1.
The cytokine storm of severe influenza and development of immunomodulatory therapy.
Liu, Q, Zhou, YH, Yang, ZQ
Cellular & molecular immunology. 2016;13(1):3-10
-
-
-
Free full text
-
Plain language summary
The influenza virus is responsible for millions of severe cases and 250 000–500 000 deaths each year. Newly emerging influenza viruses have continued to challenge medical and public health systems. These infections in humans are accompanied by an aggressive pro-inflammatory response and insufficient control of an anti-inflammatory response, a combination of events called ‘cytokine storm’. The authors review the mechanisms involved with a cytokine storm and note that there is great interest in the association between polymorphisms (individual genetic variations) and host susceptibility, which may help explain why some individuals, but not others, seem relatively resistant to cytokine storm. The authors also review the use of immune modulating treatments and conclude that the most promising therapeutic approach may be a combination of S1PR (sphingosine-1-phosphate receptor 1) agonists¬, PPAR (peroxisome proliferator-activated receptor) agonists, COX-2 (cyclooxygenase-2) inhibitors, and antioxidants, including vitamin C, N-acetylcysteine (NAC), Glycyrrhizin (a compound from liquorice), polyphenols and flavonoids (plant-based antioxidants), and should be further studied in randomised clinical trials.
Abstract
Severe influenza remains unusual in its virulence for humans. Complications or ultimately death arising from these infections are often associated with hyperinduction of proinflammatory cytokine production, which is also known as 'cytokine storm'. For this disease, it has been proposed that immunomodulatory therapy may improve the outcome, with or without the combination of antiviral agents. Here, we review the current literature on how various effectors of the immune system initiate the cytokine storm and exacerbate pathological damage in hosts. We also review some of the current immunomodulatory strategies for the treatment of cytokine storms in severe influenza, including corticosteroids, peroxisome proliferator-activated receptor agonists, sphingosine-1-phosphate receptor 1 agonists, cyclooxygenase-2 inhibitors, antioxidants, anti-tumour-necrosis factor therapy, intravenous immunoglobulin therapy, statins, arbidol, herbs, and other potential therapeutic strategies.