Narasaraju Teluguakula, Tang Benjamin M, Herrmann Martin, Muller Sylviane, Chow Vincent T K, Radic Marko
College of Veterinary Medicine, Oklahoma State University, Stillwater, OK, United States.
Department of Intensive Care Medicine, Nepean Hospital, Sydney, NSW, Australia.
Front Pharmacol. 2020 Jun 5;11:870. doi: 10.3389/fphar.2020.00870. eCollection 2020.
There is an urgent need for new therapeutic strategies to contain the spread of the novel coronavirus disease 2019 (COVID-19) and to curtail its most severe complications. Severely ill patients experience pathologic manifestations of acute respiratory distress syndrome (ARDS), and clinical reports demonstrate striking neutrophilia, elevated levels of multiple cytokines, and an exaggerated inflammatory response in fatal COVID-19. Mechanical respirator devices are the most widely applied therapy for ARDS in COVID-19, yet mechanical ventilation achieves strikingly poor survival. Many patients, who recover, experience impaired cognition or physical disability. In this review, we argue the need to develop therapies aimed at inhibiting neutrophil recruitment, activation, degranulation, and neutrophil extracellular trap (NET) release. Moreover, we suggest that currently available pharmacologic approaches should be tested as treatments for ARDS in COVID-19. In our view, targeting host-mediated immunopathology holds promise to alleviate progressive pathologic complications of ARDS and reduce morbidities and mortalities in severely ill patients with COVID-19.
迫切需要新的治疗策略来遏制2019年新型冠状病毒病（COVID-19）的传播并减少其最严重的并发症。重症患者会出现急性呼吸窘迫综合征（ARDS）的病理表现，临床报告显示，在致命的COVID-19病例中，存在明显的中性粒细胞增多、多种细胞因子水平升高以及过度的炎症反应。机械通气设备是COVID-19中治疗ARDS应用最广泛的疗法，但机械通气的生存率极低。许多康复患者会出现认知障碍或身体残疾。在本综述中，我们认为有必要开发旨在抑制中性粒细胞募集、激活、脱颗粒和中性粒细胞胞外陷阱（NET）释放的疗法。此外，我们建议应测试目前可用的药物方法作为COVID-19中ARDS的治疗方法。我们认为，针对宿主介导的免疫病理学有望减轻ARDS的进行性病理并发症，并降低重症COVID-19患者的发病率和死亡率。
