COVID-19 severity and mortality are associated with distinct cytokine profiles

Published: April 21, 2021

Severe forms of COVID-19 are known to be associated with an excessive elevation of several pro-inflammatory cytokines, a condition termed “cytokine storm”. However, therapy with biological agents intended to block the action of some of these cytokines, such as anti-interleukin (IL)-6 or anti-IL-1 antibodies, have not been uniformly successful. Such mixed results could reflect the well-known biological and clinical heterogeneity of the disease itself. It is also possible that the apparent failure of some studies might be due to the lack of stratification of patient subsets according to the degree of elevation of the cytokines or according to the severity of the disease.

Dorgham et al. show, in a recently published article in The Journal of Allergy and Clinical Immunology (JACI), that there are at least two distinct profiles of cytokine release syndromes induced by SARS-CoV-2 infection. At time of hospitalization, COVID-19 patients with severe respiratory disease present, rather surprisingly, with a low viremia and a dominant pro-inflammatory response (elevated serum levels of tumor necrosis factor- α, IL-6, IL-8 and IL-10). In contrast, high viral load and elevated type-I interferon (IFN) levels, involving both IFN-α and IFN-β, characterize patients with less severe respiratory distress. An important observation is that the intensity of the cytokine response can predict the risk of death as a function of respiratory severity, at one month after hospital admission.

Overall, the observation that distinct cytokine profiles are associated with COVID-19 severity and mortality implies the need for a personalized precision medicine approach to successfully treat COVID-19 patients.

The Journal of Allergy and Clinical Immunology (JACI) is an official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.

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