Lung under attack by COVID-19-induced cytokine storm: pathogenic mechanisms and therapeutic implications

Dr Corrado Pelaia, MD - University “Magna Græcia” of Catanzaro, Italy

The widespread outbreak of the infection caused by the respiratory syndrome coronavirus-2 (SARS-CoV-2), also known as coronavirus disease 2019 (COVID-19) or 2019 novel coronavirus (2019-nCoV), currently represents the most tremendous health emergency worldwide. The phenotypic traits of this infection span from a complete absence of symptoms, through mild and moderate clinical manifestations (fever, cough, asthenia), up to serious pneumonia possibly leading to lung failure, acute respiratory distress syndrome (ARDS), and eventually death. With regard to the causes of such different clinical expressions, a crucial role is played by complex interactions between the virus and the individual features of host immune system. In particular, when the human organism is not able to mount an efficient adaptive immune response capable of clearing the viral infection, the possible predominance and persistence of innate immune mechanisms can drive the development and amplification of a hyperinflammatory state sustained by a massive release of cytokines and chemokines. This cytokine storm should be targeted by immunomodulatory and anti-inflammatory therapies, with the aim of reducing ARDS intensity and mortality.