Velikova Tsvetelina, Valkov Hristo, Aleksandrova Anita, Peshevska-Sekulovska Monika, Sekulovski Metodija, Shumnalieva Russka
Medical Faculty, Sofia University St. Kliment Ohridski, Sofia 1407, Bulgaria.
Department of Gastroenterology, University Hospital "Tsaritsa Yoanna-ISUL", Medical University of Sofia, Sofia 1527, Bulgaria.
World J Virol. 2024 Jun 25;13(2):92521. doi: 10.5501/wjv.v13.i2.92521.
An overly exuberant immune response, characterized by a cytokine storm and uncontrolled inflammation, has been identified as a significant driver of severe coronavirus disease 2019 (COVID-19) cases. Consequently, deciphering the intricacies of immune dysregulation in COVID-19 is imperative to identify specific targets for intervention and modulation. With these delicate dynamics in mind, immunomodulatory therapies have emerged as a promising avenue for mitigating the challenges posed by COVID-19. Precision in manipulating immune pathways presents an opportunity to alter the host response, optimizing antiviral defenses while curbing deleterious inflammation. This review article comprehensively analyzes immunomodulatory interventions in managing COVID-19. We explore diverse approaches to mitigating the hyperactive immune response and its impact, from corticosteroids and non-steroidal drugs to targeted biologics, including anti-viral drugs, cytokine inhibitors, JAK inhibitors, convalescent plasma, monoclonal antibodies (mAbs) to severe acute respiratory syndrome coronavirus 2, cell-based therapies ( CAR T, ). By summarizing the current evidence, we aim to provide a clear roadmap for clinicians and researchers navigating the complex landscape of immunomodulation in COVID-19 treatment.
过度旺盛的免疫反应，其特征为细胞因子风暴和失控的炎症，已被确定为重症2019冠状病毒病（COVID-19）病例的一个重要驱动因素。因此，解读COVID-19中免疫失调的复杂性对于确定干预和调节的特定靶点至关重要。考虑到这些微妙的动态变化，免疫调节疗法已成为减轻COVID-19带来的挑战的一个有前景的途径。精准操控免疫途径提供了一个改变宿主反应的机会，优化抗病毒防御的同时抑制有害炎症。这篇综述文章全面分析了管理COVID-19中的免疫调节干预措施。我们探讨了从皮质类固醇和非甾体药物到靶向生物制剂等多种减轻过度活跃的免疫反应及其影响的方法，包括抗病毒药物、细胞因子抑制剂、JAK抑制剂、康复期血浆、针对严重急性呼吸综合征冠状病毒2的单克隆抗体（mAb）、基于细胞的疗法（嵌合抗原受体T细胞）。通过总结当前证据，我们旨在为临床医生和研究人员在COVID-19治疗中应对复杂的免疫调节局面提供清晰的路线图。
