinidad and Tobago
| | - Stanley Giddings
- Department of Clinical Medical Sciences, Faculty of Medical Sciences, The University of the West Indies, St, Augustine, Trinidad and Tobago
| | - Harold Watson
- Department of Medicine, Faculty of Medical Sciences, The University of the West Indies, Cave Hill, Barbados
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