Emerging trends in COVID-19 treatment: learning from inflammatory conditions associated with cellular therapies

Abstract

Coronavirus disease 2019 (SARS-CoV2) is an active global health threat for which treatments are desperately being sought. Even though most people infected experience mild to moderate respiratory symptoms and recover with supportive care, certain vulnerable hosts develop severe clinical deterioration. While several drugs are currently being investigated in clinical trials, there are currently no approved treatments or vaccines for COVID-19 and hence there is an unmet need to explore additional therapeutic options. At least three inflammatory disorders or syndromes associated with immune dysfunction have been described in the context of cellular therapy. Specifically, Cytokine Release Syndrome (CRS), Immune Reconstitution Inflammatory Syndrome (IRIS), and Secondary Hemophagocytic Lymphohistiocytosis (sHLH) all have clinical and laboratory characteristics in common with COVID19 and associated therapies that could be worth testing in the context of clinical trials. Here we discuss these diseases, their management, and potential applications of these treatment in the context of COVID-19. We also discuss current cellular therapies that are being evaluated for the treatment of COVID-19 and/or its associated symptoms.

In silico analysis of the supposed absence of therapeutic synergism in the association of hydroxychloroquine and azithromycin in COVID-19

“…The association of HCQ/AZI drugs is documented in the literature for protection against malaria and other sexually transmitted diseases in pregnancy and in the child's interstitial lung disease (Breuer &, 2018;García, 2020). In this case, the patient has the benefits of anti-inflammatory activity of medications (García, 2020), which can also benefit people with COVID-19 by reducing inflammatory activity caused by the virus (Cancio &, 2020;Shukla &, 2020;Shityakov &, 2014).…”

Antibodies at work in the time of severe acute respiratory syndrome coronavirus 2

“…This is a typical adaptive immunotherapy applied successfully to stem outbreaks of SARS, MERS, H1N1 pandemic of 2009, poliomyelitis, measles, and mumps [ 37 , 38 , 39 ]. However, the application of CP could not treat the Ebola virus disease.…”

Cell-Free Therapies: Novel Approaches for COVID-19

“…Together with the loss of airway epithelial cells by viral infection and replication, the additional loss of regenerating stem cells may be responsible for diminished cellular and lung regeneration (13). Cell-based therapies have been quite extensively studied for potential applicability in COVID-19, especially given the short time since the onset of the pandemic (14,15); however, due to the risk of macro-and microthrombosis, cell-free therapies may be more appealing. Cell-free therapies might decrease injury to different organs, such as lung, heart, kidney, liver, and brain, as well as reduce thrombus formation and endothelial inflammation (Figure 1).…”