Immunomodulation in COVID-19

Type Journal Article Author Nicholas E Ingraham Author Sahar Lotfi-Emran Author Beth K Thielen Author Kristina Techar Author Rachel S Morris Author Shernan G Holtan Author R Adams Dudley Author Christopher J Tignanelli URL https://www.thelancet.com/pdfs/journals/lanres/PIIS2213-2600(20)30226-5.pdf Series The Lancet Comment Volume 8 Issue June 2020 Publication The Lancet Respiratory Medicine Date 04/05/2020 DOI https://doi.org/10.1016/S2213-2600(20)30226-5 Abstract The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), continues to spread globally despite unprecedented social isolation and restrictions resulting in widespread economic decline. More than 3·2 million people have been infected and more than 230000 of them have died. To date, no treatments have been definitively shown to be effective; however, a multipronged approach to mitigate transmission, morbidity, and mortality is ongoing.1 While upstream prevention strategies such as vaccination are ideal, these strategies are unlikely to be available in time to address current clinical need. Instead, fast-tracking of drug development and repurposing of approved drugs2 has facilitated and expedited clinical trials that might hasten effective therapeutics. Many of these drugs act, at least in part, to directly limit viral replication. By contrast, the use of interleukin-6 (IL-6) inhibition might have benefits by controlling the pathological immune response to the virus. Here, we expand on the theoretical basis of IL-6 inhibition and propose potential benefits from other immunomodulators that could, in theory, prove more efficacious