COVID-19 and immunological regulations - from basic and translational aspects to clinical implications.

Schön, Michael P; Berking, Carola; Biedermann, Tilo; Buhl, Timo; Erpenbeck, Luise; Eyerich, Kilian; Eyerich, Stefanie; Ghoreschi, Kamran; Goebeler, Matthias; Ludwig, Ralf J; Schäkel, Knut; Schilling, Bastian; Schlapbach, Christoph; Stary, Georg; von Stebut, Esther; Steinbrink, Kerstin (2020). COVID-19 and immunological regulations - from basic and translational aspects to clinical implications. Journal of the German Society of Dermatology, 18(8), pp. 795-807. Wiley 10.1111/ddg.14169

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The COVID-19 pandemic caused by SARS-CoV-2 has far-reaching direct and indirect medical consequences. These include both the course and treatment of diseases. It is becoming increasingly clear that infections with SARS-CoV-2 can cause considerable immunological alterations, which particularly also affect pathogenetically and/or therapeutically relevant factors. Against this background we summarize here the current state of knowledge on the interaction of SARS-CoV-2/COVID-19 with mediators of the acute phase of inflammation (TNF, IL-1, IL-6), type 1 and type 17 immune responses (IL-12, IL-23, IL-17, IL-36), type 2 immune reactions (IL-4, IL-13, IL-5, IL-31, IgE), B-cell immunity, checkpoint regulators (PD-1, PD-L1, CTLA4), and orally druggable signaling pathways (JAK, PDE4, calcineurin). In addition, we discuss in this context non-specific immune modulation by glucocorticosteroids, methotrexate, antimalarial drugs, azathioprine, dapsone, mycophenolate mofetil and fumaric acid esters, as well as neutrophil granulocyte-mediated innate immune mechanisms. From these recent findings we derive possible implications for the therapeutic modulation of said immunological mechanisms in connection with SARS-CoV-2/COVID-19. Although, of course, the greatest care should be taken with patients with immunologically mediated diseases or immunomodulating therapies, it appears that many treatments can also be carried out during the COVID-19 pandemic; some even appear to alleviate COVID-19.

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