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Drudge Retort: The Other Side of the News
Wednesday, April 01, 2020

Cytokine storms can overtake people of any age, but some scientists believe that they may explain why healthy young people died during the 1918 pandemic and more recently during the SARS, MERS and H1N1 epidemics. And they may offer clues as to why otherwise healthy young people with coronavirus infection are succumbing to acute respiratory distress syndrome, a common consequence of a cytokine storm.

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When the body first encounters a virus or a bacterium, the immune system ramps up and begins to fight the invader. The foot soldiers in this fight are molecules called cytokines that set off a cascade of signals to cells to marshal a response. Usually, the stronger this immune response, the stronger the chance of vanquishing the infection, which is partly why children and younger people are less vulnerable over all to coronavirus. And once the enemy is defeated, the immune system is hard-wired to shut itself off.

But in some cases " as much as 15 percent of people battling any serious infection, according to Dr. Cron's team - the immune system keeps raging long after the virus is no longer a threat. It continues to release cytokines that keep the body on an exhausting full alert. In their misguided bid to keep the body safe, these cytokines attack multiple organs including the lungs and liver, and may eventually lead to death.

In these people, it's their body's response, rather than the virus, that ultimately causes harm.

In the case of the 42-year-old patient, the suspected cytokine storm led his doctors to eventually try tocilizumab, a drug they have sometimes used to soothe an immune system in distress.

After just two doses of the drug, spaced eight hours apart, the patient's fever rapidly disappeared, his oxygen levels rose and a chest scan showed his lungs clearing. The case report, described in an upcoming paper in Annals of Oncology, joins dozens of accounts from Italy and China, all indicating that tocilizumab might be an effective antidote to the coronavirus in some people.

This is astounding information IF it portends that cytokine storms are indeed the culprit behind many coronavirus-related respiratory failures.

I hope our scientific brethren (calling JPW) add more informative nuance to this emerging data. But it sure looks like this may truly be one light inside our dark tunnel.

#1 | Posted by tonyroma at 2020-04-01 02:13 PM | Reply

On March 5, China approved the drug to treat serious cases of Covid-19, the disease caused by the coronavirus, and authorized clinical trials. On March 23, the U.S. Food and Drug Administration granted approval to the pharmaceutical company Roche to test the drug in hundreds of people with coronavirus infection.

Tocilizumab is approved to quieten the chatter of immune molecules in rheumatoid arthritis and in some types of cancer. It mutes the activity of a specific cytokine called interleukin-6 that is associated with an over-exuberant immune response.

"That's the rationale for using the drug," said Dr. Laurence Albiges, who cared for the patient at the Gustave Roussy Cancer Center in Paris.

But many doctors are unfamiliar with this niche concept or how to treat it, experts said.

"Everyone's talking about cytokine storm as if it were a well-recognized phenomenon, but you could have asked medics two weeks ago and they wouldn't have heard of it," said Dr. Jessica Manson, an immunologist at University College London Hospital.

There is a relatively simple, rapid and easily available test that can detect whether a patient's body has been taken over by a cytokine storm. It looks for high levels of a protein called ferritin.

Again, great news and much more information in the article itself.

#2 | Posted by tonyroma at 2020-04-01 03:35 PM | Reply

Article is behind a pay wall for me...

Not surprising cytokine storm is a culprit for severe disease in young people. It's thought to be the driver of severe disease and death in other infections like H5N1 and SARS.

Interesting that the IL6 block is the point of intervention but I'm glad it seems to be working.

#3 | Posted by jpw at 2020-04-01 04:08 PM | Reply

Article is behind a pay wall for me...

Did you try an incognito window? NYT is supposed to be making coronavirus articles free, but I notice that this one isn't listed as yet.

I did find this story from 3/12 that dovetails this reporting: www.vox.com

#4 | Posted by tonyroma at 2020-04-01 04:18 PM | Reply

Just wondering how that would work with autoimmune diseases which are generally the immune system overreacting and also allergies which are another case of immune system overreacting.

I understand that all three are different mechanisms of over reaction but I have both an autoimmune disease and allergies so my immune system doesn't have the best track record of appropriate responses.

#5 | Posted by TaoWarrior at 2020-04-01 05:02 PM | Reply

Tao

The IL6 blocking antibody mentioned was developed for chronic inflammatory and autoimmune disorders.l and seems to be aimed at preventing the systemic consequences like liver failure and kidney disease due to chronic inflammation.

I've always been curious why therapeutics haven't been developed to dampen the immune response upstream of the cytokines, namely at the level of signaling by molecules called damage associated molecular patterns (DAMPs). These are cellular components that indicate tissue damage and induce inflammation. With cytokines storm you'd have a feed forward where Infection induces inflammation and tissue damage, which increases inflammation leading to more tissue damage ..........

#6 | Posted by jpw at 2020-04-01 05:47 PM | Reply

Immune system overrespone is probably as big a killer as any disease.

Our immune system doesn't know we have doctors. That's usually a good thing.

One of the most interesting ideas from Dr. Gupta's book comes from an investigation into primitive cultures where people live well into old age.

It is theorized that at a young age the body acquires a lifelong parasitic infection like giardia. This keeps the inflammatory response active and targeted towards a true need. Since the modern world largely lives without lifelong parasitic infection, the inflammatory response can't find a real target, so it finds something "close enough." And this is the underlying mechanism which explains autoimmune disease, of which there are many.

The elegance and parsimony of this explanation is probably why there's some truth to it.

#7 | Posted by snoofy at 2020-04-01 05:59 PM | Reply

#7

There has been a lot of talk in the MS world about varicella-zoster and maybe one other but I can't remember off the top of my head. Something about it conditions the immune response and that's why it attacks the myelin later in life, or maybe it's because it remains in the body near the CNS. I'm a bit high right now though so if I remember later I'll try to dig into it with more detail. Anyway the med I'm on works by trapping lymphocytes in the lymph nodes and that combined with 5000 IU of Vitamin D a day seems to be keeping my immune system chill, at least for the last 4 years. It unfortunately hasn't helped with allergies but claratin does that.

What is interesting (to me even if no one of a scientific mindset thinks so) is that before I started taking claratin I used to get a spring relapse every year. Allergies would kick in and a week later a relapse.

My suspicion is if I get corona I'll also get a relapse because of that I'm not sure about continuing on the lymphocyte blocker. If I stop within 5 days my levels should go back to normal, which could help fight off corona, but it increases my chance of relapse that will already be high. Now if it is an overactive immune response staying on the med might, but I doubt different kind of response, actually protect me from that. I really don't know which way to jump, and with new info coming in all the time I worry my Neuro might not either.

#8 | Posted by TaoWarrior at 2020-04-01 08:37 PM | Reply

What are you on, betaseron?

#9 | Posted by snoofy at 2020-04-01 10:41 PM | Reply

#9

Gilyena.

#10 | Posted by TaoWarrior at 2020-04-01 10:42 PM | Reply

I want to flag one important factoid for everyone reading this to understand. It might help save lives if passed on in vital moments:

But many doctors are unfamiliar with this niche concept or how to treat it, experts said.

"Everyone's talking about cytokine storm as if it were a well-recognized phenomenon, but you could have asked medics two weeks ago and they wouldn't have heard of it," said Dr. Jessica Manson, an immunologist at University College London Hospital.

Don't assume that all doctors treating coronavirus patients are cognizant of this information. Here are the links again. Bookmark them for easier reference:

www.vox.com

www.nytimes.com

#11 | Posted by tonyroma at 2020-04-02 06:25 AM | Reply

For the science junkies, watch MedCram Coronavirus Update 46, he gores into the Cytokines response in the body. I think the following is a rough layman's explanation, hopefully someone here that knows more med can correct me. Fever seems to be the modulator of Cytokines response. Inducing fever then cooling body seems to increase the immune response of the other main virus killing systems and slows the Cytokines. They are sort of the advance troops that start the fight until the body can send in the main troops. SARS Cov-2 seems to repress immune response in the main virus fighting systems leaving the Cytokines to sort of go it alone, and the are psycho and don't know when to stop. We have a lot of evidence that NSAIDS are bad, but Tylenol was listed as ok to take, however several medical personnel are warning to let the fever work unless it is pushing into dangerous levels, above 103degF. During Spanish Flu, Bayer Aspirin was a new invention. Wealthier patients given it fared much than poor patients who were given ice baths to reduce fever. I heard a quote that the word after the epidemic was that "the German chemical company killed more people than the German military".

#12 | Posted by Odbrochound at 2020-04-02 06:43 AM | Reply

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