Department of Trauma Surgery, Emergency Surgery & Surgical Critical, Tongji Trauma Center, Wuhan, China.
Department of Emergency and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Front Immunol. 2023 Jul 6;14:1200289. doi: 10.3389/fimmu.2023.1200289. eCollection 2023.
Nowadays, people have relaxed their vigilance against COVID-19 due to its declining infection numbers and attenuated virulence. However, COVID-19 still needs to be concern due to its emerging variants, the relaxation of restrictions as well as breakthrough infections. During the period of the COVID-19 infection, the imbalanced and hyper-responsive immune system plays a critical role in its pathogenesis. Macrophage Activation Syndrome (MAS) is a fatal complication of immune system disease, which is caused by the excessive activation and proliferation of macrophages and cytotoxic T cells (CTL). COVID-19-related hyperinflammation shares common clinical features with the above MAS symptoms, such as hypercytokinemia, hyperferritinemia, and coagulopathy. In MAS, immune exhaustion or defective anti-viral responses leads to the inadequate cytolytic capacity of CTL which contributes to prolonged interaction between CTL, APCs and macrophages. It is possible that the same process also occurred in COVID-19 patients, and further led to a cytokine storm confined to the lungs. It is associated with the poor prognosis of severe patients such as multiple organ failure and even death. The main difference of cytokine storm is that in COVID-19 pneumonia is mainly the specific damage of the lung, while in MAS is easy to develop into a systemic. The attractive therapeutic approach to prevent MAS in COVID-19 mainly includes antiviral, antibiotics, convalescent plasma (CP) therapy and hemadsorption, extensive immunosuppressive agents, and cytokine-targeted therapies. Here, we discuss the role of the therapeutic approaches mentioned above in the two diseases. And we found that the treatment effect of the same therapeutic approach is different.
如今，由于 COVID-19 感染人数下降和毒性减弱，人们对其警惕性有所放松。然而，由于其不断出现的变种、限制的放松以及突破感染，COVID-19 仍需要引起关注。在 COVID-19 感染期间，失衡和高反应性的免疫系统在其发病机制中起着关键作用。巨噬细胞活化综合征（MAS）是一种免疫系统疾病的致命并发症，是由巨噬细胞和细胞毒性 T 细胞（CTL）的过度激活和增殖引起的。COVID-19 相关的过度炎症与上述 MAS 症状具有共同的临床特征，如细胞因子血症、高铁蛋白血症和凝血功能障碍。在 MAS 中，免疫衰竭或抗病毒反应缺陷导致 CTL 的细胞溶解能力不足，这导致 CTL、APC 和巨噬细胞之间的相互作用延长。在 COVID-19 患者中，也可能发生同样的过程，进一步导致局限于肺部的细胞因子风暴。这与重症患者的预后不良有关，如多器官衰竭甚至死亡。细胞因子风暴的主要区别在于，COVID-19 肺炎主要是肺的特异性损伤，而 MAS 则容易发展为全身性疾病。预防 COVID-19 中 MAS 的有吸引力的治疗方法主要包括抗病毒、抗生素、恢复期血浆（CP）治疗和血液吸附、广泛的免疫抑制剂以及细胞因子靶向治疗。在这里，我们讨论了上述治疗方法在这两种疾病中的作用。我们发现，相同治疗方法的治疗效果不同。
