Abstract
Objectives
One-fifth of Covid-19 patients suffer a severe course of Covid-19 infection; however, the specific causes remain unclear. Mast cells (MCs) are activated by SARS-CoV-2. Although only recently recognized, MC activation syndrome (MCAS), usually due to acquired MC clonality, is a chronic multisystem disorder with inflammatory and allergic themes, and an estimated prevalence of 17%. This paper describes a novel conjecture explaining how MCAS might cause a propensity for severe acute Covid-19 infection and chronic post-Covid-19 illnesses.
Methods
Observations of Covid-19 illness in patients with/without MCAS were compared with extensive clinical experience with MCAS.
Results
The prevalence of MCAS is similar to that of severe cases within the Covid-19-infected population. Much of Covid-19’s hyperinflammation is concordant with manners of inflammation which MC activation can drive. Drugs with activity against MCs or their mediators have preliminarily been observed to be helpful in Covid-19 patients. None of the authors’ treated MCAS patients with Covid-19 suffered severe infection, let alone mortality.
Conclusions
Hyperinflammatory cytokine storms in many severely symptomatic Covid-19 patients may be rooted in an atypical response to SARS-CoV-2 by the dysfunctional MCs of MCAS rather than a normal response by normal MCs. If proven, this theory has significant therapeutic and prognostic implications.
【저자키워드】 COVID-19, SARS-CoV-2, Mast cell activation syndrome, Mast cell activation disease, Medical hypothesis, 【초록키워드】 Inflammation, Severe infection, Cytokine storm, Mortality, Infection, drug, mast cell, Prevalence, hyperinflammation, therapeutic, Patient, prognostic, patients, symptomatic COVID-19, Inflammatory, Atypical, observation, Activation, Implications, syndrome, allergic, Severe case, clinical experience, disorder, illnesses, objective, Course, Result, treated, activated, suffered, cause, MCs, 【제목키워드】 hyperinflammation, syndrome, cell activation,