On the genetics and immunopathogenesis of COVID-19

Abstract

Most severe cases with COVID-19, especially those with pulmonary failure, are not a consequence of viral burden and/or failure of the 'adaptive' immune response to subdue the pathogen by utilizing an adequate 'adaptive' immune defense. Rather it is a consequence of immunopathology, resulting from imbalanced innate immune response, which may not be linked to pathogen burden at all. In fact, it might be described as an autoinflammatory disease. The Kawasaki-like disease seen in children with SARS-CoV-2 exposure might be another example of similar mechanism.

Keywords: Coronavirus; Cytokine; Immune response; Innate immunity; Kawasaki disease; SARS-CoV-2.

Fig. 1

The Disintegration of the Persistence of Memory (1954) (RT) by Salvador Dali is an oil on canvas reaction to his original work The Persistence of Memory (1931). In this version, the landscape from the first painting has been engulfed by water. Disintegration of objects is occurring above and below the water. The block and plane from his original (LT) have now been separated into brick-like objects that float. Some of the bricks on the left side of the painting begin to disintegrate. A watch beneath the water is coming to pieces and another one that sunk beneath the layer of bricks, leaves bits of debris behind. While Persistence of Memory (LT) symbolizes the importance of immunological memory as cornerstone of adaptive immunity, the Disintegration of the Persistence of Memory (RT) is a metaphor for the adaptive immune response in COVID-19 [128].