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Sen ES, Ramanan AV. Cytokine Storm Syndrome Associated with Hemorrhagic Fever and Other Viruses. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2024; 1448:249-267. [PMID: 39117819 DOI: 10.1007/978-3-031-59815-9_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/10/2024]
Abstract
A wide variety of infections can trigger cytokine storm syndromes including those caused by bacteria, viruses, fungi and parasites. The most frequent viral trigger is Epstein-.Barr virus which is covered in Chapter 16. CSS associated with COVID-19 is also discussed separately (Chapter 22). This chapter will focus on other viruses including the hemorrhagic fever viruses, influenza, parainfluenza, adenovirus, parvovirus, hepatitis viruses, measles, mumps, rubella, enterovirus, parechovirus, rotavirus, human metapneumovirus and human T-lymphotropic virus. The published literature consists of many single case reports and moderate-sized case series reporting CSS, in most circumstances meeting the 2004 diagnostic criteria for hemophagocytic lymphohistiocytosis (HLH). There is no published clinical trial evidence specifically for management of HLH associated with these viruses. In some situations, patients received supportive therapy and blood product transfusions only but in most cases, they were treated with one or more of intravenous corticosteroids, intravenous immunoglobulin and/or etoposide. These were successful in many patients although in significant numbers progression of infection to CSS was associated with mortality.
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Affiliation(s)
- Ethan S Sen
- Consultant in Paediatric Rheumatology, Great North Children's Hospital, Newcastle upon Tyne, UK
| | - A V Ramanan
- Consultant in Paediatric Rheumatology, Bristol Royal Hospital for Children, Bristol, UK
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2
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Che L, Wang Z, Du N, Li L, Zhao Y, Zhang K, Liu Q. Evaluation of Serum Ferritin, Procalcitonin, and C-Reactive Protein for the Prediction of Severity and Mortality in Hemorrhagic Fever With Renal Syndrome. Front Microbiol 2022; 13:865233. [PMID: 35677912 PMCID: PMC9169039 DOI: 10.3389/fmicb.2022.865233] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 03/08/2022] [Indexed: 01/08/2023] Open
Abstract
This study aimed to analyze the clinical significance of serum ferritin, procalcitonin (PCT), and C-reactive protein (CRP) in patients with hemorrhagic fever with renal syndrome (HFRS). The demographical, clinical, and laboratory data of 373 patients with HFRS in northeastern China were retrospectively analyzed. The levels of serum ferritin and PCT in severe patients (n = 108) were significantly higher than those in mild patients (n = 265, p < 0.001) and associated with HFRS severity. The area under the receiver operating characteristic curve (AUC) values of serum ferritin and PCT for predicting the severity of HFRS were 0.732 (95% CI 0.678-0.786, p < 0.001) and 0.824 (95% CI 0.773-0.875, p < 0.001), respectively, showing sensitivity and specificity of 0.75 and 0.88 for serum ferritin, and 0.76 and 0.60 for PCT. The CRP level in HFRS with bacterial co-infection (n = 115) was higher than that without bacterial co-infection (n = 258, p < 0.001). The AUC value of CRP for predicting bacterial co-infection was 0.588 (95% CI 0.525-0.652, p < 0.001), showing sensitivity and specificity of 0.43 and 0.76, respectively. The serum ferritin level in non-survivors (n = 14) was significantly higher than in survivors (n = 359, p < 0.001). The AUC value of serum ferritin for predicting mortality was 0.853 (95% CI 0.774-0.933, p < 0.001), showing sensitivity and specificity of 0.933 and 0.739. Serum ferritin and PCT have a robust association with HFRS severity and mortality, which may be promising predictors, and CRP is an effective biomarker to assess bacterial co-infection in HFRS.
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Affiliation(s)
- Lihe Che
- Changchun Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Changchun, China.,Key Laboratory of Organ Regeneration and Transplantation of the Ministry of Education, Center for Pathogen Biology and Infectious Diseases, The First Hospital of Jilin University, Changchun, China.,Department of Infectious Diseases, The First Hospital of Jilin University, Changchun, China
| | - Zedong Wang
- Changchun Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Changchun, China.,Key Laboratory of Organ Regeneration and Transplantation of the Ministry of Education, Center for Pathogen Biology and Infectious Diseases, The First Hospital of Jilin University, Changchun, China
| | - Na Du
- Department of Infectious Diseases, The First Hospital of Jilin University, Changchun, China
| | - Liang Li
- Changchun Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Changchun, China
| | - Yinghua Zhao
- Key Laboratory of Organ Regeneration and Transplantation of the Ministry of Education, Center for Pathogen Biology and Infectious Diseases, The First Hospital of Jilin University, Changchun, China
| | - Kaiyu Zhang
- Department of Infectious Diseases, The First Hospital of Jilin University, Changchun, China
| | - Quan Liu
- Changchun Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Changchun, China.,Key Laboratory of Organ Regeneration and Transplantation of the Ministry of Education, Center for Pathogen Biology and Infectious Diseases, The First Hospital of Jilin University, Changchun, China.,School of Life Sciences and Engineering, Foshan University, Foshan, China
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Niknam Z, Jafari A, Golchin A, Danesh Pouya F, Nemati M, Rezaei-Tavirani M, Rasmi Y. Potential therapeutic options for COVID-19: an update on current evidence. Eur J Med Res 2022; 27:6. [PMID: 35027080 PMCID: PMC8755901 DOI: 10.1186/s40001-021-00626-3] [Citation(s) in RCA: 73] [Impact Index Per Article: 36.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 12/23/2021] [Indexed: 12/14/2022] Open
Abstract
SARS-CoV-2, a novel coronavirus, is the agent responsible for the COVID-19 pandemic and is a major public health concern nowadays. The rapid and global spread of this coronavirus leads to an increase in hospitalizations and thousands of deaths in many countries. To date, great efforts have been made worldwide for the efficient management of this crisis, but there is still no effective and specific treatment for COVID-19. The primary therapies to treat the disease are antivirals, anti-inflammatories and respiratory therapy. In addition, antibody therapies currently have been a many active and essential part of SARS-CoV-2 infection treatment. Ongoing trials are proposed different therapeutic options including various drugs, convalescent plasma therapy, monoclonal antibodies, immunoglobulin therapy, and cell therapy. The present study summarized current evidence of these therapeutic approaches to assess their efficacy and safety for COVID-19 treatment. We tried to provide comprehensive information about the available potential therapeutic approaches against COVID-19 to support researchers and physicians in any current and future progress in treating COVID-19 patients.
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Affiliation(s)
- Zahra Niknam
- Proteomics Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ameneh Jafari
- Advanced Therapy Medicinal Product (ATMP) Department, Breast Cancer Research Center, Motamed Cancer Institute, ACECR, Tehran, Iran
| | - Ali Golchin
- Department of Clinical Biochemistry and Applied Cell Sciences, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | - Fahima Danesh Pouya
- Department of Biochemistry, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | - Mohadeseh Nemati
- Department of Biochemistry, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | - Mostafa Rezaei-Tavirani
- Proteomics Research Center, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Yousef Rasmi
- Department of Biochemistry, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran.
- Cellular and Molecular Research Center, Urmia University of Medical Sciences, Urmia, Iran.
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Naemi FMA, Al-Adwani S, Al-Nazawi A, Al-Khatabi H. Association between HLA genotype and ferritin levels in COVID-19 infection: a study of a Saudi cohort. Infect Dis (Lond) 2021; 53:891-899. [PMID: 34304676 DOI: 10.1080/23744235.2021.1955149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND An elevation in serum ferritin levels through an unknown mechanism was observed in COVID-19 infected patients. This study examined the association between patients' HLA genotype and serum ferritin level modulation and also assessed the effect of serum ferritin levels on infection severity/mortality. MATERIALS AND METHODS One hundred and thirty-six COVID-19 Saudi patients were divided into two groups according to their ferritin levels: group 1 (<500 ng/mL, N = 67) and group 2 (>500 ng/mL, N = 69). HLA genotyping (class I and II) was carried out through the rPCR-SSO method. RESULTS High serum ferritin levels were associated with a significant increase in infection severity, as 75% of ICU patients showed high levels of ferritin compared to 43% of patients with moderate symptoms, p = .002. This elevation indicated a gender skew in that 56% of the infected male patients displayed high ferritin levels compared to 36.6% of the female patients, p = .03. In terms of mortality, 74% of patients with fatal outcomes had a high level of serum ferritin compared to 47% of recovered patients, p = .039. There was a significant difference in the HLA frequency between the two groups, with a predominance of HLA-A*01 in the low-ferritin group (19.4 vs. 6.5%, p = .002, pc = .016) and predominance of C*03 in the high ferritin group (10.9 vs. 3%, p = .047, pc = .27). CONCLUSION High serum ferritin levels are associated with an increase in COVID-19 severity, which may be affected by HLA polymorphism.
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Affiliation(s)
- Fatmah M A Naemi
- Histocompatibility and Immunogenetics Laboratory, King Fahd General Hospital, Ministry of Health, Jeddah, Saudi Arabia
| | - Shurooq Al-Adwani
- Histocompatibility and Immunogenetics Laboratory, King Fahd General Hospital, Ministry of Health, Jeddah, Saudi Arabia
| | | | - Heba Al-Khatabi
- Center of Excellence in Genomic Medicine Research, King Fahd Medical Research Center, King Abdul-Aziz University, Jeddah, Saudi Arabia
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Kobak S. The Perfect Storm: A Rheumatologist's Point of View on COVID-19 Infection. Curr Rheumatol Rev 2021; 17:141-152. [PMID: 33121412 DOI: 10.2174/1573397116666201029155105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 06/20/2020] [Accepted: 07/23/2020] [Indexed: 12/15/2022]
Abstract
The new coronavirus infection (Covid-19) is a pandemic that has affected the whole world and progresses with high morbidity and mortality. It has a high contagion rate and a course capable of rapid lung involvement with severe acute respiratory distress syndrome (ARDS) and pulmonary insufficiency. A severe clinical picture develops as a result of a "perfect cytokine storm" which results from possible immunological mechanisms triggered by the viral infection. Immune system dysregulation and possible autoinflammatory and autoimmune mechanisms are responsible for a higher amount of cytokines release from immune cells. Although no clear treatment of Covid-19 infection has emerged yet, it is argued that some disease-modifying anti-rheumatic drugs (DMARDs) may be effective in addition to anti-viral treatments. These drugs (anti-malarial drugs, colchicum dispert, biologics) have been well known to rheumatologists for years because they are used in the treatment of many inflammatory rheumatologic diseases. Another important issue is whether DMARDs, which can cause severe immunosuppression, pose a risk for Covid-19 infection and whether they have been discontinued beforehand. Although there are insufficient data on this subject, considering the risk of disease reactivation, patients may continue their DMARDs treatment under the supervision of a rheumatologist. In this article, the possible immunological mechanisms in the pathogenesis of Covid-19 infection and the efficacy and safety of various DMARDs used in the treatment are discussed from a rheumatologist's perspective in the light of recent literature data.
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Affiliation(s)
- Senol Kobak
- Department of Internal Medicine and Rheumatology, Faculty of Medicine, Istinye University, Liv Hospital, Istanbul, Turkey
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Chu R, van Eeden C, Suresh S, Sligl WI, Osman M, Cohen Tervaert JW. Do COVID-19 Infections Result in a Different Form of Secondary Hemophagocytic Lymphohistiocytosis. Int J Mol Sci 2021; 22:2967. [PMID: 33803997 PMCID: PMC8001312 DOI: 10.3390/ijms22062967] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 02/12/2021] [Accepted: 03/10/2021] [Indexed: 12/15/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has resulted in significant morbidity and mortality across the world, with no current effective treatments available. Recent studies suggest the possibility of a cytokine storm associated with severe COVID-19, similar to the biochemical profile seen in hemophagocytic lymphohistiocytosis (HLH), raising the question of possible benefits that could be derived from targeted immunosuppression in severe COVID-19 patients. We reviewed the literature regarding the diagnosis and features of HLH, particularly secondary HLH, and aimed to identify gaps in the literature to truly clarify the existence of a COVID-19 associated HLH. Diagnostic criteria such as HScore or HLH-2004 may have suboptimal performance in identifying COVID-19 HLH-like presentations, and criteria such as soluble CD163, NK cell activity, or other novel biomarkers may be more useful in identifying this entity.
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Affiliation(s)
- Raymond Chu
- Division of Rheumatology, Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON K1H 7W9, Canada;
| | - Charmaine van Eeden
- Division of Rheumatology, Department of Medicine, University of Alberta Hospital, University of Alberta, Edmonton, AB T6G 2R3, Canada; (C.v.E.); (M.O.)
| | - Sneha Suresh
- Division of IHOPE, Department of Pediatrics, Stollery Children’s Hospital, University of Alberta, Edmonton, AB T6G 1C9, Canada;
| | - Wendy I. Sligl
- Department of Critical Care Medicine and Division of Infectious Diseases, Department of Medicine, University of Alberta Hospital, University of Alberta, Edmonton, AB T6G 2B7, Canada;
| | - Mohammed Osman
- Division of Rheumatology, Department of Medicine, University of Alberta Hospital, University of Alberta, Edmonton, AB T6G 2R3, Canada; (C.v.E.); (M.O.)
| | - Jan Willem Cohen Tervaert
- Division of Rheumatology, Department of Medicine, University of Alberta Hospital, University of Alberta, Edmonton, AB T6G 2R3, Canada; (C.v.E.); (M.O.)
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Shi J, Chu C, Yu M, Zhang D, Li Y, Fan Y, Yu Y, Luo Y, Zhou W. Clinical warning of hemophagocytic syndrome caused by Epstein-Barr virus. Ital J Pediatr 2021; 47:3. [PMID: 33413556 PMCID: PMC7788532 DOI: 10.1186/s13052-020-00949-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 12/04/2020] [Indexed: 11/29/2022] Open
Abstract
Objectives This study aimed to compare the clinical features and laboratory tests of infectious mononucleosis (IM) and hemophagocytic syndrome (HLH) caused by Epstein-Barr virus (EBV) in 1–3-year-old children and to explore the risk factor of HLH caused by EBV (EBV-HLH). Methods The clinical data of 92 children with EBV infection admitted in our hospital from 2011 to 2019 were collected; 61 cases were diagnosed as EBV-IM, and 31 cases were diagnosed as EBV-HLH. The subjects’ clinical manifestations and laboratory tests were analyzed retrospectively. Results Compared with EBV-IM patients, EBV-HLH patients had longer durations of fever, both before hospitalization and overall, and a higher probability of hepatomegaly. The levels of ALT, AST, LDH, TG, SF, D-Dimer and the plasma EBV DNA load of EBV-HLH patients were significantly higher than those of EBV-IM patients. The absolute values of CD3+, CD4+, CD8+, NK, and CD3-CD19+ cells and IgA and IgM levels of EBV-HLH patients were significantly lower than those of EBV-IM patients. The plasma EBV DNA load was positively correlated with the PT, TT, α-HBDH, AST, LDH, CK, Scr, BUN, UA, TG, and CRP levels in EBV-HLH patients, and the plasma EBV DNA load was positively correlated with the D-Dimer level in the EBV-IM patients. Among the 10 different potential markers, at the cut-off point of 1721.500 μg/L, the sensitivity and specificity of D-Dimer was 88.90 and 90.20%, respectively. Conclusion The D-Dimer level may be a good prognostic indicator of EBV-HLH caused by EBV.
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Affiliation(s)
- Jinjin Shi
- Department of Infectious Disease, Children's Hospital of Soochow University, Suzhou, 215003, China
| | - Chu Chu
- Department of Infectious Disease, Children's Hospital of Soochow University, Suzhou, 215003, China
| | - Min Yu
- Department of Infectious Disease, Children's Hospital of Soochow University, Suzhou, 215003, China
| | - Dandan Zhang
- Department of Infectious Disease, Children's Hospital of Soochow University, Suzhou, 215003, China
| | - Yuqin Li
- Department of Infectious Disease, Children's Hospital of Soochow University, Suzhou, 215003, China
| | - Yujie Fan
- Department of Infectious Disease, Children's Hospital of Soochow University, Suzhou, 215003, China
| | - Yixue Yu
- Department of Infectious Disease, Children's Hospital of Soochow University, Suzhou, 215003, China
| | - Yali Luo
- Department of Infectious Disease, Children's Hospital of Soochow University, Suzhou, 215003, China
| | - Weifang Zhou
- Department of Infectious Disease, Children's Hospital of Soochow University, Suzhou, 215003, China.
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Kappert K, Jahić A, Tauber R. Assessment of serum ferritin as a biomarker in COVID-19: bystander or participant? Insights by comparison with other infectious and non-infectious diseases. Biomarkers 2020; 25:616-625. [PMID: 32700561 DOI: 10.1080/1354750x.2020.1797880] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The 2019 coronavirus disease (COVID-19) caused by the SARS-CoV-2 virus has an impact on all aspects of patient care. Serum ferritin generally represents a biomarker of choice when iron deficiency is suspected. However, ferritin is also an acute-phase-protein exhibiting elevated serum concentration in various inflammatory diseases. Here we focus on the role of serum ferritin for diagnostic and clinical management of patients with COVID-19 in comparison with other infectious and non-infectious diseases. METHODS We examined scientific articles listed in PubMed reporting on ferritin in various infectious and non-infectious diseases. We then compared these results with nine current COVID-19 ferritin reports published in 2020. RESULTS Several non-infectious, as well as non-COVID-19 infectious diseases, are characterised by a partly dramatic elevation of serum ferritin levels. All COVID-19 studies published between February and May 2020, which documented laboratory serum ferritin, indicate ferritin as a biomarker of COVID-19 severity in hospitalised patients. CONCLUSIONS Serum ferritin may be considered both a prognostic and stratifying biomarker that can also contribute to therapeutic decision-making concerning patients with COVID-19. It should be emphasised, however, that most scientific reports refer to cohorts in the Asian region. Further validation in other cohorts is urgently required.
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Affiliation(s)
- Kai Kappert
- Institute of Laboratory Medicine, Clinical Chemistry and Pathobiochemistry, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Labor Berlin - Charité Vivantes GmbH, Berlin, Germany
| | - Amir Jahić
- Institute of Laboratory Medicine, Clinical Chemistry and Pathobiochemistry, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Labor Berlin - Charité Vivantes GmbH, Berlin, Germany
| | - Rudolf Tauber
- Institute of Laboratory Medicine, Clinical Chemistry and Pathobiochemistry, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Labor Berlin - Charité Vivantes GmbH, Berlin, Germany
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Ferrari F, Visconti F, De Amici M, Guglielmi A, Colombo CN, Belliato M, Ronco C. Coronavirus disease 2019 in critically ill patients: can we re-program the immune system? A primer for Intensivists. Minerva Anestesiol 2020; 86:1214-1233. [PMID: 32755094 DOI: 10.23736/s0375-9393.20.14663-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
In December 2019, Coronavirus disease 2019 (COVID-19) emerged in Wuhan and rapidly spread around the word. The immune response is essential to control and eliminate CoV infections, however, multiorgan damage might be due to direct SARS-CoV2 action against the infected organ cells, as well as an imbalanced host immune response. In effect, a "cytokines storm" and an impaired innate immunity were found in the COVID-19 critically ill patients. In this review, we summarized the virus immune response steps, underlying the relevance of introducing the measurement of plasma cytokine levels and of circulating lymphocyte subsets in clinical practice for the follow-up of critically ill COVID-19 patients and support new therapy.
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Affiliation(s)
- Fiorenza Ferrari
- Department of Anesthesia and Intensive Care Unit, IRCCS San Matteo Hospital, University of Pavia, Pavia, Italy - .,Department of Nephrology, Dialysis and Transplantation, International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy -
| | - Federico Visconti
- Department of Anesthesia and Intensive Care Unit, IRCCS San Matteo Hospital, University of Pavia, Pavia, Italy
| | - Mara De Amici
- Immuno-Allergology Laboratory of the Clinical Chemistry Unit, IRCCS Polyclinic San Matteo Foundation, Pavia, Italy
| | - Angelo Guglielmi
- Department of Anesthesia and Intensive Care Unit, IRCCS San Matteo Hospital, University of Pavia, Pavia, Italy
| | - Costanza N Colombo
- Department of Anesthesia and Intensive Care Unit, IRCCS San Matteo Hospital, University of Pavia, Pavia, Italy
| | - Mirko Belliato
- Department of Anesthesia and Intensive Care Unit, IRCCS San Matteo Hospital, University of Pavia, Pavia, Italy
| | - Claudio Ronco
- Department of Nephrology, Dialysis and Transplantation, International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy.,Unit of Nephrology, University of Padua, Padua, Italy.,Department Nephrology Dialysis and Transplant, AUSSL 8 Regione Veneto, San Bortolo Hospital, Vicenza, Italy
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Tomasiewicz K, Piekarska A, Stempkowska-Rejek J, Serafińska S, Gawkowska A, Parczewski M, Niścigorska-Olsen J, Łapiński TW, Zarębska-Michaluk D, Kowalska JD, Horban A, Flisiak R. Tocilizumab for patients with severe COVID-19: a retrospective, multi-center study. Expert Rev Anti Infect Ther 2020; 19:93-100. [PMID: 32693650 PMCID: PMC7441800 DOI: 10.1080/14787210.2020.1800453] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background Tocilizumab, an inhibitor of the interleukin-6 receptor, may decrease the inflammatory response and control the symptoms of severe coronavirus disease 2019 (COVID-19), but the evidence is scarce. Methods This retrospective study included patients with severe COVID-19 requiring oxygen therapy who received tocilizumab in seven centers across Poland. We assessed on-treatment changes in clinical status and inflammatory markers. Results Twenty-eight patients were included (19 male), with a mean age of 61.7 ± 12.4 years. The mean time from symptom onset to the first tocilizumab dose was 10.5 ± 5.7 days. Clinical status improved within 24 hours in 11 (39%) patients, within one week in 23 (82%) patients, and within two weeks in 25 (89%); one (4%) patient showed no change and two (7%) patients died. Sixteen patients (57%) no longer needed oxygen therapy within a week (p < 0.001). The serum concentrations of C-reactive protein, procalcitonin, and fibrinogen decreased significantly (p ≤ 0.001). Lung changes improved in 21 (84%) patients within two weeks of treatment; 19 had minimal or no changes upon final examination. Conclusions Tocilizumab can control the symptoms of severe COVID-19 by reducing the inflammatory response and rapidly improves the clinical status in most patients.
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Affiliation(s)
| | - Anna Piekarska
- Department of Infectious Diseases and Hepatology, Medical University of Lodz , Lodz, Poland
| | | | - Sylwia Serafińska
- Department of Infectious Diseases and Hepatology, Wroclaw Medical University , Wroclaw, Poland
| | - Aleksandra Gawkowska
- Department of Infectious Diseases and Hepatology, Wroclaw Medical University , Wroclaw, Poland
| | - Miłosz Parczewski
- Department of Infectious, Tropical Diseases and Immune Deficiency, Pomeranian Medical University , Szczecin, Poland
| | - Jolanta Niścigorska-Olsen
- Department of Infectious, Tropical Diseases and Immune Deficiency, Pomeranian Medical University , Szczecin, Poland
| | - Tadeusz W Łapiński
- Department of Infectious Diseases and Hepatology, Medical University of Bialystok , Bialystok, Poland
| | - Dorota Zarębska-Michaluk
- Department of Infectious Diseases, Voivodeship Hospital and Jan Kochanowski University , Kielce, Poland
| | - Justyna D Kowalska
- Department of Adults' Infectious Diseases, Medical University of Warsaw , Warsaw, Poland
| | - Andrzej Horban
- Department of Adults' Infectious Diseases, Medical University of Warsaw , Warsaw, Poland
| | - Robert Flisiak
- Department of Infectious Diseases and Hepatology, Medical University of Bialystok , Bialystok, Poland
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Ohadian Moghadam S. A Review on Currently Available Potential Therapeutic Options for COVID-19. Int J Gen Med 2020; 13:443-467. [PMID: 32801840 PMCID: PMC7387864 DOI: 10.2147/ijgm.s263666] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 07/07/2020] [Indexed: 01/08/2023] Open
Abstract
A series of unexplained pneumonia cases currently were first reported in December 2019 in Wuhan, China. Official names have been announced for the virus responsible, previously known as "2019 novel coronavirus" and the diseases it causes are, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease (COVID-19), respectively. Despite great efforts worldwide to control SARS-CoV-2, the spread of the virus has reached a pandemic. Infection prevention and control of this virus is the primary concern of public health officials and professionals. Currently, several therapeutic options for COVID-19 are proposed and vaccine development has been initiated for prevention purposes. In this review, we will discuss the most recent evidence about the current potential treatment options including anti-inflammatory drugs, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, nucleoside analogs, protease inhibitors, monoclonal antibodies, and convalescent plasma therapy. Some other agents such as vitamin D and melatonin, which were recommended as potential adjuvant treatments for COVID-19 infection are also presented. Moreover, the potential use of convalescent plasma for treatment of COVID-19 infection was described. Furthermore, in the next part of the current review, various vaccination approaches against COVID-19 including whole virus vaccines, recombinant subunit vaccine, DNA vaccines, and mRNA vaccines are discussed.
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12
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Dehelean CA, Lazureanu V, Coricovac D, Mioc M, Oancea R, Marcovici I, Pinzaru I, Soica C, Tsatsakis AM, Cretu O. SARS-CoV-2: Repurposed Drugs and Novel Therapeutic Approaches-Insights into Chemical Structure-Biological Activity and Toxicological Screening. J Clin Med 2020; 9:E2084. [PMID: 32630746 PMCID: PMC7409030 DOI: 10.3390/jcm9072084] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 06/22/2020] [Accepted: 06/26/2020] [Indexed: 02/06/2023] Open
Abstract
SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) pandemic represents the primary public health concern nowadays, and great efforts are made worldwide for efficient management of this crisis. Considerable scientific progress was recorded regarding SARS-CoV-2 infection in terms of genomic structure, diagnostic tools, viral transmission, mechanism of viral infection, symptomatology, clinical impact, and complications, but these data evolve constantly. Up to date, neither an effective vaccine nor SARS-CoV-2 specific antiviral agents have been approved, but significant advances were enlisted in this direction by investigating repurposed approved drugs (ongoing clinical trials) or developing innovative antiviral drugs (preclinical and clinical studies). This review presents a thorough analysis of repurposed drug admitted for compassionate use from a chemical structure-biological activity perspective highlighting the ADME (absorption, distribution, metabolism, and excretion) properties and the toxicophore groups linked to potential adverse effects. A detailed pharmacological description of the novel potential anti-COVID-19 therapeutics was also included. In addition, a comprehensible overview of SARS-CoV-2 infection in terms of general description and structure, mechanism of viral infection, and clinical impact was portrayed.
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Affiliation(s)
- Cristina Adriana Dehelean
- Faculty of Pharmacy, “Victor Babes” University of Medicine and Pharmacy, 2nd Eftimie Murgu Sq., 300041 Timisoara, Romania; (C.A.D.); (I.M.); (I.P.); (C.S.)
| | - Voichita Lazureanu
- Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, 2nd Eftimie Murgu Sq., 300041 Timisoara, Romania; (V.L.); (O.C.)
- “Dr. Victor Babes” Clinical Hospital for Infectious Diseases and Pneumophthisiology, 300310 Timisoara, Romania
| | - Dorina Coricovac
- Faculty of Pharmacy, “Victor Babes” University of Medicine and Pharmacy, 2nd Eftimie Murgu Sq., 300041 Timisoara, Romania; (C.A.D.); (I.M.); (I.P.); (C.S.)
| | - Marius Mioc
- Faculty of Pharmacy, “Victor Babes” University of Medicine and Pharmacy, 2nd Eftimie Murgu Sq., 300041 Timisoara, Romania; (C.A.D.); (I.M.); (I.P.); (C.S.)
| | - Roxana Oancea
- Faculty of Dental Medicine, “Victor Babes” University of Medicine and Pharmacy, 2nd Eftimie Murgu Sq., 300041 Timisoara, Romania;
| | - Iasmina Marcovici
- Faculty of Pharmacy, “Victor Babes” University of Medicine and Pharmacy, 2nd Eftimie Murgu Sq., 300041 Timisoara, Romania; (C.A.D.); (I.M.); (I.P.); (C.S.)
| | - Iulia Pinzaru
- Faculty of Pharmacy, “Victor Babes” University of Medicine and Pharmacy, 2nd Eftimie Murgu Sq., 300041 Timisoara, Romania; (C.A.D.); (I.M.); (I.P.); (C.S.)
| | - Codruta Soica
- Faculty of Pharmacy, “Victor Babes” University of Medicine and Pharmacy, 2nd Eftimie Murgu Sq., 300041 Timisoara, Romania; (C.A.D.); (I.M.); (I.P.); (C.S.)
| | - Aristidis M. Tsatsakis
- Department of Forensic Sciences and Toxicology, Faculty of Medicine, University of Crete, Heraklion, 71003 Crete, Greece;
| | - Octavian Cretu
- Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, 2nd Eftimie Murgu Sq., 300041 Timisoara, Romania; (V.L.); (O.C.)
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Greenberg A, Huber BR, Liu DX, Logue JP, Hischak AMW, Hart RJ, Abbott M, Isic N, Hisada YM, Mackman N, Bennett RS, Hensley LE, Connor JH, Crossland NA. Quantification of Viral and Host Biomarkers in the Liver of Rhesus Macaques: A Longitudinal Study of Zaire Ebolavirus Strain Kikwit (EBOV/Kik). THE AMERICAN JOURNAL OF PATHOLOGY 2020; 190:1449-1460. [PMID: 32275904 PMCID: PMC7322367 DOI: 10.1016/j.ajpath.2020.03.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 03/12/2020] [Accepted: 03/17/2020] [Indexed: 12/21/2022]
Abstract
Zaire ebolavirus (EBOV) causes Ebola virus disease (EVD), which carries a fatality rate between 25% and 90% in humans. Liver pathology is a hallmark of terminal EVD; however, little is known about temporal disease progression. We used multiplexed fluorescent immunohistochemistry and in situ hybridization in combination with whole slide imaging and image analysis (IA) to quantitatively characterize temporospatial signatures of viral and host factors as related to EBOV pathogenesis. Eighteen rhesus monkeys euthanized between 3 and 8 days post-infection, and 3 uninfected controls were enrolled in this study. Compared with semiquantitative histomorphologic ordinal scoring, quantitative IA detected subtle and progressive features of early and terminal EVD that was not feasible with routine approaches. Sinusoidal macrophages were the earliest cells to respond to infection, expressing proinflammatory cytokine interleukin 6 (IL6) mRNA, which was subsequently also observed in fibrovascular compartments. The mRNA of interferon-stimulated gene-15 (ISG-15), also known as ISG15 ubiquitin like modifier (ISG15), was observed early, with a progressive and ubiquitous hybridization signature involving mesenchymal and epithelial compartments. ISG-15 mRNA was prominent near infected cells, but not in infected cells, supporting the hypothesis that bystander cells produce a robust interferon gene response. This study contributes to our current understanding of early EVD progression and illustrates the value that digital pathology and quantitative IA serve in infectious disease research.
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Affiliation(s)
- Alexandra Greenberg
- Graduate Medical Sciences, Boston University School of Medicine, Boston, Massachusetts
| | - Bertrand R Huber
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
| | - David X Liu
- Integrated Research Facility, National Institute for Allergy and Infectious Diseases (NIAID), Frederick, Maryland
| | - James P Logue
- Integrated Research Facility, National Institute for Allergy and Infectious Diseases (NIAID), Frederick, Maryland
| | - Amanda M W Hischak
- Integrated Research Facility, National Institute for Allergy and Infectious Diseases (NIAID), Frederick, Maryland
| | - Randy J Hart
- Integrated Research Facility, National Institute for Allergy and Infectious Diseases (NIAID), Frederick, Maryland
| | - Maureen Abbott
- Integrated Research Facility, National Institute for Allergy and Infectious Diseases (NIAID), Frederick, Maryland
| | - Nejra Isic
- Integrated Research Facility, National Institute for Allergy and Infectious Diseases (NIAID), Frederick, Maryland
| | - Yohei M Hisada
- Division of Hematology and Oncology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Nigel Mackman
- Division of Hematology and Oncology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Richard S Bennett
- Integrated Research Facility, National Institute for Allergy and Infectious Diseases (NIAID), Frederick, Maryland
| | - Lisa E Hensley
- Integrated Research Facility, National Institute for Allergy and Infectious Diseases (NIAID), Frederick, Maryland
| | - John H Connor
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Nicholas A Crossland
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, Massachusetts.
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Use of anakinra in severe COVID-19: A case report. Int J Infect Dis 2020; 96:607-609. [PMID: 32437934 PMCID: PMC7211644 DOI: 10.1016/j.ijid.2020.05.026] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 05/07/2020] [Accepted: 05/07/2020] [Indexed: 01/08/2023] Open
Abstract
Recent data on COVID-19 support that a later hyperinflammatory phase of COVID-19 has a decisive role in poor prognosis. The IL-1 inhibitor anakinra has been shown to be highly effective in the treatment of cytokine storm syndromes. We present here the case of a patient with critical COVID-19 successfully treated with anakinra.
Coronavirus disease 19 is a global healthcare emergency with a high lethality rate. Relevant inflammatory cytokine storm is associated with severity of disease, and IL1 inhibition is a cornerstone treatment for hyperinflammatory diseases. We present here the case of a patient with critical COVID-19 successfully treated with IL-1 receptor antagonist (anakinra).
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Sandler RD, Carter S, Kaur H, Francis S, Tattersall RS, Snowden JA. Haemophagocytic lymphohistiocytosis (HLH) following allogeneic haematopoietic stem cell transplantation (HSCT)-time to reappraise with modern diagnostic and treatment strategies? Bone Marrow Transplant 2020; 55:307-316. [PMID: 31455895 PMCID: PMC6995779 DOI: 10.1038/s41409-019-0637-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 05/28/2019] [Accepted: 06/07/2019] [Indexed: 12/23/2022]
Affiliation(s)
- Robert David Sandler
- Department of Rheumatology, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield, S10 2JF, UK.
| | - Stuart Carter
- Department of Rheumatology, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield, S10 2JF, UK
| | - Harpreet Kaur
- Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield, S10 2JF, UK
| | - Sebastian Francis
- Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield, S10 2JF, UK
| | - Rachel Scarlett Tattersall
- Department of Rheumatology, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield, S10 2JF, UK
| | - John Andrew Snowden
- Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield, S10 2JF, UK
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Carter SJ, Tattersall RS, Ramanan AV. Macrophage activation syndrome in adults: recent advances in pathophysiology, diagnosis and treatment. Rheumatology (Oxford) 2019; 58:5-17. [PMID: 29481673 DOI: 10.1093/rheumatology/key006] [Citation(s) in RCA: 146] [Impact Index Per Article: 29.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Indexed: 01/27/2023] Open
Abstract
Haemophagocytic lymphohistiocytosis (HLH) is a hyperinflammatory syndrome, which if not promptly treated, can lead rapidly to critical illness and death. HLH is termed macrophage activation syndrome (MAS) when associated with rheumatic disease (where it is best characterized in systemic JIA) and secondary HLH (sHLH) when associated with other triggers including malignancy and infection. MAS/sHLH is rare and coupled with its mimicry of other conditions, is underrecognized. These inherent challenges can lead to diagnostic and management challenges in multiple medical specialties including haematology, infectious diseases, critical care and rheumatology. In this review we highlight the pathogenesis of MAS/sHLH including its underlying triggers, key clinical features and diagnostic challenges, prognostic factors and current treatments in adults.
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Affiliation(s)
- Stuart J Carter
- Rheumatology Department, Sheffield Children's Hospital, Sheffield, UK
| | - Rachel S Tattersall
- Rheumatology Department, Sheffield Children's Hospital, Sheffield, UK.,Paediatric and Adolescent Rheumatology, Sheffield Children's Hospital, Sheffield, UK
| | - Athimalaipet V Ramanan
- Paediatric Rheumatology, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.,Bristol Medical School, University of Bristol, Bristol, UK
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17
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McElroy AK, Shrivastava-Ranjan P, Harmon JR, Martines RB, Silva-Flannery L, Flietstra TD, Kraft CS, Mehta AK, Lyon GM, Varkey JB, Ribner BS, Nichol ST, Zaki SR, Spiropoulou CF. Macrophage Activation Marker Soluble CD163 Associated with Fatal and Severe Ebola Virus Disease in Humans 1. Emerg Infect Dis 2019; 25:290-298. [PMID: 30666927 PMCID: PMC6346465 DOI: 10.3201/eid2502.181326] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Ebola virus disease (EVD) is associated with elevated cytokine levels, and hypercytokinemia is more pronounced in fatal cases. This type of hyperinflammatory state is reminiscent of 2 rheumatologic disorders known as macrophage activation syndrome and hemophagocytic lymphohistiocytosis, which are characterized by macrophage and T-cell activation. An evaluation of 2 cohorts of patients with EVD revealed that a marker of macrophage activation (sCD163) but not T-cell activation (sCD25) was associated with severe and fatal EVD. Furthermore, substantial immunoreactivity of host tissues to a CD163-specific antibody, predominantly in areas of extensive immunostaining for Ebola virus antigens, was observed in fatal cases. These data suggest that host macrophage activation contributes to EVD pathogenesis and that directed antiinflammatory therapies could be beneficial in the treatment of EVD.
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MESH Headings
- Antigens, CD/blood
- Antigens, Differentiation, Myelomonocytic/blood
- Biomarkers
- Ebolavirus/immunology
- Hemorrhagic Fever, Ebola/blood
- Hemorrhagic Fever, Ebola/diagnosis
- Hemorrhagic Fever, Ebola/immunology
- Hemorrhagic Fever, Ebola/virology
- Humans
- Immunoassay
- Killer Cells, Natural/immunology
- Killer Cells, Natural/metabolism
- Liver/immunology
- Liver/metabolism
- Liver/pathology
- Macrophage Activation/immunology
- Macrophages/immunology
- Macrophages/metabolism
- Receptors, Cell Surface/blood
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18
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Cavalli G, Dinarello CA. Anakinra Therapy for Non-cancer Inflammatory Diseases. Front Pharmacol 2018; 9:1157. [PMID: 30459597 PMCID: PMC6232613 DOI: 10.3389/fphar.2018.01157] [Citation(s) in RCA: 170] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 09/24/2018] [Indexed: 12/14/2022] Open
Abstract
Interleukin-1 (IL-1) is the prototypical inflammatory cytokine: two distinct ligands (IL-1α and IL-1β) bind the IL-1 type 1 receptor (IL-1R1) and induce a myriad of secondary inflammatory mediators, including prostaglandins, cytokines, and chemokines. IL-1α is constitutively present in endothelial and epithelial cells, whereas IL-1β is inducible in myeloid cells and released following cleavage by caspase-1. Over the past 30 years, IL-1-mediated inflammation has been established in a broad spectrum of diseases, ranging from rare autoinflammatory diseases to common conditions such as gout and rheumatoid arthritis (RA), type 2 diabetes, atherosclerosis, and acute myocardial infarction. Blocking IL-1 entered the clinical arena with anakinra, the recombinant form of the naturally occurring IL-1 receptor antagonist (IL-1Ra); IL-1Ra prevents the binding of IL-1α as well as IL-1β to IL-1R1. Quenching IL-1-mediated inflammation prevents the detrimental consequences of tissue damage and organ dysfunction. Although anakinra is presently approved for the treatment of RA and cryopyrin-associated periodic syndromes, off-label use of anakinra far exceeds its approved indications. Dosing of 100 mg of anakinra subcutaneously provides clinically evident benefits within days and for some diseases, anakinra has been used daily for over 12 years. Compared to other biologics, anakinra has an unparalleled record of safety: opportunistic infections, particularly Mycobacterium tuberculosis, are rare even in populations at risk for reactivation of latent infections. Because of this excellent safety profile and relative short duration of action, anakinra can also be used as a diagnostic tool for undefined diseases mediated by IL-1. Although anakinra is presently in clinical trials to treat cancer, this review focuses on anakinra treatment of acute as well as chronic inflammatory diseases.
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Affiliation(s)
- Giulio Cavalli
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
- Department of Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - Charles A. Dinarello
- Department of Medicine, Radboud University Medical Center, Nijmegen, Netherlands
- Department of Medicine, University of Colorado Denver, Denver, CO, United States
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19
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Abstract
Background Autoinflammatory diseases are distinct from autoimmune diseases. Whereas autoinflammatory diseases are due to dysfunctional T-cells and B-cells, autoinflammatory diseases are due to overproduction of macrophage cytokines particularly interleukin-1 beta (IL-1β). A causative role for IL-1 in autoinflammatory diseases is derived from clinical studies blocking the IL-1 receptor or neutralizing monoclonal antibodies or soluble receptors. Methods A review was performed of clinical trials in autoinflammatory diseases using the IL-1 receptor antagonist (anakinra), the soluble IL-1 receptor (rilonacept), antibodies to IL-1β (canakinumab, gevokizumab) and anti-IL-1α (xilonix). Findings Anakinra blocks the IL-1 Receptor type 1 (IL-1R1) and therefore blocks the activities of both IL-1α and IL-1β. Off-label use of anakinra is common for a broad spectrum of inflammatory diseases. Neutralization of IL-1β is used to treat hereditary autoinflammatory diseases but also atherosclerosis. Rilonacept reduces arterial wall inflammation in patients with chronic kidney disease. Neutralization of IL-1α has prolonged life in patients with advanced metastatic colorectal cancer. Compared to other cytokine blocking therapies, reducing the activities of IL-1 has an excellent safety record. Conclusions Blocking IL-1 therapies can be used to treat a wide-spectrum of acute and chronic inflammatory diseases.
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20
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Yang C, Zhu X, Zhang T, Ye Q. EBV-HLH children with reductions in CD4+ T cells and excessive activation of CD8+ T cells. Pediatr Res 2017; 82:952-957. [PMID: 28738028 DOI: 10.1038/pr.2017.178] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 06/20/2017] [Indexed: 11/09/2022]
Abstract
BackgroundIn this report, we analyzed the number and activation profiles of T cells in Epstein-Barr virus-associated hemophagocytic lymphohistiocytosis (EBV-HLH) patients and assessed their value for the diagnosis of EBV-HLH.MethodsWe compared the quantity of CD4+ T cells and CD8+ T cells in peripheral blood among HLH patients, a sepsis group, and healthy controls. We then analyzed variations in the activation marker in CD4+ T and CD8+ T cells.ResultsThe percentage of CD4+ T cells decreased in the EBV-HLH patients when compared with healthy controls, which induced significant differences in the ratio of CD4+ T cells/CD8+ T cells. The percentage of CD4+HLA-DR+ T cells, CD8+CD69+ T cells, CD8+HLA-DR+ T cells, and CD8+HLA-DR+ T cells/CD4+CD25+ T cells increased in EBV-HLH patients when compared with that in healthy controls. Compared with EBV-HLH survivors, the median percentage of CD4+CD25+ T cells (7.9 vs. 3.0) were decreased, but the ratios of CD8+HLA-DR+T cells/CD4+CD25+T cells (6.3 vs. 20.3) were increased in the dead patients.ConclusionsThere was a reduction in CD4+ T cells and abnormal activation of CD8+ T cells in the EBV-HLH patients. The percentage of CD4+CD25+ T cells and the ratios of CD8+HLA-DR+ T cells/CD4+CD25+ T cells in EBV-HLH patients had a relation to the prognosis of the disease.
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Affiliation(s)
- Cheng Yang
- Zhejiang Key Laboratory for Neonatal Diseases, Clinical Laboratory, The Children's Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Xiujuan Zhu
- Department of Nephrology, The Children's Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Ting Zhang
- College of Medical Technology, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Qing Ye
- Zhejiang Key Laboratory for Neonatal Diseases, Clinical Laboratory, The Children's Hospital of Zhejiang University School of Medicine, Hangzhou, China
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21
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Abstract
Adjunctive therapies have been proposed for use in at least 5 inflammation pathobiology phenotypes in pediatric sepsis-induced multiple organ failure. This article discusses host-pathogen interaction prototypes to facilitate understanding of the rationale for personalized therapy in these phenotypes. The article discusses the literature on adjunctive antiinflammatory and immune modulation therapies that, in addition to traditional organ support and infection source control, might be part of a personalized precision medicine approach to the reversal of each of these inflammatory pathobiology phenotypes.
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22
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Al-Samkari H, Berliner N. Hemophagocytic Lymphohistiocytosis. ANNUAL REVIEW OF PATHOLOGY-MECHANISMS OF DISEASE 2017; 13:27-49. [PMID: 28934563 DOI: 10.1146/annurev-pathol-020117-043625] [Citation(s) in RCA: 255] [Impact Index Per Article: 36.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Hemophagocytic lymphohistiocytosis is a life-threatening disorder characterized by unbridled activation of cytotoxic T lymphocytes, natural killer (NK) cells, and macrophages resulting in hypercytokinemia and immune-mediated injury of multiple organ systems. It is seen in both children and adults and is recognized as primary (driven by underlying genetic mutations that abolish critical proteins required for normal function of cytotoxic T cells and NK cells) or secondary (resulting from a malignant, infectious, or autoimmune stimulus without an identifiable underlying genetic trigger). Clinical and laboratory manifestations include fever, splenomegaly, neurologic dysfunction, coagulopathy, liver dysfunction, cytopenias, hypertriglyceridemia, hyperferritinemia, hemophagocytosis, and diminished NK cell activity. It is treated with immune suppressants, etoposide, and allogeneic hematopoietic stem cell transplantation; more than 50% of children who undergo transplant survive, but adults have quite poor outcomes even with aggressive management. Newer agents directed at subduing the uncontrolled immune response in a targeted fashion offer promise in this highly morbid disease.
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Affiliation(s)
| | - Nancy Berliner
- Brigham & Women's Hospital, Boston, Massachusetts 02115;
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23
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Cron RQ, Behrens EM, Shakoory B, Ramanan AV, Chatham WW. Does Viral Hemorrhagic Fever Represent Reactive Hemophagocytic Syndrome? J Rheumatol 2016; 42:1078-80. [PMID: 26136549 DOI: 10.3899/jrheum.150108] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Randy Q Cron
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama;
| | | | - Bita Shakoory
- Department of Medicine, Temple University, Philadelphia, Pennsylvania, USA
| | | | - Walter W Chatham
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Abstract
Macrophage activation syndrome (MAS) is a potentially life-threatening complication of rheumatic diseases such as systemic juvenile idiopathic arthritis (sJIA) and systemic lupus erythematosus. It is often considered a type of secondary hemophagocytic lymphohistiocytosis (HLH) and results from over-activation of T lymphocytes and macrophages leading to a "cytokine storm". Characteristic features are persistent fever, lymphadenopathy, hepatosplenomegaly, cytopenias (anemia, leucopenia, thrombocytopenia), raised C-reactive protein, falling erythrocyte sedimentation rate, hypofibrinogenemia, transaminitis, hypertriglyceridemia and extreme hyperferritinemia often associated with multi-organ impairment. Key to its management is early recognition of MAS which may be difficult due to similarity to systemic sepsis or flares of the underlying rheumatic disease. To aid with this process, criteria for the diagnosis of MAS in patients with sJIA derived by international consensus have been published. Although bone marrow biopsy showing hemophagocytosis is strongly supportive it is not essential for diagnosis. Together with appropriate supportive care, first-line treatment is high-dose intravenous corticosteroids with cyclosporin or intravenous immunoglobulin (IVIg) added if there is not initial response. Although etoposide is used by hematologists in treatment of HLH, there are concerns regarding organ toxicity and bone marrow suppression which weigh against its use in initial management of MAS. With increasing understanding of the pathogenesis of MAS, use of drugs targeting specific cytokines has been reported in case series. The relatively rapid effectiveness of anakinra, a recombinant IL-1 receptor antagonist, has been documented. Further studies of this and other biologic agents are required to identify the most effective and safest treatment option for refractory MAS.
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