Crisci Carlos D, Ardusso Ledit R F, Mossuz Antonela, Müller Leila
Department of Pulmonology, Allergy and Immunology, National University of Rosario School of Medicine, Santa Fe 3100, 2000 Rosario, Argentina.
Allergy and Immunology, National University of Rosario School of Medicine, Rosario, Argentina.
Curr Treat Options Allergy. 2020;7(3):422-440. doi: 10.1007/s40521-020-00258-8. Epub 2020 May 8.
Precision medicine (PM) represents a new paradigm in disease diagnosis, prevention, and treatment. To apply PM premises in an emerging coronavirus pandemic acquires potentially greater relevance in order to allow the selection of specific preventive measures as well as biomarkers that will be useful in disease management.
The identification of the new coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as the responsible for the coronavirus disease 2019 (COVID-19) pandemic had led to a plethora of strategies to contain viral dissemination, affecting life styles and personal behaviors. Viral genomic sequencing has shown that SARS-CoV-2 spike protein utilizes angiotensin-converting enzyme 2 (ACE2) found on ciliated epithelial cells of the human lungs as its specific receptor. Neutralizing antibodies to the receptor-binding domain of the spike protein were detected in patients recovered from COVID-19; however, both T cells and NK cells were reduced in severe cases. Excessive and uncontrolled releases of pro-inflammatory cytokines such as IL-1B, IL-1RA, IL-7, IL-8, IL-9, IL-10, fibroblast growth factor (FGF), granulocyte-macrophage colony-stimulating factor (GM-CSF), and tumor necrosis factor (TNFα) were increased in severe patients. These cytokines might be useful biomarkers of disease worsening and potential targets for new biological therapies currently under investigation.
Present knowledge and recent developments in PM approach to COVID-19 disease prevention, evaluation, and management are pointed out. Better understanding of pathogenic pathways together with an accurate phenotype classification of patients presented with SARS-CoV-2 infection and symptoms might contribute to a more accurate definition of biomarkers and other diagnostic tools, which may lead to more precise mitigation strategies, personalized pharmacologic options, as well as new biological therapy developments.
精准医学（PM）代表了疾病诊断、预防和治疗的新范式。在新型冠状病毒大流行中应用精准医学前提可能具有更大的相关性，以便能够选择特定的预防措施以及对疾病管理有用的生物标志物。
新型冠状病毒严重急性呼吸综合征冠状病毒2（SARS-CoV-2）被确定为2019冠状病毒病（COVID-19）大流行的病原体，这引发了大量遏制病毒传播的策略，影响了生活方式和个人行为。病毒基因组测序表明，SARS-CoV-2刺突蛋白利用人肺纤毛上皮细胞上发现的血管紧张素转换酶2（ACE2）作为其特异性受体。在从COVID-19康复的患者中检测到针对刺突蛋白受体结合域的中和抗体；然而，在重症病例中T细胞和NK细胞均减少。重症患者促炎细胞因子如IL-1B、IL-1RA、IL-7、IL-8、IL-9、IL-10、成纤维细胞生长因子（FGF）、粒细胞-巨噬细胞集落刺激因子（GM-CSF）和肿瘤坏死因子（TNFα）的过度和不受控制的释放增加。这些细胞因子可能是疾病恶化的有用生物标志物以及目前正在研究的新生物疗法的潜在靶点。
指出了精准医学方法在COVID-19疾病预防、评估和管理方面的现有知识和最新进展。更好地理解致病途径以及对出现SARS-CoV-2感染和症状的患者进行准确的表型分类，可能有助于更准确地定义生物标志物和其他诊断工具，这可能会带来更精确的缓解策略、个性化的药物选择以及新的生物疗法发展。
