Araten David J, Belmont H Michael, Schaefer-Cutillo Julia, Iyengar Arjun, Mattoo Aprajita, Reddy Ramachandra
Division of Hematology, Department of Medicine, NYU Grossman School of Medicine, NYU Langone Health, New York City, NY, USA.
Laura and Isaac Perlmutter Cancer Center, New York City, NY, USA.
Am J Case Rep. 2020 Sep 12;21:e927418. doi: 10.12659/AJCR.927418.
BACKGROUND Patients receiving immunosuppressive therapies might be more susceptible to COVID-19. Conversely, an exaggerated inflammatory response to the SARS-CoV-2 infection might be blunted by certain forms of immunosuppression, which could be protective. Indeed, there are data from animal models demonstrating that complement may be a part of the pathophysiology of coronavirus infections. There is also evidence from an autopsy series demonstrating complement deposition in the lungs of patients with COVID-19. This raises the question of whether patients on anti-complement therapy could be protected from COVID-19. CASE REPORT Case 1 is a 39-year-old woman with an approximately 20-year history of paroxysmal nocturnal hemoglobinuria (PNH), who had recently been switched from treatment with eculizumab to ravulizumab prior to SARS-CoV-2 infection. Case 2 is a 54-year-old woman with a cadaveric renal transplant for lupus nephritis, complicated by thrombotic microangiopathy, who was maintained on eculizumab, which she started several months before she developed the SARS-CoV-2 infection. Case 3 is a 60-year-old woman with a 14-year history of PNH, who had been treated with eculizumab since 2012, and was diagnosed with COVID-19 at the time of her scheduled infusion. All 3 patients had a relatively mild course of COVID-19. CONCLUSIONS We see no evidence of increased susceptibility to SARS-CoV-2 in these patients on anti-complement therapy, which might actually have accounted for the mild course of infection. The effect of anti-complement therapy on COVID-19 disease needs to be determined in clinical trials.
接受免疫抑制治疗的患者可能更容易感染新型冠状病毒肺炎（COVID-19）。相反，某些形式的免疫抑制可能会减轻对严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染的过度炎症反应，从而起到保护作用。事实上，动物模型的数据表明补体可能是冠状病毒感染病理生理学的一部分。尸检系列研究也有证据表明COVID-19患者肺部存在补体沉积。这就提出了一个问题，即接受抗补体治疗的患者是否可以预防COVID-19。病例报告：病例1是一名39岁女性，有大约20年的阵发性夜间血红蛋白尿（PNH）病史，在感染SARS-CoV-2之前，最近从依库珠单抗治疗改为ravulizumab治疗。病例2是一名54岁女性，因狼疮性肾炎接受尸体肾移植，并发血栓性微血管病，在感染SARS-CoV-2前几个月开始使用依库珠单抗维持治疗。病例3是一名60岁女性，有14年PNH病史，自2012年以来一直接受依库珠单抗治疗，在预定输液时被诊断为COVID-19。所有3例患者的COVID-19病程相对较轻。结论：我们没有发现这些接受抗补体治疗的患者对SARS-CoV-2易感性增加的证据，这实际上可能是感染病程较轻的原因。抗补体治疗对COVID-19疾病的影响需要在临床试验中确定。
