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A cytokine super cyclone in COVID-19 patients with risk factors: the therapeutic potential of BCG immunization
Institution:1. Female Reproduction and Metabolic Syndromes Laboratory, Division of Molecular Reproduction, Rajiv Gandhi Centre for Biotechnology, Thiruvananthapuram, 695 014, Kerala, India;2. Research Centre Kerala University, Senate House Campus, Palayam, Thiruvananthapuram, India
Abstract:The seventh human coronavirus SARS-CoV2 belongs to the cluster of extremely pathogenic coronaviruses including SARS-CoV and MERS-CoV, which can cause fatal lower respiratory tract infection. Likewise, SARS-CoV2 infection can be fatal as the disease advances to pneumonia, followed by acute respiratory distress syndrome (ARDS). The development of lethal clinical symptons is associated with an exaggerated production of inflammatory cytokines, referred to as the cytokine storm, is a consequence of a hyperactivated immune response aginst the infection. In this article, we discuss the pathogenic consequences of the cytokine storm and its relationship with COVID-19 associated risk factors. The increased pro-inflammatory immune status in patients with risk factors (diabetes, hypertension, cardiovascular disease, COPD) exacerbates the Cytokine-storm of COVID-19 into a ‘Cytokine Super Cyclone’. We also evaluate the antiviral immune responses provided by BCG vaccination and the potential role of ‘trained immunity’ in early protection against SARS-CoV2.
Keywords:Coronavirus  COVID-19(SARS Cov2)  Cytokine  Growth factors  Co-morbidity  BCG  ARDS"}  {"#name":"keyword"  "$":{"id":"kw0040"}  "$$":[{"#name":"text"  "_":"acute respiratory distress syndrome  SARS-CoV"}  {"#name":"keyword"  "$":{"id":"kw0050"}  "$$":[{"#name":"text"  "_":"severe acute respiratory syndrome coronavirus  MERS-CoV"}  {"#name":"keyword"  "$":{"id":"kw0060"}  "$$":[{"#name":"text"  "_":"middle east respiratory syndrome coronavirus  COVID-19"}  {"#name":"keyword"  "$":{"id":"kw0070"}  "$$":[{"#name":"text"  "_":"coronavirus disease 2019  RNA"}  {"#name":"keyword"  "$":{"id":"kw0080"}  "$$":[{"#name":"text"  "_":"ribonucleic acid  HCoV"}  {"#name":"keyword"  "$":{"id":"kw0090"}  "$$":[{"#name":"text"  "_":"human coronavirus  ALI"}  {"#name":"keyword"  "$":{"id":"kw0100"}  "$$":[{"#name":"text"  "_":"acute lung injury  TGF-β"}  {"#name":"keyword"  "$":{"id":"kw0110"}  "$$":[{"#name":"text"  "_":"transforming growth factor-β  IFN"}  {"#name":"keyword"  "$":{"id":"kw0120"}  "$$":[{"#name":"text"  "_":"interferon  TNF"}  {"#name":"keyword"  "$":{"id":"kw0130"}  "$$":[{"#name":"text"  "_":"tumor necrosis factor  IL"}  {"#name":"keyword"  "$":{"id":"kw0140"}  "$$":[{"#name":"text"  "_":"interleukin  CCL"}  {"#name":"keyword"  "$":{"id":"kw0150"}  "$$":[{"#name":"text"  "_":"chemokine (C-C motif) ligand  IL-1RA"}  {"#name":"keyword"  "$":{"id":"kw0160"}  "$$":[{"#name":"text"  "_":"interleukin-1 receptor antagonist  RANTES"}  {"#name":"keyword"  "$":{"id":"kw0170"}  "$$":[{"#name":"text"  "_":"regulated on activation  normal T cell expressed and secreted  MCP-1"}  {"#name":"keyword"  "$":{"id":"kw0180"}  "$$":[{"#name":"text"  "_":"monocyte chemoattractant protein-1  MIP"}  {"#name":"keyword"  "$":{"id":"kw0190"}  "$$":[{"#name":"text"  "_":"macrophage inflammatory protein  IP-10"}  {"#name":"keyword"  "$":{"id":"kw0200"}  "$$":[{"#name":"text"  "_":"IFN-γ-inducible protein-10  CXCL"}  {"#name":"keyword"  "$":{"id":"kw0210"}  "$$":[{"#name":"text"  "_":"C-X-C motif chemokine  TH"}  {"#name":"keyword"  "$":{"id":"kw0220"}  "$$":[{"#name":"text"  "_":"T helper  NKT"}  {"#name":"keyword"  "$":{"id":"kw0230"}  "$$":[{"#name":"text"  "_":"natural killer T cells  COPD"}  {"#name":"keyword"  "$":{"id":"kw0240"}  "$$":[{"#name":"text"  "_":"chronic obstructive pulmonary disease  MIG"}  {"#name":"keyword"  "$":{"id":"kw0250"}  "$$":[{"#name":"text"  "_":"Monokine induced by gamma interferon  BALF"}  {"#name":"keyword"  "$":{"id":"kw0260"}  "$$":[{"#name":"text"  "_":"bronchoalveolar lavage fluid  bFGF"}  {"#name":"keyword"  "$":{"id":"kw0270"}  "$$":[{"#name":"text"  "_":"basic fibroblast growth factor  G-CSF/GCSF"}  {"#name":"keyword"  "$":{"id":"kw0280"}  "$$":[{"#name":"text"  "_":"granulocyte-colony stimulating factor  GM-CSF"}  {"#name":"keyword"  "$":{"id":"kw0290"}  "$$":[{"#name":"text"  "_":"granulocyte-macrophage colony-stimulating factor  PDGF"}  {"#name":"keyword"  "$":{"id":"kw0300"}  "$$":[{"#name":"text"  "_":"platelet-derived growth factor  VEGF"}  {"#name":"keyword"  "$":{"id":"kw0310"}  "$$":[{"#name":"text"  "_":"vascular endothelial growth factor  ACE2"}  {"#name":"keyword"  "$":{"id":"kw0320"}  "$$":[{"#name":"text"  "_":"angiotensin converting enzyme 2  DPP4"}  {"#name":"keyword"  "$":{"id":"kw0330"}  "$$":[{"#name":"text"  "_":"dipeptidyl peptidase 4  TMPRSS2"}  {"#name":"keyword"  "$":{"id":"kw0340"}  "$$":[{"#name":"text"  "_":"transmembrane protease serine 2  T2DM"}  {"#name":"keyword"  "$":{"id":"kw0350"}  "$$":[{"#name":"text"  "_":"type2 diabetes  GDM"}  {"#name":"keyword"  "$":{"id":"kw0360"}  "$$":[{"#name":"text"  "_":"gestational diabetes mellitus  BCG"}  {"#name":"keyword"  "$":{"id":"kw0370"}  "$$":[{"#name":"text"  "_":"bacillus calmette- guérin  BCG-CORONA"}  {"#name":"keyword"  "$":{"id":"kw0380"}  "$$":[{"#name":"text"  "_":"reducing health care workers absenteeism in COVID-19 pandemic by enhanced trained immune responses through bacillus calmette-guérin vaccination  a randomized controlled trial  BRACE"}  {"#name":"keyword"  "$":{"id":"kw0390"}  "$$":[{"#name":"text"  "_":"BCG vaccination to reduce the impact of COVID-19 in healthcare workers following coronavirus exposure  BADAS"}  {"#name":"keyword"  "$":{"id":"kw0400"}  "$$":[{"#name":"text"  "_":"BCG vaccine for health care workers as defense against COVID 19
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