Autoinflammatory and autoimmune conditions at the crossroad of COVID-19

Authors: Rodriguez, Y., Novelli, L., Rojas, M., De, Santis M., Acosta-Ampudia, Y., Monsalve, DM., Ramirez-Santana, C., Costanzo, A., Ridgway, WM., Ansari, AA., Gershwin, ME., Selmi, C., and Anaya, JM.

Publication: J Autoimmun.; June 2020

Affiliations: Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia; Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center (IRCCS), Rozzano, Milan, Italy Dermatology, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy; Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Milan, Italy; Division of Rheumatology, Allergy, and Clinical Immunology, University of California, Davis, CA, USA; Division of Rheumatology, Allergy, and Clinical Immunology, University of California, Davis, CA, USA.

Abstract: Coronavirus disease 2019 (COVID-19) has been categorized as evolving in overlapping phases. First, there is a viral phase that may well be asymptomatic or mild in the majority, perhaps 80% of patients. The pathophysiological mechanisms resulting in minimal disease in this initial phase are not well known. In the remaining 20% of cases, the disease may become severe and/or critical. In most patients of this latter group, there is a phase characterized by the hyperresponsiveness of the immune system. A third phase corresponds to a state of hypercoagulability. Finally, in the fourth stage organ injury and failure occur. Appearance of autoinflammatory/autoimmune phenomena in patients with COVID-19 calls attention for the development of new strategies for the management of life-threatening conditions in critically ill patients. Antiphospholipid syndrome, autoimmune cytopenia, Guillain-Barré syndrome and Kawasaki disease have each been reported in patients with COVID-19. Here we present a scoping review of the relevant immunological findings in COVID-19 as well as the current reports about autoinflammatory/autoimmune conditions associated with the disease. These observations have crucial therapeutic implications since immunomodulatory drugs are at present the most likely best candidates for COVID-19 therapy. Clinicians should be aware of these conditions in patients with COVID-19, and these observations should be considered in the current development of vaccines.