COVID-19 has become a worldwide pandemic caused by the novel coronavirus named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Severe cases of COVID-19 have accounted for 10–20% of all infections, leading to more than 500,000 deaths. Increasing evidence has suggested that the inflammatory cytokine storm originating from the anti-SARS-CoV-2 immune response plays an important role in the pathogenesis of critically ill patients with COVID-19, which leads to mixed antagonistic response syndrome (MARS). In the early stage of severe COVID-19, systemic inflammatory response syndrome causes acute respiratory distress syndrome, multiple organ dysfunction syndrome, and even multiple organ failure. In the late stage of severe disease, increased production of anti-inflammatory cytokines drives the immune response to become dominated by compensatory anti-inflammatory response syndrome, which leads to immune exhaustion and susceptibility to secondary infections. Therefore, precise immunomodulation will be beneficial for patients with severe COVID-19, and immunosuppressive or immune enhancement therapy will depend on the disease course and immune status. This review summarizes the current understanding of the immunopathogenesis of severe COVID-19, especially the role of the inflammatory cytokine storm in disease progression. Immune indicators and immunotherapy strategies for severe COVID-19 are reviewed and the potential implications discussed.
【저자키워드】 severe acute respiratory syndrome coronavirus 2, Critical illness, Coronavirus disease 2019, Pneumonia, immunomodulation, 【초록키워드】 COVID-19, SARS-CoV-2, coronavirus, immune response, therapy, Pathogenesis, severe COVID-19, Immunotherapy, susceptibility, anti-SARS-CoV-2, immune, Novel coronavirus, Disease progression, infections, Immunopathogenesis, Patient, multiple organ failure, early stage, multiple organ dysfunction, secondary infections, acute respiratory distress, Immune status, Evidence, severe disease, deaths, Inflammatory cytokine storm, immunosuppressive, Critically ill patient, acute respiratory syndrome, worldwide pandemic, syndrome, systemic inflammatory response, late stage, anti-inflammatory response, anti-inflammatory cytokine, implication, Course, caused, the disease, accounted, suggested, cause, Increasing, antagonistic, with COVID-19, 【제목키워드】 COVID-19, state,