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Covid-19 does not affect everyone in the same way and by now we know it very well: studies on genetics and on the predisposition of each of us to the virus are multiplying. But there is something that is sometimes underestimated because it is not the virus itself that triggers the main problems, but the body’s response when it flows into the “storm of cytokines“.
What is it about
Not only are there risk factors such as age, obesity and other pathologies to worsen the course of the virus: in fact, healthy subjects can face complications and the most fragile patients can remain immune. What really makes the difference is the answer immune body when it receives the virus. “Covid follows two phases: in the first phase it is viral and the main mechanism is its replication: the subject presents symptoms of infection such as fever, pain, myalgia, fatigue and cough because this virus affects the respiratory tract causing pneumonia”, says the Prof. Marco Falcone, Associate Professor of Infectious Diseases at the University of Pisa, dependent on the Aoup Infectious Diseases Operational Unit and member of the board of directors of Simit (Italian Disease Society) exclusively for our newspaper. infectious and tropical).
The role of cytokines
The infectious specialist explains that this phase is characterized by the release of the first cytokines, substances that are the ‘spy’ of inflammation and are produced by subjects at different levels: some produce them in large quantities, others in smaller quantities. Cytokines, however, are also the immune system’s spy that works to intercept the virus and try to fight it. In the second phase, however, while some subjects recover quickly without even developing the symptoms of the infection that remains asymptomatic and evolves like a banal flu (in most cases), a strong response develops in a smaller percentage.storm cytokine ‘. “The immune system produces a massive amount of these substances and there is a hyperactivation that leads to inflammatory lung damage: it is no longer only the virus that attacks the lung cells but it is the subject himself who produces the inflammation that leads to Ards, it is say, respiratory distress syndrome, the lung turns white. ”Professor Falcone says Patients who develop this syndrome often end up in intensive care.
How can it be prevented?
Research efforts are focused on identifying markers, simple blood tests that can predict the risk of developing this cytokine storm. “There are markers of hyperinflammation: depending on how high they are in subjects who develop this cytokine syndrome, it is no longer necessary to intervene with antivirals but with anti-inflammatories such as cortisone and all inflammatory drugs including monoclonal antibodies, interleukin inhibitors and baricitinib , suitable drugs to block this cytokine storm and the inflammatory evolution of Covid associated with higher mortality ”, emphasizes the expert.
Here’s a drug. Only with Prof. Falcone did we talk about baricitinib (here the article), a drug that is already on the market and is normally used to combatarthritis Rheumatoid disease that reduced mortality by 71% in those who took it, improving the respiratory condition and returning to greater blood oxygenation. In Italy, however, there is no single protocol as Prof. Bassetti exclusively told us, so this drug is not necessarily always and uniformly used.
The differences between monoclonal
“When I spoke of monoclonals, I was referring to cytokine inhibitor drugs, which is inflammation: the ones they are testing are anti-Covid monoclonal drugs, indicated at an early stage of infection before this inflammatory situation arises,” he explained. Falcon. Monoclonal drugs that have been used for years are mainly used for cancer patients and to fight some types of tumors such as melanoma, lung and kidney cancers, while others are currently in clinical trials in many other cancers such as It is reported in this document from the National Institute of Health. “Anti-Covid, which block the virus early, could also block the triggering of the cytokine storm secondary to virus replication. The real problem with Covid is the complication inflammatory cause: early detection of patients who later develop this excessive inflammatory response is the only way to improve prognosis, “says Falcone.
Genetics is decisive
Researchers around the world are trying to study and understand mechanisms for which some become seriously ill and others do not while they remain in contact with the positives (as in the case of relatives): a study in Nature has identified some regions of the genome that could contain part of the response, but simple analyzes of blood in which, thanks to the hemogram used to measure the number of blood cells, platelets, hematocrit and hemoglobin, the course of the disease could be predicted by detecting the activity of immune cells. “Now they are studying blood parameters that, if present at an early stage, predict whether that person will experience a serious illness or not, but it was already being done for the vast majority of diseases. Some parameters indicate whether or not someone will have it. disease. disease, partly with Covid have been discovered but there is still work to be done, “he says exclusively for ilgiornale.it Carlo Federico Perno, Professor of Microbiology at the UniCamillus International Medical University in Rome and Director of Microbiology at the Bambino Gesù Pediatric Hospital in Rome, who explained to us how the genetic characteristics of the person regulate the infection and the severity of the disease.
The role of blood group.“Two elements must be taken into account: the severity of the disease is always a function of the amount and type of pathogen that affects us in combination with the characteristics of the person: some become infected with the flu and others do not, some people infected with HIV and others not and the same happens with Sars-Cov-2, some are infected and others do not. There are genetic elements that have been shown to be related to the infection and the severity of the disease, one of which is the group optimistic, “the expert tells us. Among these, one of the most important is the one related to interferon, a topic that we have recently addressed thanks to the study of Prof. Novelli and his staff at the Tor Vergata University in Rome.” He says that the name is a molecule that interferes with viral replication: those who have a lot will tend to be more reactive to the virus, those who have little will tend to be less. It has a deep sense and logic but it is not different from many other viral diseases ”.
The test that “predicts” the severity of the disease
To know the course and severity of the disease, as mentioned, all efforts are being concentrated but there is already a test capable of making a “prediction”, and that is the saliva. “A work on New England from a few months ago indicates how the amount of virus in saliva can be detected and correlates with the severity of the disease,” says Professor Perno. At this point, the question arises: why are nasopharyngeal swabs used almost exclusively? “Because they are registered and certified to prove the presence of the virus and its quantification and nobody until now has considered it necessary to change this rule. There have been no comparative studies that justify salivary swab versus nasopharyngeal swab, they are the Strange Things to which I cannot give a precise answer, sometimes they arise not due to lack of scientific evidence but out of habit ”, says Perno.
However, this rule does not always apply to children and adolescents for whom it is easier to verify the presence of the virus in their saliva. “When the swab is difficult to do in children, the saliva test is used and the results are still Excellent quality. Small studies show that, in the initial phase of the disease, the salivary smear contains more virus than the nasopharyngeal one ”.
In short, common sense would dictate that saliva swabs also be approved and placed next to the nasopharynx to further decrease the margin for error and simplify operations. Perhaps they will be approved at the end of the pandemic …
