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. 2023 Jan:57:100995.
doi: 10.1016/j.blre.2022.100995. Epub 2022 Jul 30.

Complement activation in COVID-19 and targeted therapeutic options: A scoping review

Endry Hartono Taslim Lim  1 , Rombout Benjamin Ezra van Amstel  2 , Vieve Victoria de Boer  3 , Lonneke Alette van Vught  4 , Sanne de Bruin  2 , Matthijs Christian Brouwer  5 , Alexander Petrus Johannes Vlaar  6 , Diederik van de Beek  5
Affiliations

Complement activation in COVID-19 and targeted therapeutic options: A scoping review

Endry Hartono Taslim Lim et al. Blood Rev. 2023 Jan.

Abstract

Increasing evidence suggests that activation of the complement system plays a key role in the pathogenesis and disease severity of Coronavirus disease 2019 (COVID-19). We used a systematic approach to create an overview of complement activation in COVID-19 based on histopathological, preclinical, multiomics, observational and clinical interventional studies. A total of 1801 articles from PubMed, EMBASE and Cochrane was screened of which 157 articles were included in this scoping review. Histopathological, preclinical, multiomics and observational studies showed apparent complement activation through all three complement pathways and a correlation with disease severity and mortality. The complement system was targeted at different levels in COVID-19, of which C5 and C5a inhibition seem most promising. Adequately powered, double blind RCTs are necessary in order to further investigate the effect of targeting the complement system in COVID-19.

Keywords: COVID-19; Complement cascade; Complement inhibition; Review; SARS-CoV-2.

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Conflict of interest statement

Declaration of Competing Interest Prof. Vlaar reports personal fees from InflaRx paid to Amsterdam UMC, outside the submitted work. All other authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Simplified figure of the complement system and theurapeutic targets in COVID-19. MAC = membrane attack complex; MBL = mannose-binding lectin; NET = neutrophil extracellular trap. Adapted from: Afzali et al., Nat Rev. Immunol (2022).
Fig. 2
Fig. 2
Flow diagram for study selection.
See this image and copyright information in PMC

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