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©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
Harnessing immunity: Immunomodulatory therapies in COVID-19
Tsvetelina Velikova, Hristo Valkov, Anita Aleksandrova, Monika Peshevska-Sekulovska, Metodija Sekulovski, Russka Shumnalieva
Tsvetelina Velikova, Monika Peshevska-Sekulovska, Metodija Sekulovski, Russka Shumnalieva, Medical Faculty, Sofia University St. Kliment Ohridski, Sofia 1407, Bulgaria
Hristo Valkov, Department of Gastroenterology, University Hospital “Tsaritsa Yoanna-ISUL”, Medical University of Sofia, Sofia 1527, Bulgaria
Anita Aleksandrova, Department of Immunology, SMDL Ramus, Simitli 6000, Bulgaria
Monika Peshevska-Sekulovska, Department of Gastroenterology, University Hospital Lozenetz, Sofia 1407, Bulgaria
Metodija Sekulovski, Department of Anesthesiology and Intensive Care, University Hospital Lozenetz, Sofia 1407, Bulgaria
Russka Shumnalieva, Department of Rheumatology, Clinic of Rheumatology, University Hospital "St. Ivan Rilski", Medical University-Sofia, Sofia 1612, Bulgaria
Author contributions: Velikova T and Shumnalieva R designed the research study; Valkov H, Aleksandrova A, performed the research; Sekulovski M and Peshevska-Sekulovska M drafted the figure; Velikova T, Aleksandrova A, Valkov H and Shumnalieva R wrote the manuscript; all authors have read and approved the final manuscript.
Supported by the European Union-NextGenerationEU, through the National Recovery and Resilience Plan of the Republic of Bulgaria, No. BG-RRP-2.004-0008.
Conflict-of-interest statement: The authors declare no conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/licenses/by-nc/4.0/ Corresponding author: Russka Shumnalieva, MD, PhD, Adjunct Associate Professor, Department of Rheumatology, Clinic of Rheumatology, University Hospital "St. Ivan Rilski", Medical University-Sofia, Urvich Street 13, Sofia 1612, Bulgaria. rshumnalieva@yahoo.com
Received: January 28, 2024
Revised: April 2, 2024
Accepted: April 11, 2024
Published online: June 25, 2024
Processing time: 147 Days and 16.9 Hours
An overly exuberant immune response, characterized by a cytokine storm and uncontrolled inflammation, has been identified as a significant driver of severe coronavirus disease 2019 (COVID-19) cases. Consequently, deciphering the intricacies of immune dysregulation in COVID-19 is imperative to identify specific targets for intervention and modulation. With these delicate dynamics in mind, immunomodulatory therapies have emerged as a promising avenue for mitigating the challenges posed by COVID-19. Precision in manipulating immune pathways presents an opportunity to alter the host response, optimizing antiviral defenses while curbing deleterious inflammation. This review article comprehensively analyzes immunomodulatory interventions in managing COVID-19. We explore diverse approaches to mitigating the hyperactive immune response and its impact, from corticosteroids and non-steroidal drugs to targeted biologics, including anti-viral drugs, cytokine inhibitors, JAK inhibitors, convalescent plasma, monoclonal antibodies (mAbs) to severe acute respiratory syndrome coronavirus 2, cell-based therapies (i.e., CAR T, etc.). By summarizing the current evidence, we aim to provide a clear roadmap for clinicians and researchers navigating the complex landscape of immunomodulation in COVID-19 treatment.
Keywords: Immunomodulation, COVID-19, SARS-CoV-2, Immunotherapy, Antiviral immune response, Cytokine storm, Adaptive immunity, Therapeutic strategies, Immune modulators, Viral infection, Host immune response
Core Tip: Effective management of coronavirus disease 2019 (COVID-19) requires a nuanced approach that harnesses the host’s immune response Immunomodulatory therapies play a pivotal role in fine-tuning the immune system, striking a balance between defense and avoiding excessive inflammation. In line with this, increased precision in targeting specific immune pathways, alongside personalized treatment strategies, holds promise in optimizing outcomes for COVID-19 patients. This paper explores the evolving landscape of immunomodulation, emphasizing its potential as a crucial component in the therapeutic arsenal against the virus.
