Division of Rheumatology and Clinical Immunology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States.
Boston University School of Medicine, Boston, MA, United States.
Front Immunol. 2020 Oct 30;11:589474. doi: 10.3389/fimmu.2020.589474. eCollection 2020.
The SARS-CoV-2 novel coronavirus has caused the COVID-19 pandemic with over 35 million cases and over a million deaths worldwide as of early October 2020. The populations most affected are the elderly and especially those with underlying comorbidities. In terms of race and ethnicity, black and hispanic populations are affected at disproportionately higher rates. Individuals with underlying conditions that cause an immune-compromised state are considered vulnerable to this infection. The immune response is an important determinant in viral infections including coronaviruses, not only in the antiviral defense but also in the disease progression, severity, and clinical outcomes of COVID-19. Systemic lupus erythematosus is a chronic autoimmune disease which also disproportionately afflicts black and hispanic populations. In lupus patients, an aberrant immune response is characterized by the presence of circulating autoantibodies, lymphopenia, aberrant T cells, and proinflammatory cytokines along with defective regulatory mechanisms, leading to immune-mediated damage to tissues. Lupus patients are often treated with immune-suppressants and therefore are immune-compromised and more susceptible to infections and may be vulnerable to coronavirus infection. While the anti-viral immune response is important to protect from coronavirus infection, an uncontrolled proinflammatory cytokine response can lead to cytokine storm which causes damage to the lungs and other organs, causing significant morbidity and mortality. Better understanding of the underlying immune response and therapeutic strategies in lupus and COVID-19 is important to guide management of this deadly infectious disease in the context of lupus and vice-versa.
截至 2020 年 10 月初，新型 SARS-CoV-2 冠状病毒已导致 COVID-19 大流行，全球超过 3500 万例病例和超过 100 万人死亡。受影响最大的人群是老年人，尤其是那些患有潜在合并症的人。就种族和民族而言，黑人和西班牙裔人群的感染率不成比例地更高。存在导致免疫功能受损状态的潜在疾病的个体被认为易受这种感染。免疫反应是包括冠状病毒在内的病毒感染的重要决定因素，不仅在抗病毒防御中，而且在 COVID-19 的疾病进展、严重程度和临床结果中。系统性红斑狼疮是一种慢性自身免疫性疾病，也不成比例地影响黑人和西班牙裔人群。在狼疮患者中，异常的免疫反应表现为循环自身抗体、淋巴细胞减少、异常 T 细胞和促炎细胞因子的存在，以及调节机制缺陷，导致免疫介导的组织损伤。狼疮患者通常接受免疫抑制剂治疗，因此免疫功能受损，更容易感染，可能易受冠状病毒感染。虽然抗病毒免疫反应对于防止冠状病毒感染很重要，但不受控制的促炎细胞因子反应可导致细胞因子风暴，从而导致肺部和其他器官损伤，导致严重的发病率和死亡率。更好地了解狼疮和 COVID-19 中的潜在免疫反应和治疗策略对于指导狼疮和反之亦然的这种致命性传染病的管理很重要。
