In a comprehensive analysis of worldwide COVID-19 data, researchers have identified the key strategies to develop effective therapeutics. The study, published in the Journal of Immunology, suggests that COVID-19 should be treated as an acute inflammatory disease and that the severity of infection is associated with the dysregulation of inflammatory immune responses and subsequent inability to develop protective immunity from the virus.
"Drugs that target the virus or suppress inflammatory immune responses have produced inconsistent results and might not be the best treatment for patients with COVID-19," said study researcher Masoud Manjili from the Virginia Commonwealth University in the US. "Instead, the use of drugs that modulate inflammation without compromising the adaptive immune response could be the most effective therapeutic strategy," Manjili added.
Dysregulated Immune Response Key Cause of Death
The majority of people infected with COVID-19 show flu-like symptoms and survive the disease. However, individuals with susceptibility factors, including age (65 years and above), sex and underlying health complications are significantly more vulnerable to the infection because their immune response is in disarray.
"Although over 90 percent of the infected individuals are asymptomatic or manifest non-critical symptoms and will recover from COVID-19, those with critical symptoms are in urgent need of treatment options," Manjili said.
Because viral loads are similar in symptomatic and asymptomatic patients with COVID-19, it appears that a dysregulated immune response is the primary cause of death as opposed to viral load, according to the study.
Considering Viable Drug Options
The most serious consequences of COVID-19 are sepsis-like cytokine storm (a severe overreaction of the immune system), blood clots and respiratory or cardiovascular complications. In response to injury or infection, the immune system will normally react with an immediate inflammatory response to limit the infection and help develop a long-lasting, protective immunity against the virus within 7-10 days.
"However, when inflammation is not modulated or resolved after serving its purpose, it turns into hyper inflammation or becomes chronic and results in the inhibition of adaptive immune responses, tissue damage or organ failure, as evidenced in many cases of novel coronavirus," the team said. "Therefore, understanding and successfully controlling the inflammation would be a promising approach for the management of COVID-19," Manjili said.
The researchers determined that the highly tailored anti-inflammatory drugs, like the blood pressure medication losartan, should be considered as viable options for treating COVID-19. "The combination of losartan with convalescent plasma in symptomatic patients could be a promising strategy for the prevention or treatment of severe clinical symptoms and will allow patients to develop immunity against the virus," Manjili said.