Division of Nephrology.
Department of Radiation Oncology.
JCI Insight. 2020 Aug 6;5(15):140711. doi: 10.1172/jci.insight.140711.
Coronavirus disease 2019 (COVID-19), the disease caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has resulted in a global pandemic and a disruptive health crisis. COVID-19-related morbidity and mortality have been attributed to an exaggerated immune response. The role of complement activation and its contribution to illness severity is being increasingly recognized. Here, we summarize current knowledge about the interaction of coronaviruses with the complement system. We posit that (a) coronaviruses activate multiple complement pathways; (b) severe COVID-19 clinical features often resemble complementopathies; (c) the combined effects of complement activation, dysregulated neutrophilia, endothelial injury, and hypercoagulability appear to be intertwined to drive the severe features of COVID-19; (d) a subset of patients with COVID-19 may have a genetic predisposition associated with complement dysregulation; and (e) these observations create a basis for clinical trials of complement inhibitors in life-threatening illness.
新型冠状病毒病 2019（COVID-19）是由严重急性呼吸系统综合征冠状病毒 2 型（SARS-CoV-2）引起的疾病，导致了全球大流行和破坏性的卫生危机。COVID-19 相关的发病率和死亡率归因于过度的免疫反应。补体激活的作用及其对疾病严重程度的贡献正日益得到认识。在这里，我们总结了关于冠状病毒与补体系统相互作用的最新知识。我们假设：（a）冠状病毒激活多种补体途径；（b）严重的 COVID-19 临床特征通常类似于补体病；（c）补体激活、失调性嗜中性粒细胞增多、内皮损伤和高凝状态的综合作用似乎相互交织，导致 COVID-19 的严重特征；（d）COVID-19 的一部分患者可能存在与补体失调相关的遗传易感性；（e）这些观察结果为补体抑制剂在危及生命的疾病中的临床试验提供了基础。
