Familial Mediterranean Fever and COVID-19: Friends or Foes?

Front Immunol. 2020 Sep 18:11:574593. doi: 10.3389/fimmu.2020.574593. eCollection 2020.

Abstract

Familial Mediterranean Fever (FMF) and COVID-19 show a remarkable overlap of clinical symptoms and similar laboratory findings. Both are characterized by fever, abdominal/chest pain, elevation of C-reactive protein, and leukocytosis. In addition, colchicine and IL-1 inhibitors treatments that are effective in controlling inflammation in FMF patients have recently been proposed for off-label use in COVID-19 patients. Thus, FMF may resemble a milder recapitulation of the cytokine storm that is a hallmark of COVID-19 patients progressing to severe disease. We analyzed the sequence of the MEFV-encoded Pyrin protein - whose mutations cause FMF- in mammals, bats and pangolin. Intriguingly, although Pyrin is extremely conserved in species that are considered either a reservoir or intermediate hosts for SARS-CoV-2, some of the most common FMF-causing variants in humans are present as wildtype residues in these species. We propose that in humans, Pyrin may have evolved to fight highly pathogenic infections.

Keywords: COVID-19; FMF disease; cytokine storm; innate immunity; pyrin.

Publication types

  • Review

MeSH terms

  • Animals
  • Betacoronavirus* / genetics
  • Betacoronavirus* / immunology
  • C-Reactive Protein / genetics
  • C-Reactive Protein / immunology
  • COVID-19
  • Colchicine / therapeutic use*
  • Coronavirus Infections* / drug therapy
  • Coronavirus Infections* / epidemiology
  • Coronavirus Infections* / genetics
  • Coronavirus Infections* / immunology
  • Familial Mediterranean Fever* / drug therapy
  • Familial Mediterranean Fever* / epidemiology
  • Familial Mediterranean Fever* / genetics
  • Familial Mediterranean Fever* / immunology
  • Humans
  • Mutation*
  • Pandemics*
  • Pneumonia, Viral* / drug therapy
  • Pneumonia, Viral* / epidemiology
  • Pneumonia, Viral* / genetics
  • Pneumonia, Viral* / immunology
  • Pyrin* / genetics
  • Pyrin* / immunology
  • SARS-CoV-2

Substances

  • MEFV protein, human
  • Pyrin
  • C-Reactive Protein
  • Colchicine