Department of Respiratory Medicine, University Hospital of Patras, Rio Patras, Greece.
Lab of Biology, Department of Biology, University of Patras, Rio Patras, Greece.
Curr Med Chem. 2021;28(26):5328-5338. doi: 10.2174/0929867328666201209100259.
A newly identified virus appeared in Wuhan, China, in December 2019, was named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and caused the coronavirus disease 2019 (COVID-19). SARS-CoV-2 presents similarities with two previous coronavirus pandemics, MERS (Middle East Respiratory Syndrome) and SARSCoV, concerning phylogenetic origin, structural composition, and clinical symptoms, thus, leading to common pathogenic mechanisms. The purpose of this review is to declare the role of interleukin-6 (IL-6) in the pathogenesis, prognosis, and treatment of COVID-19 by comparing its effect on SARS-CoV and MERS cases. Increased levels of IL-6 comprise the key for the stimulation of cytokine storm and the progression of SARS, MERS, and COVID-19 cases. Especially, in COVID-19 patients, the overactivation of NF-kΒ, which is caused by the binding of coronavirus spike protein S to alveolar epithelial cells, up-regulates IL-6 and promotes its systematic circulation, causing alveolar damage and extrapulmonary injury. Additionally, IL-6 can be used to evaluate respiratory failure and identify asymptomatic patients. Tocilizumab (TCZ), a monoclonal antibody which blocks IL-6 signaling, comprises a remedial option against COVID-19. TCZ improves oxygenation, reduces fever, and decreases levels of IL-6. IL-6 plays a major role in the pathogenesis of cytokine storm and the progression of COVID-19 and may be used as a therapeutic target against COVID-19. However, further research is needed concerning the relation of IL-6 in COVID-19 cases, and more clinical trials are required to declare TCZ as a treatment option.
一种新鉴定的病毒于 2019 年 12 月在中国武汉出现，被命名为严重急性呼吸综合征冠状病毒 2（SARS-CoV-2），并引发了 2019 年冠状病毒病（COVID-19）。SARS-CoV-2 在进化起源、结构组成和临床症状等方面与之前的两次冠状病毒大流行（中东呼吸综合征（MERS）和 SARS-CoV）具有相似性，因此导致了共同的发病机制。本综述的目的是通过比较 SARS-CoV 和 MERS 病例，阐述白细胞介素 6（IL-6）在 COVID-19 发病机制、预后和治疗中的作用。IL-6 水平升高是刺激细胞因子风暴和 SARS、MERS 和 COVID-19 病例进展的关键。特别是在 COVID-19 患者中，冠状病毒刺突蛋白 S 与肺泡上皮细胞结合引起的 NF-kΒ 的过度激活上调了 IL-6，并促进其系统循环，导致肺泡损伤和肺外损伤。此外，IL-6 可用于评估呼吸衰竭和识别无症状患者。托珠单抗（TCZ）是一种阻断 IL-6 信号的单克隆抗体，是治疗 COVID-19 的一种选择。TCZ 改善了氧合，降低了体温，降低了 IL-6 水平。IL-6 在细胞因子风暴的发病机制和 COVID-19 的进展中起主要作用，可能被用作治疗 COVID-19 的靶点。然而，还需要进一步研究 IL-6 在 COVID-19 病例中的关系，还需要更多的临床试验来宣布 TCZ 作为一种治疗选择。
