COVID-19 作为干扰素缺乏和炎症过度活跃的中介:联合使用 JAK1/2 抑制剂与干扰素的原理。

COVID-19 as a mediator of interferon deficiency and hyperinflammation: Rationale for the use of JAK1/2 inhibitors in combination with interferon.

机构信息

Department of Hematology, Zealand University Hospital, Roskilde, Denmark.

Department of Hematology, Zealand University Hospital, Roskilde, Denmark.

出版信息

Cytokine Growth Factor Rev. 2021 Aug;60:28-45. doi: 10.1016/j.cytogfr.2021.03.006. Epub 2021 Apr 14.

Abstract

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) elicits an interferon (IFN) deficiency state, which aggravates the type I interferon deficiency and slow IFN responses, which associate with e.g. aging and obesity. Additionally, SARS-CoV-2 may also elicit a cytokine storm, which accounts for disease progression and ultimately the urgent need of ventilator support. Based upon several reports, it has been argued that early treatment with IFN-alpha2 or IFN-beta, preferentially in the early disease stage, may prohibit disease progression. Similarly, preliminary studies have shown that JAK1/2 inhibitor treatment with ruxolitinib or baricitinib may decrease mortality by dampening the deadly cytokine storm, which - in addition to the virus itself - also contributes to multi-organ thrombosis and multi-organ failure. Herein, we describe the rationale for treatment with IFNs (alpha2 or beta) and ruxolitinib emphasizing the urgent need to explore these agents in the treatment of SARS-CoV-2 - both as monotherapies and in combination. In this context, we take advantage of several safety and efficacy studies in patients with the chronic myeloproliferative blood cancers (essential thrombocythemia, polycythemia vera and myelofibrosis) (MPNs), in whom IFN-alpha2 and ruxolitinib have been used successfully for the last 10 (ruxolitinib) to 30 years (IFN) as monotherapies and most recently in combination as well. In the context of these agents being highly immunomodulating (IFN boosting immune cells and JAK1/2 inhibitors being highly immunosuppressive and anti-inflammatory), we also discuss if statins and hydroxyurea, both agents possessing anti-inflammatory, antithrombotic and antiviral potentials, might be inexpensive agents to be repurposed in the treatment of SARS-CoV-2.

摘要

严重急性呼吸综合征冠状病毒 2(SARS-CoV-2)引发干扰素(IFN)缺乏状态,这会加重 I 型干扰素缺乏和 IFN 反应缓慢,与例如衰老和肥胖有关。此外,SARS-CoV-2 还可能引发细胞因子风暴,这是疾病进展的原因,也是急需呼吸机支持的原因。根据几项报告,有人认为早期使用 IFN-α2 或 IFN-β 治疗,优选在疾病早期阶段,可能会阻止疾病进展。同样,初步研究表明,使用 JAK1/2 抑制剂鲁索利替尼或巴利昔替尼治疗可能会通过抑制致命的细胞因子风暴来降低死亡率,除了病毒本身之外,细胞因子风暴还会导致多器官血栓形成和多器官衰竭。在此,我们描述了使用 IFN(α2 或 β)和鲁索利替尼治疗的基本原理,强调迫切需要探索这些药物治疗 SARS-CoV-2,无论是作为单一疗法还是联合疗法。在这方面,我们利用了几项针对慢性骨髓增生性血液癌症(原发性血小板增多症、真性红细胞增多症和骨髓纤维化)(MPNs)患者的安全性和疗效研究,在这些研究中,IFN-α2 和鲁索利替尼已成功使用了 10 年(鲁索利替尼)到 30 年(IFN)作为单一疗法,最近也联合使用。鉴于这些药物具有高度免疫调节作用(IFN 增强免疫细胞,JAK1/2 抑制剂具有高度免疫抑制和抗炎作用),我们还讨论了他汀类药物和羟基脲是否可能是具有抗炎、抗血栓和抗病毒潜力的廉价药物,可以重新用于治疗 SARS-CoV-2。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/91b1/8045432/5ff9dd7bc56b/ga1_lrg.jpg

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