Department of Gynecologic Oncology, Businco Hospital, "Azienda di Rilievo Nazionale ad Alta Specializzazione G. Brotzu", Via Jenner, 09100, Cagliari, Italy.
Hematology and Transplant Center, Businco Hospital, "Azienda di Rilievo Nazionale ad Alta Specializzazione G. Brotzu", Cagliari, Italy.
J Ovarian Res. 2021 Feb 8;14(1):28. doi: 10.1186/s13048-021-00772-6.
Improving early diagnosis along with timely and effective treatment of COVID-19 are urgently needed. However, at present, the mechanisms underlying disease spread and development, defined prognosis, and immune status of patients with COVID-19 remain to be determined. Patients with severe disease state exhibit a hyperinflammatory response associated with cytokine storm syndrome, hypercoagulability, and depressed cell-mediated immunity. These clinical manifestations, sharing similar pathogenesis, have been well-studied in patients with advanced ovarian cancer. The present review suggests treatment approaches for COVID-19 based on strategies used against ovarian cancer, which shares similar immunopathology and associated coagulation disorders.The chronicization of the hyperinflammatory cytokine storm in patients with severe COVID-19 highlights a defective resistance phase that leads to aspecific chronic inflammation, associated with oxidative stress, which impairs specific T-cell response, induces tissue and endothelial damage, and thrombosis associated with systemic effects that lead to severe multi-organ failure and death. These events are similar to those observed in advanced ovarian cancer which share similar pathogenesis mediated primarily by Interleukin-6, which is, as well demonstrated in ovarian cancer, the key cytokine driving the immunopathology, related systemic symptoms, and patient prognosis.Consistent with findings in other disease models with similar immunopathology, such as advanced ovarian cancer, treatment of severe COVID-19 infection should target inflammation, oxidative stress, coagulation disorders, and immunodepression to improve patient outcome. Correctly identifying disease stages, based on available laboratory data, and developing a specific protocol for each phase is essential for effective treatment.
急需改善 COVID-19 的早期诊断以及及时有效的治疗。然而,目前,疾病传播和发展的机制、明确的预后以及 COVID-19 患者的免疫状态仍有待确定。重症患者表现出与细胞因子风暴综合征、高凝状态和细胞介导免疫抑制相关的过度炎症反应。这些临床表现具有相似的发病机制,在晚期卵巢癌患者中已有深入研究。本综述根据针对卵巢癌的策略为 COVID-19 提出了治疗方法,因为卵巢癌与 COVID-19 具有相似的免疫病理学和相关的凝血障碍。严重 COVID-19 患者中过度炎症细胞因子风暴的慢性化突出了缺陷的抵抗阶段,导致非特异性慢性炎症,伴有氧化应激,这会损害特异性 T 细胞反应,引起组织和内皮损伤以及与全身性影响相关的血栓形成,导致严重多器官衰竭和死亡。这些事件类似于在晚期卵巢癌中观察到的事件,其发病机制主要由白细胞介素 6 介导,正如在卵巢癌中所证明的那样,白细胞介素 6 是驱动免疫病理学、相关全身症状和患者预后的关键细胞因子。与其他具有相似免疫病理学的疾病模型(如晚期卵巢癌)的研究结果一致,严重 COVID-19 感染的治疗应针对炎症、氧化应激、凝血障碍和免疫抑制,以改善患者的预后。根据现有实验室数据正确识别疾病阶段,并为每个阶段制定特定方案对于有效治疗至关重要。