Adjunct Immunotherapies for the Management of Severely Ill COVID-19 Patients

Abstract

Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It has infected millions, with more than 275,000 fatal cases as of May 8, 2020. Currently, there are no specific COVID-19 therapies. Most patients depend on mechanical ventilation. Current COVID-19 data clearly highlight that cytokine storm and activated immune cell migration to the lungs characterize the early immune response to COVID-19 that causes severe lung damage and development of acute respiratory distress syndrome. In view of uncertainty associated with immunosuppressive treatments, such as corticosteroids and their possible secondary effects, including risks of secondary infections, we suggest immunotherapies as an adjunct therapy in severe COVID-19 cases. Such immunotherapies based on inflammatory cytokine neutralization, immunomodulation, and passive viral neutralization not only reduce inflammation, inflammation-associated lung damage, or viral load but could also prevent intensive care unit hospitalization and dependency on mechanical ventilation, both of which are limited resources.

Keywords: COVID-19; IVIG; SARS-CoV-2; convalescent plasma; cytokine storm syndrome; cytokines; hyperimmune globulin; immunotherapy; inflammation; monoclonal antibody; passive immunotherapy.

Graphical abstract

Figure 1

Cytokine Storm in COVID-19 Infection Lungs are the primary organs affected by SARS-CoV-2. A dysregulated cytokine response (i.e., cytokine storm) due to an influx of activated immune cells following SARS-CoV-2 infection results in pulmonary edema, leading to damaged alveoli and formation of scarred interstitium culminating in a reduced gas exchange process. The figure was created with the support of https://biorender.com under the paid subscription.

Figure 2

Immunotherapeutic Strategies for Severely Ill COVID-19 Patients Diversified immunotherapeutic approaches against severe COVID-19 cases are illustrated. The figure was created with the support of https://biorender.com under the paid subscription.