Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection causing coronavirus disease 2019 (COVID-19) is the biggest pandemic of our lifetime to date. No effective treatment is yet in sight for this catastrophic illness. Several antiviral agents and vaccines are in clinical trials, and drug repurposings as immediate and alternative choices are also under consideration. Immunomodulatory agents like hydroxychloroquine (HCQ) as well as biological disease-modifying anti-rheumatic drugs (bDMARDs) such as tocilizumab and anakinra received worldwide attention for treatment of critical patients with COVID-19. This is of interest to rheumatologists, who are well versed with rational use of these agents. This brief review addresses the understandings of some of the common immunopathogenetic mechanisms in the context of autoimmune rheumatic diseases like systemic lupus erythematosus (SLE) and COVID-19. Apart from demographic comparisons, the role of type I interferons (IFN), presence of antiphospholipid antibodies and finally mechanism of action of HCQ in both the scenarios are discussed here. High risks for fatal disease in COVID-19 include older age, metabolic syndrome, male gender, and individuals who develop delayed type I IFN response. HCQ acts by different mechanisms including prevention of cellular entry of SARS-CoV-2 and inhibition of type I IFN signaling. Recent controversies regarding efficacy of HCQ in management of COVID-19 warrant more studies in that direction. Autoantibodies were also reported in severe acute respiratory syndrome (SARS) as well as in COVID-19. Rheumatologists need to wait and see whether SARS-CoV-2 infection triggers development of autoimmunity in patients with COVID-19 infection in the long run.
Keywords: COVID-19; autoantibodies; cytokine storm; hydroxychloroquine (HCQ); interferon; systemic lupus erythematosus (SLE).
【저자키워드】 COVID-19, Cytokine storm, interferon, autoantibodies, hydroxychloroquine (HCQ), systemic lupus erythematosus (SLE)., 【초록키워드】 Treatment, coronavirus disease, severe acute respiratory syndrome coronavirus 2, SARS-CoV-2, Autoimmunity, Rheumatic diseases, Coronavirus disease 2019, Efficacy, Vaccine, Cytokine storm, coronavirus, pandemic, Anakinra, Hydroxychloroquine, Tocilizumab, antibody, SARS-COV-2 infection, Infection, interferons, interferon, clinical trials, Gender, risk, systemic lupus erythematosus, cytokine, severe acute respiratory syndrome Coronavirus, type I interferon, Severe acute respiratory syndrome, COVID-19 infection, autoantibodies, metabolic syndrome, management, Antiviral agents, male, Older age, IFN, type I interferons, Autoimmune, HCQ, cellular entry, respiratory, antiviral agent, mechanism of action, Critical, mechanism, antiphospholipid antibodies, Immunomodulatory agents, Signaling, Trigger, Type I IFN, lupus erythematosus, rheumatic disease, SLE, triggers, in sight, acute respiratory syndrome, acute respiratory syndrome coronavirus, individual, versed, Comparisons, syndrome, critical patients, fatal disease, sight, recent, effective, catastrophic, develop, include, reported, disease-modifying anti-rheumatic drug, patients with COVID-19, 【제목키워드】 Coronavirus infection, understanding, cross, immunopathological,