Graphical abstract Highlights • According to WHO, COVID-19 pandemic belongs to very high-risk category. • Potentially lethal manifestations of COVID-19 are due to cytokine storm syndrome. • Cytokine storm in COVID-19 patients with co-morbidities is associated with elevated cytokine synergism. • Exacerbation of ‘cytokine storm’ in high risk patients could be responsible for the high mortality. • Antiviral state against SARS-CoV2 imparted by BCG vaccine involves IL-1β, TNF-α and IL-6 release from trained monocytes. The seventh human coronavirus SARS-CoV2 belongs to the cluster of extremely pathogenic coronaviruses including SARS-CoV and MERS-CoV, which can cause fatal lower respiratory tract infection. Likewise, SARS-CoV2 infection can be fatal as the disease advances to pneumonia, followed by acute respiratory distress syndrome (ARDS). The development of lethal clinical symptons is associated with an exaggerated production of inflammatory cytokines, referred to as the cytokine storm, is a consequence of a hyperactivated immune response aginst the infection. In this article, we discuss the pathogenic consequences of the cytokine storm and its relationship with COVID-19 associated risk factors. The increased pro-inflammatory immune status in patients with risk factors (diabetes, hypertension, cardiovascular disease, COPD) exacerbates the Cytokine-storm of COVID-19 into a ‘Cytokine Super Cyclone’. We also evaluate the antiviral immune responses provided by BCG vaccination and the potential role of ‘trained immunity’ in early protection against SARS-CoV2.
【저자키워드】 coronavirus, COVID-19, Coronavirus disease 2019, cytokine, Growth factors, BCG, co-morbidity, COPD, Chronic obstructive pulmonary disease, ACE2, angiotensin converting enzyme 2, SARS-CoV, severe acute respiratory syndrome coronavirus, MERS-CoV, Middle East respiratory syndrome coronavirus, HCoV, human coronavirus, IFN, interferon, ARDS, acute respiratory distress syndrome, GM-CSF, granulocyte-macrophage colony-stimulating factor, IL, interleukin, MIP, macrophage inflammatory protein, TNF, Tumor Necrosis Factor, RNA, Ribonucleic acid, VEGF, Vascular endothelial growth factor, TMPRSS2, Transmembrane Protease Serine 2, Th, T helper, CCL, chemokine (C-C motif) ligand, ALI, Acute Lung Injury, BALF, bronchoalveolar lavage fluid, IP-10, IFN-γ-inducible protein-10, MCP-1, monocyte Chemoattractant Protein-1, PDGF, platelet-derived growth factor, COVID-19(SARS Cov2), TGF-β, transforming growth factor-β, IL-1RA, interleukin-1 receptor antagonist, RANTES, regulated on activation, normal T cell expressed and secreted, CXCL, C-X-C motif chemokine, NKT, natural killer T cells, MIG, Monokine induced by gamma interferon, bFGF, basic fibroblast growth factor, G-CSF/GCSF, granulocyte-colony stimulating factor, DPP4, dipeptidyl peptidase 4, T2DM, type2 diabetes, GDM, gestational diabetes mellitus, BCG, bacillus calmette- guérin, BCG-CORONA, reducing health care workers absenteeism in COVID-19 pandemic by enhanced trained immune responses through bacillus calmette-guérin vaccination, a randomized controlled trial, BRACE, BCG vaccination to reduce the impact of COVID-19 in healthcare workers following coronavirus exposure, BADAS, BCG vaccine for health care workers as defense against COVID 19,