Complement activation in COVID-19 and targeted therapeutic options: A scoping review

Blood Rev. 2023 Jan:57:100995. doi: 10.1016/j.blre.2022.100995. Epub 2022 Jul 30.

Abstract

Increasing evidence suggests that activation of the complement system plays a key role in the pathogenesis and disease severity of Coronavirus disease 2019 (COVID-19). We used a systematic approach to create an overview of complement activation in COVID-19 based on histopathological, preclinical, multiomics, observational and clinical interventional studies. A total of 1801 articles from PubMed, EMBASE and Cochrane was screened of which 157 articles were included in this scoping review. Histopathological, preclinical, multiomics and observational studies showed apparent complement activation through all three complement pathways and a correlation with disease severity and mortality. The complement system was targeted at different levels in COVID-19, of which C5 and C5a inhibition seem most promising. Adequately powered, double blind RCTs are necessary in order to further investigate the effect of targeting the complement system in COVID-19.

Keywords: COVID-19; Complement cascade; Complement inhibition; Review; SARS-CoV-2.

Publication types

  • Review

MeSH terms

  • COVID-19*
  • Complement Activation
  • Humans
  • Randomized Controlled Trials as Topic
  • SARS-CoV-2