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Cytokine Release Syndrome in COVID-19 Patients, A New Scenario for an Old Concern: The Fragile Balance between Infections and Autoimmunity

1
Department of Clinical and Molecular Medicine, Sant’Andrea University Hospital, Sapienza University of Rome, 00182 Rome, Italy
2
Research Consultant in Immunology, 00100 Rome, Italy
3
Laboratory of Biomedical Technologies, Division of Health Protection Technologies, Ente per le Nuove Tecnologie, L’energia e l’Ambiente (ENEA), 00196 Rome, Italy
*
Author to whom correspondence should be addressed.
Int. J. Mol. Sci. 2020, 21(9), 3330; https://doi.org/10.3390/ijms21093330
Received: 11 April 2020 / Revised: 26 April 2020 / Accepted: 5 May 2020 / Published: 8 May 2020
(This article belongs to the Section Molecular Pathology, Diagnostics, and Therapeutics)
On 7 January 2020, researchers isolated and sequenced in China from patients with severe pneumonitis a novel coronavirus, then called SARS-CoV-2, which rapidly spread worldwide, becoming a global health emergency. Typical manifestations consist of flu-like symptoms such as fever, cough, fatigue, and dyspnea. However, in about 20% of patients, the infection progresses to severe interstitial pneumonia and can induce an uncontrolled host-immune response, leading to a life-threatening condition called cytokine release syndrome (CRS). CRS represents an emergency scenario of a frequent challenge, which is the complex and interwoven link between infections and autoimmunity. Indeed, treatment of CRS involves the use of both antivirals to control the underlying infection and immunosuppressive agents to dampen the aberrant pro-inflammatory response of the host. Several trials, evaluating the safety and effectiveness of immunosuppressants commonly used in rheumatic diseases, are ongoing in patients with COVID-19 and CRS, some of which are achieving promising results. However, such a use should follow a multidisciplinary approach, be accompanied by close monitoring, be tailored to patient’s clinical and serological features, and be initiated at the right time to reach the best results. Autoimmune patients receiving immunosuppressants could be prone to SARS-CoV-2 infections; however, suspension of the ongoing therapy is contraindicated to avoid disease flares and a consequent increase in the infection risk. View Full-Text
Keywords: SARS-CoV-2; COVID-19; rheumatoid arthritis; cytokine release syndrome; autoimmunity; immunomodulation; tocilizumab; hydroxychloroquine; baricitinib SARS-CoV-2; COVID-19; rheumatoid arthritis; cytokine release syndrome; autoimmunity; immunomodulation; tocilizumab; hydroxychloroquine; baricitinib
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Picchianti Diamanti, A.; Rosado, M.M.; Pioli, C.; Sesti, G.; Laganà, B. Cytokine Release Syndrome in COVID-19 Patients, A New Scenario for an Old Concern: The Fragile Balance between Infections and Autoimmunity. Int. J. Mol. Sci. 2020, 21, 3330.

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