Abstract
The present is a comprehensive review of the immunopathology of Covid-19. The immune reaction to SARS-CoV-2 infection is characterized by differentiation and proliferation of a variety of immune cells with immune mediator production and release, and activation of other pathogen resistance mechanisms. We fully address the humoral and cellular immune changes induced by the virus, with particular emphasis on the role of the “cytokine storm” in the evolution of the disease. Moreover, we also propose some immune alterations (i.e., inflammatory parameters, cytokines, leukocytes and lymphocyte subpopulations) as prognostic markers of the disease. Furthermore, we discuss how immune modifying drugs, such as tocilizumab, chloroquine, glucocorticoids and immunoglobulins, and blood purification therapy, can constitute a fundamental moment in the therapy of the infection. Finally, we made a critical analysis of a number of substances, not yet utilized, but potentially useful in SARS-CoV-2 patients, such as IFN lambda, TNF blockers, ulinastatin, siponimod, tacrolimus, mesenchymal stem cells, inhibitors of mononuclear macrophage recruitment, IL-1 family antagonists, JAK-2 or STAT-3 inhibitors.
Highlights
In December 2019, an epidemic provoked by Coronavirus disease 2019 (COVID-19) arose in Wuhan, Hubei Province, China
It is worth knowing that the differentiation of naïve CD4+ T-cells into effector and memory population is one of the most essential aspects of T-cell-mediated immunity [13], and the equilibrium between the naïve and memory CD4+ T cells is essential for maintaining an effective immune response
Such balance is altered in COVID-19 critical patients with expansion of naïve CD4+ T-cell subset and reduced memory cell percentage further showing the severity of the immune system impairment in these subjects
Summary
In December 2019, an epidemic provoked by Coronavirus disease 2019 (COVID-19) arose in Wuhan, Hubei Province, China. SARS-CoV-2 belongs to the Coronaviridae family and is correlated to the subgenus Sarbecovirus. This is an enveloped virus comprising a single-stranded positive sense RNA viral genome. Cytotoxic T lymphocytes (CTLs) are stimulated after identifying infected cells presenting the viral antigens as portions of surface antigen-MHC-I complexes. An immunoinformatic method was employed to recognize major CTL and B cell epitopes in the SARS-CoV-2 surface glycoprotein. In the fight between the virus and the human body, the immunity of the subjects reduces, and the virus virulence augments [9] This causes edema and congestion of the lung, thickening of the interstitial tissue, and augmented exudation in the alveolar space able to cause respiratory failure. We critically consider the various immuno-modifying drugs useful in the treatment of Covid-19 and underline how the immunotherapeutic approach is of fundamental importance for SARS-CoV-2 infection
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