The trinity of COVID-19: immunity, inflammation and intervention

Nat Rev Immunol. 2020 Jun;20(6):363-374. doi: 10.1038/s41577-020-0311-8. Epub 2020 Apr 28.

Abstract

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causative agent of the ongoing coronavirus disease 2019 (COVID-19) pandemic. Alongside investigations into the virology of SARS-CoV-2, understanding the fundamental physiological and immunological processes underlying the clinical manifestations of COVID-19 is vital for the identification and rational design of effective therapies. Here, we provide an overview of the pathophysiology of SARS-CoV-2 infection. We describe the interaction of SARS-CoV-2 with the immune system and the subsequent contribution of dysfunctional immune responses to disease progression. From nascent reports describing SARS-CoV-2, we make inferences on the basis of the parallel pathophysiological and immunological features of the other human coronaviruses targeting the lower respiratory tract - severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV). Finally, we highlight the implications of these approaches for potential therapeutic interventions that target viral infection and/or immunoregulation.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Animals
  • Betacoronavirus / immunology
  • Betacoronavirus / physiology
  • Coronavirus Infections* / immunology
  • Coronavirus Infections* / physiopathology
  • Coronavirus Infections* / therapy
  • Coronavirus Infections* / virology
  • Disease Progression
  • Humans
  • Inflammation / etiology
  • Inflammation / immunology
  • Pandemics*
  • Pneumonia, Viral* / immunology
  • Pneumonia, Viral* / physiopathology
  • Pneumonia, Viral* / therapy
  • Pneumonia, Viral* / virology

Supplementary concepts

  • COVID-19
  • severe acute respiratory syndrome coronavirus 2