Tocilizumab, Adipokines and Severe Complications of COVID-19
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LETTER TO THE EDITOR
Tocilizumab, Adipokines and Severe Complications of COVID‑19 Antonella Fioravanti1 · Brunetta Porcelli2 · Lucia Terzuoli2 · Maria Romana Bacarelli1 · Sara Tenti1 · Sara Cheleschi1
© Springer Nature Switzerland AG 2020
To the Editor: A recent article published by Zhang et al. [1] discussed the possible mechanism of action of tocilizumab in the treatment of patients with severe COVID-19 and stimulated some considerations on the basis of our previous experience. Obesity is considered as a major risk factor for serious COVID-19-related complications, such as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [2]. The link between obesity and acute lung injury during infection can be partially explained by the activation of the renin-angiotensin system. It has been supposed that the virus uses an angiotensin-converting enzyme 2 (ACE2)-dependent mechanism of cellular entry; this receptor is also expressed in adipocytes, including ectopic adipocytes within the alveolar interstitial [3]. However, we can postulate that obesity may predispose to the development and progression of the COVID-19 disease through several mechanisms. Growing evidence demonstrated that adipose tissue is an active endocrine organ and secretes many substances known as “adipocytokines” such as adiponectin, leptin, resistin, visfatin, chemerin, tumor necrosis factor (TNF)-α, interleukin (IL)-6, factors of the complement system, growth factors, and adhesion molecules, involved in the regulation of several processes including inflammation and immunity. Then, an abnormal secretion of adipocytokines from fat tissue can contribute to development of the condition described as “cytokine storm” which characterized the severe form of SARS-CoV-2. This comment refers to the article available online at https://doi. org/10.1007/s40261-020-00917-3. * Sara Cheleschi [email protected] 1
Rheumatology Unit, Department of Medicine, Surgery and Neuroscience, Azienda Ospedaliera Universitaria Senese, Policlinico Le Scotte, Viale Bracci 1, 53100 Siena, Italy
Section of Biochemistry, Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy
2
Tocilizumab, a humanized monoclonal antibody that acts as an IL-6 receptor antagonist, has shown remarkable efficacy and safety in the treatment of established rheumatoid arthritis (RA), systemic juvenile idiopathic arthritis, giant cell arteritis, and cytokine release syndrome. Since March 3, 2020 the National Health Commission of China has formally included intravenous (IV) tocilizumab in the treatment program of COVID-19 for its capacity to reduce or reverse the cytokine storm [4]. Also, Italian guidelines support the use of IV tocilizumab in patients with severe or critical complication of COVID-19 [5]. Preliminary results showed clinical efficacy of the drug with reduction of temperature, improvement of respiratory function, decrease of C-reactive protein and mortality associated with a favorable safety profile [6, 7]. Among the possible mechanisms of acti
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