Background: The effects of immunomodulators in patients with Coronavirus Disease 2019 (COVID-19) pneumonia are still unknown. We investigated the cellular inflammatory and molecular changes in response to standard-of-care + pidotimod (PDT) and explored the possible association with blood biomarkers of disease severity. Methods: Clinical characteristics and outcomes, neutrophil-to-lymphocyte ratio (NLR), plasma and cell supernatant chemokines, and gene expression patterns after SARS-CoV-2 and influenza (FLU) virus in vitro stimulation were assessed in 16 patients with mild-moderate COVID-19 pneumonia, treated with standard of care and PDT 800 mg twice daily (PDT group), and measured at admission, 7 (T1), and 12 (T2) days after therapy initiation. Clinical outcomes and NLR were compared with age-matched historical controls not exposed to PDT. Results: Hospital stay, in-hospital mortality, and intubation rate did not differ between groups. At T1, NLR was 2.9 (1.7–4.6) in the PDT group and 5.5 (3.4–7.1) in controls ( p = 0.037). In the PDT group, eotaxin and IL-4 plasma concentrations progressively increased ( p < 0.05). Upon SARS-CoV-2 and FLU-specific stimulation, IFN-γ was upregulated ( p < 0.05), while at genetic transcription level, Pathogen Recognition Receptors (TRLs) were upregulated, especially in FLU-stimulated conditions. Conclusions: Immunomodulation exerted by PDT and systemic corticosteroids may foster a restoration in the innate response to the viral infection. These results should be confirmed in larger RCTs.
【저자키워드】 COVID-19, immune response, Respiratory failure, immunomodulation, cytokine, Viral pneumonia, pidotimod, toll like receptor, 【초록키워드】 SARS-CoV-2, viral infection, therapy, Biomarker, Pneumonia, Influenza, disease severity, Genetic, Transcription, chemokines, in vitro, outcome, virus, Neutrophil-to-lymphocyte ratio, immunomodulator, outcomes, Characteristics, clinical, Patient, Control, plasma, molecular, Admission, in-hospital mortality, Blood, IFN-γ, RCTs, association, NLR, IL-4, cellular, Inflammatory, Standard of care, innate response, plasma concentration, Recognition, intubation rate, Standard-of-care, Effect, not differ, investigated, treated, changes in, upregulated, groups, conditions, cell supernatant, gene expression pattern, systemic corticosteroid, were assessed, 【제목키워드】 immunostimulation, Effect, with COVID-19,