COVID-19: fisiopatología y propuestas terapéuticas en investigación clínica6409
Contenido principal del artículo
Resumen
La pandemia por COVID-19 declarada por la Organización Mundial de la Salud el 11 de marzo del 2020, ha ocasionado al momento 6,287,771 casos y 379,941 muertes en todo el mundo. Alrededor del 80% de las personas infectadas por SARS-CoV-2 son asintomáticos, el resto desarrolla la enfermedad COVID-19. Factores como edad, sexo y coexistencia de comorbilidades como hipertensión, diabetes y enfermedades cardiovasculares y del sistema respiratorio aumentan la gravedad de la enfermedad. Cuando la infección por SARS-CoV-2 alcanza el tracto respiratorio inferior, la respuesta inmune se acompaña de secreción intensa de citocinas y quimiocinas, dando lugar a edema y pérdida de la función de la unidad alveolo-capilar que sumado a la tormenta de citocinas da lugar a la falla orgánica múltiple. Esta revisión describe la fisiopatología relacionada con las manifestaciones clínicas del COVID-19 y presenta los principales fármacos estudiados en ensayos clínicos.
Descargas
Detalles del artículo
El autor puede disponer de su artículo para su archivo en repositorios institucionales o en páginas web personales, con la referencia y agradecimientos a la fuente donde se ha publicado.
Citas
Arabi, Y. M., Shalhoub, S., Mandourah, Y., Al-Hameed, F., Al-Omari, A., Al Qasim, E., Jose, J., Alraddadi, B., Almotairi, A., Al Khatib, K., Abdulmomen, A., Qushmaq, I., Sindi, A. A., Mady, A., Solaiman, O., Al-Raddadi, R., Maghrabi, K., Ragab, A., Al Mekhlafi, G. A., … Fowler, R. (2020). Ribavirin and Interferon Therapy for Critically Ill Patients With Middle East Respiratory Syndrome: A Multicenter Observational Study. Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America, 70(9), 1837-1844. https://doi.org/10.1093/cid/ciz544
Bonam, S. R., Kaveri, S. V., Sakuntabhai, A., Gilardin, L., & Bayry, J. (2020). Adjunct Immunotherapies for the Management of Severely Ill COVID-19 Patients. Cell Reports Medicine, 1(2), 100016. https://doi.org/10.1016/j.xcrm.2020.100016
Bulut, C., & Kato, Y. (2020). Epidemiology of COVID-19. Turkish Journal of Medical Sciences, 50(SI-1), 563-570. https://doi.org/10.3906/sag-2004-172
Calderón, J. M., Zerón, H. M., & Padmanabhan, S. (2020). Treatment with Hydroxychloroquine vs Hydroxychloroquine + Nitazoxanide in COVID-19 patients with risk factors for poor prognosis: A structured summary of a study protocol for a randomised controlled trial. Trials, 21(1), 504. https://doi.org/10.1186/s13063-020-04448-2
Cai, Q., Yang, M., Liu, D., Chen, J., Shu, D., Xia, J., Liao, X., Gu, Y., Cai, Q., Yang, Y., Shen, C., Li, X., Peng, L., Huang, D., Zhang, J., Zhang, S., Wang, F., Liu, J., Chen, L., … Liu, L. (2020). Experimental Treatment with Favipiravir for COVID-19: An Open-Label Control Study. Engineering (Beijing, China). https://doi.org/10.1016/j.eng.2020.03.007
Cantini, F., Niccoli, L., Matarrese, D., Nicastri, E., Stobbione, P., & Goletti, D. (2020). Baricitinib therapy in COVID-19: A pilot study on safety and clinical impact. The Journal of Infection. https://doi.org/10.1016/j.jinf.2020.04.017
Cao, B., Wang, Y., Wen, D., Liu, W., Wang, J., Fan, G., Ruan, L., Song, B., Cai, Y., Wei, M., Li, X., Xia, J., Chen, N., Xiang, J., Yu, T., Bai, T., Xie, X., Zhang, L., Li, C., … Wang, C. (2020). A Trial of Lopinavir-Ritonavir in Adults Hospitalized with Severe Covid-19. The New England Journal of Medicine, 382(19), 1787-1799. https://doi.org/10.1056/NEJMoa2001282
Channappanavar, R., Fehr, A. R., Vijay, R., Mack, M., Zhao, J., Meyerholz, D. K., & Perlman, S. (2016). Dysregulated Type I Interferon and Inflammatory Monocyte-Macrophage Responses Cause Lethal Pneumonia in SARS-CoV-Infected Mice. Cell Host & Microbe, 19(2), 181-193. https://doi.org/10.1016/j.chom.2016.01.007
Chen, N., Zhou, M., Dong, X., Qu, J., Gong, F., Han, Y., Qiu, Y., Wang, J., Liu, Y., Wei, Y., Xia, J., Yu, T., Zhang, X., & Zhang, L. (2020). Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: A descriptive study. Lancet (London, England), 395(10223), 507-513. https://doi.org/10.1016/S0140-6736(20)30211-7
Coronaviridae Study Group of the International Committee on Taxonomy of Viruses. (2020). The species Severe acute respiratory syndrome-related coronavirus: Classifying 2019-nCoV and naming it SARS-CoV-2. Nature Microbiology, 5(4), 536-544. https://doi.org/10.1038/s41564-020-0695-z
Corral, P., Corral, G., & Diaz, R. (2020). Colchicine and COVID-19. Journal of Clinical Pharmacology. https://doi.org/10.1002/jcph.1684
Costanzo, M., De Giglio, M. A. R., & Roviello, G. N. (2020). SARS-CoV-2: Recent Reports on Antiviral Therapies Based on Lopinavir/Ritonavir, Darunavir/Umifenovir, Hydroxychloroquine, Remdesivir, Favipiravir and Other Drugs for the Treatment of the New Coronavirus. Current Medicinal Chemistry. https://doi.org/10.2174/0929867327666200416131117
Cui, J., Li, F., & Shi, Z.-L. (2019). Origin and evolution of pathogenic coronaviruses. Nature Reviews. Microbiology, 17(3), 181-192. https://doi.org/10.1038/s41579-018-0118-9
De Luca, G., Cavalli, G., Campochiaro, C., Della-Torre, E., Angelillo, P., Tomelleri, A. et al. (2020). GM-CSF blockade with mavrilimumab in severe COVID-19 pneumonia and systemic hyperinflammation: A single-centre, prospective cohort study. The Lancet Rheumatology, S2665991320301703. https://doi.org/10.1016/S2665-9913(20)30170-3
Fu, Y., Cheng, Y., & Wu, Y. (2020). Understanding SARS-CoV-2-Mediated Inflammatory Responses: From Mechanisms to Potential Therapeutic Tools. Virologica Sinica. https://doi.org/10.1007/s12250-020-00207-4
Giovane, R. A., Rezai, S., Cleland, E., & Henderson, C. E. (2020). Current pharmacological modalities for management of novel coronavirus disease 2019 (COVID-19) and the rationale for their utilization: A review. Reviews in Medical Virology, e2136. https://doi.org/10.1002/rmv.2136
Goker Bagca, B., & Biray Avci, C. (2020). The potential of JAK/STAT pathway inhibition by ruxolitinib in the treatment of COVID-19. Cytokine & Growth Factor Reviews. https://doi.org/10.1016/j.cytogfr.2020.06.013
Guan, W.-J., Ni, Z.-Y., Hu, Y., Liang, W.-H., Ou, C.-Q., He, J.-X., Liu, L., Shan, H., Lei, C.-L., Hui, D. S. C., Du, B., Li, L.-J., Zeng, G., Yuen, K.-Y., Chen, R.-C., Tang, C.-L., Wang, T., Chen, P.-Y., Xiang, J., … China Medical Treatment Expert Group for Covid-19. (2020). Clinical Characteristics of Coronavirus Disease 2019 in China. The New England Journal of Medicine, 382(18), 1708-1720. https://doi.org/10.1056/NEJMoa2002032
Hasöksüz, M., Kiliç, S., & Saraç, F. (2020). Coronaviruses and SARS-COV-2. Turkish Journal of Medical Sciences, 50(SI-1), 549-556. https://doi.org/10.3906/sag-2004-127
Horby PW et al. (2020). RECOVERY Trial press release. https://www.recoverytrial.net/results
Jean, S.-S., Lee, P.-I., & Hsueh, P.-R. (2020). Treatment options for COVID-19: The reality and challenges. Journal of Microbiology, Immunology, and Infection = Wei Mian Yu Gan Ran Za Zhi, 53(3), 436-443. https://doi.org/10.1016/j.jmii.2020.03.034
Jin, Y., Yang, H., Ji, W., Wu, W., Chen, S., Zhang, W., & Duan, G. (2020). Virology, Epidemiology, Pathogenesis, and Control of COVID-19. Viruses, 12(4). https://doi.org/10.3390/v12040372
Karimi-Zarchi, M., Neamatzadeh, H., Dastgheib, S. A., Abbasi, H., Mirjalili, S. R., Behforouz, A., Ferdosian, F., & Bahrami, R. (2020). Vertical Transmission of Coronavirus Disease 19 (COVID-19) from Infected Pregnant Mothers to Neonates: A Review. Fetal and Pediatric Pathology, 1-5. https://doi.org/10.1080/15513815.2020.1747120
Lai, C.-C., Ko, W.-C., Lee, P.-I., Jean, S.-S., & Hsueh, P.-R. (2020). Extra-respiratory manifestations of COVID-19. International Journal of Antimicrobial Agents, 106024. https://doi.org/10.1016/j.ijantimicag.2020.106024
Ledford, H. (2020). Coronavirus breakthrough: Dexamethasone is first drug shown to save lives. Nature, 582(7813), 469. https://doi.org/10.1038/d41586-020-01824-5
Liu, B., Li, M., Zhou, Z., Guan, X., & Xiang, Y. (2020). Can we use interleukin-6 (IL-6) blockade for coronavirus disease 2019 (COVID-19)-induced cytokine release syndrome (CRS)? Journal of Autoimmunity, 111, 102452. https://doi.org/10.1016/j.jaut.2020.102452
Liu, Y.-C., Kuo, R.-L., & Shih, S.-R. (2020). COVID-19: The First Documented Coronavirus Pandemic in History. Biomedical Journal. https://doi.org/10.1016/j.bj.2020.04.007
McMichael, T. M., Currie, D. W., Clark, S., Pogosjans, S., Kay, M., Schwartz, N. G., Lewis, J., Baer, A., Kawakami, V., Lukoff, M. D., Ferro, J., Brostrom-Smith, C., Rea, T. D., Sayre, M. R., Riedo, F. X., Russell, D., Hiatt, B., Montgomery, P., Rao, A. K., … Duchin, J. S. (2020). Epidemiology of Covid-19 in a Long-Term Care Facility in King County, Washington. The New England Journal of Medicine. https://doi.org/10.1056/NEJMoa2005412
Mehta, P., McAuley, D. F., Brown, M., Sanchez, E., Tattersall, R. S., Manson, J. J., & HLH Across Speciality Collaboration, UK. (2020). COVID-19: Consider cytokine storm syndromes and immunosuppression. Lancet (London, England), 395(10229), 1033-1034. https://doi.org/10.1016/S0140-6736(20)30628-0
Morawska, L., & Cao, J. (2020). Airborne transmission of SARS-CoV-2: The world should face the reality. Environment International, 139, 105730. https://doi.org/10.1016/j.envint.2020.105730
Organización Mundial de la Salud (2020, 3 de junio). Recuperado de https://covid19.who.int/
Park, M., Thwaites, R. S., & Openshaw, P. J. M. (2020). COVID-19: Lessons from SARS and MERS. European Journal of Immunology, 50(3), 308-311. https://doi.org/10.1002/eji.202070035
Prete, M., Favoino, E., Catacchio, G., Racanelli, V., & Perosa, F. (2020). SARS-CoV-2 Inflammatory Syndrome. Clinical Features and Rationale for Immunological Treatment. International Journal of Molecular Sciences, 21(9). https://doi.org/10.3390/ijms21093377
Ranieri, V. M., Pettilä, V., Karvonen, M. K., Jalkanen, J., Nightingale, P., Brealey, D., Mancebo, J., Ferrer, R., Mercat, A., Patroniti, N., Quintel, M., Vincent, J.-L., Okkonen, M., Meziani, F., Bellani, G., MacCallum, N., Creteur, J., Kluge, S., Artigas-Raventos, A., … INTEREST Study Group. (2020). Effect of Intravenous Interferon β-1a on Death and Days Free From Mechanical Ventilation Among Patients With Moderate to Severe Acute Respiratory Distress Syndrome: A Randomized Clinical Trial. JAMA. https://doi.org/10.1001/jama.2019.22525
RECOVERY Trial, 2020. Randomised Evaluation of COVID-19 Therapy, en https://www.recoverytrial.net/results.
Rosa, S. G. V., & Santos, W. C. (2020). Clinical trials on drug repositioning for COVID-19 treatment. Revista Panamericana De Salud Publica = Pan American Journal of Public Health, 44, e40. https://doi.org/10.26633/RPSP.2020.40
Sanders, J. M., Monogue, M. L., Jodlowski, T. Z., & Cutrell, J. B. (2020). Pharmacologic Treatments for Coronavirus Disease 2019 (COVID-19): A Review. JAMA. https://doi.org/10.1001/jama.2020.6019
Sanofi. Sanofi and Regeneron begin global Kevzara (sarilumab) clinical trial program in patients with severe COVID-19 (2020, marzo 18). Recuperado de http://news.sanofi.us/2020-03-16-Sanofi-and-Regeneron-begin-global-Kevzara-R-sarilumabclinical-trial-program-in-patients-with-severe-COVID-19
Sharun, K., Dhama, K., Patel, S. K., Pathak, M., Tiwari, R., Singh, B. R., Sah, R., Bonilla-Aldana, D. K., Rodriguez-Morales, A. J., & Leblebicioglu, H. (2020). Ivermectin, a new candidate therapeutic against SARS-CoV-2/COVID-19. Annals of Clinical Microbiology and Antimicrobials, 19(1), 23. https://doi.org/10.1186/s12941-020-00368-w
Siddiqi, H. K., & Mehra, M. R. (2020). COVID-19 illness in native and immunosuppressed states: A clinical-therapeutic staging proposal. The Journal of Heart and Lung Transplantation: The Official Publication of the International Society for Heart Transplantation, 39(5), 405-407. https://doi.org/10.1016/j.healun.2020.03.012
Stockman, L. J., Bellamy, R., & Garner, P. (2006). SARS: Systematic review of treatment effects. PLoS Medicine, 3(9), e343. https://doi.org/10.1371/journal.pmed.0030343
Tay, H. S., & Harwood, R. (2020). Atypical presentation of COVID-19 in a frail older person. Age and Ageing. https://doi.org/10.1093/ageing/afaa068
Vaduganathan, M., Vardeny, O., Michel, T., McMurray, J. J. V., Pfeffer, M. A., & Solomon, S. D. (2020). Renin-Angiotensin-Aldosterone System Inhibitors in Patients with Covid-19. The New England Journal of Medicine, 382(17), 1653-1659. https://doi.org/10.1056/NEJMsr2005760
Villar, J., Ferrando, C., Martínez, D., Ambrós, A., Muñoz, T., Soler, J. A., Aguilar, G., Alba, F., González-Higueras, E., Conesa, L. A., Martín-Rodríguez, C., Díaz-Domínguez, F. J., Serna-Grande, P., Rivas, R., Ferreres, J., Belda, J., Capilla, L., Tallet, A., Añón, J. M., … dexamethasone in ARDS network. (2020). Dexamethasone treatment for the acute respiratory distress syndrome: A multicentre, randomised controlled trial. The Lancet. Respiratory Medicine, 8(3), 267-276. https://doi.org/10.1016/S2213-2600(19)30417-5
Walls, A. C., Park, Y.-J., Tortorici, M. A., Wall, A., McGuire, A. T., & Veesler, D. (2020). Structure, Function, and Antigenicity of the SARS-CoV-2 Spike Glycoprotein. Cell, 181(2), 281-292.e6. https://doi.org/10.1016/j.cell.2020.02.058
Wang, M., Cao, R., Zhang, L., Yang, X., Liu, J., Xu, M., Shi, Z., Hu, Z., Zhong, W., & Xiao, G. (2020). Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro. Cell Research, 30(3), 269-271. https://doi.org/10.1038/s41422-020-0282-0
Xu, X., Han, M., Li, T., Sun, W., Wang, D., Fu, B., Zhou, Y., Zheng, X., Yang, Y., Li, X., Zhang, X., Pan, A., & Wei, H. (2020). Effective treatment of severe COVID-19 patients with tocilizumab. Proceedings of the National Academy of Sciences of the United States of America, 117(20), 10970-10975. https://doi.org/10.1073/pnas.2005615117
Yang, J., Zheng, Y., Gou, X., Pu, K., Chen, Z., Guo, Q., Ji, R., Wang, H., Wang, Y., & Zhou, Y. (2020). Prevalence of comorbidities and its effects in patients infected with SARS-CoV-2: A systematic review and meta-analysis. International Journal of Infectious Diseases: IJID: Official Publication of the International Society for Infectious Diseases, 94, 91-95. https://doi.org/10.1016/j.ijid.2020.03.017
Ye, Q., Wang, B., & Mao, J. (2020). The pathogenesis and treatment of the `Cytokine Storm’ in COVID-19. The Journal of Infection, 80(6), 607-613. https://doi.org/10.1016/j.jinf.2020.03.037
Zeng, Q.-L., Yu, Z.-J., Gou, J.-J., Li, G.-M., Ma, S.-H., Zhang, G.-F., Xu, J.-H., Lin, W.-B., Cui, G.-L., Zhang, M.-M., Li, C., Wang, Z.-S., Zhang, Z.-H., & Liu, Z.-S. (2020). Effect of Convalescent Plasma Therapy on Viral Shedding and Survival in COVID-19 Patients. The Journal of Infectious Diseases. https://doi.org/10.1093/infdis/jiaa228
Zhang, X., Hasoksuz, M., Spiro, D., Halpin, R., Wang, S., Vlasova, A., Janies, D., Jones, L. R., Ghedin, E., & Saif, L. J. (2007). Quasispecies of bovine enteric and respiratory coronaviruses based on complete genome sequences and genetic changes after tissue culture adaptation. Virology, 363(1), 1-10.
Zhou, D., Dai, S.-M., & Tong, Q. (2020). COVID-19: A recommendation to examine the effect of hydroxychloroquine in preventing infection and progression. The Journal of Antimicrobial Chemotherapy. https://doi.org/10.1093/jac/dkaa114