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8617689 
Journal Article 
Immune reactivity during COVID-19: Implications for treatment 
Napoli, C; Benincasa, G; Criscuolo, C; Faenza, M; Liberato, C; Rusciano, M 
2021 
Yes 
Immunology Letters
ISSN: 0165-2478
EISSN: 1879-0542 
231 
28-34 
English 
Clinical symptoms of COVID-19 include fever, cough, and fatigue which may progress to acute respiratory distress syndrome (ARDS). The main hematological laboratory findings associated with the severe form of disease are represented by lymphopenia and eosinopenia which mostly occur in the elderly population characterized by cardiovascular comorbidities and immunosenescence. Besides, increased levels of D-dimer, procalcitonin, and C reactive protein (CRP) seem to be powerful prognostic biomarkers helping to predict the onset of coagulopathy. The host immune response to SARS-CoV-2 can lead to an aberrant inflammatory response or "cytokine storm" which contributes to the severity of illness. At immunological level, patients affected by a severe form of COVID-19 show poor clinical trajectories characterized by differential "immunotypes" for which T cell response seems to play a critical role in understanding pathogenic mechanisms of disease. Also, patients with mild to severe COVID-19 displayed macrophage activation syndrome (MAS), very low human leukocyte antigen D related (HLA-DR) expression with a parallel reduction of CD04+ lymphocytes, CD19 lymphocytes, and natural killer (NK) cells. Corticosteroids resulted the best therapy for the immune dysregulation whereas repurposing of tocilizumab (IL-6 receptor antagonist) appears to have mixed results in patients with COVID-19. Besides, anticoagulative therapy was associated with reduced in-hospital mortality and need of intubation among COVID-19 patients. Furthermore, the beneficial use of intravenous immunoglobulin (IVIG) and passive immunotherapy with convalescent plasma needs to be validated in large controlled clinical trials. In this review, we summarize the main hematological parameters with a prognostic value in COVID-19 and the basis of immunological reactivity during COVID-19, with a focus on ongoing clinical trials evaluating immune targets as possible therapeutic strategies. 
Antibodies, Monoclonal, Humanized; Anticoagulants; Glucocorticoids; Immunoglobulins, Intravenous; Immunosuppressive Agents; tocilizumab; I031V2H011; Index Medicus; COVID-19; drug therapy; immune response; laboratory indexes; Glucocorticoids -- therapeutic use; Severity of Illness Index; Prognosis; Hospital Mortality; Immunoglobulins, Intravenous -- therapeutic use; Treatment Outcome; Drug Repositioning; Antibodies, Monoclonal, Humanized -- therapeutic use; Randomized Controlled Trials as Topic; Anticoagulants -- therapeutic use; Immunization, Passive -- methods; Drug Therapy, Combination -- methods; Immunosuppressive Agents -- therapeutic use; SARS-CoV-2 -- immunology; Cytokine Release Syndrome -- prevention & control; Immunotherapy -- methods; SARS-CoV-2 -- isolation & purification; COVID-19 -- complications; COVID-19 -- diagnosis; COVID-19 -- immunology; Cytokine Release Syndrome -- immunology; COVID-19 -- drug therapy; COVID-19 -- therapy