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Review Article





AU Kurya, AU Toro, UR Bello, DC Sharma


ABSTRACT: The infection started at December, 2019 with the random elevation of respiratory tract disorders at Wuhan hospital in China. Sequencing of lower respiratory tract samples by independent laboratories in china identified a novel corona virus distinct from the other SARS strains of coronavirus previously known to infect humans, which was earlier named as corona virus disease 2019 (COVID-19) by the world health organization. The present review work highlighted the outbreaks of COVID-19 on the basis of research articles published in the reputed research articles and other authentic sources. Increased morbidity and mortality rate in COVID-19 is largely associated with acute respiratory distress syndrome (ARDS). Throughout the period of SARS, MERS infections, and SARS CoV-2, Elevated level of proinflammatory cytokines and chemokine was commonly observed in patients requiring ICU admission as compared to those in which the infection was less severe and did not require ICU admission due to excessive immune responses induced by the immune system. Potential of immunomodulatory agents such as IL-1 and IL-6 receptor antagonist, TNF-α blockers and corticosteroids in treatment of COVID-19 declared urgent need for clinical researches to precisely confirm the effectiveness and safety of the therapeutics.


KEY WORDS: COVID-19, Cytokines, Coronavirus and Immunotherapy.


  1. Chen Y, Liu Q, Guo D. Emerging coronaviruses: Genome structure, replication, and pathogenesis. J. Med. Virol. 2020 Apr;92(4):418-423.

  2. Lin X, Gong Z, Xiao Z, Xiong J, Fan B, Liu J. Novel Coronavirus Pneumonia Outbreak in 2019: Computed Tomographic Findings in Two Cases. Korean J Radiol. 2020;21(3):365-368.

  3. COVID-19 Dashboard by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University. https://coronavirus.

  4. Cui J, Li F, Shi ZL. Origin and evolution of pathogenic coronaviruses. Nat Rev Microbiol. 2019;17(3):181‐192.

  5. Li F. Structure, Function, and Evolution of Coronavirus Spike Proteins. Annu Rev Virol. 2016;3(1):237‐261.

  6. Fehr AR, Perlman S. Coronaviruses: an overview of their replication and pathogenesis. Methods Mol Biol. 2015;1282:1‐23.

  7. Decaro N, Lorusso A. Novel human coronavirus (SARS-CoV-2): A lesson from animal coronaviruses. Vet Microbiol. 2020;244:108693.

  8. Monto AS, Cowling BJ, Peiris JSM. Coronaviruses. Viral Infections of Humans. 2014;199‐223. Published 2014 Feb 27.

  9. Jiang, F.; Deng, L.; Zhang, L.; Cai, Y.; Cheung, C.-W.; Xia, Z. Review of the clinical characteristics of coronavirus disease 2019 (COVID-19). J. Gen. Intern. Med. 2020, 1–5.

  10. Yang X, Yu Y, Xu J, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med 2020

  11.  PicchiantiDiamanti A, Rosado MM, Pioli C, Sesti G, Laganà B. Cytokine Release Syndrome in COVID-19 Patients, A New Scenario for an Old Concern: The Fragile Balance between Infections and Autoimmunity. Int J Mol Sci. 2020;21(9):E3330.

  12. Braciale TJ, Hahn YS. Immunity to viruses. Immunol Rev. 2013;255(1):5‐12.

  13. Tisoncik JR, Korth MJ, Simmons CP, Farrar J, Martin TR, Katze MG. Into the eye of the cytokine storm. MicrobiolMolBiol Rev. 2012;76:16-32.

  14. Cron RQ, Behrens EM. Cytokine storm syndrome. Springer Nature. Cham, Switzerland. 2019. ISBN 978-3-030-22094-5.


  16. Zhou P, Yang XL, Wang XG, et al. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature. 2020;579(7798):270-273.

  17. Xu X, Chen P, Wang J, et al. Evolution of the novel coronavirus from the ongoing Wuhan outbreak and modeling of its spike protein for risk of human transmission. Sci China Life Sci. 2020;63(3):457‐460.

  18. Wrapp D, Wang N, Corbett KS, et al. Cryo-EM structure of the 2019-nCoV spike in the prefusion conformation. Science. 2020;367(6483):1260‐1263.

  19. Xu Z, Shi L, Wang Y, et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome [published correction appears in Lancet Respir Med. 2020 Feb 25;:]. Lancet Respir Med. 2020;8(4):420-422.

  20. Bhatia M, Zemans RL, Jeyaseelan S. Role of chemokines in the pathogenesis of acute lung injury. Am J Respir Cell Mol Biol. 2012;46(5):566-572.

  21. Channappanavar R, Perlman S. Pathogenic human coronavirus infections: causes and consequences of cytokine storm and immunopathology. SeminImmunopathol. 2017;39(5):529-539.

  22. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395:497-506.

  23. Franzetti M, Pozzetti U, Carugati M, et al. Interleukin-1 receptor antagonist anakinra in association with remdesivir in severe Coronavirus disease 2019: A case report [published online ahead of print, 2020 May 15]. Int J Infect Dis. 2020;S1201-9712(20)30357-X.

  24. Ortiz-Sanjuán F, Blanco R, Riancho-Zarrabeitia L, et al. Efficacy of Anakinra in Refractory Adult-Onset Still's Disease: Multicenter Study of 41 Patients and Literature Review. Medicine (Baltimore). 2015;94(39):e1554.

  25. Kalliolias GD, Liossis SN. The future of the IL-1 receptor antagonist anakinra: from rheumatoid arthritis to adult-onset Still's disease and systemic-onset juvenile idiopathic arthritis. Expert OpinInvestig Drugs. 2008;17(3):349-359.

  26. Farouq KM, Kurya AU. Recent Advancement in Using Genetic Engineering for Curing Deadly Diseases.” IOSR Journal of Biotechnology and Biochemistry.2020; 6(2):11-17.

  27. Shehu S, Kurya AU, Aliyu U, Sharma DC. Role of Inflammatory Cytokines in the Pathogenesis of Rheumatoid Arthritis and Novel Therapeutic Targets. AJI. 2020;4(2):37-46.

  28. Venkiteshwaran A. Tocilizumab. MAbs. 2009;1(5):432-438.

  29. Fu B, Xu X, Wei H. Why tocilizumab could be an effective treatment for severe COVID-19?.J Transl Med. 2020;18(1):164.

  30. XiaolingXu, et al. Effective treatment of severe COVID-19 patients with tocilizumab.Proceedings of the National Academy of Sciences May 2020, 117 (20) 10970-10975;

  31. Shehu, S.; Kurya, A. U.; Farouq, K. M.; Toro, A. U. Molecular Pathogenesis, Clinical Efficacy and Safety of Therapeutics Used in the Treatment of Osteoarthritis. AJI2020, 4, 1-10.

  32. Channappanavar R., Fehr A.R., Vijay R., Mack M., Zhao J., Meyerholz D.K. Dysregulated Type I Interferon and inflammatory monocyte-macrophage responses cause lethal pneumonia in SARS-CoV-Infected Mice. Cell Host Microbe. 2016;19(2):181–193.

  33. Duret PM, Sebbag E, Mallick A, Gravier S, Spielmann L, Messer L. Recovery from COVID-19 in a patient with spondyloarthritis treated with TNF-alpha inhibitor etanercept [published online ahead of print, 2020 Apr 30]. Ann Rheum Dis. 2020;annrheumdis-2020-217362.

  34.  Ye Z, Wang Y, Colunga-Lozano LE, et al. Efficacy and safety of corticosteroids in COVID-19 based on evidence for COVID-19, other coronavirus infections, influenza, community-acquired pneumonia and acute respiratory distress syndrome: a systematic review and meta-analysis [published online ahead of print, 2020 May 14]. CMAJ. 2020;cmaj.200645.

  35. Yang Z, Liu J, Zhou Y, Zhao X, Zhao Q, Liu J. The effect of corticosteroid treatment on patients with coronavirus infection: a systematic review and meta-analysis. J Infect. 2020;81(1):e13-e20.

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