免疫调节剂作为 COVID-19 的潜在治疗或预防策略。

Immunomodulatory agents as potential therapeutic or preventive strategies for COVID-19.

机构信息

Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy.

出版信息

Eur Rev Med Pharmacol Sci. 2021 Jun;25(11):4174-4184. doi: 10.26355/eurrev_202106_26061.

Abstract

Currently, the COVID-19 pandemic, caused by the novel SARS-CoV-2 coronavirus, represents the greatest global health threat. Most people infected by the virus present mild to moderate respiratory symptoms and recover with supportive treatments. However, certain susceptible hosts develop an acute respiratory distress syndrome (ARDS), associated with an inflammatory "cytokine storm", leading to lung damage. Despite the current availability of different COVID-19 vaccines, the new emerging SARS-CoV-2 genetic variants represent a major concern worldwide, due to their increased transmissibility and rapid spread. Indeed, it seems that some mutations or combinations of mutations might confer selective advantages to the virus, such as the ability to evade the host immune responses elicited by COVID-19 vaccines. Several therapeutic approaches have been investigated but, to date, a unique and fully effective therapeutic protocol has not yet been achieved. In addition, steroid-based therapies, aimed to reduce inflammation in patients with severe COVID-19 disease, may increase the risk of opportunistic infections, increasing the hospitalization time and mortality rate of these patients. Hence, there is an unmet need to develop more effective therapeutic options. Here, we discuss the potential use of natural immunomodulators such as Thymosin α1 (Tα1), all-trans retinoic acid (ATRA), and lactoferrin (LF), as adjunctive or preventive treatment of severe COVID-19 disease. These agents are considered to be multifunctional molecules because of their ability to enhance antiviral host immunity and restore the immune balance, depending on the host immune status. Furthermore, they are able to exert a broad-spectrum antimicrobial activity by means of direct interactions with cellular or molecular targets of pathogens or indirectly by increasing the host immune response. Thus, due to the aforementioned properties, these agents might have a great potential in a clinical setting, not only to counteract SARS-CoV-2 infection, but also to prevent opportunistic infections in critically ill COVID-19 patients.

摘要

目前,由新型严重急性呼吸综合征冠状病毒 2(SARS-CoV-2)引起的 COVID-19 大流行是全球面临的最大健康威胁。大多数感染该病毒的人表现为轻度至中度呼吸道症状,并通过支持性治疗康复。然而,某些易感宿主会发展为急性呼吸窘迫综合征(ARDS),伴有炎症“细胞因子风暴”,导致肺部损伤。尽管目前有不同的 COVID-19 疫苗,但新出现的 SARS-CoV-2 遗传变异株在全球范围内引起了极大关注,因为它们的传染性更强,传播速度更快。事实上,一些突变或突变组合似乎赋予了病毒选择性优势,例如逃避 COVID-19 疫苗引起的宿主免疫反应的能力。已经研究了几种治疗方法,但迄今为止,尚未实现一种独特且完全有效的治疗方案。此外,用于减轻重症 COVID-19 患者炎症的类固醇类药物治疗可能会增加机会性感染的风险,从而增加这些患者的住院时间和死亡率。因此,需要开发更有效的治疗方法。在这里,我们讨论了天然免疫调节剂(如胸腺肽α1(Tα1)、全反式视黄酸(ATRA)和乳铁蛋白(LF))作为重症 COVID-19 疾病辅助或预防治疗的潜在用途。这些药物被认为是多功能分子,因为它们能够增强抗病毒宿主免疫并根据宿主免疫状态恢复免疫平衡。此外,它们能够通过直接与病原体的细胞或分子靶标相互作用或通过增强宿主免疫反应来发挥广谱抗菌活性。因此,由于上述特性,这些药物在临床环境中具有很大的潜力,不仅可以对抗 SARS-CoV-2 感染,还可以预防重症 COVID-19 患者的机会性感染。

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