Cytokine storm: Excessive inflammation may not have big role in COVID-19, says study
In a study that included 168 adults with COVID-19, 26 with flu and 16 healthy people, the researchers noted that only seven patients with the novel coronavirus disease exhibited cytokine profiles that indicated cytokine storm.
Cytokine storm is one of the many terms that the general public has been introduced to during the COVID-19 pandemic. The potentially life-threatening condition occurs when our body produces a dysregulated inflammatory response. It can lead to organ damage and even death.
Drugs like dexamethasone and tocilizumab have been proposed for the treatment and management of the condition.
Now, a study done by the American Association for the Advancement of Science, suggests that a JAK inhibitor called baricitinib may help manage cytokine storm.
Another study done by a group of researchers at the St. Jude Children's Research Hospital and Washington University School of Medicine in St. Louis indicates that cytokine storm may not be responsible for the severity of the disease in SARS-CoV-2 infection and hence every patient needs to be monitored carefully before giving them steroids.
The findings of both the studies are published in the journal Science Advances.
JAK or Janus kinase inhibitors belong to the class of disease-modifying anti-inflammatory drugs that are typically used for the treatment of conditions like rheumatoid arthritis. These drugs inhibit the functioning of enzymes called Janus kinases which otherwise promote the production of pro-inflammatory (those that increase inflammation) cytokines in the body. Cytokines are molecules that promote or control inflammation.
Previous research had suggested that baricitinib may reduce the levels of IL-6 in the body, a cytokine that is seen to be related to COVID-19 severity.
In the latest study involving about 601 COVID-19 patients, the researchers observed that a JAK inhibitor called Baricitinib is effective in improving the survival rate of patients by reducing inflammation and hence the occurrence of cytokine storms.
A total of 179 patients were enrolled from Pisa, Italy and 422 from Albacete, Spain. About 37 people in the Pisa group and 46 people from the Albacete group were given baricitinib once daily for about two weeks. The rest formed the control group. The Spain cohort was mostly older (more than 70 years of age) and hence were given lower doses of the drug.
It was found that the group that received baricitinib reported lesser complications and death (16.9 percent) than the control group (34.9 percent).
Also, in vivo studies showed that the drug can reduce the expression of ACE2 in the body. ACE2 are receptors that SARS-CoV-2 uses to enter healthy cells.
Role of cytokine storm in mortality and severe COVID-19
In a study that included 168 adults with COVID-19 , 26 with flu and 16 healthy people, the researchers noted that only seven patients with the novel coronavirus disease exhibited cytokine profiles that indicated cytokine storm. However, the cytokine levels were not as high as those noted in the flu.
Over 90 percent of COVID-19 patients needed hospitalisation; half of these needed to be shifted to the Intensive care unit and about 23 percent of all hospitalised patients died. On the other hand, more than 50 percent of the flu patients needed hospitalisation, of which about 35 percent needed the ICU and 8 percent died.
The study authors also indicated that the antiviral immune response is more suppressed in COVID-19 patients than flu patients and this, rather than dysregulated inflammation may be responsible for severe disease in the former.
Additionally, the study suggested that not all patients should be given steroids like dexamethasone since these patients are probably already developing high levels of corticosteroids and hence showing suppression of immune function. Instead, they should be treated with drugs that push their antiviral immune response.
For more information, read our article on Cytokine storm.
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