Szabo Robert, Petrișor Cristina, Bodolea Constantin, Dobre Vlad, Tranca Sebastian, Clichici Simona, Szabo Iulia, Melinte Razvan Marian, Mocan Teodora
Physiology Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania.
2nd Anesthesia Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania.
Pharmaceutics. 2023 Feb 14;15(2):646. doi: 10.3390/pharmaceutics15020646.
COVID-19 produces cytokine-mediated persistent inflammation and is associated with elevated iron stores and low circulating iron. It is believed that central to the pathophysiological mechanism is interleukin 6 and hepcidin. A state of iron overload, termed hyperferritinemia, and inflammatory anemia take place. Both conditions are linked to a worse result in critically ill patients. Blocking the interleukin 6-hepcidin pathway with Tocilizumab could present favorable outcomes. The aim of this study was to evaluate if Tocilizumab influences survival, the occurrence of sepsis, anemia and transfusions in critically ill patients suffering from COVID-19. This prospective observational study focused on levels of interleukin 6, hepcidin and blood iron parameters in patients treated with Tocilizumab. Data were compared before and after therapy as well as between treated and control groups. Results indicate that there is no difference in terms of survival nor in the rate of anemia or sepsis occurrence. Hepcidin was elevated and anemia ensued after treatment, which could indicate alternative pathways. In conclusion, when the classic interleukin 6-hepcidin pathway is blocked, inflammation seems to use alternative routes. Further understanding of these pathways is required and new pharmacological therapies need to be developed to treat persistent inflammation.
新型冠状病毒肺炎（COVID-19）会引发细胞因子介导的持续性炎症，且与铁储存升高及循环铁水平降低有关。据信，白细胞介素6和铁调素是病理生理机制的核心。会出现一种名为高铁蛋白血症的铁过载状态以及炎症性贫血。这两种情况均与危重症患者的更差预后相关。使用托珠单抗阻断白细胞介素6-铁调素通路可能会带来良好的结果。本研究的目的是评估托珠单抗是否会影响新型冠状病毒肺炎危重症患者的生存率、脓毒症的发生、贫血情况及输血情况。这项前瞻性观察性研究聚焦于接受托珠单抗治疗患者的白细胞介素6、铁调素及血铁参数水平。对治疗前后以及治疗组与对照组的数据进行了比较。结果表明，在生存率、贫血发生率或脓毒症发生率方面没有差异。治疗后铁调素升高且出现了贫血，这可能表明存在其他途径。总之，当经典的白细胞介素6-铁调素通路被阻断时，炎症似乎会采用其他途径。需要进一步了解这些途径，并开发新的药物疗法来治疗持续性炎症。
