Abstract
The ongoing pandemic coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is rapidly spreading and has resulted in grievous morbidity and mortality worldwide. Despite the high infectiousness of SARS-CoV-2, the majority of infected individuals are asymptomatic or have mild symptoms and could eventually recover as a result of their balanced immune function. On the contrary, immuno-compromised patients are prone to progress into severe or critical types underpinned by the entanglement of an overexuberant proinflammatory response and injured immune function. Therefore, well-coordinated innate and adaptive immune systems are pivotal to viral eradication and tissue repair. An in-depth understanding of the immunological processes underlying COVID-19 could facilitate rapidly identifying and choosing optimal immunotherapy for patients with severe SARS-CoV-2 infection. In this review, based on current immunological evidence, we describe potential immune mechanisms and discuss promising immunotherapies for COVID-19, including IL-6R blockades, convalescent plasma, intravenous gamma globulin, thymosin alpha1, corticosteroids, and type-I interferon, and recent advances in the development of COVID-19 vaccines.
Highlights
The ongoing coronavirus disease 2019 (COVID-19) pandemic triggered by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has gripped the world in an unprecedented crisis, entailing issues with the economy, health care, and education
In the newly reported randomized clinical trial of Convalescent plasma (CP) therapy for COVID-19 conducted in China, Li et al tested the role of CP in severe or lifethreatening COVID-19 patients with 52 randomized patients concurrently receiving standard care serving as the treatment group and another 51 randomized patients who received standard supportive care alone serving as controls [71]
A single-center study reported on 1568 patients infected with severe or critical COVID-19 disease in Wuhan, of whom 138 patients received 200−1200 ml CP transfusion depending on different clinical status and body weight, and another 1430 patients only received standard of care [72]
Summary
The ongoing coronavirus disease 2019 (COVID-19) pandemic triggered by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has gripped the world in an unprecedented crisis, entailing issues with the economy, health care, and education. Protracted and severe lymphopenia strongly correlates with adverse outcomes and fatality [4, 5] Together, these clinical observations indicate that, apart from direct viral toxicity, immune dysregulation serves as an independent and potent. The released virus-associated damageassociated molecular patterns (DAMPs), involving intracellular contents from dying cells [12] as well as pathogen-associated molecular patterns (PAMPs), including viral RNA [13], are identified by multiple pattern-recognition receptors (PRRs) on innate immune cells, such as dendritic cells, monocytes, macrophages, neutrophils, and epithelial cells [14]. TLR-3/7 activation leads to nuclear translocation of the NFkB and IRF3 [15]
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