Autoinflammatory and autoimmune conditions at the crossroad of COVID-19

J Autoimmun. 2020 Nov;114:102506. doi: 10.1016/j.jaut.2020.102506. Epub 2020 Jun 16.

Abstract

Coronavirus disease 2019 (COVID-19) has been categorized as evolving in overlapping phases. First, there is a viral phase that may well be asymptomatic or mild in the majority, perhaps 80% of patients. The pathophysiological mechanisms resulting in minimal disease in this initial phase are not well known. In the remaining 20% of cases, the disease may become severe and/or critical. In most patients of this latter group, there is a phase characterized by the hyperresponsiveness of the immune system. A third phase corresponds to a state of hypercoagulability. Finally, in the fourth stage organ injury and failure occur. Appearance of autoinflammatory/autoimmune phenomena in patients with COVID-19 calls attention for the development of new strategies for the management of life-threatening conditions in critically ill patients. Antiphospholipid syndrome, autoimmune cytopenia, Guillain-Barré syndrome and Kawasaki disease have each been reported in patients with COVID-19. Here we present a scoping review of the relevant immunological findings in COVID-19 as well as the current reports about autoinflammatory/autoimmune conditions associated with the disease. These observations have crucial therapeutic implications since immunomodulatory drugs are at present the most likely best candidates for COVID-19 therapy. Clinicians should be aware of these conditions in patients with COVID-19, and these observations should be considered in the current development of vaccines.

Keywords: Antiphospholipid syndrome; Autoimmunity; COVID-19; Cytokine storm syndrome; Cytopenia; Guillain-Barré syndrome; Kawasaki disease; SARS-CoV-2; Vaccines.

Publication types

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

MeSH terms

  • Adaptive Immunity / genetics
  • Autoimmune Diseases / diagnosis
  • Autoimmune Diseases / immunology*
  • Autoimmune Diseases / therapy
  • Autoimmune Diseases / virology
  • Betacoronavirus / immunology*
  • Betacoronavirus / isolation & purification
  • COVID-19
  • COVID-19 Testing
  • Clinical Laboratory Techniques
  • Coronavirus Infections / diagnosis
  • Coronavirus Infections / epidemiology
  • Coronavirus Infections / immunology*
  • Coronavirus Infections / therapy
  • Critical Illness
  • Cytokine Release Syndrome / diagnosis
  • Cytokine Release Syndrome / immunology*
  • Cytokine Release Syndrome / therapy
  • Cytokine Release Syndrome / virology
  • Female
  • Genetic Predisposition to Disease
  • Humans
  • Immunity, Innate / genetics
  • Immunization, Passive / methods
  • Inflammation Mediators / blood
  • Inflammation Mediators / immunology
  • Macrophage Activation / genetics
  • Macrophage Activation / immunology
  • Male
  • Pandemics
  • Pneumonia, Viral / diagnosis
  • Pneumonia, Viral / epidemiology
  • Pneumonia, Viral / immunology*
  • Pneumonia, Viral / therapy
  • Risk Factors
  • SARS-CoV-2
  • Severity of Illness Index
  • Sex Factors

Substances

  • Inflammation Mediators

Supplementary concepts

  • COVID-19 serotherapy