جستجوی مقالات مرتبط با کلیدواژه « cytokine storm » در نشریات گروه « پزشکی »

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), also known as coronavirus disease 2019 (COVID-19), is a pandemic crisis. Little is known about the treatment of this disease, and supportive care is the only therapy for patients with COVID-19. It has been shown that mineral vitamins have an important role in improving the health status of the patients, and several studies have investigated their effects on patients affected with other coronaviruses. In this review, the probable mechanisms of action of each vitamin against COVID-19 infection, the benefits of co-therapy of vitamins with other supplements, and the recommended daily intake of each nutrient are discussed.

Phytochemicals are compounds found in plants that possess a variety of bioactive properties, including antioxidant and immunomodulatory properties. Recent studies have highlighted the potential of phytochemicals in targeting specific signalling pathways involved in cytokine storm, a life-threatening clinical condition resulting from excessive immune cell activation and oversupply of proinflammatory cytokines. Several studies have documented the immunomodulatory effects of phytochemicals on immune function, including their ability to regulate essential cellular and molecular interactions of immune system cells. This makes them a promising alternative for cytokine storm management, especially when combined with existing chemotherapies. Furthermore, phytochemicals have been found to target multiple signalling pathways, including the TNF-α/NF-κB, IL-1/NF-κB, IFN-γ/JAK/STAT, and IL-6/JAK-STAT. These pathways play critical roles in the development and progression of cytokine storm, and targeting them with phytochemicals represents a promising strategy for controlling cytokine release and the subsequent inflammation. Studies have also investigated certain families of plant-related constituents and their potential immunomodulatory actions. In vivo and in vitro studies have reported the immunomodulatory effects of phytochemicals, which provide viable alternatives in the management of cytokine storm syndrome. The collective data from previous studies suggest that phytochemicals represent a potentially functional source of cytokine storm treatment and promote further exploration of these compounds as immunomodulatory agents for suppressing specific signalling cascade responses. Overall, the previous research findings support the use of phytochemicals as a complementary approach in managing cytokine storm and improving patient outcomes.

Tocilizumab (TCZ), a monoclonal antibody against interleukin-6 (IL-6), was recommended for treatment of Covid-19 patients with a risk of cytokine storm but showed variable effect on outcome. The aim was to assess the association of outcome following tocilizumab administration with various physiological, pathological and pharmacological factor in Covid- 19 patients.

Retrospective observational study from June 2020 to July 2020. All indoor Covid positive patients who received tocilizumab were included and relevant information was captured in the case record form. Data was analyzed to the study association of various physiological factors, comorbidities, severity of disease, laboratory parameters and co-administered drugs with the outcome following tocilizumab administration.

Total 25 patients received tocilizumab during study period. Older age group (p=0.001), high NEWS score, hypertension (OR: 3.62; p=0.05) and hydroxychloroquine(HCQ) administration (OP=6.66; p=0.009) showed significant association with a worst outcome. Hypertension and hydroxychloroquine usage was analyzed after adjustment with NEWS score using MH adjusted analysis, which revealed a trend of worst outcome in HCQ recipients but the association was not significant with hypertension. High pre-treatment IL-6 (death 570.11+498.76; discharge110.31+ 49.68; p: 0.0011); high post-treatment ferritin level (death 1756.5+ 1622.03; discharge 711.71+ 421.23; p: 0.019) as well as post-tocilizumab rise in ferritin level was associated with worst outcome (p= 0.029).

Participants having higher cytokine level/or high NEWS score were unlikely to benefit from tocilizumab. Increased in ferritin level even after tocilizumab appeared to be an indicator of failure of treatment.

In patients with coronavirus disease 2019 (COVID-19) with multiple organ involvement, interleukin-6 (IL-6) is an important biomarker of the hyperinflammatory immune response, cytokine storm, and fatal outcomes. Our research aims to comprehend the value of polysulfone membrane-based hemodialysis (HD), not only in terms of lowering renal load but also in terms of enhancing outcomes by addressing the IL-6 levels in patients with chronic kidney disease (CKD) on maintenance HD (MHD).

This prospective observational analysis was conducted from July 2020 to January 2022 at a tertiary care hospital in Prayagraj, Uttar Pradesh, India. 181 patients, with a history of CKD on MHD, hospitalized in COVID-19 wards were chosen for this study. The usual baseline blood values of the patients were assessed. HD was done on the Fresenius polysulfone membrane (FX-8) with an effective surface area of 1.4 m2and an ultrafiltration coefficient of 12 (ml/h × mmHg). Patients' IL-6 levels were initially checked before dialysis,and in patients who survived, they were repeated on the day of discharge. Data were analyzed using SPSS software.

Out of a total of 181 patients, 95 were survivors and 86 were non-survivors. Most non-survivors were elderly (P < 0.001). The mean neutrophil-lymphocyte ratio (NLR) and D-dimer levels were substantially greater in non-survivors than in survivors (P < 0.001). Non-survivors had considerably higher mean serum levels of IL-6, creatinine, and urea (P < 0.001). The average number of HD treatments received by survivors was higher (P < 0.001). The relationship between delta IL-6 and delta serum creatinine for survivors had a strong positive correlation of r = 0.775 (P < 0.001).

This study demonstrates that IL-6 is a subpar predictor of prognosis in convalescent CKD patients with COVID-19. It also emphasizes the use of HD as a life-saving therapeutic strategy that is also cost-effective. Lowering IL-6 levels can both enhance renal outcomes and calm the cytokine storm.

Cytokines produced by T helper cells (Th cells) have essential roles in the body’s defense against viruses. Inadequate and high levels of specific cytokines can have side effects. This literature review article discusses the mechanisms of Th1 responses in SARS-CoV-2 and sheds light on the pivotal role of various inflammatory markers in COVID-19-related complications. The latest literary works relevant to this study were carefully chosen and evaluated. Extensive searches were conducted across multiple databases, such as Scopus, PubMed, Google Scholar, and ScienceDirect. After evaluating the existing literature, it has been observed that unregulated immune responses result in heightened inflammation. Recent studies have provided proof that the occurrence of cytokine storms can significantly contribute to the severity of COVID-19, ultimately resulting in multi-organ failure and loss of life. Factors that influence the Th1 cell response and its impact on COVID-19 severity include the timing of the immune response, pre-existing immune conditions, viral load, and genetic susceptibility. Ultimately, by effectively managing the cytokine storm, we have the potential to greatly reduce the number of deaths caused by this virus.

The coronavirus disease of 2019 (COVID-19) may be considered sepsis on the basis that all the pathological events and the subsequent organ-to-organ interaction in sepsis also occur in COVID-19. In this article, the authors first discussed the rationale for the use of vitamin C (Vit-C) in sepsis and septic patients. They also reviewed the role of a high dose of Vit-C in COVID-19, which included clinical trials designed for the management of this viral disease.

The researchers explored databases of PubMed, Scopus, ISI Web of Science, and Google Scholar. Data were extracted to assess the effects of Vit-C in septic patients and also the efficacy of supplementation with a high dose of Vit-C regarding the clinical outcomes of patients with COVID-19.

Recent research findings indicate that severe inflammatory responses (cytokine storms) and oxidative stress are important causes for the high mortality in COVID-19 patients. It seems, however, that administering high doses of Vit-C can offer a therapeutic benefit. High doses of intravenous Vit-C, with its antioxidant properties and pleiotropic functions, could attenuate the tissue damage caused by excessive levels of free radicals following the cytokine storm and septic shock in severe cases of the disease.

Recent literature suggests that high doses of Vit-C have a potential role in reducing mortality and intubation rates in critically ill COVID-19 patients. However, determining the optimal duration and dose of Vit-C in these patients requires further studies.

COVID-19 (coronavirus disease 2019) was first identified in China in December 2019 and is rapidly spreading worldwide as a pandemic. Since COVID-19 causes mild to severe acute respiratory syndrome, most studies in this context have focused on pathogenesis primarily in the respiratory system. However, evidence shows that the central nervous system (CNS) may also be affected by COVID-19. Since COVID-19 is spreading, it is necessary to study its possible cognitive effects on COVID-19 patients and their recovery.

The articles used in this study were searched by keywords, such as cytokine storm and COVID-19, COVID-19 and executive dysfunction, cognitive disorder, and COVID-19, central nervous system (CNS) and COVID-19, coronavirus, neuroinvasion in Science Direct, Scopus, PubMed, Embase, and Web of Science databases based on preferred reporting items for systematic reviews and meta-analysis (PRISMA) checklist. The study evaluates all observational studies published between December 2019 and April 2021 in peer-reviewed journals, including cross-sectional, cohort, case-control studies, case reports, and case series. The search result was 106 articles, of which 73 articles related to COVID-19, the stages of infection by this virus, its effect on the nervous system and neurological symptoms, the cytokine storm caused by this infection, and the possible cognitive consequences caused by this virus in patients, has been reviewed. Other articles were not checked due to their limited relevance to the topic under discussion.

Studies showed that neurons may be directly affected by severe acute respiratory syndrome coronavirus (SARS-CoV)-1 and SARS-CoV-2. Furthermore, various studies indicated that systemic inflammation (so-called “cytokine storm”) is also responsible for brain damage induced by infection with SARS-CoV-1 and SARS-CoV-2. 
In such a way that these patients showed elevated levels of interleukin (IL-), 6, 8, and 10 and of tumor necrosis factor-alpha (TNF-α) in their blood. 

Various cognitive defects have been observed following an increased level of cytokines, such as tumor necrosis factor-alpha (TNF-α) and interleukin (IL)-6, 8. Therefore, due to the increased level of these pro-inflammatory factors in the brains of these patients, cognitive deficits can be expected, which need further investigation.

Context: 

In 2019, a novel Coronavirus officially named byWHOas coronavirus disease of 2019 (COVID-19) pneumonia quickly spread worldwide and became a pandemic. At first, it was considered that the complications just included older populations, but its association with Kawasaki vasculitis disease further complicated the issues.

Evidence Acquisition: 

A literature search was conducted using various scientific databases of Springer, Scopus, Wiley, Science Direct, PubMed, ProQuest, Cochrane Library, Embase, and Clinical Key. Keywords COVID-19, Kawasaki vasculitis, Mucocutaneous Lymph Node Syndrome, pediatric, RNA viruses, cytokine storm, 2019 nCoV Diseases, SARS CoV 2 Infection, and SARS CoV 2 were used to filter the search results. After assessing each retrieved article against inclusion-exclusion criteria, 63 papers were deemed eligible for inclusion in this review.

Our study linked Kawasaki disease with COVID-19 pneumonia in three pathways: (1) interference of angiotensin-converting enzyme 2 (ACE2) receptor and renin-angiotensin-aldosterone system (RAAS) in the pathogenesis of SARS CoV 2 and Kawasaki vasculitis diseases, (2) the similarity of clinical manifestation and immune system response in SARS CoV 2 and Kawasaki vasculitis diseases, (3) the role of COVID-19 as a risk factor next to other risk factors.

Kawasaki vasculitis disease could be indicated along with infection with Coronaviridae viruses in pediatrics. Recognition of Kawasaki vasculitis disease with focusing on COVID-19 pathogenesis, aside from restriction of risk factors and detection of best treatment.

COVID-19, caused by the SARS-CoV-2 virus, has emerged as a global health threat. Due to coronovirus mutations and genetic variations, effective treatments remain elusive. Currently, the primary strategy for disease management revolves around coronovirus vaccines, representing the sole avenue for disease control. A prominent factor in the pathogenesis of COVID-19 is the severe inflammation triggered by a phenomenon known as cytokine storm. This review delves into the pivotal role of interleukin-6 (IL-6) in orchestrating the cytokine storm and explores the intricate network of signaling pathways and inhibitors, including phytochemicals. Numerous clinical trials have explored the potential of anti-cytokine agents and medicinal plants with cytokine-modulating attributes in COVID-19 patients. According to various studies investigating the effects of medicinal plants on COVID-19, four specific plants—Silybum marianum L., Tanacetum parthenium L., Curcuma longa L., and Zingiber officinale Rosc.—have exhibited significant anti-IL-6 signaling properties. However, further rigorous clinical data are needed to establish their prophylactic or therapeutic efficacy. Overall, both in-vivo and clinical studies suggest that the aforementioned medicinal plants, endowed with proven anti-inflammatory and immune-modulatory properties, particularly through IL-6 reduction, could make valuable contributions to the management of COVID-19.

Cytokine storm is an aberrant response from the host immune system, and a main responsibility for the incidence of acute respiratory distress syndrome. The existence of the virus induced cytokine has been linked to mortality in patients with COVID-19. The study was aimed to review the genes that role in cytokine storm as therapeutic targets in patients with COVID-19.We demonstrated the role of pro-inflammatory cytokines in conditions that are often associated with COVID-19. Hyperproduction of mostly pro-inflammatory cytokines such as, IFN-γ, IL-6, IL-1, TNF-α, and Chemokines, which target lung tissue preferentially, can significantly worsen the prognosis in almost all cases.  Data about the cytokines in this disease will support the development of more useful COVID-19 patient management strategies. In the management of COVID-19 patients, targeting cytokines can decrease mortality and increase survival rates.

COVID-19, caused by SARS-CoV-2, requires new approaches to control the disease. Programmed cell death protein (PD-1) and cytotoxic T-lymphocyte–associated protein 4 (CTLA-4) play important roles in T-cell exhaustion in severe COVID-19. This study evaluated the frequency of whole blood lymphocytes expressing PD-1 and CTLA-4 in COVID-19 patients upon admission to the intensive care unit (ICU) (i.e., severe) or infection ward (i.e., moderate) and after 7 days of antiviral therapy. COVID-19 patients were treated with either favipiravir or Kaletra (FK group, 11 severe and 11 moderate) or dexamethasone plus remdesivir (DR group, 7 severe and 10 moderate) for 7 days in a pilot study. Eight healthy control subjects were also enrolled. The frequency of PD-1+ and CTLA-4+ lymphocytes in whole blood was evaluated by flow cytometry. Patients on DR therapy had shorter hospital stays than those on FK therapy. The frequency of PD-1+ lymphocytes in the FK group at baseline differed between COVID-19 patients and healthy controls, while the frequency of both PD-1+ and CTLA-4+ cells increased significantly 7 days of FK therapy. The response was similar in both moderate and severe patients. In contrast, the frequency of PD-1+ and CTLA-4+ lymphocytes varied significantly between patients and healthy controls before DR treatment. DR therapy enhanced PD-1+ but not the CTLA-4+ frequency of these cells after 7 days. We show that the frequency of PD-1 and CTAL-4-bearing lymphocytes during hospitalization was increased in Iranian ICU COVID-19 patients who received FK treatment, but that the frequency of CTLA-4+ cells was higher at baseline and did not increase in patients who received DR. The effectiveness of DR treatment may reflect differences in T-cell activation or exhaustion status, particularly in CTLA-4-expressing cells.

The current pandemic coronavirus disease‑19 (COVID‑19) is still a global medical and economic emergency with over 244 million confirmed infections and over 4.95 million deaths by October 2021, in less than 2 years. Severe acute respiratory syndrome (SARS), the Middle East respiratory syndrome coronavirus (MERS), and COVID‑19 are three recent coronavirus pandemics with major medical and economic implications. Currently, there is no effective treatment for these infections. One major pathological hallmark of these infections is the so‑called ‘cytokine storm,’ which depicts an unregulated production of inflammatory cytokines inducing detrimental inflammation leading to organ injury and multiple organ failure including severe pulmonary, cardiovascular, and kidney failure in COVID‑19. Several studies have suggested the potential of curcumin to inhibit the replication of some viruses similar to coronaviruses. Multiple experimental and clinical studies also reported the anti‑inflammatory potential of curcumin in multiple infectious and inflammatory disorders. Thus, we hypothesized that curcumin may provide antiviral and anti‑inflammatory effects for treating COVID‑19. Although these studies suggest that curcumin could serve as an adjuvant treatment for COVID‑19, its molecular mechanisms are still debated, especially its potential to modulate the toll‑like receptors/TIR‑domain‑containing adapter‑inducing interferon‑β/nuclear factor kappa‑light‑chain‑enhancer of activated B cells (TLR/TRIF/NF‑κB) pathway. The preliminary results showed that curcumin modulates the nuclear factor kappa‑light‑chain‑enhancer of activated B cells (NF‑κB) pathway, a common pathway controlling cytokine production in multiple infectious and inflammatory disorders. Here, we hypothesize and discuss whether curcumin treatment may provide antiviral and anti‑inflammatory clinical advantages for treating COVID‑19 by modulating the TLR/TRIF/NF‑κB pathway. We also review the current data on curcumin and discuss potential experimental and clinical studies that require defining its potential clinical implications in COVID‑19.

COVID-19 disease is the cause of daily morbidity and mortality worldwide due to its high transmissibility and pathogenicity. To date, intravenous immunoglobulin (IVIg) injection has been used as one of the various treatments for this disease. This study aimed to determine the effect of IVIg injection on the treatment of patients with Coronavirus-induced cytokine storm.

A total of 174 patients with COVID-19 were included in this study based on their clinical characteristics and laboratory findings and were divided into two groups of IVIg recipients and non-recipients according to the treatment they received. Statistical analysis was performed using SPSS version 22.0. A p-value less than 0.05 was considered statistically significant.

IVIg was used to treat merely 20 patients and Kaletra and hemoperfusion drugs were used more among IVIg recipient patients (P=0.003 and P=0.001, respectively). COVID-19-positive PCR tests were significantly more frequent among IVIg recipients (P=0.026). The polymorphonuclear neutrophil (PMN) count (P=0.007) and sodium level (P=0.007) were significantly higher in the IVIg recipient group on the first admission day. Moreover, INR levels in the IVIg recipient group were significantly lower on the seventh admission day (P=0.020). The median of total intensive care unit (ICU) duration of hospitalization among IVIg recipients was significantly higher (P=0.001).

It seems that the use of IVIg in COVID-19 patients should be further investigated.

IVIg injection could decrease mortality and slightly increase the survival rate among COVID-19 patients.

Pregnant women with coronavirus disease 2019 (COVID-19) have a higher risk of morbidity and mortality compared with the general population. Possible pathways are: I) in patients with COVID-19, cytokine storm defined as the excess release of pro-inflammatory cytokines such as interleukin 1β (IL-1β), IL-6, and tumor necrosis factor-α (TNF-α) has been associated with morbidities and an even higher rate of mortality. II) Labor, despite being a term/preterm, has an inflammatory nature, although, inflammation is more prominent in preterm delivery. During labor, different pro-inflammatory cytokines such as IL-1β, IL-6, and TNF-α are involved which as mentioned, all are crucial role players in the cytokine storm. III) Tissue injury, and during labor, (especially cesarean section) is shown to cause inflammation via pro-inflammatory cytokines release including those involved in the cytokine storm through the activation of nuclear factor κB (NFκB). IV) post-partum hemorrhage with a notable amount of blood loss which can cause significant hypoxemia. In this condition, hypoxia-inducible factor 1α which has a cross-talk with NFκB, leads to the expression of IL-1β, IL-6, and TNF-α as both angiogenic and pro-inflammatory factors. Considering all the mentioned issues and pathways, we suggest that clinicians be careful about the escalation of the inflammatory status in their pregnant COVID-19 patients during/following labor.

Hemophagocytic lymphohistiocytosis (HLH), is a disorder seen more often in children and is life-threatening in terms of over- activation of macrophages, and T cells resulting in cytokine storm. HLH can be familial or secondary to infections,malignancy, immunosuppression, and autoimmune conditions, such as systemic lupus erythematosus (SLE). Here, we report a 10-year old female with previously diagnosed SLE who hospitalized because of fever and pancytopenia.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) provokes the host immune responses and induces severe respiratory syndrome by overreaction of immune cells. IL-1β is a pro-inflammatory cytokine highly associated with the related inflammation and cytokine storm, and several IL-1β antagonists are being used to treat cytokine release syndrome (CRS). Accordingly, some studies and clinical trials are investigating the effects of IL-1β antagonists for controlling Coronavirus disease 2019 (COVID-19) associated CRS. Here, we will review any interaction and association between IL-1β and SARS-CoV-2 infection.

The novel coronavirus disease 2019 (COVID-19) was declared a global pandemic. There is an urgent need for finding efficient medical treatments to diminish the high mortality rate of the mutant variants of the virus. This study aimed to determine the efficacy of edaravone in patients with moderate COVID-19.

This single-center non-randomized controlled clinical trial was performed on hospitalized patients with moderate COVID-19. The patients were divided into two groups of intervention (n=17) and control (n=16). Patients in the intervention group received three doses of edaravone (30 mg) for three interval days (Days 2, 4, and 6). Admission to the intensive care unit (ICU), need for intubation, and mortality were the primary outcomes.

All cases had 15-60% lung involvement. Although edaravone reduced the admission to ICU, need for intubation, and mortality rate in patients with moderate COVID-19, the results were not statistically significant. Baseline characteristics, admission days, and clinical parameters were similar between the two groups (P>0.05).

Administration of edaravone 30 mg for three days had no significant effect on the overall outcome of patients with moderate COVID-19. Practical Implications. In this study, none of the COVID-19 patients receiving edaravone had ICU admission, intubation, and mortality. However, no significant difference was found between the clinical outcomes of the control and intervention groups.