COVID-19 illness: Different comorbidities may require different immunological therapeutic targets.

COVID-19 illness: Different comorbidities may require different immunological therapeutic targets.

Publication date: Sep 19, 2023

The SARS-CoV-2 pandemic has led to more than 6,870. 000 deaths worldwide. Despite recent therapeutic advances, deaths in Intensive Care Units still range between 34 and 72%, comprising substantial unmet need as we move to an endemic phase. The general agreement is that in the first few days of infection, antiviral drugs and neutralizing monoclonal antibodies should be adopted. When the patient is hospitalized and develops severe pneumonia, progressing to a systemic disease, immune modifying therapy with corticosteroids is indicated. Such interventions, however, are less effective in the context of comorbidities (e. g., diabetes, hypertension, heart failure, atrial fibrillation, obesity and central nervous system-CNS diseases) which are by themselves associated with poor outcomes. Such comorbidities comprise common and some distinct underlying inflammatory pathobiology regulated by differential cytokine taxonomy. Searching in the PubMed database, literature pertaining to the biology underlying the different comorbidities, and the data from the studies related to various immunological treatments for the Covid-19 disease were carefully analyzed. Several experimental and clinical data have demonstrated that hypertension and atrial fibrillation present an IL-6 dependent signature, whereas diabetes, obesity, heart failure and CNS diseases may exhibit an IL-1a/b predominant signature. Distinct selective cytokine targeting may offer advantage in treating severe COVID-19 illness based on single or multiple associated comorbidities. When the patient does not immediately respond, a broader target range through JAKs pathway inhibitors may be indicated. Herein, we discuss the biological background associated with distinct comorbidities which might impact the SARS-CoV-2 infection course and how these should to be addressed to improve the current therapeutic outcome.

Concepts Keywords
Diabetes atrial fibrillation
Pandemic comorbidities
Therapy COVID-19
Worldwide diabetes
heart failure


Type Source Name
disease MESH COVID-19
disease MESH infection
disease MESH pneumonia
disease MESH disease immune
disease VO effective
disease MESH hypertension
disease MESH heart failure
disease MESH atrial fibrillation
disease MESH obesity
disease MESH CNS diseases
pathway REACTOME SARS-CoV-2 Infection

Original Article

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