Ludwig Boltzmann Institute for Experimental and Clinical Traumatology in the AUVA Trauma Research Center, Vienna, Austria.
Department of Bioengineering, University of California San Diego, La Jolla, California.
Shock. 2020 Oct;54(4):416-437. doi: 10.1097/SHK.0000000000001565.
Approximately 3 billion people around the world have gone into some form of social separation to mitigate the current severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. The uncontrolled influx of patients in need of emergency care has rapidly brought several national health systems to near-collapse with deadly consequences to those afflicted by Coronavirus Disease 2019 (COVID-19) and other critical diseases associated with COVID-19. Solid scientific evidence regarding SARS-CoV-2/COVID-19 remains scarce; there is an urgent need to expand our understanding of the SARS-CoV-2 pathophysiology to facilitate precise and targeted treatments. The capacity for rapid information dissemination has emerged as a double-edged sword; the existing gap of high-quality data is frequently filled by anecdotal reports, contradictory statements, and misinformation. This review addresses several important aspects unique to the SARS-CoV-2/COVID-19 pandemic highlighting the most relevant knowledge gaps and existing windows-of-opportunity. Specifically, focus is given on SARS-CoV-2 immunopathogenesis in the context of experimental therapies and preclinical evidence and their applicability in supporting efficacious clinical trial planning. The review discusses the existing challenges of SARS-CoV-2 diagnostics and the potential application of translational technology for epidemiological predictions, patient monitoring, and treatment decision-making in COVID-19. Furthermore, solutions for enhancing international strategies in translational research, cooperative networks, and regulatory partnerships are contemplated.
全球约有 30 亿人采取了某种形式的社交隔离措施,以减轻当前严重急性呼吸综合征冠状病毒 2(SARS-CoV-2)大流行的影响。大量需要紧急护理的患者的涌入,使许多国家的卫生系统迅速濒临崩溃,对感染 2019 年冠状病毒病(COVID-19)和其他与 COVID-19 相关的危重疾病的人造成了致命后果。关于 SARS-CoV-2/COVID-19 的可靠科学证据仍然很少;我们迫切需要扩大对 SARS-CoV-2 病理生理学的理解,以促进精准和靶向治疗。快速信息传播的能力如同一把双刃剑;现有的高质量数据差距经常被轶事报告、相互矛盾的声明和错误信息所填补。这篇综述探讨了 SARS-CoV-2/COVID-19 大流行所特有的几个重要方面,强调了最相关的知识空白和现有的机会窗口。具体而言,重点关注 SARS-CoV-2 免疫发病机制,以及实验治疗和临床前证据在支持有效临床试验规划方面的适用性。本文讨论了 SARS-CoV-2 诊断方面的现有挑战,以及转化技术在 COVID-19 中的流行病学预测、患者监测和治疗决策方面的潜在应用。此外,还考虑了增强转化研究、合作网络和监管伙伴关系的国际战略的解决方案。