Cytokine Storm in COVID-19: “When You Come Out of the Storm, You Won’t Be the Same Person Who Walked in”

Abstract

In December 2019, a novel coronavirus, COVID-19, was discovered to be the causal agent of a severe respiratory infection named SARS-CoV-2, and it has since been recognized worldwide as a pandemic. There are still numerous doubts concerning its pathogenesis and particularly the underlying causes of the various clinical courses, ranging from severe manifestations to asymptomatic forms, including acute respiratory distress syndrome. The major factor responsible for acute respiratory distress syndrome is the so-called “cytokine storm,” which is an aberrant response from the host immune system that induces an exaggerated release of proinflammatory cytokines/chemokines. In this review, we will discuss the role of cytokine storm in COVID-19 and potential treatments with which counteract this aberrant response, which may be valuable in the clinical translation.

The impact of COVID-19 infection on the cytokine profile of pregnant women: A prospective case-control study

“…The excessive inflammatory response to COVID-19 infection is regarded as the main pathophysiological triggering event behind mortality and morbidity in infected individuals [6] . Aberrant production of cytokines like TNF-a, IL-1, IFN γ, IL-4, and IL-10 have been reported in severe cases with increased rates of adverse outcomes [23] . For this reason, researchers have been working on novel treatment options focusing on the alteration of immune responses in COVID-19 patients [24] , [25] .…”

“…Excessive production of IL-6 is associated with adverse pregnancy outcomes like preterm delivery, preterm premature rupture of the membranes, and chorioamnionitis [31] . Additionally, increased IL-6 levels are observed in severe COVID-19 cases and it is regarded as one of the key actors of the famous ''cytokine storm'' [5] , [23] , [24] . Significantly higher IL-6 levels were found for the study group in the present study and no significant difference was observed between the pregnancy trimesters.…”

JAK-STAT Pathway Inhibition and their Implications in COVID-19 Therapy

“…These inflammatory responses can lead to the release of macrophages, monocytes, and other cytokines and chemokines, leading to cytokine storms, thus deteriorating the conditions in COVID-19 patients [ 14 ]. Therefore, inflammatory markers play a crucial role in describing disease severity in COVID-19 patients.…”

The critically ill patient with COVID-19 and ARDS: Providing rational solutions to new and old challenges

“…Cytokine storm, bradykinin storm and secondary hemophagocytic lymphohistiocytosis (HLH) have been suggested as potential consequences of COVID-19 infection. [22][23][24] This dysregulated immune response can lead to pulmonary endothelial and alveolar epithelial damage that causes vascular leak and alveolar edema seen in ARDS.…”

“…20,21 There still remain unanswered questions regarding steroid use, although corticosteroid use is now advocated by the as Interferon beta-1b and Emapulumab. 23…”